CAIRO, Egypt — Offering a cigarette is as common as a handshake in Egypt, where the culture of smoking is so entrenched that patients sometimes light up in hospital rooms. But now the government is getting serious about the health risks, launching a new campaign of stark visual warnings about tobacco's dangers.

Starting Aug. 1, cigarette labels in Egypt will be required to carry images of the effects of smoking: a dying man in an oxygen mask, a coughing child and a limp cigarette symbolizing impotence.

It's a major step in Egypt's fledgling anti-smoking campaign and a dramatic change in a country where public discussion of smoking's health risks is nearly nonexistent.

"I would like to quit but I just can't. But when you see pictures like this, like that sick man, that has an effect — it does encourage you to stop," said Osama Sabri Mohammed, a 39-year-old civil servant puffing on a cigarette outside a government building in downtown Cairo.

The impotence message might have a particular effect on Egyptians, he said, because "they are really concerned about that."

The photo of the limp cigarette comes with the warning that "long-term smoking has an effect on marital relations" — somewhat coyer than a version the European Union has recommended for its member countries, which states directly that smoking causes impotence and shows a discontented young married couple sitting apart in bed.

Twelve countries, including Canada, Jordan, Brazil and Thailand, require graphic photos of the effects of smoking to be printed on cigarette pack.

But the campaign faces a tough challenge among Egypt's die-hard smokers.

Egypt is one of the top 15 smoking countries in the world: Nearly 60 percent of all adult males in the country of 79 million people use tobacco in some form, compared to 24 percent of men in the United States.