Multidimensional - UNICEF€¦ · on selected slums and unplanned areas in Cairo, Alexandria, Port...

Multidimensionalchild poverty

in slums and unplannedareas in Egypt

© United Nations Children’s Fund, Egypt; andInformal Settlements Development Facility

October 2013

United Nations Children’s Fund 87, Misr Helwan Agricultural Road, Maadi, Cairo, Egypt Telephone: (20-2) 25265083-7Fax: (20-2) 25264218Website: www.unicef.org/egypt

Informal Settlements Development Facility 3, Mokhayam El-Daem Street, Nasr City, Cairo, EgyptTelephone: (20-2) 22609198Fax: (20-2) 22634000Website: www.isdf.gov.eg/index.htm

The views expressed in this publication reflect the opinions of the authors of the study and do not necessarily reflect positions of the United Nations Children’s Fund or the Informal Settlements Development Facility.

Any part of this publication may be freely reproduced for educational and non-profit purposes using the following reference:

UNICEF and Informal Settlements Development Facility, Egypt (2013), Multidimensional Child Poverty in Slums and Unplanned Areas in Egypt, UNICEF Egypt and ISDF, Cairo.

Permission in writing is required to use any part of this publication for commercial purposes.

Cover Photo:© UNICEF/Mounir El-Shazly/2012

Design and layout:Moody Graphics

ISBN: 978-977-90-1285-8

iii

Foreword

For children in Egypt, as in most countries around the world, life in the city often means a life of opportunities. On average, children in urban areas have a better chance of survival and development than their peers in rural areas. They have better access to health and education services, to housing, to water and sanitation, and are less likely to live in poverty.

However, averages can mask the reality of the life of a significant share of children living in urban centres. These are the children who are left behind – who are excluded from many opportunities offered by the cities in which they live. Average statistics blur the size and the nature of the disparities they face. A lack of solid and disaggregated data renders them invisible in the policy arena.

While Egypt remains a predominantly rural country, urban growth is rampant and is expected to accelerate in the coming decades. By 2030, almost half of the population will live in urban areas. In the last decades, the expansion of Egyptian cities has been for the most part unplanned, with a growth in informal settlements that has been accompanied in some areas by the growth of slums.

It is in these informal settlements – and especially in slums – that disparities are concentrated. Children who grow up in slums face poverty and multiple deprivations that threaten their potential and crucial early years of development.

This study is the result of the collaboration between the Informal Settlements Development Facility (ISDF) of the Egyptian Cabinet and UNICEF. It complements the previous studies on child multidimensional poverty in Egypt by presenting data for selected informal settlements in four major cities. It aims to present the living conditions of children in slums and unplanned areas and to inform policies and interventions to address identified challenges.

The findings of the study reinforce calls for urgent action, given that every child left behind represents a missed opportunity for Egypt’s development and prosperity. The concentration and the multidimensional character of child poverty in disadvantaged urban areas require coordinated efforts and investments that combine physical infrastructure interventions such as housing, water, sanitation; quality social services, including health and education; support to family livelihood and income-generation activities; access to information; as well as social and child protection. Tearing down the barriers that prevent all children from enjoying their most fundamental rights – to survive, develop, be protected and participate – is one of the best possible investments Egypt can make for its future.

Eng. Khaled Abdel-Aziz Gabarti Mr. Philippe DuamelleExecutive Director UNICEF Representative in EgyptInformal Settlements Development Facility

iv

Acknowledgements

This study on child multidimensional poverty is the result of the collaboration between the Informal Settlements Development Facility of the Egyptian Cabinet and UNICEF. It has been written by Dr. Ali Faramawy and Manal Shaheen from the Informal Settlements Development Facility (ISDF) and Dr. Leonardo Menchini from the United Nations Children’s Fund (UNICEF).

The study benefited a great deal from the background research and data analysis that have been conducted by the Center for Economic & Financial Research & Studies (CEFRS) at Cairo University. The team composed by Dr. Heba El-Leithy, Dr. Manal Metwally and Dr. Dina Armanious, also proposed the research methodology and designed the household survey developed for the study. The household survey has been carried out by a team led by Dr. Fatma El-Zanaty.

Both ISDF and UNICEF would like to thank the working team and express their appreciation for the efforts of all consultants, field supervisors and data collectors participating in the study.

We acknowledge the contribution of the members of the Project Advisory Committee with their technical expertise, dedication, and commitment to the project. Special appreciation is extended to the governors of Cairo, Alexandria, Sohag and Port Said for their interest and motivation, and for the guidance and the support they provided to the research.

The study benefited from the advice and the comments of Dr. Nasr El-Sayed (Secretary General, National Council for Childhood and Motherhood, NCCM), Dr. Lamiaa Mohsen (Professor at Cairo University, and former Secretary General, NCCM), Philippe Duamelle (UNICEF Representative in Egypt), Roberto Benes and Samman Thapa (UNICEF Regional Office for Middle East and North Africa), Dr. Bruno Martorano and Luisa Natali (UNICEF Office of Research), Dr. Hania Sholkhamy (American University in Cairo), and Dr. Luca Tiberti (Laval University, Canada).

Responsibility for the views expressed and for the way in which data are used or presented in the report rests with the authors and contributors.

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Contents

Acronyms

Executive Summary

Chapter 1. Understanding child poverty in urban areas

Chapter 2. Methodology and data tools

Chapter 3. Overview of the slums and the unplanned areas

Chapter 4. Severe child deprivation in slums and unplanned areas

Chapter 5. Multidimensional child poverty in slums and unplanned areas and implications for policy

Notes

References

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1

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21

27

37

55

63

65

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Acronyms

ANC Ante-natal care

CAPMAS Central Agency for Public Mobilization and Statistics

CRC United Nations Convention on the Rights of the Child

DHS Demographic and Health Survey

DPT Diphtheria, pertussis and tetanus vaccine

EDHS Egypt Demographic and Health Survey

EPI Expanded Programme on Immunization

FGM/C Female genital mutilation/cutting

HIECS Household Income Expenditure and Consumption Survey

ISDF Informal Settlements Development Facility

ISUP Informal Settlement Upgrading Programme

MICS Multiple Indicator Cluster Survey

MMR Measles, mumps and rubella vaccine

UNDP United Nations Development Programme

UNICEF United Nations Children’s Fund

WHO World Health Organization

1

In 2012, around 13 million children lived in Egypt’s urban areas. As in most countries around the world, these urban children enjoy better living conditions and greater opportunities than their rural peers, including better chances of survival, better nutrition, higher school achievements, better access to social services and economic infrastructure, and a lower risk of being income poor.

However, not all urban children share the same living standards and opportunities. Recent average trends for urban Egypt show stagnation or even deterioration in some dimensions of well-being, a sign of wide and probably growing disparities and deprivations within the urban setting. Average statistics hide both the existence of substantial pockets of poverty and deprivation and the scale of the inequalities faced by some children living in Egyptian cities.

This study aims to reduce the knowledge gap on poverty and deprivation in urban areas by going beyond average figures to explore the living conditions of children in the most disadvantaged parts of cities, i.e. in slums and unplanned areas.1,2 In doing so, it allows for a better understanding of the complex reality of urban areas and reveals important lessons for effective social policy interventions that aim to combat poverty and promote the realization of children’s rights.

I. Summary of key findings

This study, which focuses on a selected group of informal settlements in four major Egyptian cities (Cairo, Alexandria, Port Said and Sohag), found that poverty and deprivation among children living in slum areas stands at very high levels – in some cases, reaching or exceeding those observed in the most deprived rural areas of the country. The study found that, in early 2012, 41.5 per cent of children in the selected slums were experiencing monetary poverty3, compared with child poverty rates of 26 per cent at the national level4, 33 per cent in rural areas and 16 per cent, on average, in urban areas.

The disadvantage of children living in slums is evident across many dimensions of their well-being, and particularly in relation to their housing conditions and their access to the water and sanitation infrastructure. More than half of children living in the selected slums are severely deprived in terms of sanitation, and around 48 per cent live in overcrowded dwellings or dwellings made of poor construction materials. Slightly less than 30 per cent live in households without any direct water connection coming into the dwelling or with frequent interruptions in the water supply. In most cases, the levels of deprivation in these domains are higher than those recorded in rural areas.

Children in slums also experience high rates of deprivation in nutrition, with

Executive Summary

2

substantial levels of severe stunting and significant levels of severe underweight, and in education, with higher rates of school drop-out before the completion of compulsory education. For these well-being dimensions, the gap with the urban average is less striking, but the levels of severe deprivation are high and represent a matter of primary policy concern.

Most children living in slums suffer from severe deprivation in at least one dimension of well-being; many of them also suffer the burden of overlapping deprivation in two or more dimensions, reflecting a deeper and mutually reinforcing disadvantage (the rate of multiple deprivation ranges between 50 per cent for children aged 5-11 to 57 per cent for children under five). Infrastructural factors (housing and access to basic utilities) are the main factors responsible for the severity of the disadvantage of slums dwellers.

In the unplanned areas covered by the study, the levels of poverty and deprivation were lower than those observed in slums and close to those found in urban areas on average, with peaks of severe deprivation in nutrition (with 26 per cent of children

under the age of five severely deprived as a result, primarily, of high levels of stunting) and education (with 37 per cent of children aged 12-17 failing to complete compulsory education). Around 13 per cent of children in unplanned areas are severely deprived in terms of access to water – a deprivation that is mainly in the form of interrupted supply. Overall the share of children who are severely deprived in at least one dimension ranges between 36 per cent (for children aged 5-11) and 50 per cent (for children aged 12-17), while between 8 and 11 per cent of children across the different age ranges face the burden of multidimensional deprivation.

II. Methodology

This study is based on a household survey and a community questionnaire, conducted in February 2012, that focused on selected slums and unplanned areas in Cairo, Alexandria, Port Said and Sohag (see Table 1). The selection of the slums areas was carried out in accordance with the intervention priorities of ISDF, while the unplanned areas were chosen for their close proximity to the selected slums.

Table 1: Slums and unplanned areas covered by the study

Slums Unplanned areas

Cairo:

Tal El Akareb

Hakr El Sakakiny Ezbet Khairallah

Ezbet Abo Qarn

Alexandria:

Kom El Malh Maawa El Saiadeen

Port Said:

Zerzaraa Al Qabouty

Sohag:

El Qomah Abo Bakr

3

The analysis on multidimensional poverty builds on the experience of two reports on child poverty in Egypt, both published in 2010, which were part of a global study promoted by UNICEF to produce evidence on the specific forms of poverty and deprivation that affect children in low- and middle-income countries. The key features of the approach for that study are the specificity and the multidimensionality of children’s poverty and deprivation and the linkage with the Convention on the Rights of the Child.

The approach affirms the special nature of poverty among children. First, it recognizes that poverty affects the lives of children in ways that differ from the experience of adults. The age at which children experience poverty, together with its duration at the most crucial time in their development, leaves children particularly vulnerable to its impact – which can be life-long and, in many cases, irreversible. Second, it conceives poverty as multidimensional, encompassing different domains of human life, and not simply as an economic/monetary challenge.

Finally, it reflects poverty as a violation of children’s rights.

This study adopts both a multidimensional analytical (and non-monetary) approach to study child poverty, while also presenting the more traditional measures of income poverty (using the child as the unit of computation of the poverty rate, and the national lower poverty line as poverty threshold). Multidimensional poverty is analysed against seven child well-being dimensions and their composite indicators (and thresholds) that are designed to better reflect extreme forms of deprivation in the Egyptian development context (see Table 2).5

The deprivation analysis for any single dimension is disaggregated by the following childhood age groups: 0-4, 5-11 and 12-17. The results of the single dimensions are then combined to assess the prevalence of multidimensional poverty. A child is considered to be multidimensional poor if severely deprived in at least two dimensions of well-being.

Table 2: Dimensions and description of the indicators of severe deprivation

Dimension Definition of severe deprivation indicators (by age group)

Health

● Children aged 0-4: i) children aged 2-4 who have not been fully immunized or ii) children aged 0-4 who recently suffered from an illness involving diarrhoea or pneumonia and who had not received any medical advice or treatment.

● Children above the age of 4: data on the health dimensions are not available.

Nutrition

● Children aged 0-4: i) children suffering from severe stunting, wasting or underweight (- 3 standard deviations from the median of the international reference population) or ii) had never breastfed at all.

● Children aged 5-11 and 12-17: children suffering from stunting or wasting (according to the international standards).

4

Water● All age groups: children living in households with i) no piped water

into the dwelling, or ii) water piped into the dwelling but distribution interrupted daily.

Sanitation

● All age groups: children living in households without improved sanitation facilities (a household is considered to have an improved sanitation facility if it has sole use of a modern or traditional flush toilet that empties into a public sewer, Bayara (vault) or septic system).

Shelter● All age groups: children living in dwellings i) with five or more people

per room, and/or ii) with only one room, and/or iii) with no flooring material.

Education

● Children aged 0-4: deprivation for the education dimension is not calculated.

● Children aged 6-11: i) children who have never been to school, or ii) have been to school but are not currently attending.

● Children aged 12-17: i) children 12-15 who have not completed primary education, or ii) children 16-17 who have not completed basic education (primary + preparatory)

Knowledge/information

source

● Children aged 0-4: deprivation for the Knowledge/information dimension is not calculated

● Children aged 5-11: children living in households without a TV, radio or a computer.

● Children aged 12-17: children living in households without a TV, radio, computer or mobile phone.

III. Study results in selected slums and unplanned settlements

Basic utilities and social infrastructure

The results from the community questionnaire shows that the unplanned areas included in the study are, in general, covered by basic utilities and by social and economic infrastructures that have expanded and improved following the growth of informal areas. This is not the case for slums areas: electricity, water and sanitation networks may be present in most of them, but this does not necessarily mean actual access.

Among the slum areas, Zerzaraa in Port Said does not have any of these public utility networks (i.e. electricity, water

and sanitation networks), while Ezbet Abo Qarn, in Cairo, is not covered by a sewage system.

A more pronounced gap emerges when reviewing the presence of education and health services (Tables 3 and 4). Primary schools are present in three out of the four unplanned areas under analysis. The majority of slums, conversely, do not have primary schools and only Ezbet Abo Qarn, in Cairo, has a preparatory school. This is also the only slum area under review with a maternal and child care centre. No other health office was found in the slums, while only two of the six slum settlements have a pharmacy, in stark contrast to the unplanned areas – all of which have at least one pharmacy and, with the exception of Maawa El Sayadeen, at least one health office.

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Table 3: Availability of education and health facilities in the selected slum areas, 2012

Slums Nursery / Kindergarten

Primary School

Preparatory School

Health Office / Health Unit

Maternal & Child

Care Centre

Private doctor/Clinic

Pharmacy

Cairo:

Tal El Akareb No No No No No No No

Hekr El Sakakiny No No No No No No No

Ezbet Abo Qarn No Yes Yes No Yes No No

Alexandria:

Kom El Malh Yes Yes No No No No Yes

Port Said:

Zerzaraa No No No No No No No

Sohag:

El Qomah Yes No No No No Yes Yes

In addition, all of the sampled locations – slums and unplanned areas – suffer from environmental degradation, including garbage and stagnant water in the streets, air pollution, and widespread incomplete building construction.

Severe deprivation in seven dimensions of well-being and monetary poverty among children

The results of the analysis of severe deprivation, by childhood age groups, are summarized in Table 5.

Table 4: Availability of education and health facilities in the selected unplanned areas, 2012

Unplanned areas Nursery / Kindergarten

Primary school

Preparatory school


Maternal & Child

Care Centre


Pharmacy

Cairo:

Ezbet Khairallah Yes Yes Yes Yes No Yes Yes

Alexandria:

Maawa El Saiadeen No No No No No No Yes

Port Said:

El Qabouty No Yes No Yes No No Yes

Sohag:

Abo Bakr Yes Yes Yes Yes No Yes Yes

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Table 5: Summary of the results on severe deprivation on the single dimensions, selected slums and unplanned areas, 2012

Percentage of children severely deprived in each single dimension

Children aged 0-4 Children aged 5-11 Children aged 12-17




Health 4.3 4.5 - - - -Nutrition 32.2 26.4 8.9 10.7 8.8 5.0Water 29.7 14.0 30.6 13.1 28.0 12.5Sanitation 53.2 4.0 49.6 4.7 49.1 4.4Shelter 52.8 5.0 49.2 5.4 43.6 4.5Education - - 13.4 13.0 43.2 37.4Knowledge/ information

- - 6.1 2.7 2.5 0.7

The picture emerging from the analysis is that deprivation is widespread in informal settlements, and especially in slums, in particular in relation to shelter, water and sanitation – i.e. in domains that are, to a large extent, endogenous to the definition of slums. The nutrition and education dimensions also register substantial rates of severe deprivation in both types of informal settlement, while severe deprivation in the health and in the information and knowledge source dimensions is less widespread. When national data are available, they show that children in unplanned areas suffer levels of extreme deprivation in line with, or slightly higher than, urban averages, while for children living in slums, deprivation in the housing-related dimensions is similar to, or exceeds, the level recorded in rural areas.

In more detail: in the sanitation dimension, around half of children living in slum areas do not have access to improved facilities. In unplanned areas this rate is lower than 5 per cent. Similar trends are observed for shelter deprivation, with children in

slums at high risk of living in extremely overcrowded homes or in buildings made of poor materials.

High levels of extreme deprivation in the shelter and sanitation dimensions are clear reflections of the combined impact of an inadequate infrastructure in slum areas coupled with economic poverty. These factors also explain the relatively high levels of deprivation in the water dimension, which affects around 30 per cent of children in slums.

Severe deprivation in the water dimension is also substantial in unplanned areas, with the share of children without adequate access ranging from 12.5 per cent for the age group 12-17 and 14 per cent for those under five.

Results in the nutrition dimension differ markedly according to the age group. For children under five, the levels of severe deprivation are high in both slums (32 per cent) and unplanned areas (26 per cent), with the disadvantage for children in slums

7

driven mainly by the higher prevalence of severe stunting and the higher percentage of children who were never breastfed. Even if, for this dimension, the gap between slums and the urban average is less pronounced, the high levels of severe deprivation are clearly a matter of primary policy concern. For older children, severe nutrition deprivation levels are lower, but not negligible, ranging from 5 to 10 per cent.

In the education dimension, severe deprivation stands at 37 per cent in unplanned areas and 43 per cent in slums for children aged 12-17, and is a consequence of the high levels of school drop out before the completion of compulsory education. For the age group 5-11, the deprivation rate stands at 13 per cent in both types of locations, reflecting higher levels of participation in primary school and lower levels of drop-outs.

Deprivation in the dimension of information and knowledge sources is less prevalent, in relative terms, than the other forms of deprivation, especially in unplanned areas: TV sets and mobile phones are common in households with children, with only a minority not owning any of these assets.

Finally, in the health dimension, severe deprivation rates stand at slightly over 4 per cent in both types of settlement – a reflection of the good coverage of immunization and of some appropriate health care practices. However, if other indicators of access and use of health services are taken into

consideration, the situation appears less rosy: among children under five: 21 per cent in slums and 18 per cent in unplanned areas were born to mothers who did not receive any ante-natal care check from trained providers, while the share of births not attended by skilled health personnel was 17 per cent and 18 per cent respectively.

The data on deprivation are complemented with statistics on monetary poverty, which show that 19.8 per cent of children in unplanned areas were living in poverty in January 2012, slightly higher than the urban average of 16 per cent recorded in 2011 by a national survey. In contrast, the poverty rate for children living in slums stood at 41.5 per cent, more than double the rate recorded in the neighbouring unplanned locations and surpassing the rates recorded on average for children in rural areas in 2010/11 (Figure 1). The national poverty line in Egypt reflects extremely low levels of consumption, therefore this high concentration of monetary poverty in slum areas means that a very large proportion of households with children lack the resources to allow adequate consumption of food and other essential goods and it is consistent with the high levels of deprivation in most of the individual dimensions of child well-being. In contrast, the rates of child monetary poverty in unplanned areas is not very dissimilar to the urban average – again, this is in line with the findings on the other child well-being dimensions.

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Figure 1: Percentage of children with consumption levels under the national poverty line (selected slums and unplanned areas, 2012 and national, urban and rural averages, 2010/11)

41.5

19.8

16

2010/11 January 2012

33

Per

cent

age

of c

hild

ren

livin

g in

pov

erty

26

EGYPT Rural Urban Slums Unplannedareas

45

40

35

30

25

20

15

10

5

0

Source: Child poverty rates for Egypt, rural and urban areas in 2010/11 have been calculated by UNICEF Egypt from the 25% of the HIECS 2010/11 survey sample provided by CAPMAS. Child poverty rates for slums and unplanned areas are calculated from the results of the survey conducted for this study.

Multidimensional child poverty in slums and unplanned areas

Severe deprivation in any single dimension of well-being is a cause for concern, given the importance of each dimension for a child’s life and development. However, the experience of deprivation in more than one dimension represents even deeper disadvantage, with different manifestations of poverty often reinforcing each other. While data on deprivation in single

dimensions give information on the extent of the specific problem, the analysis of cumulative deprivations and their links to each other provides a deeper understanding of the living conditions of children and more robust evidence to articulate and integrate the necessary policy responses.

Figures 2, 3 and 4 show the percentages of children who experience simultaneous severe deprivations across the different childhood age groups.6

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Figure 2: Multidimensional deprivation among children under five, selected slums and unplanned areas, 2012

5 deprivationsSlums

Unplanned areas4 deprivations or more

3 deprivations or more


1 deprivationor more

No deprivation

0.2

0.2

1.2

8.5

44.1

55.9

0.1

0.5

25.7

57.4

16.2

100 10080 8060 6040 4020 200

Percentage of children according to the number of deprivations

83.8

Figure 3: Multidimensional deprivation among children aged 5-11, in selected slums and unplanned areas, 2012

5 or 6 deprivations Slums





No deprivation

0.3

0.6

1.5

8.1

36.1

63.9

0.1

4.6

21.0

50.2

21.0

79.0

100 10080 8060 6040 4020 200


10

Figure 4: Multidimensional deprivation among children aged 12-17, in selected slums and unplanned areas, 2012






No deprivation

0.6

0.5

2.3

11.5

50.0

50.0

0.0

7.2

27.4

55.3

15.7

84.3

100 10080 8060 6040 4020 200


Overall, most children living in slums – whatever their age group – are severely deprived in at least one dimension, and more than 50 per cent of them are multidimensional poor. The share of children suffering from three or more deprivations is also substantial, reaching 27 per cent and 26 per cent respectively for those aged 12-17 and those under the age of five.

The most common types of deprivations are found in the dimensions of sanitation and shelter, with each accounting for slightly less than one third of the total number of deprivations observed among children under the age of five and among those aged 5-11. For children aged 12-17, severe deprivation in education is another major source of multidimensional poverty.

The share of children experiencing at least one form of severe deprivation drops substantially in unplanned areas, ranging

from 36 per cent for children aged 5-11 to 50 per cent for children aged 12-17. The key dimensions of severe deprivation vary across the different age groups, ranging from deprivations in nutrition for younger children in particular, and in education for the older age group.

IV. Policy implications

Slums are, by definition, characterized by severe housing deprivation and are, at the same time, both a manifestation and result of poverty. This study provides new and important evidence on the nature and scale of deprivation experienced by children and their families in urban areas, and shows the concentration of extreme poverty and disadvantage in slums, with levels of deprivation that are in many cases far higher than the national averages and similar to, and sometimes higher than, the levels observed in poor rural areas.

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The results show that children who are growing up in slum areas are not sharing most of the opportunities enjoyed by most urban dwellers. The levels of severe deprivation are close to 80 per cent for all childhood age groups living in slums. Comparable information on deprivation in rural areas shows that children in slums are just as likely to be deprived in relation to water as rural children, and face an even higher risk of being deprived of sanitation. Multidimensional poverty for children in slums ranges from 50 to 60 per cent, with some variation across the different childhood age groups.

In other words, most children in slums are deprived at least of one basic dimension of well-being, and a very substantial proportion of them have the cumulative burden of being severely deprived in one or more dimensions. While they may have access to basic social services (which are often available in neighbouring areas), they face poor housing conditions, overcrowding, and inadequate access to water and sanitation, as well as malnutrition, especially those children under the age of five. These factors compound the other major deprivations suffered by children in slums, particularly the low levels of income and consumption (below the national poverty line) that prevent households from escaping the vicious circle of poverty.

The policy priorities emerging from the analysis reflect, therefore, the need for a combination of interventions to support household incomes (job creation,

income-generation activities and targeted social-protection interventions) and interventions in the areas of housing and basic utilities, including water and sanitation infrastructure.

Effective forms of income support need to be developed for families with children, such as cash transfer programmes that are targeted to the poor and that include nutrition, health and education components. At the same time, interventions are needed, as a matter of urgency, to address slum housing problems in their different forms, to ensure that affordable and adequate dwellings are available and to improve the coverage and reliability of water and sanitation networks.

The urgent need for interventions to address the high levels of malnutrition among younger children is common to slums, unplanned areas and other parts of Egypt.

Egypt’s sustained population growth, compounded by widespread and (to some extent) growing levels of poverty and disparity in urban areas, could aggravate the situation. Action is needed, therefore, not only to address the existing multidimensional deprivation and poverty problems, but also to prevent the expansion of existing or the emergence of new slums. The scope for effective public policy is enormous and should link together city housing policies and investment in both social services and effective social protection to provide a supportive environment for children.

© U

NIC

EF/

2012

/You

sri A

ql

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1.1 Introduction

Egypt’s progress on its social development indicators has been uneven over the past two decades. Improvements in many areas have been matched by stagnation and deterioration in some other important domains and by persistent disparities between geographical locations and socio-economic groups.

The important reduction in child mortality and the improvements in maternal health and primary school enrolments contrast with the limited progress in the creation of decent employment opportunities and in the reduction of gender disparities, and with the increasing levels of malnutrition.7 Despite a decade of sustained economic growth, income poverty has increased, with more than one quarter of the population (25.2 per cent) living below the national lower poverty line in 2010/11, equivalent to more than 20 million people.8 This indicates that the benefits of economic growth have not been shared equally, despite Egypt’s sizeable investments in social protection policies and programmes.9

In addition, the average national progress seen on many social indicators has masked persistent levels of inequality within the country. In most human development dimensions, those who live in rural areas, in Upper Egypt and in poorer households are lagging behind the rest of the Egyptian population, in particular urban dwellers and those living in the most economically dynamic governorates.

Children are particularly vulnerable in this context of mixed progress and persistent inequalities. The 2010 study by UNICEF and Cairo University, Child Poverty and Disparities in Egypt, showed that children are at higher risk of poverty and deprivation than the rest of the population.10 Poverty for children goes beyond the income and consumption dimensions to include issues of access to quality social services and infrastructure. It is manifested in deprivation and disparities in health and survival, education, housing, access to water and sanitation and access to adequate information, as well as the likelihood of meaningful active participation in family and social life.

Childhood is the formative stage for every human being – a single and irreplaceable period in the physical, cognitive and emotional development of every individual. A child who experiences poverty and deprivation during this developmental phase, even if temporary, is likely to feel their long lasting and detrimental effects, with the risk of transmitting the disadvantage to the next generation.11 In addition, as shown by studies in many developed countries, child poverty and disparities are translated into significant costs for society as a whole, which impairs the prospects for national development and economic growth.12

A second 2010 study, by UNICEF and the Egyptian National Child Rights Observatory, analysed the trends on children’s multidimensional poverty and confirmed the mixed nature of national progress, which includes success stories

Chapter 1. Understanding child poverty in urban areas

14

alongside persistent challenges, as well as deterioration in some indicators.13 This study found that important results were achieved between 2000 and 2008 in reducing child deprivation in health, water, sanitation and information. However, even though shelter deprivation had declined over time, 15 per cent of children were still living in inadequate housing conditions in 2008. In addition, over the same period, the percentage of children living in income poverty grew and a major increase was registered in malnutrition levels.14

Both studies confirmed that children living in rural areas were at higher risk of deprivation than their peers in urban areas, in large part a reflection of the lower coverage of social and economic infrastructure in rural areas, together with greater constraints in income-generation opportunities. These reports also show that rural children experienced notable improvements in their living conditions during the past decade, and that there were some signs of convergence in child well-being between rural and urban areas. This was partly the result of the specific policies put in place by the Egyptian government for the development of the most disadvantaged areas of the country.

However, it was also the result of the stagnation or even deterioration in a series of indicators for children in urban areas, particularly those living in the Urban Governorates. For example, a comparison of the data from the 2005 and the 2008 Demographic and Health Surveys (DHS) reveals that the under-five mortality rate declined from 71 per thousand live births to 46 per thousand in rural Upper Egypt, while the improvement in Urban Governorates was negligible, falling from 34 to 32 deaths per thousand. On child nutrition, the worsening of stunting, wasting and underweight levels

between 2000 and 2008 was driven mainly by their increase in Urban Lower Egypt and in Urban Governorates.15

Egypt’s cities have expanded very rapidly in recent decades. This urban growth has been largely informal (i.e. unplanned) and has included the growth of slums. While it is self-evident that poverty is likely to be concentrated in the country’s growing slums, there is a lack of specific data on their scale or the conditions for those who live within them. Even less is known about children, who account for a large percentage of the slum population.

The recent trends in poverty and deprivation in urban areas are becoming a matter of national concern. The complex dynamics of urban transformation, combined with sustained population growth and persistent imbalances in the labour market (unemployment, underemployment and the dominance of the informal sector), is fuelling inequalities and divergence of opportunities among urban children. However, a chronic lack of data that are adequately disaggregated has prevented a clear understanding of the nature and extent of deprivations experienced by children in urban settings. Average measures for cities mask the reality of areas where the poverty and deprivation experienced by children are concentrated.16 Very often, the most deprived areas or population groups are not included in national administrative or survey data and, as a consequence, they are not reflected in poverty and deprivation statistics. They are not, therefore, considered in policy responses.

The lack of adequate data can result in policy interventions that do not address or respond to the needs of people living in informal areas and that could lead to a waste of efforts with limited impact.

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1.2 Aim and approach of this study: going beyond the average figures for urban areas

This study aims to reduce the knowledge gap on poverty and deprivation in urban areas and provide elements for effective policy responses by focusing on the situation of children in the most disadvantaged parts of some of Egypt’s major cities.

In 2012, the population of Egypt reached 83 million, with children (those aged 0-17) accounting for around 37 per cent of the total population. The country is predominantly rural. Urban dwellers represent around 43 per cent of the country’s population, a share that has remained relatively stable over the past three decades. Approximately 36 million people, including 13 million children, live in urban areas, and around two-fifths of these inhabit the country’s two biggest cities, Cairo and Alexandria.17

As in most countries of the world, urban children in Egypt, on average, enjoy better living conditions and better opportunities than their rural peers. They have better survival chances, better nutrition outcomes, higher school enrolment rates, better access to services and to social and economic infrastructure, and a lower risk of being income poor.

However, not all urban children share the same living standards and the same opportunities. Children living in slums are among those at higher risk of being ‘invisible’ in terms of planning and services and, at the same time, at higher risk of multidimensional poverty. Aggregated data for urban areas do not allow for the assessment of the living conditions of those at greatest risk of poverty, deprivation and neglect. The major surveys used to provide evidence on key social indicators at national

level often fail to include those without formal addresses or permanent homes, including those who live in slum areas. Even when the data collection does cover the most disadvantaged areas, there is a risk that the concentration of deprivation in these areas will be masked when indicators are averaged with those of better-off urban communities close by.

This study builds on the experience of the two mentioned studies carried out in 2010 to adopt an analytical approach based on the multidimensional nature of children’s poverty to assess the fulfillment of child rights in informal areas, including slums and unplanned urban areas. It provides new evidence on the magnitude and the characteristics of child poverty and disparities in these locations, focusing on children aged 0-17 who live in selected slums and unplanned areas in four Egyptian cities: Cairo, Alexandria, Port Said and Sohag.

Its indicators and analysis aim to reflect and aggregate the individual child’s experience of poverty across different dimensions of well-being. The selection of indicators is grounded in child rights, and the selected dimensions are linked with the commitments made by States, including Egypt, when they ratified the Convention on the Rights of the Child. Compared with the previous studies on child poverty in Egypt, the indicators for this study are designed to better reflect poverty and deprivation as experienced by the different childhood age groups (0-4 years, 5-11 years and 12-17 years).

The statistical analysis of child multidimensional poverty and deprivation is based on a household survey conducted in February 2012 designed to collect data on child indicators, as well as on families’ social, economic and demographic background.

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1.3 A general overview of slums and unplanned areas in Egypt

The growth of informal settlements has dominated the Egypt’s urban development in the past five or six decades and has actually represented a response to the country’s housing challenges in a period of major demographic, social and economic transformations.

In the early 1950s, Egypt had a population of slightly more than 21 million people, 68 per cent of whom were living in rural areas. A trend towards rapid and sustained urban growth was already clear, fuelled by internal migration directed in particular to the country’s biggest cities. In just 15 years, between 1950 and 1965, the population living in urban areas almost doubled, increasing from 6.9 million to 13 million – an annual growth rate of 4.2 per cent, compared to less than 2 per cent each year registered in rural areas. In 1975, urban dwellers accounted for 43 per cent of the total Egyptian population, which stood, at that time, at around 40 million people. Since then, the proportion of urban dwellers has fluctuated only minimally: in 2012 urban dwellers still accounted for 43 per cent of the total population of Egypt.18

On average, between 1975 and 2012, the urban and rural populations grew at a very similar rate. The main driver of urban growth has been natural demographic growth, rather than internal migration from rural to urban areas, which has actually declined.19 However, population projections for the coming decades suggest a new acceleration of urban growth and, according to the demographic simulation by the United Nations, the urban population will account for almost half of Egypt’s population by 2030.20

Between 1950 and 2012, the urban population grew by approximately five

times or, in absolute numbers, by around 30 million individuals. This extraordinary transformation has put cities under huge pressure to provide housing and social and economic infrastructure for a rapidly growing population. The demographic pressure has been particularly heavy for the major urban and economically dynamic centers of the country.

The appearance and rapid growth of informal urban settlements is, therefore, a relatively recent phenomenon, mainly as a response to rampant population growth and the economic transformation of the country, as well as the reduced ability of the State to provide low cost housing.

Informal settlements started to develop and grow in the major urban centres in the early 1960s, with the unplanned and unregulated expansion of cities on agricultural land and partly in the desert. This growth accelerated during the 1960s and 1970s as a result of multiple compounding factors in addition to internal economic migration and the natural population growth. These additional factors included the need to accommodate the population evacuated from the Suez Canal zone in the years of war (1967-1973) and the cash-based economic boom produced by the remittances of Egyptians who had migrated to the Gulf States, which boosted the construction sector in the country’s major cities.21

Despite the attempts of the government to limit informal urban growth, the expansion of informal settlements continued through the following decades, and continues to this day in a sustained rhythm. Overall, at the time of the 2006 Census, it was estimated that 60 per cent of Egypt’s urban population was living in informal settlements.22

Such informal settlements dominate the urban development in the country, but contrary to a widespread misconception, they are not necessarily synonymous with

17

poverty and deprivation, and only parts of them can be identified as slums. Informal settlements in Egypt are heterogeneous and have evolved over time, with a progressive coverage of basic social and economic infrastructure and utilities.23 In many ways, a large part of Egypt’s informal urban development can be considered an effective response to the country’s rampant demographic growth and the existing political and economic constraints.

One of the major interventions deployed by the Egyptian government to respond to the emerging urban challenges is the Informal Settlement Upgrading Programme (ISUP), which began to provide services for 1,221 informal settlements in the 1990s. To date, the ISUP has provided basic urban services for 352 informal areas and developed 13 deteriorated areas. In 2004, attempts to revise the programme focused on supporting local government in preparing detailed plans to enable development efforts and restrict the growth of informal areas.

More recently, following the Doweka disaster in September 2008 when part of the Mokattam Mountain in Cairo collapsed, taking the lives of many local residents, the Informal Settlements Development Facility (ISDF) has been created to coordinate efforts and finance for the development of informal areas.

Urban informal settlements: distinguishing between slums and unplanned areas

In the Egyptian context the term ashwa’iyyat (literally, ‘disordered’ or ‘haphazard’) has been used to identify the urban informal settlements that have developed without adherence to any urban planning or building regulations. The term is also associated with perceived problems of accessibility and viability, narrow streets, disordered constructions, high population density, insufficient infrastructure and services,

and a lack of open spaces. This is a broad category that encompasses a large range of different types of settlements. In the past, the national and international literature on urban issues has, on occasions, used the term ‘slum’ as meaning ashwa’iyyat, generating an overestimation of the slum phenomenon in Egypt and creating a general confusion in terms of policy implications and solutions.

The approval of the Presidential Decree No. 305 represents an important development in the clarification of the definition of informal settlements and slums, as it created the ISDF and led to an operational distinction of informal settlements between ‘Unplanned areas’ and ‘Unsafe areas’ (or slums).24

On the one hand, unplanned areas are characterized as being developed in contravention of planning and building laws and regulations (and that do not fall into the categories reported below, which are used to identify slum areas). A summary scheme developed by ISDF (see Table 1.1) shows that these areas have an average density of 500 persons per feddan 25 and building heights ranging from 4 to 10 floors. Most of these areas are covered by basic utilities networks and have an acceptable level of safe housing.

Slum areas, on the other hand, are those territories where at least 50 per cent of their housing structures fall under at least one of the following four categories, ordered by degree of risk.

● Grade 1: Areas subjects to direct life threat (for example those under sliding geological formations, those in flood areas and those under threat of railway accidents).

● Grade 2: Areas with inappropriate shelter conditions (for example, with buildings made of make-shift materials, sites that are unsuitable for building, structurally

18

unsound buildings, buildings in ruins and sites built on waste dumps).

● Grade 3: Areas exposed to health risks, including areas without access to clean drinking water or improved sanitation; areas exposed to heavy industrial pollution or located under high- or medium-voltage electrical power lines).

● Grade 4: Areas of instability as a result of the lack of legal security of tenure.

The average population density in slum areas is 200 persons per feddan (less than half of the average density for unplanned areas) and building heights are, in general, of 1 or 2 floors.

Table 1.1: Key features of slums and unplanned areas in Egypt


Typical population density: 200 habitants per feddan

500 habitants per feddan

Typical building height: 1-2 floors 4-10 floors

Lack of safe housing Provide acceptable housing conditions

Require immediate and urgent intervention Require medium- and long-term development interventions

Source: ISDF

The ISDF has the full responsibility for the development of slums following an approach that emphasises, when possible, in situ upgrading (the main exceptions are the areas classified under Grade 1, for which the displacement of residents is mandatory). Local governments, however, are responsible for the medium- and long-term development of unplanned areas, in collaboration with central organizations mandated to provide infrastructure and services.

In 2009, ISDF conducted a survey to produce a National Map of Slum Areas to determine a baseline for its interventions. The national map identified 404 slum areas, including 212,000 residential units for an estimated population of 1.1 million inhabitants. The majority of these areas (around 70 per cent) came under

the Grade 2 of risk (inappropriate shelter conditions), followed by Grade 3 (exposure to health risk).

In 2010, ISDF issued the National Slum Upgrading Action Plan, which included 66 slum upgrading projects in 18 governorates as a part of the 2010-2012 pilot phase. In early 2013, 22 projects have been completed and 66 are operational. The most significant completed intervention has been seen in the Zerzaraa slum area in Port Said City, in the second half of 2012.

The January 2013 update of the ISDF National Map of Slum Area identified 369 slum areas, 259 of them categorized as Grade 2 category, 65 as Grade 3 and 26 as Grade 1 (see Figure 1.1). More than half of the slums are on private property, but the areas classified under Grade 1 were located predominantly on government land.

19

Figure 1.1: Number of slums in Egypt according to the ISDF risk category, January 2013 update

grade 1. Areas that threaten life

grade 2. Areas of unsuitable housing conditions

grade 3. Areas exposed to health risks

grade 4. Areas of instability due to lack of tenure security

30025020015010050

259

26

65

19

0

Number of slums for each Grade of risk

total number of slums: 369

Source: ISDF (2013).

Note: According to the ISDF classification system by risk degree, the higher grade overrules the lower grade. This implies, for example, that if an area qualifies for Grades 2 and 3, it is classified under Grade 2 only.

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This analysis on children’s multidimensional poverty in slums and unplanned urban areas builds on the experience of the first two reports on child poverty in Egypt, both published in 2010, which were part of a global study promoted by UNICEF to produce evidence on the specific forms of poverty and deprivation affecting children in low and middle income countries.26

The methodology of the global study was adapted to different country contexts using an analytical framework elaborated by a team of researchers at the University of Bristol, UK.27 The key features of the approach for this study are the specificity of children’s poverty and deprivation (which cannot be reduced to a generic poverty measurement/assessment for the overall population with a unique measure), the multidimensionality of child poverty, and the linkage with children’s rights, specifically with the Convention on the Rights of the Child.

Many definitions of poverty and child poverty have been developed in the most recent years.28 In 2007, the General Assembly of the United Nations adopted a powerful definition, with overall implications that are reflected in this study:

“Children living in poverty are deprived of nutrition, water and sanitation facilities, access to basic health-care services, shelter, education, participation and protection, and that while a severe lack of goods and services hurts every human being, it is most threatening and harmful to children, leaving them unable to enjoy their rights, to reach their full potential and to participate as full members of the society.” 29

First of all, this definition recognizes the special nature of child poverty. Poverty affects children’s life in ways that differ to the experience of adults and can have long lasting (in many cases irreversible) impacts on the life of an individual child: the age at which they experience poverty, and its duration, make children particularly vulnerable to poverty.

Second, the definition conceives poverty as multidimensional, encompassing different domains of human life, and not simply its economic/monetary aspects.

And finally, the definition reflects poverty as a violation of children’s rights, given the interdependence, interrelation and indivisibility of those rights.

2.1 A framework on children’s multidimensional poverty

Looking at child poverty only through an income or wealth lens is limiting and can lead to inadequate policy conclusions. Income and wealth are important in determining the well-being of individuals, but they are just means, rather than ends. Child well-being is about more than household income and consumption levels. It depends on many other contextual factors, including the family conditions and interactions, the presence of (and effective access to) social services, environmental conditions and the institutional framework.

This study adopts a multidimensional analytical approach to understand child poverty, but also presents the more

Chapter 2. Methodology and data tools

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traditional measures of income poverty (using the child as the unit of computation of the poverty rate).

Measuring income poverty

The income poverty rates presented in this report reflect the percentages of children living in households with consumption below the national poverty line. Income poverty is therefore measured at the household level and reflects consumption levels that fall below a minimum threshold, represented by that poverty line.

The national poverty line used in this study is known as the ‘lower poverty line’ and is constructed by Egypt’s Central Agency for Public Mobilization and Statistics (CAPMAS) using a cost-of-basic-needs methodology. The poverty line has two distinct components: a food component that reflects the cost of a basic diet (based on calorie-requirement standards differentiated by age and gender) and a non-food component. The values of the food and non-food components are estimated to reflect the levels of prices that are prevalent in the areas under analysis. In 2010/11, the value of the national poverty line was 3,076 Egyptian Pounds per person per year.30

Measuring children’s multidimensional poverty

There is no unified approach for defining and measuring child poverty, and many new developments in research on children have occurred only during the last decade. This study adopts an approach to measuring multidimensional child poverty that is inspired by the approach proposed by the Bristol research team. It therefore adapts poverty calculations using indicators (and thresholds) that better reflect the Egyptian context and articulates the indicators in the dimensions according to the age of child.31

Seven dimensions of child well-being are included:

1. health

2. nutrition

3. water

4. sanitation

5. shelter

6. education

7. knowledge/information source.

A composite indicator is constructed for each dimension to reflect a situation of extreme deprivation. The deprivation analysis is performed for any single dimension disaggregated in the following childhood aged groups: 0-4, 5-11 and 12-17. The results of the single dimensions are combined to assess the prevalence of multidimensional deprivation: in coherence with the previously mentioned studies on child poverty in Egypt, a child is considered multidimensional poor if severely deprived in at least two well-being dimensions. The well-being/poverty framework differs by childhood age group in terms of dimensions and indicators included, therefore the results for the age groups cannot be compared with each other or aggregated in single multidimensional poverty measures for all children aged 0-17.

In addition to the indicators constructed to assess poverty and deprivation, the analysis for the single dimension includes other indicators that complement the analytical assessment when these are available. The child poverty and deprivation dimensions and the indicators constructed for the analysis are shown in Table 2.1, which also links the dimensions with the relevant articles of the Convention on the Rights of the Child (CRC) in the third column.

23

Table 2.1: Dimensions and description of the indicators of severe deprivation

Dimension Definition of severe deprivation indicators (by age group)

Relevant CRC articles

Health

● Children aged 0-4: i) children aged 2-4 who have not been fully immunized or ii) children aged 0-4 who recently suffered from an illness involving diarrhoea or pneumonia and had not received any medical advice or treatment.

● Children above the age of 4: data on the health dimensions are not available.

Articles 6, 23, 24 and 27

Nutrition

● Children aged 0-4: i) children suffering from severe stunting, wasting or underweight (- 3 standard deviations from the median of the international reference population) or ii) had never breastfed at all.

● Children aged 5-11 and 12-17: children suffering from stunting or wasting (according to the international standards).

Articles 24 and 27

Water

● All age groups: children living in households with i) no piped water into the dwelling, or ii) water piped into the dwelling but distribution interrupted daily.

Articles 23, 24, 27, 28, 29

Sanitation

● All age groups: children living in households without improved sanitation facilities (the household is considered to have improved sanitation facilities if it has sole use of a modern or traditional flush toilet that empties into a public sewer, Bayara (vault) or septic system).

Articles 23, 24, 27,28, 29

Shelter

● All age groups: children living in dwellings i) with five or more people per room, and/or ii) with only one room, and/or iii) with no flooring material.

Article 27

24

Education

● Children aged 0-4: deprivation for the education dimension is not calculated.

● Children aged 6-11: i) children who have never been to school, or ii) have been to school but are not currently attending.

● Children aged 12-17: i) children 12-15 who have not completed primary education, or ii) children 16-17 who have not completed basic education (primary + preparatory)

Articles 28 and 29

Knowledge/information source

● Children aged 0-4: deprivation for the Knowledge/information dimension is not calculated

● Children aged 5-11: children living in households without a TV, radio or a computer.

● Children aged 12-17: children living in households without a TV, radio, computer or mobile phone.

Article 17

2.2 The survey: questionnaire, sample and field work

This study on is based on data collected with tools designed to reflect the above described analytical framework.

A household survey and a community survey have been developed, using as their models the Egypt Demographic and Health Survey (EDHS), the CAPMAS Household Income Expenditure and Consumption Survey and the Multiple Cluster Indicator Survey (MICS).

The household survey consisted of three questionnaires, one to collect general information on the households, one to collect information on children aged 0-11, and one for children aged 12-17.

The household questionnaire was designed to collect detailed data from the head of the household on all de jure members, including

questions on age, marital status, education, health and working status. It also contained sections on: income and expenditure; access to education, health and social-solidarity services; perception of poverty; pollution; and included an anthropometric module to collect height and weight measurements for all children.

The questionnaire for children aged 0-11 years (administered to the mother or the caretaker) was designed to collect data on: ante-natal, delivery and post-natal care; breastfeeding; immunization; and the health status of each child below the age of five. The questionnaire contained sections on education, work status and general health for children aged 5-11 years, and on the mother’s attitude towards female genital mutilation/cutting (FGM/C) for daughters under the age of 12.

The questionnaire for children aged 12-17 (administered directly to the

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child) was designed to collect data on education, work and general health status. A section on knowledge, practice and attitude about FGM/C and sexual harassment was included for girls only.

The community survey was developed to collect information on the community infrastructure, interdependence and social cohesion.

The target sample was 6,000 households with children (3,000 in slums and 3,000 in unplanned areas), in four major Egyptian cities (Cairo, Alexandria, Port Said and Sohag). The slum areas were selected by ISDF according to its intervention priorities, including those belonging to the Grade 2 category, reflecting inappropriate shelter conditions.

The selected areas are not statistically representative of the heterogeneous nature of slum areas in Egypt, but

they certainly reflect the worst living conditions and key common characteristics of slums. For unplanned areas, the selection ensured proximity to slum areas whenever possible and was carried out in agreement with the relevant governorate authorities.

The interviews took place in February 2012; Table 2.2 reports the distribution of the actual sample in six slums and four unplanned locations in the cities selected for the study.32 For the slums (with the exception of Ezbet Abo Qarn in Cairo) a full enumeration of households has been conducted. For unplanned areas, the sample was selected with a probabilistic sampling method using the maps of the locations obtained from the relevant governorates and producing a household listing for the selected areas. The actual interviews and anthropometric measurements were performed only for households with at least one member aged 0-17.33

Table 2.2: Slums and unplanned areas, sample distribution


AreaHouseholds interviewed Area

Households interviewed

Estimated total number of households in the area*

Cairo:

Tal El Akareb 199

Hakr El Sakakiny 400 Ezbet Khairallah 1,525 150,000

Ezbet Abo Qarn 692

Alexandria:

Kom El Malh 291 Maawa El Saiadeen 500 2,000

Port Said:

Zerzaraa 773 Al Qabouty 501 900

Sohag:

El Qomah 645 Abo Bakr 500 2,000

Total sample, slums 3,000 Total sample, unplanned 3,026

Note: *the data on the estimated number of households in unplanned areas were provided by the relevant Governorates.

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3.1 Basic social infrastructure in informal urban areas

The development of informal settlements has followed different stages, with settlements often occupying and transforming former agricultural or unused land, or, in a few cases, adapting and transforming the pre-existing use of the land. For unplanned settlements in particular, social and economic infrastructure has expanded, including electricity, water and sanitation networks, social services (such as health and education), markets and shops.

The survey’s community questionnaire collected a series of data on the environment of the slums and unplanned areas included in this study, their coverage of basic social and economic infrastructures, and the main problems affecting the locations, all with important impacts on child development and well-being.

The information collected (see Table 3.1) confirms that unplanned areas are, in general covered by the major utility networks (electricity, water and sewage), as are most of the slums. However Zerzaraa in Port Said does not have any of these public-utility networks, and Ezbet Abo Qarn in Cairo is not covered by a sewage system.

Table 3.1: Availability of basic utility networks in the selected slums and unplanned areas, 2012

Slums Electricity Water network

Sewage network

Unplanned areas Electricity Water network

Sewage network

Cairo:

Tal El Akareb Yes Yes Yes

Hekr El Sakakiny Yes Yes Yes Ezbet Khairallah Yes Yes Yes

Ezbet Abo Qarn Yes Yes No

Alexandria:

Kom El Malh Yes Yes Yes Maawa El Saiadeen Yes Yes Yes

Port Said:

Zerzaraa No No No El Qabouty Yes Yes Yes

Sohag:

El Qomah Yes Yes Yes Abo Bakr Yes Yes Yes

Note: the information reported in the table indicates the existence of the individual utility networks in the area under analysis and does not necessarily reflect actual household connection (see for example Table 3.6 on household water connections).

Chapter 3. Overview of the slums and unplanned areas

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A more pronounced disadvantage for slum areas emerges when the presence of education and health services is taken into consideration (tables 3.2 and 3.3). In unplanned areas, primary schools are present in three out of the four areas under analysis, the exception being Maawa El Saiadeen in Alexandria. In slums, conversely, the majority of the locations do not have primary schools

and only Ezbet Abo Qarn in Cairo has a preparatory school. The latter is also the only slum area with a Maternal and Child Care Centre. No other health office was found in the slums, while only two of the six slum settlements have a pharmacy. On the other hand, all the unplanned areas have at least one pharmacy and all, except Maawa El Sayadeen, have at least one health office.

Table 3.2: Availability of education and health facilities in the selected slum areas, 2012

Slums Kindergarten Primary School

Preparatory School


Maternal & Child

Care Centre


Pharmacy

Cairo:

Tal El Akareb No No No No No No No

Hekr El Sakakiny No No No No No No No

Ezbet Abo Qarn No Yes Yes No Yes No No

Alexandria:

Kom El Malh Yes Yes No No No No Yes

Port Said:

Zerzaraa No No No No No No No

Sohag:

El Qomah Yes No No No No Yes Yes

All of the sampled locations – slums and unplanned areas – suffer from environmental degradation, including the presence of garbage and stagnant water in the streets, air pollution, and widespread incomplete building construction.

The summary assessment derived from the community questionnaire confirms that unplanned areas are, in general, covered by basic utilities and social and economic infrastructure, a coverage that expanded and improved progressively alongside the growth of informal areas.34 The situation is different for slums areas:

electricity, water and sanitation networks are present in most of them, but this does not necessarily mean actual access, while the presence of basic education and health facilities is rare.

3.2 Demographic and socio-economic profiles of households with children

Households with children in slums and unplanned areas are quite homogeneous in terms of size. The average number of people in a household is 4.8 in slums and 4.7 in unplanned areas.35 Households with

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four members are the most common, accounting for 28 per cent of the total, followed by households with five members (24 per cent). Analysis of the number of children living in the household

reveals some minor differences between slums and unplanned areas, with the latter having a slightly higher proportion of households with three children than slum areas (see Figure 3.1).

Table 3.3: Availability of education and health facilities in the selected unplanned areas, 2012

Unplanned areas Kindergarten Primary School

Preparatory School


Maternal & Child

Care Centre


Pharmacy

Cairo:

Ezbet Khairallah Yes Yes Yes Yes No Yes Yes

Alexandria:

Maawa El Saiadeen No No No No No No Yes

Port Said:

El Qabouty No Yes No Yes No No Yes

Sohag:

Abo Bakr Yes Yes Yes Yes No Yes Yes

Figure 3.1: Distribution of households by number of children living in the household, selected slums and unplanned areas, 2012

1 32 4 5 - 6 7 - 8

10.9

5.6

0.6

21.3

32.531.1

26.327.5

25.4

11.3

6.6

0.8

Number of children living in the household

Per

cent

age

of h

ouse

hold

s

35

30

25

20

15

10

5

0

Slums

Unplanned areas

30

More substantial differences emerge from the data on the actual presence of parents in the family. In unplanned areas, around 92 per cent of the child population lives with both parents; this percentage declines to 86 per cent in slums (see Figure 3.2). Slightly less than 13 per cent of children in slums live only with one parent: the mother in the

vast majority of cases. In addition, 7 per cent of children in the slums have a father who is alive but is not present in the household, while for slightly less than 5 per cent their father is dead. In both slums and unplanned areas around 1 per cent of children live without any parent and almost all of these children live with other relatives.

Figure 3.2: Distribution of the child population according to the number of parents living in the household, selected slums and unplanned areas, 2012

12.7

0.8

86.4

92.2

1.36.6

Per

cent

age

of c

hild

ren

100

90

80

70

60

50

40

30

20

10

0

Slums

Both parents in the household

Only one parent

No parent

Unplanned areas

This difference in household composition affects the distribution of households according to the sex of the head, with female-headed households accounting for 13 per cent of the total in slums, and 7 per cent in unplanned areas. The average age profiles of household heads also differ between unplanned areas and slums, the latter having a significantly higher proportion of older heads of household, aged 45 years or older (see Table 3.4).

In slum areas, 36 per cent of households have heads who never attended school

and 27 per cent whose education ended after primary school. Slightly less than 40 per cent of the household heads are in permanent employment, 46 per cent are in temporary work, while 13 per cent are not employed and are not looking for a job. In unplanned areas, around half of the household heads went beyond primary education, with 5 per cent attending university. However, the share of those who never attended school is substantial, at close to 25 per cent. Almost half (47 per cent) of the household heads in unplanned areas have a stable job and 44 per cent have a temporary occupation.

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Table 3.4: Gender and education level of the heads of households, selected slums and unplanned areas, 2012

Head of the householdSlums Unplanned areas

(% of households with children)

Gender

- Male 87.0 93.1

- Female 13.0 6.9

Age group

18-24 3.3 4.1

25-34 27.9 35.2

35-44 32.4 32.0

45-54 22.9 19.5

55 and more 13.4 9.2

Maximum level of education attended

- Never attended school 35.9 24.6

- Primary 27.4 27.6

- Preparatory 12.8 16.3

- Secondary 21.7 26.9

- University 2.2 4.6

Employment status

- Permanent job 38.5 46.7

- Temporary/occasional job 45.9 43.5

- Not employed and looking for a job 2.3 1.0

- Not employed and not looking for a job (out of the labour force)

13.3 8.7

In summary, households with children in slums and unplanned areas are, on average, of a similar size, while their profiles differ more in terms of their composition and socio-economic background, characteristics that are mutually reinforcing.

In slums, the percentage of children living with only one parent (notably the mother) is significantly higher and household heads

are, on average, older. The disadvantage for children in slums emerges more clearly when the education level and the employment status of the household heads are taken into consideration, with a higher proportion of household heads who never attended schools and who have either precarious employment or no employment at all.

32

3.3 Housing conditions and access to water and sanitation

For most slum dwellers, living in a slum area is not a temporary experience. Around 60 per cent of the respondents to the survey have lived in the same slum location for more than 10 years and an additional 25 per cent of households for a period ranging between 5 and 10 years. However, some differences emerge when comparing the different slum settlements: Zerzaraa in Port Said, for example, has grown mainly in the last 10 years (with around half of the households in that location for 5 to 10 years, and around 20 per cent settling in the area in the previous 3-4 years), while for Cairo and Alexandria residence in slums is much more persistent over time (with more than 70 per cent of households living in the same location for more than 10 years). On average, in the slum areas selected for this study, only 5 per cent of the households moved to their current location in the four years preceding the survey.

Low-standard dwellings are prevalent in slums (Figure 3.3). The percentage of households living in apartments is 29 per cent, while those living in a separate house or in a rural-type house account for respectively 8 per cent and 5 per cent of the total. A substantial proportion of

households with children shares a housing unit with other households (23 per cent) or occupies independent one/two room dwellings. More extreme conditions are found among the 20 per cent of households that live in shanty type dwellings such as shacks (with a very high concentration in the Zerzaraa in Port Said).

In unplanned areas, 87 per cent of households live in apartments and an additional 6 per cent live in separate houses. The residual 6 per cent of households live in lower-standard dwelling conditions, consisting of one or more rooms in shared housing units or one or two independent rooms in a building.

The extreme housing conditions in slums are confirmed by the data on major structural problems affecting dwellings (Table 3.5). One quarter of the slum dwellings have demolished walls and 55 per cent have cracked walls; around half suffer from bad ventilation. In unplanned areas, 14 per cent of households live in dwellings with bad ventilation. In addition, while almost all dwellings in unplanned areas are connected directly to the water network, in slum areas only around 75 per cent of households have piped water coming into their homes (Table 3.6) and in many cases the connection is illegal (no water meter is present). Slum dwellers face similar disadvantages in relation to sanitation.

33

Figure 3.3: Distribution of households by type of dwelling, selected slums and unplanned areas, 2012

40 40 60 8020 20

6.4

0.4

4.1

1.7

0.1

87.3

8.2

5.1

29.0

22.9

15.2

19.7

0

Slums

Unplanned areas

Rural-type house*

Apartment

One or more rooms in a housing unit

Independent room/two rooms

Shacks

Separate house

Percentage of households

Note: * A rural-type house is a kind of dwelling that is prevalent in rural areas, made in mud brick and, in general, with natural or rudimental flooring material.

Table 3.5: Distribution of households by dwelling conditions, selected slums and unplanned areas, 2012

Percentage of households with children living in a dwelling affected by the following problems


Demolished walls 23.3 2.1

Cracked walls 55.0 10.0

Walls without windows 31.7 9.3

Dwelling with bad ventilation 48.8 13.7

34

Table 3.6: Water connection and sanitation facilities for households with children,selected slums and unplanned areas, 2012

Percentage of households with children Slums Unplanned areas

Water connection

- Water piped directly into the dwelling 77.5 98.4

Sanitation

- Private toilet 64.9 95.5

- Toilet shared with other households 34.9 4.2

- Public toilet 0.2 0.3

Sanitation – Drainage system

- Public sewer 69.4 71.0

- Vault (Bayara) 2.8 0.1

- Septic system 9.1 28.8

- Piped connected to ground water or to the street 17.2 0.0

- Emptied (no connection) 1.5 0.2

3.4 Monetary poverty and food security

The latest nationwide estimates show that, in 2010/11, 26 per cent of Egyptian children were living in households with consumption below the national lower-poverty line. In rural areas, around one third of all children were poor, compared with 16 per cent of urban children, Upper Egypt Governorates were the regions with the highest concentration of poverty, while Urban Governorates displayed the lowest prevalence.36 No disaggregated data are available for informal urban settlements.

The survey conducted for this study allowed for the calculation of the child poverty rates for the selected unplanned and slum areas by including a short consumption module in the questionnaire.37 In January 2012 (the month of reference for the consumption module), the percentage of children in unplanned areas living in

poverty was 19.8 per cent, slightly higher than the urban average registered one year before, which stood at 16 per cent. In contrast, the poverty rate for children living in slums reached 41.5 per cent – more than double the rate recorded in the neighbouring unplanned locations and also surpassing the rates recorded on average for children in rural areas in 2010/11 (Figure 3.4).

The value of the national poverty line in Egypt reflects very low levels of consumption. Therefore this high concentration of monetary poverty in slum areas means that a large proportion of households with children have levels of resources that do not allow adequate consumption of food and other essential goods.

To complement data on consumption expenditure, the survey also collected information on the occurrence of food shortages for the household in the month before the survey and on the major strategy the household adopted to

35

cope with that shortage. These data are consistent with the poverty estimates and confirm the deep disadvantage for children living in slums: 36 per cent of the survey respondents living in slums declared that their household suffered a food shortage in the month preceding the data collection, while an additional 50 per cent reported that the quantity of food was barely sufficient.

For unplanned areas, the percentage of respondents who felt that they had

insufficient access to food was 21 per cent, with another 50 per cent of respondents assessing their food access as barely sufficient. The most common strategy used by households to cope with a food shortage is to consume cheaper food (for example reducing the consumption of meat) or to reduce the size of meals. A substantial share of the households that experienced food shortages reacted to the crisis by reducing other types of expenditure, including their spending on health and education.

Figure 3.4: Percentage of children with consumption levels under the national poverty line (selected slums and unplanned areas, 2012 and national, urban and rural averages, 2010/11)

41.5

19.8

16

2010/11 January 2012

33

Per

cent

age

of c

hild

ren

livin

g in

pov

erty

26

EGYPT Rural Urban Slums Unplannedareas

45

40

35

30

25

20

15

10

5

0

Source: Child poverty rates for Egypt, rural and urban areas in 2010/11 have been calculated by UNICEF Egypt from the 25% of the HIECS 2010/11 survey sample provided by CAPMAS. In 2010/11, the average national value of the Lower Poverty Line was 3,076 Egyptian Pounds per year per person. Child poverty rates for slums and unplanned areas are calculated from the data of the household survey conducted for this study.

© U

NIC

EF/

2012

/Mou

nir

El-S

hazl

y

37

This chapter provides an overall assessment of severe child deprivation in selected informal urban areas in Egypt in the dimensions of health, nutrition, water, sanitation, shelter, education and knowledge/information, in addition to the more traditional monetary poverty measurements presented in chapter 3.

For each dimension, the analysis is based on the composite indicators of severe deprivation described in Table 2.1 (chapter 2). For each dimension the deprivation analysis is conducted separately for children aged 0-4, for children aged 5-11, and for children aged 12-17; the single deprivation results are then aggregated in the multidimensional deprivation analysis presented in chapter 5. In a few cases, the deprivation analysis is supplemented by additional indicators to provide a more accurate picture of the challenges that Egypt is facing in improving the living conditions for children in the most disadvantaged parts of its urban areas.

4.1 The health dimension

Children’s health is influenced by a complex range of factors. These include household and community environments, care and hygienic practices, access to adequate safe water and food and the availability and correct use of sanitation facilities, as well as adequate preventive and curative health care services and other health facilities. All of these factors play a key role in determining children’s health and survival, but most of them are difficult to measure and aggregate into composite indicators of child health, particularly when it comes to the health of older children.

Therefore, the analysis of poverty and deprivation in the health dimension is limited to access to the provision of basic health interventions for children under the age of five.

Severe health deprivation: children under five not immunized or not receiving adequate health treatment in the event of illness

The indicator adopted in this study to measure the prevalence of severe health deprivation among children under the age of five combines information on the immunization received by each child and the adequate treatment of diarrhoea and acute respiratory infections. More specifically, a child is considered health deprived if he or she is not fully immunized (for the age group 2-4) and/or had untreated diarrhoea or acute respiratory infections in the two weeks prior to the survey (this component of the indicator is applied to all children aged 0-4).

Children aged 2-4 are considered fully immunized if they have received all the inoculations recommended by WHO under the Expanded Programme on Immunization (EPI), specifically those for tuberculosis, polio (three doses), DPT (three doses) and measles (or as an alternative to the latter, the MMR – measles, mumps and rubella – vaccination).

Table 4.1 provides data on the coverage of the different vaccinations (measles coverage is estimated by combining the coverage data on the measles vaccine and

Chapter 4. Severe child deprivation in slums and unplanned areas

38

the MMR vaccine). Vaccination coverage is high, both in slums and unplanned areas, and is in line with – and slightly higher than – the average national coverage rates calculated from administrative sources.

Overall, the share of children who had not received all of the recommended vaccinations was 1.6 per cent in slums and 2.1 per cent in unplanned areas.

Table 4.1: Immunization rates for children aged 2-4, selected slums and unplanned areas, 2012

SlumsUnplanned

areas

National coverage rates from

administrative sources, 2011

(% of children aged 2-4 who are immunized) (% coverage)

Tuberculosis 99.7 99.4 98

Polio 3 99.1 98.9 96

DPT 3 99.1 99.0 96

Measles 98.8 98.6 96

Full immunization 98.4 97.9 NA

Source: Data on immunization in slums and unplanned areas are drawn from the survey conducted for this study. Data on national coverage rates for immunization are from UNICEF and WHO (2013).

Note: DPT refers to combination vaccines against diphtheria, pertussis and tetanus. NA: not available.

The other component of the health deprivation indicator uses information on untreated diarrhoea and acute respiratory infections among children under five.38 According to the survey, 2.5 per cent of children in slums and 2.4 per cent in unplanned areas had experienced an episode of diarrhoea that went untreated in the two weeks preceding the survey, while the percentages for untreated respiratory infections were 1.1 per cent in slums and 1.3 per cent in unplanned areas.

The combination of the components of the child health indicator shows that 4.3 per cent of children under the age of five who live in slums and 4.5 per cent of children who live in unplanned areas are severely health deprived (see Figure 4.1).39 The negligible difference between slums and unplanned areas reflects both the good penetration of immunization coverage in poor areas, but also the persistence of untreated diarrhoea and respiratory infections in unplanned settlements.

39

Figure 4.1: Severe health deprivation among children under five, selected slums and unplanned areas, 2012

4.54.3

Per

cent

age

of c

hild

ren

0-4

who

are

sev

erel

yde

priv

ed in

tne

hea

lth d

imen

sion


Unplanned areas

Slums

10

9

8

74

6

5

4

3

2

1

0

Additional indicators on young children’s health: antenatal care and skill birth attendance

Appropriate and timely ante-natal care and skilled birth attendance are important determinants of the survival, development, health and nutrition of a child. For all children under the age of five, the study’s survey collected information on the number of ante-natal care visits by their mother

(including their timing and their location), as well as on skilled birth attendance and the place of the delivery.

The results summarized in Table 4.2 show that, in both slums and unplanned areas, the levels of inadequate perinatal care are significantly higher than those observed for the care interventions included in the health deprivation indicator (i.e. inadequate immunization and untreated diseases).

40

Table 4.2: Antenatal care coverage and skilled birth attendance, selected slums and unplanned areas, 2012

Percentage of children under five whose mother received:


Results from the EDHS 2008

Urban Rural Total

Ante-natal care (ANC) from trained provider

At least one ANC visit 78.8 82.3 85.0 66.9 73.6

At least 4 ANC visits 70.2 77.3 80.5 57.4 66.0

1st ANC visit before the end of the 4th month 67.5 74.0 - - -

No ANC 21.2 17.7 15.0 33.1 26.4

Delivery care

Delivery attended by a doctor 81.8 80.3 86.8 67.1 74.4

Delivery attended by trained nurses 0.8 1.9 3.3 5.1 4.5

Delivery not attended by skilled personnel 17.4 17.8 9.9 27.8 21.1

Delivery in a health facility 82.0 79.9 85.5 63.6 71.7

Delivery at home 18.0 20.1 14.5 36.3 28.2

-Delivery at home, assisted by skilled personnel 0.6 2.3 4.6 8.5 7.1

Source: data for urban and rural areas and total Egypt are from the Egypt Demographic Health Survey 2008.

The survey shows that 21 per cent of children in slums were born to mothers who did not attend any ante-natal care, while the mothers of an additional 10-15 per cent attended some ante-natal care, but the number of visits was below the recommended quantity and/or started too late, i.e. after the end of the fourth month of pregnancy. The situation for children in unplanned areas was slightly better, with around 75 per cent of their mothers receiving adequate and timely ante-natal care visits. Data for skilled birth attendance depict a similar picture, this time with more homogeneity between slums and unplanned areas. Overall, around 20 per cent of births in both areas occur at home and only a small minority of them is attended by skilled health personnel.

Table 4.2 also provides, for comparison, the results of the EDHS for urban and rural areas in 2008. Across all of the indicators of perinatal-care coverage, the urban average was better than the average found in informal areas in 2012, and rural areas lagged far behind, with around one third of rural children born to mothers who did not benefit from antenatal care. The gap between urban averages and those for informal areas is larger for delivery care than it is for antenatal care.

Overall, in both slums and unplanned areas, a substantial share of children are not receiving adequate and timely perinatal care. This contrasts sharply with the low prevalence of extreme health deprivation reported earlier. While immunization is close to universal and untreated diarrhoea and

41

respiratory diseases are being kept under the threshold of 5 per cent of all children under five, it is clear that key perinatal health care interventions are not reaching a substantial part of the child population in informal settlements.

4.2 Nutrition deprivation

In the past decade, child nutrition has emerged as one of Egypt’s pressing national development challenges. The EDHS estimated that, in 2008, 29 per cent of all Egyptian children under five were stunted and that 14 per cent were severely stunted.40 The overall prevalence of stunting in urban areas in 2008 was 27 per cent – not far from the average observed in rural areas of 30 per cent. In the same year, the levels of wasting and underweight for children under five were, respectively, 7 per cent and 6 per cent. For all the three malnutrition measures – wasting, stunting and underweight – there had been a significant deterioration since 2000.

For the analysis of nutrition deprivation, the indicator selected to assess severe malnutrition among children differs according to the age group. For children under five, it combines information on different forms of anthropometric measures and information

on breastfeeding practices; while for older children the assessment is limited to data on anthropometric measures.

Severe nutrition deprivation among children under five in slums and unplanned areas

The following measures of undernutrition are analysed to assess severe malnutrition among children under five:

● stunting, i.e. low height for age, reflecting chronic malnutrition or the effects of recurrent or chronic illness

● wasting, i.e. low weight for height, reflecting recent, acute, episodes of malnutrition

● underweight, i.e. low weight for age, reflecting acute or chronic malnutrition or both.

The measurement of undernutrition is based on the WHO Child Growth Standards41, and children are considered severely malnourished if their anthropometric measures are below - 3 standard deviations from the international reference population.42 In addition, a child is considered severely deprived in the malnutrition dimension if he or she was never breastfed.

Table 4.3: Moderate and severe stunting, wasting and underweight among children under five, selected slums and unplanned areas, 2012

Percentage of children under five

Stunting Severe stunting

Wasting Severe wasting

Underweight Severe underweight

Slums 33.1 20.3 8.1 4.4 13.1 6.6

Unplanned areas 31.2 16.6 7.4 4.2 11.9 5.2

Urban, 2008 27.1 13.6 8.2 3.3 6.0 1.4

Rural, 2008 29.9 14.2 6.7 3.1 6.0 1.2

Total, 2008 28.9 14.0 7.2 3.2 6.0 1.3

Source: data for urban and rural areas and total Egypt are from the EDHS 2008.

42

Levels of undernutrition among children under five are high, especially for stunting and underweight, in both slums and unplanned areas and exceed those found by the EDHS in 2008 for the whole country and for urban areas. In slums areas, around 33 per cent of children under five are stunted and 13 per cent are underweight, the same indicator stands at 31 per cent and 12 per cent respectively in unplanned areas. The levels of severe stunting and severe underweight in the selected informal settlements are significantly higher than the averages observed in urban and rural areas in 2008.

Figure 4.2 summarizes all the components of the indicator for severe nutrition deprivation by including the share of children who were never breastfed (8.6 per cent in slums and 6.3 per cent in unplanned areas).43 The aggregation of the four indicator components shows that 32.2 per cent of children under five in slums areas are severely deprived in the nutrition dimension, a level substantially higher than that observed in unplanned areas, at 26.4 per cent.44

Severe nutrition deprivation for children aged 5-17 in slums and unplanned areas

For children aged 5-11 and 12-17, the indicator of severe deprivation includes only two anthropometric measures: stunting and wasting.45 According to this combined measure, a child aged 5-17 is considered severely deprived in the nutrition dimension

if he or she is severely stunted or/and severely wasted.

The results of the survey are reported in Figure 4.3 and suggest some contrasting trends, by location and also by age group. For children aged 5-11, those living in slums are slightly less exposed to severe malnutrition than those in unplanned areas (for the latter

Figure 4.2: Severe nutrition deprivation among children under five, selected slums and unplanned areas, 2012

Per

cent

age

of c

hild

ren

unde

r fiv

e

Severestunting

Severewasting

Severeunderweight

Neverbreastfed

Severenutrition

deprivation

35

30

25

20

15

10

5

0

32.2

26.4

6.38.6

5.2

20.3

4.24.46.6

Slums

Unplanned areas

16.6

43

the severe deprivation rate reaches almost 11 per cent), while this situation is reversed for those in the 12-17 age group. In addition, while the level of severe nutrition deprivation declines by

more than half from one age group to the other in unplanned areas, the level remains almost the same across age groups in slums.

Figure 4.3: Severe nutrition deprivation among children aged 5-11 and 12-17, selected slums and unplanned areas, 2012

8.9

10.7

8.8

5.0

Per

cent

age

of c

hild

ren

who

are

sev

erel

y de

priv

ed in

the

nut

ritio

n di

men

sion

12

10

8

6

4

2

0

Slums

Unplanned areas

Children 5 - 11 Children 12 - 17

4.3 Water deprivation

Actual access to clean and safe water is not only vital for child survival and health, it is also connected very strongly to the fulfillment of other rights: in many contexts. Where a piped water network is not available, children (especially girls) are among those at greatest risk of being tasked by the family to fetch water, compromising their time for education and leisure. Access to water depends on the availability and reliability of the infrastructure, but also on the entitlement of the households and their capacity to pay for a water connection.

In Egypt as a whole, the main challenges in terms of access to water are found in rural areas. In 2008, according to the EDHS, the share of households without a water connection in the dwelling was 13.3 per cent in rural areas compared with just 1.5 per cent in urban areas.46

Chapter 3 of this report shows that basic utility networks (including water) have an extensive coverage of informal urban settlements, including most of the slums. However, the mere presence of a water network does not necessarily mean concrete access for the household. In

44

Table 4.4: Children living in dwelling without water connection or with non-continuous water supply, selected slums and unplanned areas, 2012

Percentage of children affected by the following:


Age group 0-4 5-11 12-17

Age group 0-4 5-11 12-17

1. No water connection into the dwelling 14.0 15.3 14.6 0.9 1.3 1.2

2. Dwelling connected, but water supply interrupted daily

15.7 15.3 13.4 13.1 11.8 11.3

Severely deprived children in the water dimension (1+2)

29.7 30.5 28.0 14.0 13.0 12.5

The results for the sub-components of the water indicator are summarized in Table 4.4. Around 15 per cent of children in slums live in dwellings without a direct water connection, while this share declines to around 1 per cent in unplanned areas. The level of non-connection in slums is close to the share of rural households without piped water into the dwelling that was observed in 2008, while the result for unplanned areas mirrors the average for urban areas.

For the other subcomponent – daily interruptions in the water supply – the share of deprived children is substantial in both areas, with between 11 and 16 per cent of

children in the different age groups affected by such daily interruptions.

The aggregate results for severe water deprivation are reported for all children in Figure 4.4, with a clear and marked disadvantage for children living in slums: 30 per cent of them are severely deprived of water access, either because they have no water connection into their dwellings or because of the daily discontinuity of water supply. In unplanned areas, the percentage of children affected by severe water deprivation is around 13 per cent and this is almost exclusively the result of the frequent interruptions of water supply.

addition, quantitative access is only one of the conditions for the fulfillment of the right to water, with its safety and quality of equal importance.

The indicator constructed to assess severe deprivation in the water dimension combines information on water connection

and on the continuity of water supply. More specifically, children are considered severely water deprived if they live in dwellings without a direct connection to the water network or, in the case of connected dwellings, if the water supply is interrupted daily.

45

Figure 4.4: Severe water deprivation among children aged 0-17, selected slums and unplanned areas, 2012

13.3

29.5

Per

cent

age

of c

hild

ren

(0-1

7) s

ever

ely

depr

ived

in t

ne w

ater

dim

ensi

on


35

30

25

20

15

10

5

0

4.4 Sanitation deprivation

Lack of access to adequate sanitation services has implications that are similar to inadequate access to water in terms of the potential impact on children’s survival, health and nutritional status. Additionally – especially for girls – lack of privacy and the use of shared sanitation facilities increase the exposure to the risk of sexual harassment and abuse.

Sanitation deprivation has three main components. The first concerns the availability of adequate toilet facilities, the second is the toilet’s waste management/ drainage system, and the third is the use of the facility by one or more households. A household is considered to have improved sanitation facilities if it has sole use of a modern or traditional flush toilet that empties into a public sewer, bayara (vault) or septic system.

In the multidimensional child poverty framework adopted in this study, a child is considered to be severely deprived in the sanitation dimension if he or she lives in a household without an improved sanitation facility.

Figure 4.5 shows the gap in severe sanitation deprivation between children in slums and children in unplanned areas. Around half of children aged 0-17 in slums live in households without an improved sanitation facility. In one third of these cases, the problem is the non-availability of a flush toilet with adequate sewage system and in two thirds the problem is that the flush toilet is shared among two or more households. In contrast, the level of severe sanitation deprivation among children in unplanned areas stands at 4.4 per cent, and is solely the result of sharing facilities among two or more households, with all children having access to a modern or traditional flush toilet with an adequate sewage system.

46

Figure 4.5: Severe sanitation deprivation among children aged 0-17, selected slums and unplanned areas, 2012

Total 0-1712-175-110-4

60

50

40

30

20

10

0

4.44.44.7

50.849.149.6

53.2

4.0

Slums

Unplanned areas

Per

cent

age

of c

hild

ren

who

are

sev

erel

yde

priv

ed in

tne

san

itatio

n di

men

sion

As in the case of water, comparable data for rural and urban areas on the sanitation dimension are available from the EDHS and show that, in 2008, 11.5 per cent of rural households and 2.3 per cent of urban households did not have access to improved sanitation facilities.47 This comparison highlights the distinctive challenge of sanitation in slums, where severe deprivation is more than four times higher than in rural areas.

4.5 Severe shelter deprivation

Water and sanitation deprivations are elements of inadequate housing, given the absence of infrastructure for basic utilities or the lack of entitlement or resources to access these services. To complete the picture of inadequate housing, the multidimensional poverty and deprivation framework includes an indicator of severe deprivation that reflects overcrowded dwelling conditions or poor and unhealthy construction materials. All of these can have a direct impact on children’s health, and

also affect education (given, for example, the lack of adequate spaces for study), socialization and leisure opportunities.

A child is considered severely deprived if he or she lives i) in a dwelling with five or more people per room and/or ii) in a dwelling with only one room 48, and/or iii) in a dwelling without flooring material. The indicator is the same for all the childhood age groups.

The results for the three components of extreme shelter deprivation are reported in table 4.5. In all instances, children in slums are experiencing high levels of deprivation. Overcrowding, in its different forms, is the dominant factor in housing deprivation, with, for example, more than 40 per cent of children under five in slums living in a dwelling with only one room. In addition, around 20 per cent of children live in dwellings without flooring material. In unplanned areas, no single component of dwelling deprivation reaches the level of 5 per cent.

47

Table 4.5: Children living in overcrowded dwellings or in dwellings without flooring material, selected slums and unplanned areas, 2012

Percentage of children living in households suffering the following forms of shelter deprivation


Age group 0-4 5-11 12-17

Age group 0-4 5-11 12-17

More than five persons per room 17.5 23.7 21.4 1.8 3.3 2.9

Dwelling with only one room 42.3 35.6 29.9 4.6 4.6 3.7

Dwelling without flooring material 20.8 22.2 18.8 1.0 1.1 1.1

Note: the three components of the shelter deprivation indicators can overlap. A child is considered severely deprived if at least one of the above conditions is satisfied.

Figure 4.6 displays the overall results for the three childhood age groups and for all children aged 0-17. Around half of children living in slums are suffering from severe shelter deprivation, in the form of overcrowding, poor construction materials or both. The highest risk of deprivation is found among children

under the age of five, a result of the higher share of families living in dwellings with only one room. Again, in contrast, the prevalence of extreme deprivation is far lower in unplanned areas – at 5.5 per cent – although this is still a worrying level and quite homogeneous across childhood age groups.

Figure 4.6: Severe shelter deprivation among children, selected slums and unplanned areas, 2012

Children 0-17Children 5-11 Children 12-17Children 0-4

60

50

40

30

20

10

0

5.04.55.4

48.3

43.6

49.2

52.8

5.0

Slums

Unplanned areas

Per

cent

age

of c

hild

ren

who

are

sev

erel

yde

priv

ed in

tne

she

lter

dim

ensi

on

48

4.6 Severe education deprivation

Urban areas in Egypt have almost universal levels of enrolment in primary education and high levels of enrolment in preparatory and secondary education. The survey fielded for this study collected information on school participation for children aged 3-17, and Figure 4.7 reports the attendance rates for age groups corresponding to pre-primary, primary, preparatory and secondary education.

For pre-school aged children, the attendance rate is low, standing at just 9 and 5 per cent respectively for slums and unplanned areas. This is a reflection, in part, of the absence of nurseries and kindergartens in these areas, and of the lack of resources to access these services. Participation in pre-schools grows with the age of the child and is the highest for those aged five.

School attendance rates reach the highest levels for children in primary school ages (6-11) at around 87 per cent, with substantial parity between slums and unplanned areas. In detail, attendance is lower for children aged six (the consequence of a delayed entrance in the school system) and grows to percentages close to 90 per cent for the subsequent years. Overall, the proportion of children of primary school age who do not attend school stands at between 10 and 15 per cent.

School attendance declines for older age groups, dropping to around 75 per cent for those aged 12-14, and to just over 50 per cent for those aged 15-17 in both the slums and unplanned areas included in the study.

Figure 4.7: Percentage of children attending school in the school year 2011/12, selected slums and unplanned areas, 2012

Children 15-17Children 6-11 Children 12-14Children 3-5

100

90

80

70

60

50

40

30

20

10

0

5.04.55.4

52.451.5

75.575.6

87.086.6

49.2

8.95.3


Per

cent

age

of c

hild

ren

curr

ently

att

endi

ng s

choo

l

49

Current school participation is the main component used to assess severe deprivation in the education dimension. In the multidimensional poverty framework a child in the 6-11 age group (primary-school age) is considered severely deprived in the education dimension if not currently

enrolled in a school programme; while for the older age group (12-17 years), a child is considered severely deprived if he or she is aged 12-15 and has not completed primary education, and if he or she is aged 16-17 and has not completed preparatory education.49

Table 4.6: Children who never attended school or dropped out from the education system, selected slums and unplanned areas, 2012

Percentage of children Slums Unplanned areas

Children aged 6-11 who never attended school 9.8 10.0

Children aged 6-11 who dropped out of school 3.6 2.9

Children aged 12-17 who never attended school 8.0 2.8

Children aged 12-17 who dropped out of school 30.4 33.4

The sub-components of education deprivation indicators are displayed in Table 4.6. For the 6-11 age group, around 10 per cent of children, in both types of settlement, never attended school (most of them are children aged six whose entrance into the school system was delayed). Another 3 to 4 per cent took part in education, but dropped out of school before completing their primary education. Overall, this means that around 13 per cent of children aged 6-11 are severely deprived in the education dimension (see Figure 4.8).

For the older age group, the share of children severely deprived grows quite

substantially. In part, this is the result of past trends in school participation and, in particular, drop-outs from school before the completion of compulsory education or marked delays in basic education progression.

Overall, 43 per cent of children aged 12-17 in slums are severely deprived in the education dimension. In unplanned areas, the share of children severely deprived in education is 37 per cent. In both types of location, these levels of deprivation are determined mainly by the high levels of drop-outs before the completion of compulsory school.

50

Figure 4.8: Severe deprivation in education among children, selected slums and unplanned areas, 2012

13.013.4

43.2

37.4

Per

cent

age

of c

hild

ren

who

are

sev

erel

y de

priv

ed in

the

edu

catio

n di

men

sion

50

45

40

35

30

25

20

15

10

5

0

Slums

Unplanned areas

Children 6 - 11 Children 12 - 17

4.7 Knowledge/information deprivation

The previous six sections have assessed child deprivation using traditional indicators and dimensions, namely health, nutrition, water and sanitation, housing and education. The last dimension of the child multidimensional poverty framework assesses deprivation in information, communication and knowledge sources. Access to such sources has a positive potential for children’s cognitive and social development, and these sources are crucial means of transmission of basic information on health, education and other subjects relevant for the development of the child.

Extreme deprivation in this dimension is measured with two different indicators respectively for children aged 5-11 and children aged 12-17, while the indicator is not computed for children in the younger age group.

A child aged 5-11 is considered deprived of information and knowledge sources if he or she lives in a household without any of the following assets: a TV set, a radio or a personal computer. The survey results (Table 4.7) show that around 93 per cent of children 5-11 in slums and 97 per cent of children in unplanned areas have a TV set at home. Radios and personal computers are less common and, in general, children in slums have substantially less access to these assets.

51

Table 4.7: Children aged 5-11 living in households with a radio, a TV set or a personal computer

Percentage of children living in households owning the following assets

Children aged 5-11


Radio 23.7 32.7

TV set 93.0 97.0

Personal computer 8.1 20.9

For children aged 12-17, the list of information and knowledge assets also includes the availability of at least one mobile phone in the household. The overall result is not dissimilar to that

observed for the younger age group, with widespread ownership of TV sets and mobile phones and a lower diffusion of radios and personal computers.

Table 4.8: Children aged 12-17 living in households with a radio, a TV set, a personal computer or a mobile phone

Percentage of children living in households with the following assets

Children aged 12-17


Radio 25.7 36.2

TV set 92.4 98.1

Personal computer 8.5 21.6

Mobile phone 87.6 95.9

The data on the possession of the communication assets are aggregated in the summary indicator of severe deprivation in the knowledge/information sources, as shown in Figure 4.9. Overall, there is widespread access to these sources, as reflected in the possession of communication assets. Deprivation levels are relatively low, especially in unplanned areas. In slums, the severe deprivation rate reaches 6 per cent for children aged 5-11 and 2.5 per cent for the older age group. In unplanned areas the prevalence is less than

half that observed in slums. For comparison, in 2008 the share of children aged 0-17 who were severely deprived in this dimension was 2.4 per cent nationwide, 3.5 per cent in rural areas and 0.7 per cent in urban areas.50 However, these low prevalence rates do not mean that the problem is unimportant: the possession and use of some these basic information and knowledge assets are very common, especially in urban areas, and being severely deprived in this dimension may reflect a deeper risk of social exclusion.

52

Figure 4.9: Severe deprivation in information and communication sources among children, selected slums and unplanned areas, 2012

2.7

6.1

2.5

0.7

Per

cent

age

of c

hild

ren

who

are

sev

erel

y de

priv

edin

the

info

rmat

ion

and

know

ledg

e di

men

sion

10

8

6

4

2

0

Slums

Unplanned areas

Children aged 5 - 11 Children aged 12 - 17

4.8 Severe deprivation in seven dimensions of child well-being: a summary

This section summarizes the results of the analysis on severe deprivation in seven key areas of well-being, for three different childhood age groups, in both slums and unplanned areas (see Table 4.9).

One clear trend is consistent across all childhood age-groups: the disadvantage for children living in slums is marked in the three dimensions that reflect housing and utility infrastructure (a result that is consistent with the definition of slum areas). In the sanitation dimension, around half of children living in slum areas do not have access to improved facilities. In the selected unplanned areas this rate is lower than 5 per cent. Similar disparities are observed for the indicator on shelter deprivation,

with children in slums at high risk of living in extremely overcrowded dwelling or in buildings made of poor materials.

High levels of extreme deprivation in the shelter and in the sanitation dimensions are clear reflections of the combined impact of an inadequate infrastructure in slums coupled with economic poverty. These factors also explain the substantial levels of deprivation in the water dimension: among children living in slums the severe deprivation rate is around 30 per cent for all three age groups.

Severe deprivation in the water dimension is also substantial in unplanned areas, with a deprivation rate ranging from 12.5 per cent for children aged 12-17 and 14 per cent for children under five. In these areas, around 99 per cent of children live in dwellings connected to the water network and the registered levels of

53

deprivation are almost exclusively the result of unreliable and interrupted water distribution. For slums, the high deprivation levels are the result of the

combination of a chronic lack of water connections into dwellings and, for those households that are connected, the lack of daily continuity in distribution.

Table 4.9: Summary of the results on severe deprivation on the single dimensions, selected slums and unplanned areas, 2012

Percentage of children severely deprived in each single dimension

Children aged

0-4

Children aged

5-11

Children aged

12-17




Health 4.3 4.5 - - - -

Nutrition 32.2 26.4 8.9 10.7 8.8 5.0

Water 29.7 14.0 30.6 13.1 28.0 12.5

Sanitation 53.2 4.0 49.6 4.7 49.1 4.4

Shelter 52.8 5.0 49.2 5.4 43.6 4.5

Education - - 13.4 13.0 43.2 37.4

Information/knowledge - - 6.1 2.7 2.5 0.7

In the nutrition dimension results are mixed. For children under five, the levels of severe deprivation are high in both slums (32 per cent) and unplanned areas (26 per cent), with the disadvantage for children in slums driven mainly by the slightly higher prevalence of severe stunting and the slightly higher percentage of children who were never breastfed.

In the education dimension, severe deprivation is 37 per cent in unplanned areas and 43 per cent in slums for children aged 12-17, and is a consequence of the high levels of school drop out before the completion of compulsory education. For the younger age group, the deprivation rate drops to 13 per cent in both types of urban locations.

Deprivation in information and knowledge sources is relatively less widespread than the other forms of deprivation, especially in unplanned areas: TV sets and mobile phones are common in households with children, with only a minority of households not owning these assets.

Finally, in the health dimension, severe deprivation rates stand at slightly over 4 per cent in both locations – a reflection of the good coverage of immunization and of some appropriate health care practices.

In summary, the picture emerging from the analysis is that deprivation is widespread in informal settlements, and especially in slums, for the housing-related dimensions (shelter, water and sanitation). The nutrition and education dimensions register also substantial rates of severe deprivation in both slums and unplanned areas, while severe deprivation in the health and in the information and knowledge source dimensions is less widespread. When national data are available, they show that children in unplanned areas suffer levels of extreme deprivation in line with, or slightly higher than, urban averages. For children living in slums, deprivation in the housing-related dimensions is similar to, or exceeds, the level recorded in rural areas.

55

The indicators presented in chapter 4 reflect conditions of severe deprivation in dimensions that are fundamental for child well-being and development. The experience of severe deprivation in more than one dimension represents a deeper condition of disadvantage, where different manifestations of poverty may well reinforce each other. While data on severe deprivation in single dimensions of well-being are important to understand the extent of the single problem and to inform the policy response, the analysis of cumulative deprivations and how deprivations relate one to the other provides a deeper understanding of the living conditions of poor children and evidence to better articulate and integrate the necessary policy responses.

This chapter elaborates the results discussed earlier in this study and investigates the overlapping of severe deprivations. The analysis presents the percentages of children by the number of severe deprivations that they are experiencing simultaneously. Following the approach of the previous studies on child poverty in Egypt, a child is considered ‘multidimensional poor’ when severely deprived in two dimensions or more.

5.1 Multidimensional poverty among children aged 0-4

In slums, most children under five (84 per cent) suffer from at least one form of severe deprivation (see Figure 5.1). The

decomposition of data shows that the most common types of deprivation are found in the dimensions of sanitation and shelter, with each accounting for slightly less than one third of the total number of deprivations observed among children under the age of five (Figure 5.2).51 In unplanned areas, the share of children experiencing at least one form of severe deprivation drops to 44 per cent. In these unplanned locations, the nutrition dimension accounts for the largest contribution to severe deprivation by far, followed by the water dimension.

Multidimensional poverty (two deprivations or more) is widespread in slums: 57 per cent of children under five suffer from at least two forms of severe deprivation and around 26 per cent are severely deprived in three or more dimensions. For children in unplanned areas, multidimensional poverty stands at less than 10 per cent, while the overlap of deprivation in three dimensions is found only for around 1 per cent of children.

The majority of children under five in slum areas experience multidimensional poverty. Deprivation in the housing-relevant dimensions is a major factor, suggesting that the inadequate infrastructure is a primary cause of the disadvantage. For unplanned areas, severe deprivation in nutrition dominates the profile of disadvantaged children, but it is associated with other deprivations only in a limited number of cases.

Chapter 5. Multidimensional child poverty in slums and unplanned areas and implications for policies

56

Figure 5.1: Multidimensional deprivation among children under five, selected slums and unplanned areas, 2012

5 deprivationsSlums





No deprivation

0.2

0.2

1.2

8.5

44.1

55.9

0.1

0.5

25.7

57.4

16.2

100 10080 8060 6040 4020 200


83.8

Figure 5.2: Percentage composition of severe deprivation among children under five (share of each dimension in the overall number of severe deprivations observed in the relevant population)


Health

Sanitation

Water

Shelter

Nutrition30.9

2.5

18.78.3

7.4

26.0

9.349.0

30.617.3

Note: This figure reports data on the percentage share of each dimension among the overall cases of severe deprivation observed in the population of this age group.

57


For children of primary-school age, the analysis includes two additional dimensions: education and access to information/knowledge sources, but does not include the health dimension.

The pattern of multidimensional poverty for children aged 5-11 is very similar to the one discussed for the younger age group (see Figure 5.3). In slum areas, 79 per cent of children are severely deprived in at least one dimension. Multidimensional poverty affects half of

all children, and it is determined mainly by severe deprivation in sanitation, shelter and water:the three dimensions together account for around 85 per cent of all the deprivations suffered by children aged 5-11 in slums (see Figure 5.4).

In unplanned areas, 36 per cent of children are deprived in at least one dimension, while multidimensional poverty stands at 8 per cent. The stronger contributions to severe deprivation in unplanned areas are made by the water dimension (reflecting the interruptions of water distribution), followed by education and nutrition.

Figure 5.3: Multidimensional deprivation among children aged 5-11, in selected slums and unplanned areas, 2012






No deprivation

0.3

0.6

1.5

8.1

36.1

63.9

0.1

4.6

21.0

50.2

21.0

79.0

100 10080 8060 6040 4020 200


58

Figure 5.4: Percentage composition of severe deprivation among children aged 5-11 (share of each dimension in the overall number of severe deprivations observed in the relevant population)

7.1

32.0

19.7

31.8

28.1

11.5

22.1

5.8

22.5

10.1

5.53.9


Knowledge

Education

Sanitation

Water

Shelter

Nutrition

Charts 5-4



For children aged 12-17, the general patterns of severe deprivation and multidimensional poverty are similar to those observed for the other age groups, with a stronger concentration of disadvantage among children living in slums compared with unplanned areas dwellers. For the latter, however, the high levels of drop-outs from education before the completion of compulsory schooling are making the prevalence of those severely deprived in at least one dimension high in comparison to the other age groups (Figures 5.5 and 5.6).

The analysis finds that 84 per cent of children aged 12-17 in slum areas are severely deprived and that 55 per cent are multidimensional poor. The corresponding rates for children living in unplanned areas are 50 per cent for severe deprivation, and 11.5 per cent for multidimensional poverty. A decomposition of data shows that in slums the two leading dimensions responsible for severe deprivation are sanitation and shelter, this time followed by education. For unplanned urban areas, the education dimension is responsible for more than half of the cases of severe deprivation observed in the sample.

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Figure 5.5: Multidimensional deprivation among children aged 12-17, selected slums and unplanned areas, 2012






No deprivation

0.6

0.5

2.3

11.5

50.0

50.0

0.0

7.2

27.4

55.3

15.7

84.3

100 10080 8060 6040 4020 200


Figure 5.6: Percentage composition of severe deprivation among children aged 12-17 (share of each dimension in the overall number of severe deprivations observed in the relevant population)

24.7

1.4 4.8

25.0

6.8

58.2

19.4

7.1

1.0 7.5

16.028.1

Knowledge

Education

Sanitation

Water

Shelter

Nutrition

Charts 5-6


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5.4 Multidimensional poverty and implications for policy

Overall, the results of this study show that children who are growing up in slum areas are not benefitting from most of the opportunities enjoyed by most urban dwellers as a result of urban development. For these children, the risk of living in monetary poverty is much higher than the national average and even higher than the rate observed in rural areas: in all, 41.5 per cent of children in slums live in households with consumption levels below the national poverty line. At the same time, the levels of severe deprivation are around 80 per cent

for all childhood age groups living in slums – twice the income poverty rate for this group. Multidimensional poverty ranges from 50 to 60 per cent, with some variation across the different age groups (Figure 5.7).

In other words, the majority of children in slums are deprived of one basic dimension of well-being, and a very substantial proportion of them have the cumulative burden of being severely deprived in one or more dimensions. The very high levels of deprivation and multidimensional poverty are mainly explained by the housing related dimensions, as well as nutrition (for younger children) and education (for older children in particular).

Figure 5.7: Severe deprivation, multidimensional poverty and monetary poverty among children in selected slum areas, 2012

Monetarypoverty

(children 0-17)

Children 5-11 Children 12-17Children 0-4

90

80

70

60

50

40

30

20

10

0

41.5

84.3

55.3

50.2

79.083.8

57.4

Severe deprivation (at least one dimension)

Multidimensional poverty (at least two dimensions)

Per

cent

age

of c

hild

ren

61

The comparison between the monetary and non-monetary indicators confirms their complementary nature in providing evidence on children’s living conditions.

The high level of income poverty is the consequence of inadequate job and income-generation opportunities as well as the inadequacy of social protection provisions to prevent household consumption levels falling below the poverty line.

The high level of multidimensional poverty, however, is mainly the result of the severe forms of deprivation in housing and basic utilities infrastructure that characterize slum areas. Overcrowded dwelling and poor construction materials, the lack of access to improved sanitation facilities, followed by inadequate access to water are the three factors that widen the gap between children living in slum areas and those living in other urban areas, including unplanned areas and formal areas.

Severe deprivation in the nutrition and education dimensions (especially for children under five) is also substantial, but only slightly higher than the levels observed, for example, in unplanned areas. This suggests that the underlying determinants of such deprivation are not specific to slums.

The levels of severe deprivation are comparatively low, although still substantial, in the health and the information/knowledge dimensions. Immunization and treatment for diarrhoea and respiratory infections are common; the lack of health facilities in slum areas does not prevent, in fact, families from using the services available in the neighbouring areas (even if this access can have additional economic costs to cover transportation). However, the picture changes when other basic health interventions are considered, for example the perinatal care interventions. The survey data highlight that around one fifth of children under five in slums were

born to mothers who did not have any ante-natal care from a trained provider and for a similar share the delivery was not attended by skilled personnel.

Availability and formal access are only two conditions for the realization of the rights to health care and education services. The quality of the services is also essential for good health and education outcomes. The nature of the data collected for this research unfortunately does not allow the assessment of the quality of services accessed.

The study shows that life in a slum is associated with high levels of multidimensional poverty for children. While it does not seem to compromise access to basic social services for the child (which are available in neighbouring areas), poor housing conditions, overcrowding, inadequate access to water and sanitation are very common, alongside malnutrition, especially for children under the age of five. These factors compound the other major deprivations suffered by children in slums, particularly the low levels of income and consumption (below the national poverty line) that are preventing households from escaping the vicious circle of poverty.

The policy priorities emerging from the analysis reflect, therefore, the need for a combination of interventions to support household incomes and interventions in the areas of housing and basic utilities, including water and sanitation infrastructures.

The urgent need for interventions to address the high levels of severe malnutrition among younger children is common to slums, unplanned areas and other parts of Egypt. Similarly, there is an urgent need to address the relatively low levels of ante-natal care coverage and skilled birth attendance.

Together with interventions to support job creation and income-generation activities to meet the needs of those living in slums,

62

other forms of income support need to be developed for families with children, such as cash transfer programmes that are targeted to the poor and that include nutrition, health and education components. At the same time, interventions are needed, as a matter of urgency, to address the slum housing problems in their different forms, to ensure that affordable and adequate housing is available and to improve the coverage and reliability of water and sanitation networks.

Egypt’s sustained population growth, compounded by widespread and to some extent growing levels of poverty and disparity in urban areas, could aggravate the slum problem in the country. Action is needed, therefore, not only to address the existing multidimensional deprivation and poverty problems in slums, but also to prevent the expansion of existing or the emergence of new slums.

To realize the rights of children in slums, a focused approach is needed that integrates the multidimensional nature of poverty, bringing together the monetary aspects and better and reliable social infrastructure, housing and basic social services. In doing so, the strategic approach should link together city housing policies and investment in social services and effective social protection.

The strategy adopted by the Government of Egypt, with the creation of the ISDF, which determined the priorities for

intervention based on grades of housing or location risk, is a realistic one to confront the most extreme forms of dwelling deprivation in urban areas. In this respect, this study confirms that the criteria adopted by ISDF to select the intervention priority areas are able to identify areas with widespread unsuitable housing conditions and also a concentration of monetary poverty and multidimensional deprivation. In essence, the slum-mapping criteria identify not only poor shelter conditions but also, more importantly, those slum dwellers who are particularly deprived. Furthermore, the results of this study – by focusing on children and the fulfillment of their rights – emphasise the importance of the accessibility and quality of social infrastructure, basic utilities and social services, which are interlinked and essential for any strategy to confront extreme poverty in urban areas.

Slums are, by definition, characterized by severe housing deprivation and are, at one and the same time, both a manifestation and result of poverty. This study has provided new evidence on the nature and scale of deprivation experienced by children and their families in urban areas, and shows the concentration of extreme poverty and disadvantage in slums, with levels of deprivation that are in many cases far higher than the national averages and similar to the levels observed in poor rural areas.

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Chapter 1

1 According to the Egyptian legislation introduced in 2008 with the creation of the Informal Settlements Development Facility (ISDF), slums (or unsafe areas) are urban informal settlements where at least half of the housing structures are in areas subject to i) direct life threat, and/or ii) with inappropriate shelter conditions and/or iii) areas exposed to health risk and/or iv) in areas with instable tenure (due to lack of tenure rights).

2 Unplanned areas are urban informal settlement developed in contradiction with planning and building laws and regulations, and which do not fall into the four categories defining slums mentioned above.

3 A child is considered poor if he/she lives in a household with consumption levels below the national poverty line, calculated with the methodology adopted by CAPMAS.

4 National data refer to 2010/11.

5 This study follows closely the adaptation of the Bristol methodology prepared for the Egyptian National Child Rights Observatory (ENCRO) by El Leithy and Armanious (2011).

6 The deprivation analysis for the different age groups is carried out using different (age specific) indicators. Therefore the results for the age groups cannot be compared and aggregated in single multiple deprivation measures for all children aged 0-17. See chapter 2 of the report for a detailed description of the methodology.

Chapter 2

7 Ministry of Economic Development and United Nations Development Programme (2010).

8 Central Agency for Public Mobilization and Statistics (2012a).

9 In the fiscal year 2011-12, the Government of Egypt allocated around 30 per cent of its budget to social protection, mainly in the form of energy subsidies and, to a lesser extent, food subsidies.

10 UNICEF and Center for Economic and Financial Research and Studies of Cairo University (2010).

11 See for example, Boyden and Dercon (2012).

12 UNICEF (2010).

13 UNICEF and Egyptian National Child Rights Observatory (2010).

14 El-Zanaty and Way (2009).

15 Demographic and Health Survey, online Stat Compiler.

16 UNICEF (2012).

17 Elaboration of data from CAPMAS (2012b) and other data extracted from CAPMAS website.

18 Elaboration of data from CAPMAS and from the United Nations, Population Division (2012).

19 The natural demographic growth is the change in the size of population due to births and deaths occurring during a reference period. It does not take into consideration the effect of migration.

20 United Nations Population Division (2012).

21 Khalifa (2011).

22 ISDF data.

23 World Bank (2008) and Sims (2011).

24 Unsafe is a transliteration of the Arabic word Gheir Amen (غري �آمن) used to refer to the word slum.

25 The feddan is a surface measurement unit used in Egypt (1 feddan = 0.42 hectares).

26 See the website of the UNICEF’s Global Study on Child Poverty and Disparities, at http://unicefglobalstudy.blogspot.com

27 Gordon, Nandy, Pantazis, Pemberton and Townsend (2003).

28 See Minujin and Nandy (2012).

29 See http://www.unicef.org/media/media_38003.html

30 See CAPMAS (2012a).

31 This study follows closely the adaptation of the Bristol methodology prepared for the Egyptian National Child Rights Observatory (ENCRO) and presented in El Leithy and Armanious (2011).

32 The data collection in the field was conducted by eight teams, each consisting

Notes

64

of one supervisor and four interviewers. Interviewers and supervisors had previous experience with large scale sample surveys and received appropriate and specific trainings for this project, in particular on how to hold interviews, how to complete questionnaires using the visual methods, on child height and weight measurement, role playing, etc. For each questionnaire, the data collector received an informed consent from the respondent.

33 The response rate to the survey has been 100 per cent in both slums and unplanned areas. The response rates to the questionnaire for children aged 12-17 have been, respectively, 99.3 per cent in slums and 99.0 per cent in unplanned areas.

Chapter 3

34 With reference to Cairo, see also Sims (2011).

35 The substantial homogeneity in terms of household size between slums and unplanned areas is confirmed for all four cities under analysis. However, significant differences do exist between cities: the average size of households with children ranges between the minimum of 4.2 members observed in Port Said and the maximum of 5.5 members in Sohag.

36 UNICEF calculations based on a nationally representative quarter of the sample of the CAPMAS Household Income Expenditure and Consumption Survey (HIECS) 2010/11.

37 For the calculation of the poverty rates, the 2010/11 lower poverty-line value has been updated to take inflation into consideration. However, the use of different survey designs prevents a rigorous and precise comparison between the poverty rates.

Chapter 4

38 For diarrhoea, treatments include any homemade treatment, including Oral Rehydration Therapy.

39 Children are classified as severely health deprived if they are deprived in at least one of the indicator components.


41 See http://www.who.int/childgrowth/en/

42 These measures reflect conditions of extreme nutrition deprivation. For example, children who suffer severe wasting (i.e. whose weight-for-height is below – 3 standard deviations of the WHO standards) have a highly elevated risk of death compared to the other children. In a well-nourished population there are virtually no children below – 3 standard deviations. See World Health Organization and UNICEF (2009).

43 The rates of children under five who were never breastfed in slums and unplanned areas are higher than those observed in 2008. According to the 2008 EDHS, they were respectively 4.8 per cent in urban areas and 3.9 per cent in rural areas.

44 Children are classified as severely deprived in the nutrition dimension if they are deprived of at least one of the four components.

45 For both indicators of stunting and wasting, the WHO references are used to identify malnourished children.



48 The computation of rooms does not include bathrooms, kitchens and halls.

49 For pre-school age children, the education dimension is not included in the multidimensional poverty framework.

50 UNICEF and Center for Economic and Financial Research and Studies of Cairo University (2010).

Chapter 5

51 The data on the shares of each type of deprivation are based on the overall counting of deprivations observed in the population under analysis.

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References

Boyden, Jo and Stefan Dercon, Child Development and Economic Development: lessons and future challenges, Young Lives, University of Oxford, Oxford, 2012.

CAPMAS, Poverty Indicators from the Household Income, Expenditure and Consumption Survey 2010-2011, CAMPAS, Cairo (in Arabic), 2012a.

CAPMAS, Egypt in Figure 2012, CAPMAS, Cairo, 2012b.

El Leithy, Heba and Dina Armanious, ‘Towards a New Definition of Child Poverty Indicators in Egypt: a sensitivity analysis’ mimeo, paper prepared for the Egyptian National Child Rights Observatory, ENCRO, Cairo, 2011.

El-Zanaty, Fatma, and Ann Way, Egypt Demographic and Health Survey 2008, Ministry of Health, El-Zanaty and Associates, and Macro International, Cairo, 2009.

Gordon, David, Shailen Nandy, Christina Pantazis, Simon Pemberton and Peter Townsend, Child Poverty in the Developing World, Policy Press, Bristol UK, 2003.

Khalifa, Marwa A., ‘Redefining Slums in Egypt: unplanned versus unsafe area’, Habitat International, 35: 40-49, 2011.

Minujin, Alberto, and Shailen Nandy, Global Child Poverty and Well-Being: measurement, concepts, policy and action, The Policy Press, Bristol UK, 2012.

Ministry of Economic Development and UNDP, Egypt’s Progress Towards Achieving the Millennium Development Goals 2010, Ministry of Economic Development, Cairo, 2010.

Sims, David, Understanding Cairo. The logic of a city out of control, American University in Cairo Press, Cairo, 2011.

UNICEF, ‘The Children Left Behind. A league table of inequality in child well-being in the world’s rich countries’ Innocenti Report Card, No. 9, UNICEF Innocenti Research Centre, Florence, 2010.

UNICEF, ‘Children in an Urban World’, State of the World’s Children 2012, UNICEF, New York, 2012.

UNICEF and Center for Economic and Financial Research and Studies of Cairo University, Child Poverty and Disparities in Egypt: Building the social infrastructure for Egypt’s future, UNICEF Egypt, Cairo, 2010.

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UNICEF and Egyptian National Child Rights Observatory, Trends of Child Poverty and Disparities in Egypt between 2000 and 2008, UNICEF Egypt, Cairo, 2010.

UNICEF and World Health Organization, Immunization Summary, 2013 Edition, UNICEF and WHO, New York and Geneva, 2013.

United Nations Population Division, World Urbanization Prospects: the 2011 revision, CD-ROM edition, United Nations Population Division, New York, 2012.

World Bank, Arab Republic of Egypt: Towards an urban sector strategy, Report No. 44506-EG, Sustainable Development Department, Middle East and North Africa Region, The World Bank, Washington DC, 2008.

World Health Organization and UNICEF, WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children, A Joint Statement by the World Health Organization and the United Nations Children’s Fund, Geneva and New York, 2009.

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