Today Iran is struggling with a deadly coronavirus epidemic. Similarly, in 1927 when Reza Shah Pahlavi was on the throne, the country had to fight cholera. This epidemic was at its height in late summer and early fall of that year, reaching the southwestern province of Khuzestan from the Iraqi port of Basra and infecting areas as far as the southeastern province of Sistan and Baluchistan.

How did Reza Shah and his government cope with the cholera outbreak almost 100 years ago?

To eradicate this epidemic, Iran’s National Health Bureau, the predecessor to today’s Ministry of Health, quarantined infected regions and dispatched doctors and drugs to those areas. The bureau’s policies included forced injection of anti-cholera vaccine, remittances of funds and taking sanitary actions in infected areas.

Fighting epidemics must be an operation coordinated by central government and all citizens must follow the same orders and guidelines for this fight to be effective. In 1927, after cholera turned into an epidemic across Iran, the National Health Bureau created a Commission for the Preservation of Health that reviewed reports from infected areas and issued orders to control the situation.

The cholera bacterium entered Iran from the Iraqi port of Basra and ultimately infected areas as far west as the province of Sistan and Baluchistan. To contain the spread of the disease, checkpoints were set up to prevent people from traveling to and through infected areas of Khuzestan and in Qasr-e Shirin on Iran’s western borders, and in an area which today is called Zahedan on the eastern border.

Maritime quarantines were set up in Muhammara (today’s Khorramshahr) and in the ports of Bushehr and Bandar Abbas. Passengers on ships were examined and, if they showed symptoms of cholera, they were quarantined.

What was done inside the quarantined areas?

Quarantine rules must be clear to workers and people who are quarantined. The newspaper Ettela’at, which had started publishing a year before the cholera outbreak, published 12 rules established by the government to manage quarantines.

1. Drinking water must be brought into quarantine in sealed metal containers equipped with a faucet. The water must be safe and the lids must have a lock.

2. Floors must be cleaned regularly using lime water.

3. Enclosed lavatories must be built and must be disinfected daily with lime water.

4. New arrivals must be kept under supervision and segregated from earlier arrivals without the opportunity of physical interaction.

5. As far as possible, everyone must eat cooked meals.

6. Cooking separate meals for individuals that can spread the disease must be prevented.

7. All quarantine workers must cut contact with people outside the quarantined area and all must receive vaccine injections.

8. All sanitary workers (doctors, orderlies, security guards, cooks, tea makers, etc.) must be vaccinated.

9. Anyone entering the quarantine must be vaccinated if they do not have a certificate of vaccination. Residents of Qasr-e Shirin must be vaccinated regularly.

10. As far as possible, families should be given separate space within the quarantined area.

11. A set of tents should be prepared for first and second-class travelers. The floors of these tents must be carpeted with wicker and must be washed with lime water regularly.

12. For Europeans, necessary items must be acquired separately.

Closing Iran’s Land and Sea Borders

Preventing the spread of the disease outside Iran's borders, and containing it within, is the duty and responsibility of the government. Therefore, after the cholera outbreak, all borders were closed and only two Persian Gulf ports remained open to ships and travelers. Pilgrimage to Iraqi holy cities was also prohibited until the epidemic had passed.

After the closing of sea and land borders, Iran's government turned its attention to building modern quarantine centers. It built such centers on the western and eastern borders and at northern and southern ports. The results were new quarantines in Bandar Pahlavi (today’s Bandar Imam) and the port of Astara on the Caspian Sea in the north, in Muhammara (today’s Khorramshahr), Abadan, Bandar Abbas, Bushehr, Bandar Langeh, Bandar Shahpour (today’s Bandar Imam Khomeini) in the south and in Qasr-e Shirin to the west.

In 1927, because of the spread of cholera, medical stations were established close to cities with military personnel to maintain order. In other areas, where there were no medical stations, the National Health Bureau’s workers were posted on roads to prevent vehicles people from traveling from infected towns to other cities. They were also supported by military personnel.

The soldiers followed orders issued by the head of the medical station. Besides medicine, vaccines and necessary equipment, permanent or temporary quarantines had doctors who were assigned by the Health Bureau. Since there was a shortage of physicians, the Bureau also dispatched some doctors across Iran to cities not infected with cholera to treat patients.

All doctors sent reports of treatments given and medical problems encountered in the areas to the central office in Tehran so that the government could adjust its policies based on these reports.

Help from Germany and Upgrading Iran’s Pasteur Institute

Asking for foreign help when there is an epidemic is part of a government’s duty to its citizens. During the 1927 cholera epidemic, some of the necessary vaccines were sent to Iran by Germany. The vaccines were transported by air and were distributed across the country. Iran also purchased equipment from Germany to produce the vaccine.

Reports published by the newspaper Ettela’at in 1927 show that the Iranian government asked for medicine and specifically for vaccines from India, Iraq, Georgia and Baku in today’s Republic of Azerbaijan. The same year, Iran’s Pasteur Institute received new equipment and its staff was expanded.

During this period, the Pasteur Institute succeeded in producing between 7,000 and 10,000 doses of the vaccine each day and in delivering them to the National Health Bureau. With the increase in vaccine production, vaccination stations were set up in Bushehr, Bandar Abbas and other cities such as Shiraz, Isfahan, Kerman and Kermanshah. Since the province of Khuzestan bordered Iraq, where the cholera epidemic in Iran had originated, in the next phase of the response, vaccination stations were set up in Abadan, Khorramshahr and also in the provincial capital of Ahvaz.

One of the main reasons for the spread of cholera in Iran was the disregard for sanitary precautions, especially when it came to drinking water, filthy streets and alleys and unhygienic public bathhouses. New laws were therefore passed to keep water safe by preventing cattle herders from taking their cattle to the rivers. Tanneries were relocated to outside cities and the government started digging wells for toilets and creating the basic infrastructure of a sewage system. In the cities that were worst hit by cholera, the streets were covered with crude oil and homes were disinfected with sulfur.

Three years later, when a fresh cholera epidemic started in the Afghan city of Jalalabad, Iran’s National Health Bureau relied on its experience from 1927, closed Iran’s borders with Afghanistan and quarantined and treated travelers in border areas. The epidemic in Afghanistan lasted until 1936, but a year later a new cholera epidemic started in Karachi. This time, Iran’s maritime borders were closed and ships could not sail to or from Karachi. After 1927, a cholera epidemic did not re-enter Iran from the east.

The National Law to Fight Contagious Diseases: Secrecy is Outlawed

The most important law to fight cholera and other epidemics, was passed under Reza Shah, was the National Law to Fight Contagious Diseases. According to this law, government was ordered to have plans ready to prevent epidemics.

The law was passed in 1941, approximately three months before the Allied invasion of Iran that forced Reza Shah to resign. The law specified cholera and its variants, bubonic plague, yellow fever, smallpox, scarlet fever, measles, diphtheria, infectious diarrhea (dysentery) and meningitis as infectious diseases. Under this law, doctors, midwives, heads of families and managers of hotels were ordered to report to their local health bureau if they came across cases of any of these illnesses.

Violating this law was punishable – so that that outbreak of contagious diseases could not be kept a “secret”.

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