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The MENA Region and COVID-19
Impact, Implications and Prospects
Zeina Hobaika, Lena-Maria Möller, Jan Claudius Völkel, Zeina Hobaika, Lena-Maria Möller, Jan Claudius Völkel
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The MENA Region and COVID-19
Impact, Implications and Prospects
Zeina Hobaika, Lena-Maria Möller, Jan Claudius Völkel, Zeina Hobaika, Lena-Maria Möller, Jan Claudius Völkel
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About This Book
Focusing on the Middle East and North Africa (MENA) region, which comprises some of the world's richest countries next to some of the poorest, this book offers excellent insights into the discriminatory consequences of the COVID-19 pandemic.
With a geographic focus on the MENA region, the multidisciplinary case studies collected in this edited volume reveal that the coronavirus's impact patterns are a question of two variables: governance performance and socioeconomic potency. Given the global, unprecedented, complex, and systemic nature of COVID-19 – and its long-term implications for societies, governments, international organisations, citizens and corporations – this volume entails a relevance to regions undergoing similar dynamics. Analyses in the book, therefore, have implications for the comparative study of the pandemic and its impact on societies around the globe. Understanding related dynamics and implications, and making use of lessons learned, are a pathway to deal with future similar crises.
Questions covered in the volume are relevant to geopolitics, social implications and the relations between political leaders and citizens as beings embedded in various strategies of communication. The volume will appeal to scholars of international politics, political science, risk or crisis governance, economics and sociology, human rights and security, political communication and public health.
The Open Access version of this book, available at http://www.taylorfrancis.com, has been made available under a Creative Commons Attribution- Non Commercial- No Derivatives 4.0 licence.
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1IntroductionThe MENA region and COVID-19 – concept and content of this book
Zeina Hobaika, Lena-Maria Möller and Jan Claudius Völkel
DOI: 10.4324/9781003240044-1
1.1 COVID-19 in the MENA region: countering an unexpected crisis
This edited volume tackles an urgent, timely question: how has the unprecedented and far-reaching crisis caused by the COVID-19 pandemic affected social, political and individual life in countries of the region commonly referred to as the ‘Middle East and North Africa’ (MENA)?
Especially the MENA region’s many Arab countries, which are at the centre of this book’s analysis, are oftentimes perceived as a single homogeneous union due to the similarities in language and the major religion. However, they differ distinctively in many regards: while a few are (semi-)democratic, such as Lebanon and Tunisia, and some are in transformation, as is currently the case in Algeria and Sudan, others are characterised by more authoritarian forms of government, such as many Arab monarchies and Egypt. Sadly, there are also a number of war-torn countries, for example Iraq, Libya, Syria and Yemen. Similarly, while the resource-rich economies along the Persian Gulf belong to the world’s most affluent countries, Yemen and the Gaza strip rank among the world’s poorest regions.
Given these economic and political variances, it hardly comes as a surprise that countries in the region also differ strongly in their provisions of public policies, including health. While the rich Gulf monarchies offer world-class medical facilities and attract a large number of doctors and nursing staff from other Arab countries, less affluent countries only offer insufficient public health care systems: there are 14 doctors per 10,000 inhabitants in the 22 member states of the League of Arab States (LAS), whereas the Gulf Cooperation Council (GCC) features 25 doctors per 10,000 (Hasan, 2021: 1151). Around 20 hospital beds exist per 10,000 population in Arab countries, compared to, for example, 52 in the EU (Hasan, 2021: 1151). Tunisia was said to provide a maximum of 200 intensive care beds in public hospitals at the beginning of the pandemic, and only 550 respirators were available in Morocco (Joffé, 2020: 517). Personal protective equipment (PPE) and testing kits have remained scarce, if not completely inaccessible, for the impoverished population in many parts of the Arab world. In countries with high numbers of internally displaced persons (IDPs), refugees or otherwise undocumented persons, health provisions are not extensive or specific enough to cover them all – a shortfall which becomes particularly dangerous in times of a pandemic (Wehbe et al., 2021: 3). This includes the rich Gulf monarchies, where blue-collar migrant workers – usually much more numerous than the local population – have only limited health care services at their disposal (Asi, 2020).
With 6% of gross domestic product (GDP), Arab countries spent only half as much on health than the global average in 2017 (Hasan, 2021: 1152). Unsurprisingly then, MENA countries performed only moderately to badly in the 2016 Healthcare Access and Quality Index, which measures the personal health care access and quality in 195 countries (Lozano, 2018). Overall, the MENA region scored a meagre 55.8 on a scale from 0 (worst) to 100 (best); Lebanon (in 33rd place) performed best with a score of 85.6, followed by Israel (35th/84.8), Qatar (41st/81.7), Kuwait (44th/80.7), Saudi Arabia (52nd/77.1), Oman (54th/76.2), Bahrain (65th/72.0), Iran (66th/71.8), Libya (67th/71.1), United Arab Emirate (UAE) (73rd/70.3), Jordan (74th/70.2), Tunisia (77th/69.4), Syria (88th/67.2), Algeria (99th/63.1), Egypt (111th/58.0), Morocco (112th/57.6), Palestine (114th/57.4), Iraq (125th/51.1), Sudan (136th/45.8) and Yemen (140th/43.3).
This imbalance is also reflected in the highly diverging life expectancies across the Arab world, ranging between 50 and 57.1 years in Somalia and Sudan, respectively, to 78.2 and 81.5 years in Qatar and Lebanon, respectively (Jabbour, 2013: 357). In the poorer countries, state-of-the-art health care services are usually offered in private or military clinics (for cash or only for eligible patients); meanwhile conditions in public hospitals are typically insufficient for patients and staff alike. Above all, medical research is largely underdeveloped, or, in conflict countries, completely impossible (El Achi et al., 2019). Despite some increases since the mid-2000s, the World Health Organization’s Eastern Mediterranean Regional Office (WHO-EMRO) still counts Arab countries ‘among the lowest producers of systematic reviews’ (AlKhaldi, Al-Surimi and Meghari, 2020: 11): between December 2019 and March 2020, only 4.26% of the global research output regarding COVID-19 came from Arab countries, mostly Saudi Arabia (35.65%), Egypt (20.78%) and the UAE (11.73%) (Zyoud, 2021: 3). However, not only intra-Arab knowledge production in the field of medical research is limited: so is intra-Arab exchange of knowledge. Additionally, existing medical research is conducted in clinical laboratories without sufficient consideration of the socioeconomic aspects, as Jabbour (2013: 358) states:
Work on social determinants, from human rights to trade policies to environmental engineering, is either in infancy or not at all part of health system mandates. The health-in-all-policies approach to health promotion has not taken root – or perhaps not even been planted across the region.
Given these grave and far-reaching shortcomings, the United Nations’ Economic and Social Commission for Western Asia (ESCWA) expected the implications of the COVID-19 pandemic to rest heavily on states and societies. According to ESCWA’s estimates from the initial weeks of the pandemic, approximately 1.7 million people were likely to lose their jobs in 2020, and another 8 million people, half of them children, were destined to fall into poverty. Besides the already low oil price, the pandemic threatened tourism and hospitality industries, as well as the stream of vital remittances from migrant workers in richer countries who support their families back home. A pandemic-induced economic decline would trigger devastating consequences for people’s adequate nutrition and sanitation, access to clean drinking water, shelter, health care and education (Karamouzian and Madani, 2020: 886).
The region’s largely insufficient health provisions are the result of grossly underperforming political systems. After decades of what political scientists perceived as ‘Arab exceptionalism’ in an attempt to explain why none of the ‘waves of democracy’ that swept the world took hold in the MENA region (Lust, 2011), a scent of ‘permanent uncertainty’ has become a region-wide pattern more recently. Hardly any expert on the region had predicted the breath-taking changes that affected so many Arab countries in early 2011, triggering unprecedented protests against political suppression, economic mismanagement and kleptocratic governance. Admittedly, a quiescent order appears to have been restored now in most countries and ‘normality’ has seemingly regained control across the region, i.e. non-democratic regimes exercising far-reaching power based on rent-generated resource distribution to their supporters, while suppressing potential opponents with uncompromised police violence and a sophisticated security apparatus. However, protesters in Algeria and Sudan have triggered a new round of regime changes in 2019, and, also surprisingly, various Arab countries started to revise their fundamental rejection of diplomatic relations with Israel in late 2020, having the potential to create completely new regional power relations.
In that particular parallelism of inertia and commotion, stagnation and dynamic, the coronavirus caught the MENA region – and the whole world – largely unprepared. While other recent epidemics had already made an impact on the MENA region – such as Middle East respiratory syndrome (MERS), which was first identified in Saudi Arabia in 2012, or Ebola, which, after being transmitted by air passengers from West Africa, threatened Dubai Airport as one of the world’s leading international transport hubs two years later – these warning signs have remained largely ignored due to a ‘global failure by public health systems to adequately assess and respond to such outbreaks, because of an absence of proper risk assessment and communication, transparency, and serious intent to define and control the outbreaks’ (Zumla et al., 2015: 101).
The novel coronavirus SARS-CoV-2 developed a completely different dynamic. Public life around the globe changed significantly: a simple handshake could potentially bring death and suffering and face masks became an accepted part of our daily apparel. With the growing spread, clinics and hospitals in even the richest countries were pushed to the limits of their capacities, if not beyond. As of 1 July 2021, almost 3.95 million deaths in relation to the COVID-19 pandemic had been recorded by Johns Hopkins University’s Coronavirus Resource Center; more than 182 million had contracted the virus (Johns Hopkins University & Medicine, 2021; on the difficulties connected with COVID-19 statistics, see Viglione, 2020). In Arab countries, more than 3.2 million infections and 55,000 deaths were reported as of December 2020, numbers that had rapidly increased since September 2020 (Wehbe et al., 2021: 1).
While in the initial months the coronavirus was said not to discriminate between rich and poor concerning its infectiousness, its consequences differ markedly: financially sound societies may be able to afford economic shutdowns, but citizens in poorer countries lack the opportunity to not go to work – if they even can afford the ‘luxury’ of seeing a doctor. Moreover, keeping children out of school for months can be compensated for (at least partly) through excellent learning conditions at home, but children from families with fewer resources usually lack the necessary conditions. The MENA region is believed to be especially prone to infectious diseases like COVID-19: in ‘normal’ times, the globally leading ‘ME3 carriers’ Emirates, Etihad and Qatar Airways transport millions of travellers to and from the region. This not least because the Arabian Peninsula is a prime destination for millions of labour migrants and religious pilgrims. Besides, there are the millions of refugees and IDPs who form communities that are particularly vulnerable to infectious diseases. And in general, ‘Middle Eastern populations have high rates of diabetes and cardiovascular problems that have been found to be risk factors for severe COVID-19 disease’ (Sawaya et al., 2020: 1).
Not only does the Arab world contain specific risk factors, but the current public health systems are often in a deplorable situation as well. While some countries had established dedicated counter-epidemic units in their public health administrative structures after their prior experiences with MERS and Ebola – as well as severe acute respiratory syndrome (SARS) in 2002–4 and the H1N1 influenza (‘swine flu’) in 2009, which certainly helped in formulating effective response strategies against COVID-19 in 2020 – the very limited cross-regional cooperation hindered the vital spread of knowledge about this novel coronavirus. In addition, insufficient statistics in many Arab countries regarding infection rates and COVID-19-related casualties rendered fundamental research unreliable (Sawaya et al., 2020: 2). Given the surprisingly low COVID-19 numbers that were reported from many Arab countries, especially during the infancy of the pandemic, Eberhard Kienle (2020) identified an ‘Arab exceptionalism, once again’, notably this time not concerning ‘the deplorable large-scale absence of transitions from authoritarianism but the welcome protection of public health, perhaps even encouraged and facilitated by the former’.
Arab governments’ initial COVID-19 responses partially followed the global trend: closing borders and imposing lockdowns as well as curfews to limit personal movement and contact, even by cancelling communal Friday prayers and Sunday masses and issuing guidelines for safe practices for religious occassions such as Ramadan (Karamouzian and Madani, 2020: 886), Palm Sunday and Easter. Socioeconomic support measures were launched and a number of regimes released prisoners from overcrowded jails, albeit sometimes according to questionable or problematic selection criteria, as criminals were prioritised over political prisoners in many instances (El-Sadani, 2020). Despite such measures, hospital caregivers in a number of Arab countries got desperately overwhelmed: In early 2021, videos from two Egyptian hospitals went viral, showing desperate staff and COVID-19 patients allegedly dying due to a shortage of medical oxygen – claims which the Egyptian government fervently rejected (Michaelson, 2021). Similarly, in March 2021, six COVID-19 patients in a Jordanian hospital suffocated due to a lack of medical oxygen, and the devastating blaze in a COVID-19 station of a Baghdad hospital in April 2021, killing 82 and injuring 110, showed the suffering and despair of patients, staff and families alike.
Anti-COVID-19 vaccination campaigns have picked up speed in only a few MENA countries so far. As of late June 2021, 59.7% of Israelis and 58.01% of Bahrainis were vaccinated; Qatar reported vaccination rates of 49.64%, and the UAE of 38.79%. Many other countries in the region, however, lag behind: Morocco (24.7%), Jordan (13.51%), Palestine (6.89%), Lebanon (6.24%), Tunisia (4.65%), Iran (1.95%), Kuwait (0.89%), Egypt (0.76%), Sudan (0.28%) and Syria (0.03%) all remain at a far distance. At the stage of only first doses were Saudi Arabia (51.57%), Libya (5.52%), Iraq (1.36%) and Yemen (0.79%); for Algeria, no official data were recorded.1
Globally, the coronavirus has drastically shown the importance of functioning governance. Countries in which the political leadership denied the seriousness of the virus at some point were hit exceptionally hard. This notably included long-standing, well-established democracies such as the United Kingdom and the United States of America. Countries where the political leadership initiated measures at an early stage, however, were able to protect their citizens astonishingly well, including countries from the middle or lower ranks of the Human Development Index (HDI) from the United Nations Development Programme (UNDP), such as Vietnam or Thailand, as a comparative analysis conducted by Bloomberg impressively showed (Hong, Chang and Varley, 2020/2021). In their updated list from 28 June 2021, some MENA countries ranked among the world’s best COVID-19 responders – Israel (4th), Turkey (14th), Saudi Arabia (15th) and the UAE (18th) – even when compared with leading HDI countries such as the Netherlands (22nd), Canada (24th) or Germany (28th). Meanwhile, Egypt (33rd), Iraq (37th) and Iran (42nd) are the lowest-ranked MENA representatives out of a total of 53 analysed countries (the region’s war-torn countries, Libya, Syria and Yemen, were not included).