The COVID-19 pandemic and health systems in the Middle East – a chance for a new beginning? ǀ View

I read with some dismay last week, the self-congratulatory triumphalism of a Saudi commentator extolling his country’s pandemic response while gloating at the misfortune and failures of some of its neighbours and regional rivals. The virus, of course, remains impartial to the squabbles of regional governments or even those of the largest global power-brokers. For example, Mike Pence, the US vice-president, was busy offering conspiracy theories earlier this week by suggesting China knew about a widespread outbreak as early as November 2019. This, of course, may have simply been a feeble attempt to distract from the United States’ own policy failure, as the pandemic tears across America fuelled by a disjointed and poorly coordinated national response.

Saudi Arabia and partner states in the Gulf Cooperative Council (GCC) would be better served by building on the commendable success and lessons learned from their MERS-CoV outbreak response efforts and focusing on those areas of their health systems and wider societies that are still weak and could be further improved. The COVID-19 pandemic – even as it rages across all our borders – serves as a global pause button, a watershed moment in history for all countries to reflect upon our current state of affairs and consider where they’re going and what they might do better. It’s an opportunity to make systemic wholesale improvements.

For the Saudis and their GCC brothers and sisters, one of the most glaring systemic weaknesses in their societies is the unconscionable disparity in legal and employment rights, and access to health and social services, between their nationals and the migrant labour workforce that actually keeps their countries running and serviced (a workforce that far outnumbers nationals across the GCC). Currently under lockdown in many settings, large numbers of these foreign workers – often on subsistence incomes – are living on charity handouts and on the brink of mass COVID-19 outbreaks in their cramped labour camps. While food and drink distribution has been generally very good during the current crisis, as evidenced by the considerable support being provided by the Dubai government around the densely populated quarantine zone of Deira, for example, governments in the GCC have been less effective in providing adequate employee protections and appropriate housing and healthcare for migrant labourers – key needs during a high transmissible outbreak.

Physiologically, national or migrant, both are equally vulnerable to the virus – but when only one group has any meaningful access to the social protections and high-quality healthcare on offer by the State, then any model of pandemic preparedness is quickly overwhelmed and becomes unsustainable for everyone. The images of a migrant worker in a box labelled ‘hand sanitizer’ standing in Saudi ARAMCO’s lobby – the richest, biggest company by value in the world – dispensing hand gel for passing executives, illustrates in one snapshot what hundreds of pages of Amnesty International and Human Rights Watch reports struggle to do – the gross inequalities on brazen display across the GCC. The two agencies remain constant irritants to the whole Middle East region over its human rights records and have once again been highlighting the scant regard being paid to migrant labourers in the rush to put in place pandemic containment measures, such as suspension of all non-essential business and severe travel restrictions.

If a measure of a society’s stature is how it cares for its weakest and most vulnerable, then the GCC as a whole falls woefully short, given the huge oil wealth and resources at its disposal. The wildly spiralling outbreak unfolding across the United States, too, is in no small part directly due to the significant inequalities and variable access to health services across the country – one where over 30 million people either have no health insurance or are under-insured and who then delay accessing healthcare out of fear of the associated financial costs, thus putting both themselves and those they are exposed to at risk and further driving transmission.

Universal health coverage and social welfare for all residents irrespective of citizenship status should be a key priority for the GCC going forward and should be a central pillar for any pandemic preparedness strategy. It would also be more in keeping with the values and traditions of an avowedly religious region. The Prophet Muhammad (peace be upon him) expounded in his farewell sermon: “All mankind is from Adam and Eve. An Arab has no superiority over a non-Arab, nor a non-Arab has any superiority over an Arab; also a white has no superiority over a black, nor a black has any superiority over white except by piety and good action.”

Perhaps now is the time for those principles to be re-established in the region and applied to all residents – nationals and migrants – especially as they pertain to legal concerns around access to healthcare, employment and social protections.

While the Saudis and their GCC friends have without doubt moved swiftly and decisively over the course of the pandemic – limiting pilgrimages to Mecca and Medina, suspending flights and bringing in social distancing measures and so on – there are some clear additional areas for improvement in both developing pandemic preparedness and response capacities over the longer term. Firstly, the wider Middle East region has a young, vibrant and well-educated youth, an ample workforce to fuel the self-sufficiency necessary to drive pandemic preparedness sustainably.

Secondly, there is no reason why diagnostics, vaccine and therapeutics development and its subsequent manufacture cannot take place within the region itself. Entrepreneurship initiatives like Tamkeen in Bahrain should be set up across the region and expanded. The over-reliance on short-term external experts and consultancy groups parachuted in to advise on everything, from pandemic plans to laboratory services and testing kits, means that sustainable capacities are rarely developed and everything on offer is from groups with no long-term interests in the region beyond a transactional financial relationship.

For example, despite the significant numbers of cases across the region as a whole, there are very limited high containment laboratory facilities in place to safely store COVID-19 patient samples or set up biobanks to carry out the innovative and necessary public health and clinical research that would inform locally tailored responses. How many therapeutic clinical trials or COVID-19 vaccine and diagnostic development projects are underway in this oil-rich region? Next to none. Research and Innovation are key planks of pandemic preparedness and on both counts the region performs poorly. It appears much of the investment that has taken place has centred around buying European football clubs and developing oversized retail malls to sell entertainment and overpriced luxury goods to a wealthy, increasingly unproductive, elite.

In addition, and perhaps more importantly, the region desperately needs a rapprochement between its squabbling regional powers, one based on a shared geographical space and shared values. The GCC should recognise the huge challenges that Iran and Turkey have had to face during this pandemic. For all its many faults, Iran has graciously hosted millions of Afghan refugees for decades, providing them with gainful employment and equitable access to primary and secondary healthcare services. The country is currently reeling from the effects of the pandemic, compounded by crippling American sanctions, curtailing its ability to source Personal Protective Equipment (PPE) and critical care supplies. Turkey, the GCC’s other favourite “frenemy,” is host to 4 million Syrian Arab refugees and an unstable southern border – a huge additional complexity to have to deal with in the midst of an evolving pandemic.

It is time for the GCC to extend a hand of solidarity and use this shared crisis as an opportunity to build bridges and develop truly regional emergency and pandemic response capacity. Perhaps the starting point for this could be supporting the current responses in badly-affected neighbouring countries by sending supplies and expertise where needed, and then in the longer term, developing a well-resourced regional Centre for Disease Control – a meritocratic institution drawing on expertise from across the region. One that has the ability to build and maintain a regional public health workforce in all areas of expertise, coordinate diagnostics, vaccination and treatment strategies (both the development and manufacture of these essential medical countermeasures) and organise the necessary research and innovation to ensure the region becomes self-sufficient and self-reliant. It is at that point the region can stand proudly and claim to be making valuable contributions to global pandemic preparedness and response.

  • Dr Osman Dar is director of the Global Health Programme’s One Health project at Chatham House.


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