In ancient China, Japan, and Korea it is clear that roundworm and whipworm were the most common parasites present. Where data are available to estimate how common these parasites were, they suggest that more than half of the population were infected. Flukes spread by eating raw fish and crustaceans were a significant health risk, but less than half of individuals appear to have been affected. These include Chinese liver fluke, Fasciolopsis, Gymnophalloides, Metagonimus, and Paragonimus. The range of species of flukes present seem to have been higher in Korea and Japan than China, which may reflect the range of species endemic there, or the range of foods traditionally eaten raw in each culture. Oriental schistosomiasis is contracted by wading in still freshwater, so farmers growing rice in paddy fields were at particular risk. Major trade routes such as the Silk Road have been shown to act as conduits for the spread of intestinal parasites across East Asia.

A broad range of parasites were present in ancient Egypt and Nubia, with 15 different species, including ectoparasites, helminths, and protozoa. Some are spread directly from one person to another (such as pinworm and head lice), some pass through animals as part of their life cycle (such as Taenia tapeworms, fish tapeworm, and trichinella), while others require biting insect vectors to spread them (such as malaria, leishmaniasis, and filariasis). Around 40% of ancient Nubians had head lice, 10% of Nubians were infected by visceral leishmaniasis, 22% of Egyptian mummies were positive for malaria, and 17% were positive for schistosomiasis. As malaria and schistosomiasis cause chronic anaemia and fatigue during physical work, they must have been responsible for a considerable drain upon the capabilities of the workforce in these civilizations along the Nile.

Early communities of the Arctic, subarctic, and north-west coast were most at risk of fish tapeworm infection, as these societies relied heavily on fish in their diet. In the north-eastern and south-eastern woodland regions early populations living around the Great Lakes would also have been at risk of fish tapeworm infection. Those communities living further south, especially those engaging in farming, were prone to parasites spread by poor sanitation including pinworm, roundworm, the protozoa Giardia sp. that causes dysentery, and possibly hookworm. Considering the early inhabitants of the great basin and arid south-west, populations were infected by pinworm at least by 7000 BCE, spread by close contact between group members in cave sites. Thorny-headed worm eggs may indicate the consumption of crickets as part of the early hunter-gatherer diet in these communities. With the introduction of agriculture we see an increase in the range of parasite species present, to include whipworm, roundworm, dwarf tapeworm, and taeniids. As population size and density increased, we find a progressive increase in pinworm (30–70% of coprolites in some communities) and head lice (44% of mummies).

Three sites of Kharga Oasis (Dush, Labakha, and El-Deir), which were explored between 1981 and 2010, are considered in this chapter. They were occupied from the end of the fourth century BC till the early fifth century AD. About a thousand buried individuals were examined. The studies concerned sex ratio, age at death, causes of death, and pathology of mummies. More men than women were discovered, and the number of children found was particularly high in the Christian cemetery at El-Deir. Regarding age at death, the main feature is the proportion of women between 12 and 40 (as at many cemeteries). The pathological study, mainly based on X-rays, revealed problems with bones (fractures, arthritis, scoliosis…), problems with teeth (worn teeth, decay cases), and many cases of bilharzia. Presence of GAL (growth arrest lines) was observed on many mummies or skeletons,indicating periods when food was inadequate. Exploring cemeteries revealed the activities of their inhabitants: they were mainly farmers and craftsmen involved in potting, weaving, wickerwork, stone-cutting, and woodwork. There were obviously “rich” and “poor” tombs, but differences in quality could be due to an impoverishment of populations between Ptolemaic and Roman times.

The comparison of two small oases of the Kharga and Dakhla depressions, in the Western Desert of Egypt, confirmed that spring-fed oases have been attractive after the onset of aridity, ca 4500 BC, but irrigated agriculture has not been proved yet before the Intermediate Period. Irrigated areas were suject to harsh constraints despite the wealth of underground water during millennia: wind-induced dune shifting and soil erosion in Amheida and El-Deir, while flash floods destroyed most of the El-Deir oasis during the Roman period. Recovery was more difficult because artesian springs, which relied on water stored during the wet phase of the Holocene, were progressively exhausted by irrigation practices and could no longer compensate for the drying up of the oasis environment. If natural factors are not the unique causes of economic decay in the oases, they may have some responsibility in the progressive abandonment of agriculture during the third and fourth centuries. Amheida disappeared to the benefit of El-Kasr fortress, while El-Deir retained some importance for caravan trade between Hibis and the Nile Valley thanks to a well secured by a newly built fortress from 288 to the sixth century AD.