Quarantining whom?

Mediterranean disease detention then and now

Society This article is part of the series Mediterranean routes

The word quarantine made an unexpected comeback in 2020, after having been out of mind for as long as most of us can remember. But only as far back as the early 20th century, crossing the Mediterranean often meant spending weeks in isolation. Then and now, something remains true. Not all travellers are equal.  

One week ahead of the 2021 Berlin Marathon, held as always at the end of September, a handful of runners from my team in Beirut had just finished their marathon training. They were in the shape they had hoped – and struggled hard – to be in. Only one hurdle remained: entry into Germany. Because of covid-19, travellers to the country must not only secure a visa and be fully vaccinated with a EU-approved vaccine (not including the Sinopharm, Sinovac and Sputnik V vaccines), they also, depending on nationality and port of departure, had to quarantine for a period of ten days. Lebanon, in the non-European corner of the Mediterranean, was on that list. Luckily for my running friends, athletes were exempted from quarantine – but this still left the issue of our coach, who stopped running himself long ago.

The Mediterranean, where waves roll ashore in Beirut and other ports, is where it all began.

Less than two years ago, a similar scenario would have been hard to imagine. The idea of quarantining or declaring your health on arrival would have seemed like a relic from the past, or a sci-fi like future. With the arrival of covid-19, of course, it was not. Just like that, the virus added a whole set of new procedures to our lives. But these measures, as novel as they seemed, are not new. The idea of stopping disease with isolation is as old as our knowledge of these illnesses themselves, and has been at the front of anti-epidemic strategies since the Middle Ages. And the Mediterranean, where waves roll ashore in Beirut and other ports, is where it all began. 

The birth of quarantines

In 1377, the Ragusan Republic, a great maritime power centred on today’s Dubrovnik, announced a decree. The ruling said that anyone arriving at the port from a “pestilential location” must undergo one month of quarantine. Dubrovnik, like other cities at the time, was used to outbreaks of contagious disease and had already been sending suspicious cases to small, uninhabited islands for decades. But the decree in 1377 formalised the measure. Soon, Mediterranean ports like Venice, Marseille, Pisa, Genoa and Mallorca followed suit and established quarantines of their own, marking the beginning of a quarantine regime that eventually came to extend to the entire Mediterranean.

The word “quarantine” itself is a direct legacy from this era. Quaranta giorni, “forty days” in Italian, was the period most maritime travellers had to isolate. The rationale behind the number remains a mystery: perhaps it came from Hippocrates’ theories on illness or the Pythagorean theory of numbers – or Jesus’ desert travail, which lasted for exactly forty days.

Throughout much of history, survival to the plague was fifty-fifty at best, and 80-90 percent fatality rates were common.

The fear on everyone’s mind at the time was the plague, a highly contagious disease spread by fleas living on rodents. The disease was so fearful that it became a blanket term for all infectious diseases, including cholera and leprosy, which oftentimes were referred to simply as “plague”. We still have incomplete knowledge of early epidemics in history, as many ancient Chinese, Indian, Egyptian and other texts are left out of mainstream history writing. But the first known plague, named after the Byzantine emperor Justinian, hit Europe in 541-542 A.D., wiping out half of the continent’s people. 

The most well-known epidemic came many centuries later. The Black Death – or simply The Plague – killed an undetermined number of people in the 1300s, between 25 and 100 million. Throughout much of history, survival to the plague was fifty-fifty at best, and 80-90 percent fatality rates were common. The best advice, as the Italians said, was for a long time to simply fuge cito, longe et tarde revertere – “flee fast, as far as possible, and return as late as possible.”

Lazaretto life

It was during the Black Death that Mediterranean travellers got to know the practice of quarantine for the first time. The analogy to prison is not far off: quarantine stations or lazarettos set up to isolate people regulated their every move inside. Should you so much as touch someone from another batch of quarantinees, your own sejour was extended or started over from the beginning. Ships, when arriving at a port, had to flag a yellow flag and stay on anchor while the captain was taken ashore for questioning. In case of any confirmed or suspected disease, all crew and goods had to isolate. Inside, especially in early quarantines, life was simple. In Dubrovnik, you would camp out in small residential quarters with doors that could be locked from both outside and inside. Your goods were stored downstairs, and guarding them was part of the lazaretto visit.

“Flee fast, as far as possible, and return as late as possible.”

Throughout history, quarantine varied greatly depending on your status and financial means. For important merchants or diplomatic envoys, it could be a rather comfortable affair. You could rent furniture and servants, and order cooked restaurant meals. Privileged guests in Dubrovnik’s quarantine could send for meat, butter, sugar, spices and, during colder periods, snow from the nearby Mount Snijeznica to keep food and drinks chilled.

In the 1830s, Najaf Koolee Mirza, an Iranian prince from the Qajar Dynasty, stayed in quarantine on Malta en route to London, which all travellers coming to Britain from the east had to do at the time. His notes, besides recounting the unfortunate love story of a Turkish man in quarantine who fell in love with a Maltese woman and accidentally killed them both by giving her a ring that was not disinfected, also described a boredom “leading to lethargy” while stuck in quarantine.

Many succumbed, if not to the plague or whatever disease was haunting people at the time, then to harsh conditions in confinement.

Malta’s lazaretto, on a small island right in the harbour of Valletta, was considered a “model institution” in the Mediterranean. It had a gondola where quarantined passengers could do business meetings, and a parlatorio where they could speak to friends on a boat some distance from the shore. Many famous lodgers stayed in the lazaretto in the 1800s, including British statesman Benjamin Disraeli who said that it was there, after reading old newspapers lying around the institution, that he started to “understand politics”, and poet Lord Byron, who scribbled his name on one of the walls in the area reserved for important persons.

But the vast majority of people ordained to quarantine in Mediterranean lazarettos were people from the poorer strata of society. For soldiers, sailors, fishers and crews on ships, quarantine was simply part of life. The lazaretto was a place you just had to visit, at one or both ends of a journey. Many succumbed, if not to the plague or whatever disease was haunting people at the time, then to harsh conditions in confinement. In times of major outbreaks, lazarettos were often overcrowded, and suspected and confirmed cases were quarantined together. A travel narrative describes a group of 300 farmers crossing the Austrian border from the Ottoman Empire. Unable to afford any shelter, they spent ten days outside in freezing weather, wearing clothes that had been disinfected by a favoured method of the time: fumigation, in this case submersion in cold water.

A new quarantine regime

Given the ongoing conflicts and rivalry among states around the Mediterranean at the time, it is remarkable that a shared quarantine regime came to take such a strong hold. Alex Chase-Levenson, author of the book Yellow Flag: Quarantine and the British Mediterranean World 1780-1860, suggests that quarantine came to function as a sort of mutually assured deterrence.

“Everyone had to follow the rules otherwise their own ships would be stopped or delayed in quarantine, something that countries were not willing to risk. As a result, a shared standard emerged,” he says.

For many ports, establishing quarantine stations was a necessity.

Interestingly, it was a system that took shape mostly from the bottom up. In early quarantines like those of Dubrovnik and Venice, so-called kacamortis (from the Italian word for “catch” and morte, “death”) not only ran lazarettos but also, in times of crisis, often replaced local politicians. Local port officials came to hold vast authority and were able to impact trade, economy and politics. By the 1700s and 1800s, most Mediterranean ports had their own health boards and councils. In Malta, writes Chase-Levenson, “quarantine was to be governed as a matter of politics and administration influenced by medicine, not the other way around.”

For many ports, establishing quarantine stations was a necessity. To end up with disease at your door (which they often did, regardless) had enormous economic and social consequences. Running a lazaretto certainly entailed substantial costs, but these were to a large degree borne by merchants and shipping companies. In 1878 for example, when 3,000 pilgrims on their way home from Mecca were delayed by Egyptian quarantine measures in Sinai, the Suez Canal Company had to manage their transport. 

Throughout the ages, quarantine and disease politics have reflected inequalities around the Mediterranean.

For some cities, offering quarantine meant gaining an upper hand in the competition with neighbouring ports, and they grew economically as a result. Malta’s reputation as a well-managed quarantine, along with its central position in the Mediterranean, favoured it as a port. In 1835, the island quarantined 801 ships and 12,932 individuals; in 1840, 653 ships and 11,689 individuals.

Beirut was also boosted by its quarantine, which helped make it a port of choice over neighbouring cities like Tripoli and Lattakia. It also contributed to the establishment of an affluent merchant class in the city. The site of Beirut’s quarantine, a rocky piece of land north of the old urban borders, later grew into an entire neighbourhood, still named Karantina. Armenians fleeing the genocide in the early 1900s stayed there, as did Palestinians escaping the creation of Israel several decades later. Arpi Mangassarian, the founder of an Armenian cultural centre in Beirut, grew up listening to stories about her mother’s aunt, who stayed in Karantina as a young girl.

“I think she was about 17 or 18 when she came there, arriving from Bulgaria where she had first fled to. The conditions were not good in the quarantine, but it was a way for her to come to Beirut and continue with her studies there. It was not very acceptable for girls to go alone at that time, but she did it anyway,” Mangassarian says.

Colonialism and the quarantine order

Throughout the ages, quarantine and disease politics have reflected inequalities around the Mediterranean. Health boards, even in southern ports, mainly had European consuls, merchants and sanitary advisors as members. This way, dialogue remained “one-sided and dominated by Europeans.” In the mid-1800s, a series of international sanitary conferences were held but these operated according to “the logics of imperial expansion and competition”. While international in name, the conferences did not benefit all equally, writes Valeska Huber in the Journal of Global History – rather, they aimed at “safeguarding trade and imperial traffic”.

Dialogue remained “one-sided and dominated by Europeans.”

This went in line with prevailing stereotypes in Europe about other regions in the world. Not only was the continent seen as culturally, economically and politically superior, it also had better health policies – and cleanlier inhabitants. In the European narrative, colonial and other Mediterranean regions were “disease-ridden”. Egypt was seen as “the cradle of the plague”; India as “the home of cholera”. The pilgrimage route to Mecca was thought of as particularly contaminated. These ideas fed into existing stereotypes, not least about Arab and Muslim “others”.

In the 1800s, the British admiral Charles Colville Frankland wrote about the gardens surrounding Damascus. The groves, he wrote, were “indeed beautiful”, but also “teeming with danger” since there, “the pestilence shoots her arrows in silence and rapidity”. An article in the British Medical Journal in 1893 stated that as long as the Saudi Arabian region of Hejaz, home to Mecca and Medina, “remains a closed book to the hygienic world, so long shall we be in danger”. 

As a result, quarantine procedures came to consistently favour European shipping and travel. Scales of “contagiousness” used to determine the length and intensity of isolation marked Ottoman and Egyptian ports as “highly susceptible”. The lazaretto in Beirut operated according to a three-tier classification: “Healthy European”, “Suspect Egyptian, Syrian and Greek” and “Contaminated Ottoman”. By the 1800s, every single person and all trade goods coming from the Ottoman Empire to Europe had to quarantine – regardless of whether there was an outbreak at the moment or not. 

“At that time, ninety per cent of all ships on the Mediterranean came from cities with no reports of disease and no disease on board,” Chase-Levenson says.

Minorities like Roma and Jews were also repeatedly blamed for spreading disease, as were people living in homelessness and poverty. In 1836 Naples, health officials hindered the free movement of “prostitutes and beggars”; other cities banned them from entering the city gates. In Dubrovnik in the 17th century, the terrifying so-called Plague of the Maids was blamed on housemaids, who were seen as causing the disease. In reality, maids were hit particularly hard because they were weak and malnourished. The idea that European Jews caused outbreaks by “poisoning wells and fountains” took such strong hold in the Middle Ages that Pope Clement VI, in order to defend the community, announced an alternative explanation: the plague, according to the Church, had natural causes like astral influence and God’s will.

 The great “unequaliser” 

When covid-19 broke out, many first believed that the epidemic would hit people in an equal manner. Madonna, sitting in a bathtub filled with milk and rose petals, even called it “the great equaliser”. But things turned out differently. The pandemic came to fortify already existing borders, and often hit those without privilege and wealth worse than others.

“History is somehow repeating itself. All are concerned by the pandemic, but we see that specific groups are much more affected. It is exacerbating an already existing situation,” Catrinel Motoc from Amnesty International in London says. 

When covid-19 broke out, many first believed that the epidemic would hit people in an equal manner.

The organisation published a report in 2020 on discrimination in Europe during the pandemic. Oftentimes, it is the same groups that were targeted historically that now face racist measures. In Slovakia and Bulgaria, Roma communities have been singled out by government control mechanisms. Over 50,000 Roma were cut off from the rest of the country in Bulgaria during mandatory quarantines, and planes were used to “disinfect” the Roma neighbourhood in Yambol. In Slovakia, the military was tasked to enforce measures in Roma areas.

“This is institutionalised racism, which is particularly pervasive. It is purposefully and specifically coming from the authorities,” Motoc says.

Countries including Greece, Serbia, Italy and Cyprus have all targeted refugees and migrants in lockdowns and quarantines. Italy operated “quarantine boats” to isolate migrants and asylum-seekers – often people living in the country for months or years – after testing positive for covid-19. The Euro-Mediterranean Human Rights Monitor calls this harmful to people who already have experienced trauma at sea. It also, the monitor says, “nourishes the idea that a migrant is more dangerous to public security than an Italian who tests positive for the virus”. In 2020, a 15-year-old boy was brought to a quarantine ship in Sicily, despite being ill and with evident signs of torture on his body. It took twelve days until he was brought to hospital; two days later, after testing negative for covid-19, he died.

Rhetorically, containment of migration has been conflated with containment of the new virus.

Travel restrictions and quarantine requirements hit people differently too. Many countries have decided to fully or partially ban travellers from certain countries, often not based on numbers of covid-19 cases. Europe, which for long has employed sophisticated restrictive measures to stop people from entering the continent, including the outsourcing of “migration management” to neighbouring states, made it harder than before to obtain visas and asylum. Almost one hundred years after closing its lazaretto, Malta this year introduced a list of so-called dark red countries, from which citizens cannot visit except “in certain limited circumstances, only with prior authorisation”. At the time of writing, all southern Mediterranean (and all African) nations were on the list except for Egypt and Libya. 

Rhetorically, containment of migration has been conflated with containment of the new virus. Just a few weeks after Greece got its first case of covid-19 (from Italy), prime minister Kyriakos Mitsotakis said that the country could “no longer accept more illegal entries” and tightened its border controls, especially around the Aegean islands where many migrants arrive. Ursula von der Leyen, president of the European Commission, backed Greece, calling it a “European shield”. In Italy, then-interior minister Matteo Salvini said that “allowing migrants to land from Africa, where the presence of the virus was confirmed, is irresponsible” and that Italy should make its borders “armour-plated”.

European nations are rarely on these list.

Elsewhere in the Mediterranean, Lebanon has imposed mandatory hotel quarantines on and off in periods, often targeting only passengers from specific countries, mainly in Asia and Africa. Lebanese, in their turn, were banned from entering Saudi Arabia, where many Lebanese reside or work, without spending two weeks outside of Lebanon first: Jordan became a favoured country for these 14-day stops. Turkey, too, imposed 10-day hotel quarantines on certain travellers and completely banned citizens of South Asia, Brazil, Nepal and Sri Lanka. European nations are rarely on these lists – them having better access to vaccines and many developing economies’ dependency on tourism are two reasons why.

One and a half years into the covid-19 pandemic and counting, it is clear that quarantine has managed to survive the test of time as a favoured measure to prevent infectious disease. The historical quarantine regime of the Mediterranean has changed: previously lengthy periods of isolation are now down to more manageable intervals. Hotels and private homes have replaced lazarettos, even though, as Chase-Levenson points out, “a quarantine hotel at an airport is essentially a lazaretto of today”. 

The historical quarantine regime of the Mediterranean has changed: previously lengthy periods of isolation are now down to more manageable intervals; hotels and private homes have replaced lazarettos.

Old quarantine sites have fallen to oblivion, been torn down or given entirely other functions. Dubrovnik’s ancient lazaretto now houses a café, a concert venue and an art space. Malta’s lazaretto is undergoing restoration: the plan is to open offices and a boutique hotel. On Venice’s quarantine island, greenery is finding its way through the walls of the abandoned buildings. In the August 4, 2020, explosion in Beirut, Karantina, situated near the port, was one of the worst hit areas. 

Quarantine has also lived on as a form of “unequaliser”, contrary to what many believed when covid-19 first hit. While no one can be sure to avoid illness and death, wealth and privilege does take you through quarantine and restrictions much smoother. The Mediterranean sea may not be as natural a divider as it was in times of maritime travel, but in the age of flying, the region remains divided by invisible borders, many of which have been strengthened by pandemic politics.

Certainly, quarantine has helped to limit the spread of viruses, not least before the entry of antibiotics and other efficient medicine. In Alexandra, for example, the 1899 outbreak of plague was exceptionally mild, perhaps most of all thanks to the cooperation and compliance of residents to quarantine measures. How well today’s policies will work is yet to be seen.

My marathon running friends made it to Berlin without any problems in the end. One of them got her visa right on time; the others already had 10-year Schengen visas from before. Our coach, it turned out, could enter as part of the team. Right before they were about to leave, as I was talking to one of my friends, he made a joke about being caught in quarantine and missing the race. “In that case, I guess we’ll just have to run away,” he smiled.

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All illustrations for the Mediterranean Routes series were produced by Atelier Glibett in Tunis. 

This publication was produced with the financial support of the European Union within the framework of the regional program Med Dialogue for Rights and Equality. All content is the sole responsibility of Mashallah News and does not necessarily reflect the views of the European Union. The Our Mediterranean project (#ourmediterranean on social media) has four partners: Maydan, Civitas Institute, Réseau Euromed France and Mashallah News.

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