Swanie Potot Introduction

The violence encountered by the migrants studied in this text is of several kinds: they were confronted with the 'structural violence' of poverty and economic crisis having in their countries of origin [START_REF] Galtung | Violence, Peace and Peace Research[END_REF], and they are now facing racist violence in the place they have migrated to in order to work. Categorised not as refugees but as economic migrants, they do not benefit from any sort of international protection regime. The analysis shall focus on the Almeria province of Andalusia, in the South of Spain, where large numbers of foreign workers from various origins are employed in agriculture. In this region, massive exploitation of cheap and reliable manpower, together with strong competition for jobs between workers, have led to severe interethnic tensions. During the year 2000, these tensions escalated into riots directed mainly against Moroccan workers, causing dozens of people to be injured as they were chased down the streets of the agricultural centre of El Ejido. Since then, Moroccans workers, who for decades have been the main group of foreigners working in the area, are being steadily replaced by other migrants, among whom Rumanians are estimated to be the most numerous. This essay explores the social relations shaped by such contestations in the context of labour migration. Agriculture is the most important economic activity in the area and the entire social life of the Almeria region seems to revolve around this sector. The sharp rise in economic productivity of the area has been the work of persons from a variety of backgrounds: Spaniards coming from other regions, Moroccans, who have been immigrating here for decades, Rumanians, relative newcomers and very much subdued, and others. But this collective activity has not given rise to solidarities or collective feelings amongst those workers. On the contrary, the pragmatics of the context have been articulated into an atmosphere of social distance and conflict, in which the various groups are in search not only of economic promotion but also of social recognition. Xenophobia plays a key role here. While Spaniards tend to deploy it as a strategic dimension of their human resources management, Moroccans attempt to resist it in order to regain a sense of dignity, whereas Rumanians negotiate their identity as whites, intending to gain social recognition by inscribing themselves into Spanish racism. This chapter analyses such complexities of racism and their link with territory. A comparison of Moroccan and Rumanian migrants' attitudes will underline that relations to space, composed through the history and resources of those groups, strongly condition their dealings with social exclusion. This will lead us to investigate how personal and collective histories, meanings and objectives of migration, as well as social, juridical and political contexts in places of arrival, play a role in the process of attachment to territory and the collective representations of immigrant workers. The analysis will proceed in four steps. A first step will shed a light on the social and economic context which led various populations to come to work in the area. It will show how a social scale has been built parallel to the growth of the region, placing different groups on ranking levels. A second part will explore the sources of increasing racism toward Moroccans during the last decade and their collective responses to it. A third section will deal with the recent arrival of 02/04/2009 2/15 Rumanians, considered highly desirable by many Spaniards, and their development of a very different relationship to space. The conclusion intends to explain the absence of solidarity based on class consciousness between farm labourers and the overwhelming weight attributed to origin in their self-identification. The Colonisation of Almeria Province Fifty years ago, the Campo de Dalias, as the region of El Ejido was formerly called, was just a windy, salty desert. As the region was the poorest part of Spain, its inhabitants would emigrate in large numbers to other European countries. The subsequent development of the area relied on a strong colonisation policy. This policy was very efficient, as, today, the area has become the richest in Spain, with the highest net domestic product per person [START_REF] Checa | De la Andalucia de los emigrantes a la de los inmigrantes-Diez años para la reflexion[END_REF]. The colonisation of the area goes back to the 1950s. Under the tutelage of the ministry of agriculture, wells were dug to make the lands arable. The government then allocated small lots to modest families, promoting familial enterprises. The aim of this policy was to stop emigration by making it possible for people to develop economic enterprise in Spain. This policy resulted in the first wave of immigration into the province: in the course of two decades, hundreds of Spaniards from close or distant provinces came as colonists, attempting to make their fortune in the farming sector. The first greenhouses appeared in the 1960s, but it was only ten years later that this kind of cultivation became dominant. According to official data, in 1963 only half a hectare of greenhouses had been erected, while in 1984 they covered fourteen thousand hectares, including more than twelve thousand developed with government support. Financial assistance, via banks and state grants, allowed rapid access to property and agricultural equipment. The products resulting from these plantations-fruit and vegetable harvests--were sold to an increasingly vast region. Profits for small farmers were huge, and the region became known as the Green El Dorado. The economic growth of the area continued to be supported by the integration of Spain into the European Economic Community. Considered by the ECC, and later the European Union, as a disadvantaged zone to be integrated with priority, Andalusia benefited fully from European subsidies during the last twenty years. But by the early 1980s, this expansion was confronted with an environmental problem, since all the water used in the greenhouses comes from underground. With time, this water had been polluted by chemical products and became far less abundant. For this reason, in 1984 the government decided to stop the colonisation process (law 117/1984), putting an end to the grants and no longer selling land. This decision marks the beginning of the development of a new illegal economy in the province. Despite the law, greenhouses continued to be built, and wells irrigate more and more land. By the end of the century, the number of greenhouses was twice what it had been in 1984, nearly thirty thousand hectares [START_REF] Checa | De la Andalucia de los emigrantes a la de los inmigrantes-Diez años para la reflexion[END_REF]. Since the mid 1980s, all agricultural development in the province has been completely outside any legal control, and new farmers remain very eager. Meanwhile, farms have been restructured: intensive exploitation has slowly replaced small-scale operations, which have often gathered into cooperatives. Subsequently, rising demand from European markets, coinciding with improvements in transport, has promoted exports, which have become the most important mode of trade for Andalusian fruits and vegetables. These changing conditions led to the recruitment of a new kind of labour force. Until the 1980s, workers were mostly family members, but with intensive agriculture the need arose for casual workers, very flexible and poorly paid, in order to maximise profits from intensive production. Initially most casual workers were unemployed people from the area or nearby provinces. But economic difficulties encountered by 02/04/2009 3/15 farmers, in contrast to overall economic growth in Spain, reduced the available reserve of Spanish workers willing to work in poor conditions, and landowners were enticed to exploit another type of labour. This led to the second wave of migration, dominated by foreign, low-skilled workers, coming mostly from North Africa, who could be paid low wages and managed in a very flexible way. This turning point occurred in the mid 1980s, when the model of the small family farm was overtaken by a more industrial mode of production. Contributing to this process is the fact that for the last twenty years Spanish farmers have had to compete on the European market with other agricultural regions in South Mediterranean countries that enjoy climatic conditions as good as Andalusia's while labour is much cheaper. In this context, and confronted with the hegemony of a few large supermarket companies that bargain harshly on every transaction, product prices have systematically decreased while demand has steadily increased. Until the 1990s, Spain coped with this situation thanks to market protection and financial support from the European Union, but with the progressive withdrawal of import quotas imposed on non-EU members, competition is becoming very effective. Moreover, the type of sales has changed: nowadays farmers have to respond to very fluctuating demands from supermarkets all over Europe, and the harvesting of produce is done almost on real-time, following requests by supermarkets for delivery in the freshest possible state. In such a context, massive exploitation of cheap labour has become essential to keep the sector running, and it is clear that foreign workers have been playing a central role in the process of modernisation of Andalusian agriculture. Today, even more than it was ten years ago, it is essential for the farmers to have, on the spot, a readily available reserve of workers who can be used and dismissed according to the unpredictable variations of activity. In this schema, the origins and statuses of foreign workers have become strongly diversified: South Americans, Filipinos, Africans and Eastern Europeans are now often hired alongside Moroccans. That is the main characteristic of the third period of immigration in the province. Job conditions are very hard: in the greenhouses the temperature is often well above 45°C, and workers frequently handle very dangerous toxic products. Every year some of them are contaminated, sometimes fatally, while they are processing vegetables (European Civic Forum 2004). But despite all these downsides, the area is still a very attractive place for people from poorer countries who seek to work in Western Europe. This third phase is also marked by the structural role played by undocumented workers. As they do not have the benefit of any protection concerning wages and dismissals, they provide to some extent the flexibility required by the farming companies [START_REF] Berlan | Agriculture et migrations[END_REF]. This exploitation is possible because these people are, by necessity, devoted entirely to agriculture. As Dan, one of my Rumanian informants, explained: Here, if you don't have legal documents, you have no choice but to work in greenhouses. In the construction sector, employers want you to be covered by insurance; there are many accidents, so they don't want any problem. They want you to be insured, but if you are undocumented you can't get insurance. In greenhouses, what can happen to you? There is little chance you hurt yourself with tomatoes, is there? And actually, we are so many foreigners here, they don't need undocumented ones, they leave us in the greenhouses while they employ those who manage to get papers. (Dan, interview, 19 August 2000, translated from Rumanian) Though some documented migrants leave the province to find better jobs in the north 02/04/2009 4/15 or in the Madrid area, and a small proportion of undocumented migrants get repatriated by the authorities, the arrival of hundreds of new migrants all year long maintains the reserve of workers at a high level. Only legal migrants obtain permanent or, more often, longer-term contracts (for a few months); most undocumented foreigners are casual workers hired on a daily basis. If they have no friends who are more settled in the area and who can help them find an occasional job, they go, every morning, to a 'job-market square' where they offer their labour to potential employers. During high season--January and February, and September to November-nearly all of them find some work; but during low season, many remain unemployed. For example, during the research, Dan--quoted above--was sharing a flat with five other Rumanians, two women (a mother and daughter) and three men, of whom only the two women, who had been in the area for two years, were actually working. August being in the middle of the low season, the others were out of work. The three young men spent their time wandering, hoping for an improbable opportunity to work while waiting for the resumption of the agricultural activity in September. As they had nothing to do during this period, they would go to the beach for hours, this activity being free. This situation of temporary unemployment in the black job-market is a point of tension between migrants, since it puts them in competition for jobs, while, as we shall see, the divisions and competitions between workers of different origins contribute to the implicit management of this special kind of labour power.

Political Tensions and Racist Violence

In this context of large-scale legal and illegal immigration, racism is part of everyday life, especially towards people from the Maghreb and Black Africans. In February 2000, racial tensions exploded into three days of riots against Moroccan workers after a mentally ill young Moroccan killed a Spanish girl. Following these exactions, Moroccan workers went on general strike. Then, large numbers of workers from Eastern European countries arrived who, so was it argued by journalists, had come especially to take the place of the striking Moroccan workers (El País 10 Feb. 2000;Le Monde 13 Feb. 2000). A deeper analysis of the situation, however, shows that coexistence of these populations dates back to a time before these events. Rumanian workers were being hired frequently in Spanish greenhouses since the mid 1990s. It was thus the increasing social and economic tensions of the sector that brought the presence of Rumanians to light. This process is of great interest, for, with no fundamental change, the strained situation to which it led made it possible to observe clearly the different ways in which the various populations related to territory, as we shall see below. The events of February 2000 were not the first violent expressions of racism against Moroccans in the area. Two years previously, in February 1998, two workers from the Maghreb were burnt to death in their shelter. A few months later, a foreign farm worker was executed at night by a masked commando. In both cases, the matter was closed with no proceedings; police in the area are not prone to prosecuting Spaniards in cases of racist attacks. The racist riots in February 2000 were indeed the consequence of a violent racist climate, endemic in the area, but their outbreak and the popular aspect they took on at that particular moment can be explained by related circumstances that, for several months, inflamed the situation. Two parallel processes aggravated tensions between Spanish bosses and Moroccan workers. The first is rooted in the economic quarrel between Spanish and Moroccan farmers. The fruit, vegetable and fishing sectors are often sources of clashes between the Spanish and Moroccan governments. For many years, traditional modes of production did not allow Moroccans and other South Mediterranean farmers to compete with Spanish producers, but nowadays, more and more farms use modern equipment. Across the Strait of Gibraltar, Spanish farmers fear that the Moroccan trade will supplant the hegemonic position of Spain on the European market. Moreover, some huge food-processing companies have started relocating their plants to Morocco. Up to the present, import quotas of Moroccan products to the European Union are regularly determined by the European Commission after negotiations with Morocco, and each year custom rates are lowered for those quotas. Yet import into Europe is not controlled, or is badly controlled, and Spanish farmers regularly complain that Moroccan quotas are illegally exceeded, thus reducing their own opportunities to export to the rest of the European Union. Furthermore, an agreement signed in 1995 between the European Union and Morocco aims at creating, in 2012 or thereabouts, a free trade zone within the framework of a Euro-Mediterranean partnership. In that event, Spanish and Moroccan products would be in direct competition on the European market. Spanish farmers denounced this agreement, for according to them it endangers their own future. In Andalusia, and more specifically in the region of Almeria where most producers of fruit and vegetables for export are located, the fear of 'unfair' competition thus heightened feelings against Moroccans. Farmers' unions complained of the government's deserting them: Farmers in Almeria are being sacrificed to globalisation. The importation of tomatoes from Morocco is increasing, and in return, Spanish multinational companies have access to the [Moroccan] communications market, and an agreement with Spanish fishermen is being negotiated. (Extract from interview with representatives from the COAG of Almeria quoted by FCE 2004: 48, author's translation) In El Ejido, tensions created by this situation were aggravated when, in January 2000, the Confederation of Farmers' and Breeders' Trade Unions (COAG) denounced the Moroccan export of tomatoes, which exceeded thirty thousand metric tons. In the same month, the system of import certificates installed during the previous year, and requested by Spanish farmers, was abolished, as demanded by the Moroccan authorities. In reaction, on 25 January, one thousand five hundred farmers demonstrated their anger and blocked the ports of Algeciras and Cadiz. A series of violent acts against Moroccan fruit and vegetable haulers on Spanish territory followed: lorries were burnt, cargoes ruined, drivers manhandled. In Andalusia, Moroccans, be they lorry drivers or farm workers, were subjected to increasing animosity. The situation became ever more strained since the farmers' protests found an echo among political parties now campaigning for the March 2000 legislative elections--all the more so since the electoral campaign focussed attention on the new immigration law. During debates about law 4/2000, finally voted on 22 December 1999, farmers from El Ejido area closed ranks. The proposed law had a particular progressive aspect that could not satisfy the position of the Andalusian farmers. Its aim was to give some rights to illegal immigrants, and it included a plan, for the following years, to reduce the number of undocumented migrants by increasing the number of regularisations and making procedures automatic after a two-year presence on Spanish territory. Above all, this law sought to penalise employers that hired foreign workers illegally, which in the Almeria area meant condemning the whole economic life of the region. In the months after it passed, farmers' unions joined 02/04/2009 6/15 forces in a national debate on a scale far beyond themselves, in order to radically amend the bill submitted by minister M. Pimentel. In Andalusia, the argument reinforced resentment against Moroccan workers, who were held partially responsible for the advancement of the new law, insofar as, thanks to the Forum for the Integration of Immigrants, several associations defending immigrants' rights made their claims loud and clear. Although the law passed, the subject remained at the core of the national debate because of the elections scheduled for March 2000. The Popular Party, which itself had created the law, promised to review it if it were re-elected. The question of immigration thus became a primary theme of the campaign. Detractors of the law and xenophobic candidates ceaselessly pointed out the damaging effects of immigration and denounced problems caused by immigrants. Such rhetoric was particularly prominent in the Almeria region, where racism had already been obvious before this argument. Law 4/2000 was scheduled to come into effect on 1 February 2000; the next day, all foreigners present since 1999 would be able to start a regularisation procedure. Anti-immigration voices exceeded all predictions: they expressed the fear that the country would be rapidly invaded by immigrants who, strengthened by the new law, would not behave in accord with their 'proper' status in Spanish society anymore. Many of the media took over this point of view, stating, with pictures to prove it, that an increasing number of pateras1 from the Maghreb were arriving on the Spanish coast. Again, this mainly concerned southern regions of Spain, and some voices lashed farmers who hired illegal workers and thus generated a perpetual appeal for new immigrants. In the Almeria region, the farmers' reaction consisted in demanding that immigrants behave with greater social discretion; they chased them away from public places and attacked immigrants' associations. It is in this context of increasing racism that we must understand the riots in El Ejido. External circumstances stimulated anti-Moroccan feelings and established a climate filled with the potential for extreme violence. The smallest event was then enough to catalyse this and allow hatred of 'Moors' to erupt into violence. On 22 January a Moroccan worker killed two Spanish neighbours during a quarrel. During the following days, the town council, whose mayor, J. Encisco, is well known for his xenophobic position, organised a demonstration calling for 'justice to be dispensed'. This event, which seemed pacifist, was used as a means of expression by racist groups. Still, things might have ended there, if a second event had not happened some days later. A young Moroccan, later declared to be a mentally disturbed person, killed a Spanish woman in El Ejido. That triggered the riots: in the course of the next three days, racist rioters sacked the city and set upon Moroccan workers. Tension decreased only when five hundred policemen intervened and journalists arrived, bringing the situation to the attention of the rest of the world. Ultimately, about sixty Moroccans were injured and twenty-two persons arrested, eleven on each side of the dividing line.

In reaction, on 7 February, Moroccan farm workers launched a strike for an undetermined period of time. This collective action had clear, concrete demands (improved living conditions, a guarantee of minimal rights) and aimed at creating a social existence for immigrants in the region. Still, this was not a general strike, as all non-Moroccan foreign workers continued their labour in the greenhouses. Hence, their shared predicament did not erase the ethnic split; rather, the opposite occurred.

Relations to Space

Though the acts of violence against Moroccans may be explained by the context outlined above, it does not help us understand the lack of solidarity among foreign 02/04/2009 7/15 workers in the area and the unwillingness of other workers, especially Rumanians, to join the demonstrations. I suggest that this atmosphere of division was due to the history and social position of the different migrant groups in this place. Because they arrived under dissimilar conditions and are in different stages of their migratory process, 'old' and 'new' arrivals have not developed same links to territory.

Moroccans--'Old' Migrants in a Process of Local Integration

Moroccans, geographically in close proximity and economically disadvantaged, were the first to benefit from the opportunity to work in Spain. Most of the early arrivals were men from the countryside who were sent abroad by their families to give their community the possibility to stay put (Checa 1994). Their plan was to work temporarily in Spain, even if conditions were harsh, spending as little as possible on living expenses so as to send most of their income home, which at this point in time was clearly identified as being in the country of origin. But for this first generation, most of the time, this precarious situation lasted much longer than anticipated, and permanent returns were actually quite rare. So they began to share their life between two places: the symbolic aspects of home remained in Morocco, where their migration helped them gain social consideration, but their continual presence in Andalusia, though regularly interrupted by long holidays at home, drove them to develop social relations there and, gradually, to settle in Spain. During the 1990s, we began to see, in the streets of El Ejido, some 'Arabic' coffee shops and a few Muslim butcher shops. And, whereas at the beginning of the 1980s most workers lived in slum conditions in the countryside, often using the cortijos--shelters in which tools are usually stored--as accommodation, by the end of the 1990s some streets in El Ejido town were known as Moroccan neighbourhoods. Some Moroccan workers still live in cortijos, but many have followed the same experience as Hamid: When I arrived for the first time, in 1992, I stayed in the greenhouses-anywhere, where I could, I had no place to go. Then, after maybe two weeks, I went to Farid's cortijo, a cousin of mine, we used to work for the same boss and we lived in his cortijo, far away from here, near Balerma. Then, when I came back in 1995, I joined his [Kamel's] flat: his roommates had left and he couldn't pay for it on his own, so he asked us, me and my friend. We said yes, because it was nicer, it's a good flat and we are in town, it's better than in the countryside. Me, I couldn't rent a flat, because I didn't have legal papers, but Kamel [who had been regularised in Spain] had papers for the flat in his name, so we pay him and he deals with the owner. So, we live here, in this building [in El Ejido], we are four in the flat, there is also a young boy, seventeen, who arrived two months ago. He's Kamel's nephew. (Interview in an El Ejido street, 20 August 2000) Connections across the Mediterranean Sea increased steadily during the last twenty years and places grew closer. Links have been tightened between the province of Almeria and some Moroccan villages, which have sometimes sent nearly all their able-bodied males across the Strait of Gibraltar. Every inhabitant of these villages has heard of Andalusia, and most of them have some friends or relatives there. They also often possess some electrical appliances or clothes purchased in Europe. All of them have stories about Almeria, and even if they have never been there, they can easily imagine how it is. For decades, Spanish agriculture has been regarded as a chance to make money that would be impossible to earn in Morocco. So even though the place has always been difficult to get to (Spain, being an EU member, imposes a strict visa regime on Morocco), many young Moroccans have long considered the south of Spain as part of their personal space: it is a place where they have links and where they can 02/04/2009 8/15 plan to go sometime in the future. In this sense, we can say that these migrants constructed a 'transnational space', as Portes defines it [START_REF] Portes | Global Villagers The Rise of Transnational Communities[END_REF]: strongly connected places joined by a multiplicity of links. This closeness and the hopes it allows had an impact, with time, on the migratory project itself. The migrant model of a family emissary evolved into something more individualistic: instead of being sent by their kin, young people started to leave of their own will, seeking a better life in a richer country.2 Thus nowadays many Moroccans who reach the Andalusian coast have emigrated with personal motives, not knowing when they will be able to go back and with the hope of obtaining, in time, the opportunity to stay legally in Spain. When they do, they often invite their wives to join them in Spain, making their family life in that country. In their memory, and even in their vocabulary, Morocco remains their home country, but their everyday life is clearly developing in Spain. The way they manage their earnings is significant: when a couple is reunited in Spain, less than one-third of their wages are sent back home, while the situation is the inverse when a migrant is single (Checa 1994). This new situation changes the way these migrants consider their place in the Spanish area. As the idea of permanent return fades away or is seriously delayed, their presence, not only as workers, but also as full persons, becomes a critical point. They no longer consider their stay as a temporary situation of hardship compensated for by the benefits gained in the home country. Social considerations are henceforth a matter that has importance in the area of immigration itself. Progressively, they seek not only better working conditions but also more respect from the local population. This is a major issue with Spaniards: having been confronted with racism for years, Moroccans now expect to be considered inhabitants of the region and part of its social life. In contrast to the 1980s, many Moroccan workers nowadays, even if undocumented, refuse to hide away as the dominant Spanish community expects them to. While Spaniards try to contain them in areas outside town--by not renting them flats and by expelling them from Spanish bars, for example (some bars have a notice on the door saying 'Forbidden to Foreigners')--they do not hesitate to gather in the streets after work or to socialise in bars owned by compatriots downtown. In doing so, they give their presence a certain public visibility. These everyday life practices may not be considered by all of them to be acts of resistance, but in the context, they are a point of tension with many Spaniards, as these practices declare to all the presence in the region of a large contingent of people from the Maghreb. Indeed, during the last twenty years, undocumented migrants have been tolerated in the province--because they were playing a crucial role in its economic development--on the condition of discretion and social invisibility. It is this tacit agreement that is being called into question today by Moroccans, many of whom settle fully in Andalusia. More actively, some Moroccans, in spite of their illegal situation, are getting involved in local public life, responding favourably to the invitations of Spanish NGOs and trade unions. The latter realised the importance of such a reserve of cheap labour in the region and understood that, if they wanted to sustain the local working class, they had to take into account and denounce the working conditions imposed on foreign workers. Meanwhile, organisations more preoccupied with racism also wished to enrol these disaffected migrants. For a long time, these invitations fell on deaf ears, but some extreme cases-injured workers thrown out onto the street because they could not work anymore, or people victimised by physical racist violence--led a few migrants to contact these organisations. The friendship they encountered and the support they received encouraged others to join when they encountered difficulties 02/04/2009 9/15 with their bosses. So, at the end of the 1990s, some Moroccans, first legal workers and then even undocumented ones, became union members or sympathisers. Thanks to these structures, and with the support of Spaniards, these Moroccans gave voice to their social demands. Benefiting from legal support, they were able to claim their rights and make use of medical assistance or the Spanish justice system. In 1999, unexpectedly, a few hundred Moroccan workers demonstrated in the streets of Campo Hermoso (near El Ejido) to protest acts of racism. Though they were very few relative to the number of Moroccans working in the region, this was the first time migrants were acting publicly. On this occasion, they abandoned their usual submissive attitudes to show to the Spanish population that even if they were not full citizens, they were full persons, with demands and expectations. They asked for more respect from their employers but also from the Spanish population itself, demanding rights as basic as the right to walk in public space at any hour (usually, any African or Moroccan in the streets during working hours is arrested by the police), the right to enter any shop or bar without suffering discrimination, or the right to lodge a complaint against an employer (since the police most often refuse to register it). Not surprisingly, their demands were not met by local authorities or farmers, but it was a little revolution: before this incident nobody would have thought they were capable of such a collective action. In the same period, trade unions took a role in the political debate on foreign workers and were mobilised when the new immigration law was publicly discussed in 1999. As the quotas of legal migrants were being decided between Spain and Morocco, the unions drew attention to illegal migrants and claimed rights for them. By this action, Moroccan migrants, in spite of the fact that only a small minority of them were activists, became the centre of a national debate in Spanish public life. This situation irritated Spanish farmers, since it was the presence of a population without any rights and totally ignored by the Spanish population that guaranteed the exploitation of these workers. As Burgess and Park mentioned in their 'cycle of racial relations' [START_REF] Burgess | Introduction to the Science of Sociology[END_REF], it is through conflict that these migrants were gaining social acknowledgment of their existence in Spain. In this second phase, the majority of Moroccan workers did not fit the model of a 'transnational community' anymore, but seemed instead to be in a process of settlement in the country. What is meant here when we speak of 'settling' does not imply a matter of time but depends rather on the way migrants regard their own presence in the region. Through the activity of the most vindictive actors, it became clear to everybody that Moroccans were moving socially to a new position. More than a cheap and invisible labour force, they increasingly expected to achieve a symbolic and material place in the area. This is the key to understanding what occurred in El Ejido in February 2000. Migrant claims did not fit with the economic role offered to this population and, through racist violence, Spanish demonstrators made it clear to Moroccans that they were not willing to accept them if they refused to keep their traditional place: that of very discreet and vulnerable workers. El Ejido's mayor was quite clear on this point when he declared that 'NGOs bear all the blame [for the racist demonstrations], since they taught immigrants their rights' (J. Encisco cited in Diario 16, 11 Feb. 2000). It is the evolution of their social status that was the target here. Spanish demonstrators were asking Moroccan migrants to return to their previous attitude of total submission. Responding to this demand, Moroccan workers, documented and undocumented, intended to show their economic power and collective solidarity by going out on strike. At stake was the new social place they intended to occupy, low on 02/04/2009 10/15 the social scale but at least recognised and respected. It is clear that these events did not result suddenly from one particular event-even though a tragic one--such as the murder of a Spanish girl by a Moroccan. Rather we must make sense of them in a longer process of settlement from the earliest immigrant workers in the province onwards. The racism expressed by Spanish farmers towards Moroccans has its own logic in this process: it orders a certain hierarchy between social groups. This explains why Moroccans were not joined, during the strike, by migrants of other nationalities. The latter have different immigration histories in the area and, while they do share similar working conditions, they do not share the same social relation to the place.

Rumanians--Unsettled and Anchored in Mobility

After Moroccans, Rumanians appear to be the second largest group of foreign workers in Almeria, though we must be careful with our estimates because a large majority of these workers are undocumented. Migrants from Romania are of diverse social backgrounds: some come from collective farms in the south of Romania, which have partially collapsed since the end of Ceausescu's3 dictatorship in 1991, but there are also people from towns, relatively educated, who see work in Spain as an opportunity to improve their living conditions in Romania. For example, during my fieldwork I met a doctor from Rosiori (a town on the Danube plain) working with her two daughters in the greenhouses. Different generations are represented, but two groups predominate: young people between twenty and thirty years old without dependants, and older people with adult children. Though their social backgrounds are diverse, many hail from the same region of Romania, the department of Teleorman, as they use their social networks to facilitate their migrations. Rumanians are the main competitors with Moroccans for jobs, and in the context of racism described above, they appear to be the employers' favourite foreign workers nowadays. The first Rumanians to be hired arrived in the mid 1990s, and the group grew very rapidly. Again, their undocumented status makes estimates approximate, but during the high season in 2005 there were probably between seven and ten thousand in the province of Almeria (still a minority compared with Moroccans, of whom there are believed to be between twenty and twenty-five thousand). During the events of 2000, Rumanians were far less numerous, no more than a few thousand, but they represented a point of crystallisation for the attention of external observers, such as journalists, because they played a crucial role in the reorganisation of foreign labour in the Almeria province. Parallel to the steady arrival of Moroccans, the end of the century was marked by a diversification of foreign recruitment. Farmers enrolled people from South America, mainly Ecuador and Colombia, from sub-Saharan Africa, from the Philippines and from Eastern Europe. Obviously, this turn to new sources of recruitment was not due to a lack of potential Moroccan workers but can be understood as an answer to the reluctance Moroccans were showing during the same period towards being submissive. In such a situation, Rumanians are particularly appreciated, for the attitude they present is just the reverse of the Moroccans'. This characteristic is due not only to the fact that they are more compliant because they are in an earlier phase of migration, like Moroccans in the 1980s, but they also regard their presence in Spain in a different way. Until the year 2000, Rumanian workers played the game of invisibility expected from this kind of labour force perfectly: with the exception of their employers, nobody had noticed their presence in the area. This is why the newspapers later wrote that Rumanians had been sent from their country to Andalusia for the purpose of 02/04/2009 11/15 breaking the Moroccans' strike. Their appearance is probably partly responsible for the success of this discretion: being white-skinned and dressed like the Spaniards, they can walk through the streets without being spotted as foreigners. The presence of a large proportion of women (around 30 percent) also tends to make this group less suspect to the local population: these migrants do not congregate in 'worrisome' male groups in public spaces. During interviews, Spaniards often postulated that Rumanians did not need to assimilate, as they were already close to the Spanish population in many ways, culturally as well as morally. Of course, we know from inter-ethnic research that closeness and cultural differences between groups do not rely on any essential characteristic but depend on the situation and the relations between groups [START_REF] Barth | Ethnic groups and boundaries. The social organisation of culture difference[END_REF]. Moreover, Rumanians are very circumspect about their presence because they do not want to be noticed by the local population. I suggest that this attitude is due mostly to the way they envisage their migration. This is how Iliena sees her situation: You know, here, you cannot be integrated; Spaniards don't want foreigners to settle here, they just want us to work. But it fits what we want, we don't want to stay here, we don't care about Spain; we are here because we can work. If there are jobs here, we come here. We go where we can earn some money, here, in Castellón or in France, everywhere there is something to do… I have friends all over Europe and I go where it's good for me, for jobs… It is easy for us to find jobs, because we don't ask much, because what is a small wage for you or for a Spaniard is a big one for Rumania. (Iliena, interview in Balerma, 19 August 2000) I have conducted parallel fieldwork in Spain, France and Great Britain on the same kind of Rumanian migration, and these different situations seem to propose a new model of migration, quite distant from either assimilation or transnationalism as Portes defines it. Rumanian migrants are not successors to a long tradition of international mobility: most of them started to move after the end of the Ceausescu dictatorship, not because they were marginal in their own country but because the 'transition' to capitalism had such a social cost that it pushed the middle classes into a state of poverty that had been unknown to them before. It is in reaction to this social disqualification that people of various social origins decide to go abroad to earn wages no longer available at home. But most of them have not emigrated properly--rather, they use the wealth differential between geographically close countries to improve their lifestyle at home, becoming international commuters. As in other Eastern European countries [START_REF] Morokvasić | Settled in Mobility": Engendering post-wall migration in Europe[END_REF]), many of them became petty traders at the beginning of the 1990s, selling cheap Rumanian goods abroad and importing any kind of foreign products. In a second period, this model of temporary migration has been extended to more distant lands and longer periods (Diminescu 2003). Visa regulations imposed by EU members until 2002 and the possibility to obtain--legally or on the black market--a tourist visa for up to three months has certainly encouraged these back-and-forth movements. Since 2002, this tendency has been reinforced as Rumanians no longer need visas to travel to the EU, but they are obliged to return to their home country every three months or they can have their passport withdrawn. It is thus much more attractive for this population to commute than to settle in a place abroad. Unlike Moroccans who, after taking high risks to reach the Spanish coast, intend to stay as long as they can on the other side of the Mediterranean, Rumanians are pushed, by institutional arrangements, towards a continuing mobility between places. In such a context, Rumanian workers develop original practices that consist not 02/04/2009 12/15 of reinforcing their presence in one territory but of accumulating places where they can find temporary jobs in social migrant networks. When a person discovers a new destination where foreign workers are welcome, she or he exploits it and will often tell a few friends about it. By doing so, the discoverer makes an appeal to compatriots who are connected, even if not directly, to his or her social network. Meanwhile, she or he might learn from compatriot migrants that an interesting work opportunity exists in another country and will then forsake the first destination for a new one. Communication between migrants from the same area of origin is stimulated by frequent returns, as, in home cities or villages, migrants constitute something like a social group who do not hesitate to go out collectively, showing off their social success due to migration [START_REF] Potot | Les migrants transnationaux: une nouvelle figure sociale en Roumanie[END_REF]. Thus, these migrants are more connected to a network of mobility in which several places are exploited at the same time, than anchored in a particular territory of immigrant arrival. This is quite clear in Andalusia, where many Rumanian migrants explained that it was not their first destination of migration. Some of them had worked in Italy before, where they were employed in restaurants or hotels; others had worked in construction in France or Germany, and so forth. It emerged that these routes were dependent on connections and bridges they could rely on, a function of the people they knew all over Europe. Consequently, these people are not willing to struggle for their rights in one place: their mode of resistance is mobility. When a situation is worsening in one place, or if they simply find a better opportunity, they just keep moving to another niche [START_REF] Waldinger | The making of an immigrant niche[END_REF]) already 'domesticated' by colleagues. In a situation of conflict they are more inclined to exit than to voice, as Hirschman would put it [START_REF] Hirschman | Exit, voice, and loyalty: responses to decline in firms, organizations, and states[END_REF]. The costs of these movements, psychological and financial, are minimised by reliance on compatriots to find work and shelter. This does not mean that a strong sense of solidarity exists between all Rumanian migrants-arrangements are made only between persons who know each other or if somebody is recommended by a friend--but on a large scale, this kind of organisation appears to be a solid social background that favours international migration, at least throughout the EU. Of course, these observations should not lead us to suppose that not a single Rumanian will settle in the south of Spain, but only that there is little chance, for now, of seeing collective Rumanian action erupting, since the strength of the group comes more from its scattering than from its capacity to organise demonstrations. Apart from the fact that they have not developed the same attachment to territory as Moroccans, another motivation led Rumanians not to join the latter's demonstrations. Their social proximity in Spain has clearly not developed into a resource of collective identification. It is important for Eastern Europeans not to appear to close to people from Africa, primarily because this is what their favourable position in the competition for jobs relies on. If they had voluntarily joined the protest, they would have lost their qualities in the employers' eyes, mainly their perceived reliability, and would then be relegated just like the others. This situation of competition for jobs sustaining racism resonates with Bourgois' description of racist tensions between recent and older immigrant in New York City [START_REF] Bourgois | Search of Respect: Selling Crack in El Barrio[END_REF]. Yet the second reason, less pragmatic and more symbolic, appears to be essential in our case study. Rumanians, overwhelmingly, share the racist perceptions that many Spaniards have of Moroccans. In their representations, ethnic closeness is much more important than social or conjectural proximity. Indeed, they share some job conditions with Moroccans and are as such situated in the same place on the labour social scale. However, they see themselves as being much closer to Spaniards, sharing a Christian culture and expecting to live by the same standards. In doing so, they tend to 02/04/2009 13/15 wholeheartedly make theirs the Spanish xenophobic representations of Moroccans. This attitude can be related to the strong racism existing in Romania toward Gypsies [START_REF] Trandafoiu | Racism and Symbolic Geography in Romania: The Ghettoisation of the Gypsies[END_REF]. Stereotypes are thus translated from one population to another, without taking into account the differences between both situations. Thus, Rumanian workers explained me, a fundamental distinction between them and Moroccans came from the fact that Moroccans were originally nomadic, while Rumanians were not. There is nothing in the Moroccans' background that supports such notions of a supposed Gypsy-like nomadic origin, and even Spaniards do not share this view. Another racist stereotype imported from Romania relies on the idea that Moroccans were afraid of water and avoided it. This attitude is usually attributed to Gypsies who, in the ninetieth century, were systematically expelled from sources of water in Romania as they were suspected to pollute them and who, as a consequence, took up the habit of camping far away from sources or rivers. During my fieldwork, the harshest xenophobic talk did not come from Spaniards but from Rumanians. While Spanish racist enunciations would always be preceded by "I am not racist but…", Rumanians would never take this kind of precaution, speaking as if racism was a universal point of view. In such a context, joining Moroccans demonstrating against Spaniards and denouncing racism would not only have been meaningless, but being associated with them would even be depreciative with regard to their own identity. Rumanians thus preferred not to damage representations of themselves by sharing the Spanish position. This attitude places them in the camp of the white majority and, at the same time, gives them the opportunity to take up better jobs by replacing relegated Moroccans.

Conclusion

This chapter has shown how racism appears as a practice of division not only between Spaniards and foreign workers but also between workers of various foreign origins. In this sense, it is quite clear that it is an important element of the management of manpower [START_REF] De Rudder | L'inégalité raciste. L'universalité républicaine à l'épreuve[END_REF]. Origin being a factor of division, it reinforces the atmosphere of competition between workers and militates against any general collective action. Solidarity or even identification along class lines, common to all farm workers, cannot emerge as long as these ethnic identities remain stronger. With each group of origin intending to promote its own position, it seems that these differentiations are not likely to disappear. Moreover, this organisation around group identities is exacerbated by the employers' attribution of specific qualities to each group and by their ranking on scales of values. Coming from different backgrounds, each migrant group then develops its own view of its role and prospects in the area. For Moroccans, even more than better job conditions, a key issue is to obtain social acknowledgement and to be accepted as being part of the local population. Meanwhile, Rumanians are not so much attached to territory and could leave the place rapidly if the atmosphere became harsher for them. Thus, it is clear that the social action of the workers does not depend on objective conditions of labour but more on social representations and on resources available. The core question, for these economic migrants, is to maintain a positive self identification, in spite of their lowly role in the labour market. For Moroccans, who are more involved in a process of settlement, this search of respectability passes through a struggle for their rights and against racist representations. For Rumanians, their way of resisting social depreciation due to their migration is to align themselves symbolically with the dominant group, depreciating others. We can suppose they will keep this attitude as long as Spaniards privilege them. But if the situation was to change, for example if new migrants from elsewhere were to be favoured instead of 02/04/2009 14/15 them, it is very improbable that they would be categorised with Moroccans. In such a situation, which is very likely to appear in a context of harsh competition for jobs, it is probable that Rumanians would leave for other places in Europe, making use of their particular relation to space, since their main resource consists not of a capacity of collective protest but of transnational networks.

  The second concerns the political climate during the months preceding the March 2000 elections. Let us look at both in turn.


Badre Eddine Lmimouni
email: b.lmimouni@um5r.ac.ma

Christophe Hennequin
email: chris-tophe.hennequin-sat@aphp.fr

Richard O S Penney
email: rpenney@gaffi.org

David W Denning
email: ddenning@manchester.ac.uk

Estimated incidence and prevalence of serious fungal infections in Morocco

Keywords: Aspergillus, Candida, Cryptococcus, Pneumocystis, keratitis 34 35 fungal diseases are relatively common and need pro-active diagnosis, to

Objective: Few data are published from Morocco on fungal disease, although numerous case reports attest to a wide range of conditions in the country. Here we estimate for the first time the incidence and prevalence of serious fungal diseases in the country. Methods: Detailed literature searches in English and French were conducted for all serious fungal infections. Demographic and individual underlying condition prevalence or annual incidence was obtained from UNAIDS (HIV) WHO (TB) and other international sources. Deterministic modelling was then applied to estimate fungal disease burden. Results: Morocco's population in 2021 was 36,561,800. Multiple publications describe various fungal diseases, but epidemiological studies are rare. The most frequent serious fungal infections were tinea capitis (7258/100,000) and recurrent vulvovaginal candidiasis (2794/100,000 females). Chronic pulmonary aspergillosis is also relatively common at 19,290 prevalence (53/100,000) because of the relatively high rate of tuberculosis. Asthma in adults prevalence exceeds 1 million, of whom fungal asthma (including allergic bronchopulmonary aspergillosis (ABPA)) probably affects 42,150 (115/100,000). Data are scant on candidaemia (estimated at 5/100,000), invasive aspergillosis (estimated at 4.1/100,000), HIV-related complications such as 29 cryptococcal meningitis and Pneumocystis pneumonia and mucormycosis. Fungal keratitis is esti-30 mated at 14/100,000). Mycetoma and chromoblastomycosis are probably rare. Conclusion: Fungal 31 disease is probably common in Morocco and diagnostic capacity is good in the teaching hospitals.

32

These estimates need confirmation with methodologically robust epidemiological studies.

Introduction

Serious fungal infections have generally been increasing in frequency, but lack of 37 diagnosis of many people affected, limits the usefulness of some epidemiological sur-38 veys. For example, the diagnosis of invasive aspergillosis is often missed [START_REF] Danion | Why are so many cases of invasive aspergillosis missed?[END_REF] and if the ties, while the actual toll that these infections take is under-appreciated. Here, we attempt 44 to show that, in Morocco as in many low or middle incomes countries, many, but not all, managed in the clinic.

Morocco is a predominantly Muslim country in north Africa with a population of nearly 37 million (11 th in Africa) [2]. Split into French and Spanish protectorates in the first half of the 20 th century, it has been an independent monarchy since 1956. Morocco's economy is the fifth-largest in Africa by GDP and 13 th in terms of GDP per capita [START_REF]Report for Selected Countries and Subjects[END_REF].

There are very few data on the burden of fungal diseases in Morocco, unlike many of the Arab League countries [START_REF] Kmeid | Epidemiology and burden of invasive fungal infections in the countries of the Arab League[END_REF]. We have estimated the incidence and prevalence of the most serious fungal diseases, using national, regional and international data in specific populations at risk. Our attempt to collate what is known and published provides a national gap analysis, which can be addressed.

Methods

This literature review was based on articles about fungal infections using the Google Scholar and PubMed/Medline search engines, African newspapers, health reports, epidemiological journals in Morocco and WHO reports. The articles searched were in English and French. The keywords searched were: fungal infection, opportunistic disease, HIV/AIDS, tuberculosis, chronic pulmonary, cryptococcosis, histoplasma, all associated with Morocco. There are few studies on fungal diseases in Morocco. Where no article was found from Morocco or North Africa, we used data from other countries outside the continent.

The socio-demographic data were taken from the CIA world fact book [2]. HIV prevalence and AIDS deaths were taken from the 2019 UNAIDS report [5]. We assumed that HIV-infected people not on antiretroviral therapy (ART) develop profound immunodeficiency over 7 years (77% of cases are B subtype [START_REF] Akrim | HIV-1 Subtype distribution in Morocco based on national sentinel surveillance data 2004-2005[END_REF]) and that the rate failure of ART (measured primarily by ART resistance) is 11%. Pulmonary tuberculosis (TB) annual incidence was taken from the WHO Global report 2020 [7], and we derived the pulmonary TB survivors. Asthma prevalence in adults was taken from a survey of 10,051 interviewees in 14,289 households conducted in 2008 [START_REF] Nafti | Prevalence of asthma in North Africa: the Asthma Insights and Reality in the Maghreb (AIRMAG) study[END_REF]. Chronic obstructive pulmonary disease (COPD) prevalence was derived from the BREATHE study with 10.5% admitted to hospital annually, as in Algeria [START_REF] Polatli | Chronic obstructive pulmonary disease and associated healthcare resource consumption in the Middle East and North Africa: The BREATHE study[END_REF][START_REF] Tageldin | Distribution of COPD-related symptoms in the Middle East and North Africa: Results of the BREATHE study[END_REF]. Lung cancer was taken from Global cancer observatory [START_REF]Morocco Fact Sheet[END_REF] and acute myeloid leukaemia (AML) from the WHO expert committee on middle income countries [START_REF]Review of Cancer Medicines on the WHO List of Essential Medicines[END_REF]. Only renal and autologous bone marrow transplants are performed in Morocco [13]. Liver transplantation has been performed since 2019 (2 at the Military teaching hospital Mohammed the fifth in Rabat and 8 at the Rabat University hospital.

The various populations and denominators were used to estimate prevalence or incidence of different fungal diseases, as described in other papers [START_REF] Wahyuningsih | Serious fungal disease incidence and prevalence in Indonesia[END_REF]. The assumptions used to compute annual incidence or prevalence are also shown.

Results

Morocco's population in 2021 was 36,561,800 of whom 27% are children 14 years old or younger, 9,614,960. There are an estimated 10,256,400 women between the ages of 15 and 54 years. In 2020, UNAIDS estimated that 22,000 were living with HIV, of whom about 16,500 are taking ART. There were about 36,000 new cases of tuberculosis in 2020, of which about 18,000 were pulmonary and only 410 had co-infection with HIV. The survival rate of TB is about 93%. Asthma prevalence in adults and children was documented in 2008 at 3.89% of the population, or just over 1 million adults affected. The COPD prevalence (GOLD stage 2-4) was estimated as part of the international BREATHE study and 2.2% of the population were documented with it -a total of 775,980 people, of whom about 84,500 are admitted to hospital each year. There are 7,530 lung cancer cases annually, and about 800 AML cases. Only about 40 renal and 5 allogeneic haematopoietic stem cell transplants are done annually.

Overall, our estimate is that approximately 3,300,000 people in Morocco (9% of the population) suffer from a serious fungal infection. This total is heavily dominated by tinea capitis in children, which is probably common, but perhaps not as common as our estimate.

Pulmonary fungal diseases

Invasive aspergillosis (IA) was assumed to complicate 13% of AML patients and an equal number of all other haematological malignancies, lymphoma and multiple myeloma, a total of 210 cases of IA annually [START_REF] Lortholary | Epidemiological trends in invasive aspergillosis in France: The SAIF network (2005-2007)[END_REF]. An estimated 2.6% of lung cancer patients (n=7,353 in 2020) develop IA [START_REF] Yan | Clinical characteristics of 45 patients with invasive pulmonary aspergillosis: retrospective analysis of 1711 lung cancer cases[END_REF], a total of 190 patients. Among the 85,450 people with COPD admitted to hospital, 1,100 (1.3%) probably develop IA [START_REF] Guinea | Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome[END_REF][START_REF] Hammond | The global impact of Aspergillus infection on COPD[END_REF]. Overall, the annual incidence of IA is about 1,500 patients (4.1/100,000).

Chronic pulmonary aspergillosis (CPA) may be mistaken for pulmonary TB, be a co-infection during or in the weeks after completion of anti-tuberculous therapy, or may develop in the years after TB cure, especially in this with residual pulmonary cavities.

In 2020, 18,360 pulmonary TB cases were reported in Morocco, of whom 8% were not proven, and overall, 3,056 patients died. Many patients with aspergilloma and CPA are described from Morocco, usually in surgical series [START_REF] Harmouchi | Pulmonary aspergilloma: from classification to management[END_REF][START_REF] Harmouchi | Pulmonary aspergilloma: surgical outcome of 79 patients in a Moroccan center[END_REF][START_REF] El Hammoumi | Lung resection in pulmonary aspergilloma: experience of a Moroccan center[END_REF][START_REF] Benjelloun | Chronic pulmonary aspergillosis: a frequent and potentially severe disease[END_REF][START_REF] Kabiri | Pulmonary aspergilloma: results of surgical treatment. Report of a series of 206 cases[END_REF]. The estimated annual and post-TB incidence and prevalence are shown in Table 1. This assumes a 19% rate of CPA in undocumented TB cases [START_REF] Oladele | Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians[END_REF], a 10% rate of CPA at the end of anti-tuberculous therapy and in the # Rate per 100,000 females only 6 months after this [START_REF] Setianingrum | Evaluation and comparison of automated and manual ELISA for diagnosis of chronic pulmonary aspergillosis (CPA) in Indonesia[END_REF][START_REF] Setianingrum | A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL)[END_REF], and a 6.5% and 0.2% annual rate in those with and without cavitation at the end of anti-tuberculous therapy (22%) [START_REF] Page | Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation[END_REF][START_REF] Denning | Global burden of chronic pulmonary aspergillosis as a sequel to tuberculosis[END_REF]. It also assumes a 20% first year mortality of CPA and 7.5% thereafter [START_REF] Ohba | Clinical characteristics and prognosis of chronic pulmonary aspergillosis[END_REF][START_REF] Maitre | Chronic pulmonary aspergillosis: prevalence, favouring pulmonary diseases and prognosis[END_REF]. Overall, annual incidence of CPA related to TB is estimated at 2,482 cases with 165 deaths in the immediate 12 months after first presentation with possible TB. The 5-year period prevalence is estimated at 11,551 with an additional 791 deaths annually. Assuming that TB is the underlying pulmonary condition in 60% of the patients [START_REF] Smith | Underlying pulmonary disease frequency in patients with chronic pulmonary aspergillosis[END_REF], a total CPA prevalence of approximately 19,290 (53/100,000).

The percentage of adults with asthma in 2008 was estimated at 3.89% which means about 1,038,000 affected. Of these, an estimated 26,000 have allergic bronchopulmonary aspergillosis (ABPA) (2.5%) [START_REF] Al-Mobeireek | Allergic bronchopulmonary mycosis in patients with asthma: period prevalence at a university hospital in Saudi Arabia[END_REF]. Assuming that 10% of these asthmatic people have poorly controlled and severe asthma, and that 33% of these people are sensitised to fungi, we estimate that 34,260 have severe asthma with fungal sensitisation (SAFS) [START_REF] Denning | Fungal allergy in asthma-state of the art and research needs[END_REF]. There may be some duplication between these groups, and if this is 30%, then about 42,200 adults have 'fungal asthma' in Morocco (115/100,000). ABPA has been described many years ago in Morocco [START_REF] Bensouda | Aspects of broncho-pulmonary aspergillosis in Morocco. Apropos of 11 cases[END_REF].

A few distinctive cases of fungal rhinosinusitis have been described [START_REF] Boutarbouch | Sphenoid sinus aspergillosis simulating pituitary tumor in immunocompetent patient[END_REF][START_REF] Bijou | Unusual Location of a Fungus Ball: The Concha Bullosa, a Review of the Literature[END_REF]. It is not possible to estimate the burden but if as common as in Israel then 5% of the population may be affected by allergic fungal rhinosinusitis [START_REF] Ben-Ami | Estimating the burden of fungal diseases in Israel[END_REF].

HIV-related fungal diseases

Among Morocco's population of HIV patients, an estimated 2,600 in 2020 are at risk of a serious optimistic infection. While Pneumocystis pneumonia has been reviewed as a topic in Morocco [START_REF] Herrag | Pneumocystis jirovecii: what does this mean?[END_REF], data on incidence are lacking. Data has been published some years ago for Tunisia [START_REF] Ennalfer-Jerbl | Frequency of Pneumocystis carinii pneumonia in HIV-infected patients in Tunisia[END_REF]. Assuming an incidence of 15% (a general figure for many countries [START_REF] Bongomin | Global and national prevalence of fungal diseases -Estimate precision[END_REF]), an annual incidence in HIV patients is likely to be 195 patients. Cryptococcal meningitis is described in Morocco [START_REF] Aoufi | Cryptococcal neuromeningitis in immunosuppressed subjects at Rabat University Hospital (Morocco)[END_REF][START_REF] Sodqi | Causes of death among 91 HIV-infected adults in the era of potent antiretroviral therapy[END_REF][START_REF] Dollo | Retrospective study of neuromeningeal cryptococcosis in patients infected with HIV in the infectious diseases unit of university hospital of Casablanca, Morocco[END_REF][START_REF] El Fane | Central Neurological Diagnosis in Patients Infected with HIV in the Infectious Diseases Unit of University Hospital of Casablanca, Morocco[END_REF][START_REF] Bandadi | Forty cases of neuromeningeal cryptococcosis diagnosed at the Mycology-Parasitology Department of the Ibn Sina hospital in Rabat, over a 21-year period[END_REF]. Cryptococcal meningitis is less frequent at 2.9%

(general figure used for the eastern Mediterranean countries) [START_REF] Rajasingham | Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis[END_REF] so an estimated 160 patients are likely affected annually. Oesophageal candidiasis is a common problem in HIV patients and assuming that 20% of those with low CD4 counts and 5% of those on ART are affected, it is likely that 1,350 patients are affected at least annually. There are probably a small number of cases of histoplasmosis in Morocco [START_REF] Chihab | American histoplasmosis: a case with cutaneous presentation in Morocco[END_REF][START_REF] Tazi | Histoplasmose sacrée dix ans après un lymphome non hodgkinien du sacrum : à propos d'un cas[END_REF][START_REF] Elansari | Histoplasma capsulatum sinusitis: Possible way of revelation to the disseminated form of histoplasmosis in HIV patients[END_REF], but it is not possible to estimate the burden.

Invasive and superficial candidiasis

Although candidaemia is described in Morocco, few studies collating its incidence are published, and none with a general population denominator. In children with leukaemia, Candida spp accounted for 14% of healthcare-associated infections (invasive aspergillosis was not diagnosed) [START_REF] Cherkaoui | Healthcare-associated infections in a paediatric haematology/oncology unit in Morocco[END_REF]. The risk factors in intensive care include implanted catheters and broad-spectrum antibacterial agents, as in other countries [START_REF] Massou | Systemic candidiasis in medical intensive care unit: analysis of risk factors and the contribution of colonization index[END_REF]. Candida albicans, C. glabrata and C. tropicalis were the most frequent pathogens. We have assumed a conservative annual incidence of 5/100,000, which converts to about 1,800 cases [START_REF] Arendrup | Epidemiology of invasive candidiasis[END_REF][START_REF] Cleveland | Changes in incidence and antifungal drug resistance in candidemia: results from population-based laboratory surveillance in Atlanta and Baltimore, 2008-2011[END_REF].

As in other countries, probably about 33% of cases occur in intensive care, including neonatal and burn units. Using data derived from France, where peritoneal (intraabdominal) candidiasis is 50% as common as candidaemia in ICU [START_REF] Montravers | AmarCand study group. A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units[END_REF], we anticipate 275 cases annually.

Oral and vaginal candidiasis are common problems, but not generally too serious.

However, we have estimated the more problematic recurrent vulvovaginal candidiasis in pre-menopausal women, using a 6% rate [START_REF] Denning | Global burden of recurrent vulvovaginal candidiasis[END_REF]. This computes to over 510,000 women affected in any one year. One cross-sectional study of 114 consecutive women referred to gynaecology specialist found 22.8% to have a positive microscopy for Candida spp. [START_REF] Benchellal | Vulvovaginal candidiasis in the military teaching hospital Mohammed the fifth (Morocco)[END_REF].

Candida albicans was isolated most frequently (69,2%), followed by Candida glabrata and Candida tropicalis (15.5% each). The most commonly affected age group was 25-35 years.

The literature is silent on recurrent vulvovaginal candidiasis for Morocco.

Skin and eye infections

Tinea capitis is reported from several series in Morocco [START_REF] Oudaina | Epidemiology of tinea capitis in outpatients at the Children's Hospital in Rabat (Morocco)[END_REF][START_REF] Boumhil | Tinea capitis in the military hospital Mohammed V (Morocco)[END_REF][START_REF] Elmaataoui | Tinea capitis etiology in Ibn Sina Hospital in Rabat (Morocco)[END_REF][START_REF] El Mezouari | Tinea capitis in the military hospital Avicenna (Morocco): Review of 8 years (2006-2013)[END_REF][START_REF] Halim | Mycological and epidemiological aspects of tinea capitis in ibn rochd university hospital center, Casablanca (Morocco)[END_REF][START_REF] Aqil | A prospective study of tinea capitis in children: making the diagnosis easier with a dermoscope[END_REF]. A recent meta-analysis of tinea capitis in Africa estimated that 23% in school aged children, or 2,663,557 (95% CI 1,968,716-3,358,398) and 7,285/100,000. This could be an over-estimation, as rates of tinea capitis may be influenced upwards by countries in sub-Saharan Africa.

Mycetoma has been reported infrequently in Morocco over many years [START_REF] Amrani | Le pied de Madura[END_REF][START_REF] Asly | Mycetoma (Madura foot): A case report[END_REF][START_REF] Baha | Mycétome actinomycosique du pied à Actinomycetes viscosus au Maroc[END_REF][START_REF] Bouhamidi | foot: a case report[END_REF][START_REF] Efared | Mycetoma in a non-endemic area: a diagnostic challenge[END_REF][START_REF] Marc | Clinique et épidémiologie des mycétomes au Maroc[END_REF][START_REF] Messoudi | Le pied de Madura: pathologie rare au Maroc (à propos de 15 cas)[END_REF], and the country is above the 'Mycetoma' belt [70]. About 50% of the cases are fungal, or eumycetoma [70]. To date 18 cases of chromoblastomycosis have been reported in Morocco [START_REF] Santos | The global burden of chromoblastomycosis[END_REF]. No cases of sporotrichosis have been reported from Morocco.

Mucormycosis is described from Morocco, but is probably uncommon or rare [START_REF] Razouk | The subcutaneous mucormycosis due to Lichtheimia corymbifera: A case report in an immunocompetent child[END_REF][START_REF] Lmekki | Rhinocerebral mucormycosis[END_REF][START_REF] Razem | Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report[END_REF][START_REF] Abilkassim | Rhinofacial mucormycosis : A case report[END_REF]. One case of cutaneous mucormycosis in an immunocompetent child has been reported [START_REF] Razouk | The subcutaneous mucormycosis due to Lichtheimia corymbifera: A case report in an immunocompetent child[END_REF], as well as one case of rhinofacial mucormycosis [START_REF] Abilkassim | Rhinofacial mucormycosis : A case report[END_REF] Fungal keratitis is a serious and often blinding condition, usually related to minor eye injury or wearing of contact lenses. While occasionally reported in Morocco [START_REF] Er-Rami | Severe keratomycosis due to Fusarium solani induced by a telluric foreign body: About a case in Moroccan Sahara[END_REF][START_REF] Elouarradi | Corneal ectasia following keratomycosis[END_REF],

no large series have been published. We have therefore used the data from Egypt to estimate annual incidence -14/100,000 or 5,120 cases.

Discussion

In Morocco, life expectancy at birth in women is 74 years and in men is 72 years [START_REF]Life expectancy at birth (years)[END_REF], and 27% of the population is under the age of 15 [2]. There is no compulsory or universal health insurance scheme. In 2007, 16% of the population had some form of medical insurance, including 11% of the population which was covered by public-sector insurers [START_REF] Ruger | Health financing and insurance reform in Morocco[END_REF]. Most of the population identify as Arabs or Arab-Berbers and are Sunni Muslims.

Very few people from sub-Saharan Africa live in Morocco, despite the geographical proximity. The major limitation to this work is the lack of large studies from the country. Almost all the estimates are inferences. For example we found only one paper on vulvovaginal candidiasis and none on recurrent disease, yet it is unlikely that Moroccan women are immune to this troublesome complaint. There are considerable bodies of work on chronic pulmonary aspergillosis and aspergilloma, principally surgical series, with a note that this disorder is relatively frequent. There are multiple publications focused on HIV infection, but less on the complications of AIDS. Several Moroccan authors have summarised the clinical approach to particular conditions, such as Pneumocystis pneumonia, chronic pulmonary aspergillosis indicative of local awareness of these conditions.

Diagnostic provision in

The estimation approach to chronic pulmonary aspergillosis differs from prior estimates which have primarily focussed on post-anti-tuberculous CPA. Here we have included estimates of misdiagnosed TB (which is probably a numerically small problem in Morocco as 94% of cases are confirmed bacteriologically), and cases occurring during and immediately after therapy. Again all the assumptions made are based on studies from other countries and given genetic components to CPA susceptibility, these estimates are likely to be inaccurate. They require local studies to be done.

The very large numbers of children with tinea capitis may well be an over-estimation. In the one study from Morocco, 18% of children attending hospital had tinea capitis, but this is clearly a select population.

This survey supports previous reports from other north-African countries that about 9% of Moroccan inhabitants suffer from fungal infections. The most important by their incidence/prevalence are pulmonary fungal infections (mostly Aspergillus diseases) and superficial (tinea capitis) and mucosal (vulvo-vaginal candidiasis). These population-based data should promote the implementation of a fungal surveillance system to describe more precisely the landscape of these infections that should drive some public health care policy.

39 WHO

 39 Essential diagnostic tests Aspergillus antibody, Histoplasma antigen or Pneumocystis 40 PCR are not routinely available, then chronic pulmonary aspergillosis, disseminated 41 histoplasmosis and Pneumocystis pneumonia will be grossly under-diagnosed. The 42 common lack of diagnosis relegates much fungal disease to clinical oddities and curiosi-43

Table 1 .

 1 The estimated annual caseload (incidence or prevalence) of serious fungal infections in Morocco and number per 100,000 population.

	Fungal infection	Predominant Groups at Risk	Rate Per 100,000 Estimated Number of Cases
	Cryptococcal meningitis	AIDS	0.43	160
	PCP	AIDS	0.53	195
		Haematological malignancy, lung
	IA	cancer and 1.3% of COPD	4.1	1,500
		admissions to hospital
	CPA	Tuberculosis patients and other respiratory disorders	52.8	19,290
	ABPA*	Adult asthma patients	71.0	25,950
	SAFS*	Adult asthma patients	93.7	34,260
	Candidaemia	Hospitalised patients	5.00	1,830
	Candida peritonitis	Post-surgical patients	0.75	275
	Oesophageal candidiasis	HIV infection	3.7	1,346
	Recurrent vaginal candidiasis #	Adult women	2794	510,740
	Mucormycosis	Multiple, especially diabetes	0.20	73
	Fungal keratitis	Corneal injury, contact lens	14.0	5,120
	Tinea capitis	4-14-year-old children	7285	2,664,000
	Total burden estimated			3,305,100
	PCP, Pneumocystis pneumonia; IA, invasive aspergillosis; CPA, chronic pulmonary aspergillosis;
	ABPA, allergic bronchopulmonary aspergillosis; SAFS, severe asthma with fungal sensitisation;
	* Duplication between ABPA and SAFS is likely as both are sensitised to Aspergillus. Fungal
	asthma total probably 42,150 (115.3/100,000).

  Morocco for fungal diseases is reasonable in teaching hospitals. There are nine University Hospital Centers linked to a School of Medicine and in these hospitals, there are eight Parasitology and Mycology Departments and 16 specialists in topic: in Rabat, Casablanca, Marrakesh, Agadir, Fez, Meknes, Oujda and Tangier.

	In Laayoune, a university hospital is being developed. The lack of publications of large
	series of patients reflects a lack of time -clinical and teaching commitments leave little
	time for surveillance or research.

Diagnostic capacity is good in the teaching centres, with all offering microscopy, culture and histopathology and almost all cryptococcal and Aspergillus and Candida antigen, as well as Aspergillus antibody. Pneumocystis PCR is only available in Casablanca and Rabat, and Histoplasma antigen testing is not available. It is not clear if the country has cases of histoplasmosis in humans (as opposed to the relatively frequent equine histoplasmosis (epizootic lymphangitis) caused by a separate sub-species H. farciminosum). Opportunities exist from strengthening capacity with external funds from, for example, the Global Fund for AIDS, TB and Malaria

[START_REF] Bolan | Leveraging Global Fund investments for health systems strengthening: a qualitative case study on Morocco's Concept Note development[END_REF]

.

Funding: This work was partially supported by Gilead Sciences, who had no input into the content.

Institutional Review Board and Ethics Statement: Not applicable.

Data Availability Statement: All applicable data is published and referenced in the paper.

Acknowledgments: None

Author Contributions: This article was conceived by DWD in accord with a long-term program od estimating the burden of serious fungal disease in each country. All four authors contributed to the data generation, reference acquisition, analysis and writing process. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest:

The authors report no conflicts of interest.