FIGUIG, MOROCCO // For more than three decades a small bird-like man called Dr Abdelhak Hamouditou has cared for the people of Figuig, a Moroccan oasis town on the Algerian border. Increasingly - and mysteriously - they are getting cancer. "There are too many cases for a town this size," said Dr Hamouditou. "I know of at least 20 at present; there should be three to five."
The cancer rate among Figuig's 12,000 inhabitants has climbed rapidly in recent years, fuelling speculation that French nuclear tests carried out a half-century ago in Algeria may be to blame. Meanwhile, local taboos and Figuig's isolation are complicating efforts to treat patients. Figuig consists of seven adjoined villages for seven tribes of Amazigh, or Berbers, an ancient people who have inhabited North Africa since before recorded history. In recent decades, border closures by Algeria have helped make the former trading centre a dead-end.
Dr Hamouditou was born in Figuig 77 years ago. After studying medicine in Yugoslavia, he returned in 1977 and today directs the town's Red Crescent clinic, where most locals go for medical care. Fifteen years ago, Dr Hamouditou noticed a rise in cases of cancer. Today, he is among them. "Three years ago I felt a sharp pain in my abdomen," he said, peeling back the foil from a packet of large pink pills in his office. "They found a ball the size of a fist in my liver. These things are my chemotherapy."
He put the packet on his desk and an assistant brought him a glass a water. Then he slipped a pill between his lips, drank and threw back his head. "They're supposed to attack the virus that caused my cancer, but so far I haven't seen an effect." He rose to return to work. In the corridor, nomad children from the surrounding desert were lined up awaiting their yearly inspection by dentists visiting from Rabat, the capital.
"I'm tired," Dr Hamoutidou said. "But I prefer to die in my job, not in my bed." Dr Hamouditou is unsure what is causing the spike in cancer. But he and others in Figuig say the answer may lie in explosions that rang across the Algerian desert 50 years ago. From 1960 to 1966, France conducted 17 nuclear tests in Algeria as part of its search for a bomb to make it a major player in the Cold War. While most were underground, four aerial explosions were set off near the town of Reggane, about 650km from Figuig.
In theory, winds could have carried radioactive particles to Figuig, said Ray Guilmette, the director of the Center for Countermeasures against Radiation at Lovelace Respiratory Research Institute in Albuquerque, New Mexico. "One test was over 20 kilotons," he said. "That's plenty of energy to inject material into the stratosphere." Nuclear explosions throw up dust clouds loaded with unstable atoms called radionuclides, Mr Guilmette said. If inhaled, radionuclides can bombard human cells with subatomic particles that may cause mutation and cancer.
"One feature of local fallout patterns is that they come and go fairly quickly," Mr Guilmette said. "The people at risk have to be there at the time." That happened near test sites in Algeria, according to local victims' rights groups and former French soldiers who say they developed cancer and other health problems as a result. In February, France's Le Parisien newspaper, citing classified documents, reported that French soldiers in Algeria were deliberately exposed to radiation from tests to study its effects. The report came two months after France passed a law allowing people irradiated and given cancer by its nuclear tests to claim state compensation.
According to Figuig's mayor, Omar Abou, no study has yet been done to determine whether nuclear fallout is a factor in cancer there. The initial question is whether the wind blew towards Figuig at the time of the Reggane tests, said Mr Guilmette. "If the cloud didn't go that way, you can rule it out as a possible cause." For now, Dr Hamouditou is struggling to coax timid cancer patients to come to see him.
"Many people are afraid to admit they have cancer because they think it shows weakness," he said. "When they finally come for treatment they're in the final stages." One exception was Boualem Moussaoui, a date farmer who awoke one morning two years ago to discover a lump under his left jaw. "First it was the size of a chicken egg, then a turkey egg, then a second lump appeared." Mr Moussaoui promptly told Dr Hamouditou, who after preliminary consultation sent him for cancer tests to the city of Oujda, a seven-hour bus trip from Figuig and home to the nearest hospital equipped to treat the illness.
Confirmed by a biopsy at Oujda's hospital, Mr Moussaoui's cancer is today under control, he said. But he had to sell belongings and rely on friends and family to cover a medical bill of 170,000 Moroccan dirhams (Dh69,700). Not all cancer patients find that kind of money, said Dr Hamouditou. "All I can give them are painkillers." firstname.lastname@example.org