In January 2022, the 47th annual Arab Health conference was held both online and in person at the Dubai World Trade Center in the United Arab Emirates (UAE). More than 50,000 healthcare professionals from around the world attended, including healthcare executives, government officials, medical equipment manufacturers and representatives, educators, providers and technicians, and various other stakeholders. Participants mingled in person for the first time since the beginning of the COVID-19 pandemic, interacting throughout the multiple days of the conference, which were filled with lectures, exhibitions, and other events.
The robust exposition seemed to signal that, at least in some respects, the Middle East’s healthcare sector is thriving. And indeed, an estimated $781 million in business was generated from this event alone. Noteworthy announcements included: the world’s first healthcare metaverse platform, launched by Emirates Health Services; multiple new healthcare facilities, including King’s College Hospital Jeddah, the first UK hospital in Saudi Arabia; advancements in health monitoring and surveillance efforts, such as a new app-based electrocardiogram that claims to be 95 percent accurate; and even a new collaboration between Abu Dhabi and Israel that focuses on bio-convergence—the fusion of health and life sciences with engineering and technology.
Despite substantial advances, decades of data suggest that the actual health of most citizens across the Middle East region is less than optimal, especially among those who are the most marginalized, such as the region’s refugees and other conflict-afflicted populations.
But despite these substantial advances, decades of data suggest that the actual health of most citizens across the Middle East region is less than optimal, especially among those who are the most marginalized, such as the region’s refugees and other conflict-afflicted populations. Indeed, most Arab countries are well known for spending very little on social services, including healthcare. Despite the dazzling display of innovation presented at the Arab Health conference, most Arab countries are behind on medical technology and care models, even in the wealthy Gulf states, which were the most represented countries at this recent event.
The glaring disparity between economic efforts to invest in a rapidly growing healthcare sector and the minimal actual public health services afforded to the Arab world’s populations provides insight into the region’s overall approach to development, which often focuses on lucrative, high-profile projects instead of addressing citizens’ real needs. That said, it is undeniable that the Arab world, with its burgeoning medical and pharmaceutical sectors, is becoming an increasingly important contributor to global health initiatives. What, then, is the status of these sectors in a world desperate to emerge from the ongoing COVID-19 pandemic, and what does their growth mean for the region?
A Brief History of the Arab Healthcare Sector
Just a century ago, the healthcare sector in the Arab world was struggling to deal with challenges posed by the colonial and military systems that governed its territories at the time. Up until the Second World War, hospitals in the region were primarily small, private facilities set up by doctors who had received their medical training abroad before returning to their home countries to practice medicine. Although many Arab countries had become at least nominally independent nations by the 1950s, the legacy of colonialism continued to be felt, including in the healthcare system, where the paternalistic, top-down approach that was implemented under colonial rule persisted. Often inadequate government facilities were established for the poorest residents, while those with resources would usually pay for care in private facilities or would travel abroad for medical procedures—both trends that continue today.
Up until the Second World War, hospitals in the region were primarily small, private facilities set up by doctors who had received their medical training abroad before returning to their home countries to practice medicine.
The region has seen significant turmoil in the many decades since its countries gained independence, and very few Arab nations have enjoyed the stability, transparency, and prosperity that is required to build a functional healthcare system. Yet health indicators such as overall life expectancy and infant and maternal mortality rates undeniably improved in the second half of the 20th century, due in large part to a decrease in regional poverty, improvements in water, sanitation, and electricity systems, and a reduction in the mortality burden of communicable diseases. However, due to economic, political, and social factors, health outcomes across the Arab world today differ widely, with the best performance found in wealthy states like Bahrain and Oman, and extremely poor performance in fragile, low-income countries like Yemen and Somalia.
Of course, the trajectories of public health outcomes and health-related industries are quite different. Regional trends like population growth, aging populations, and a rise in noncommunicable diseases such as heart disease, type 2 diabetes, and cancer have certainly contributed to countries in the region—and especially Gulf countries—taking an interest in investing in their healthcare sectors. But still, these issues have existed for decades, and if the health of these countries’ citizens was truly a priority, there are multiple mechanisms by which countries could have intervened, including by emphasizing preventive care, increasing publicly available healthcare coverage, and improving overall healthcare infrastructure. The reality is that the markets for medical and pharmaceutical products and services have exploded in recent decades, especially with the rise of digital technologies. And although up until just a few years ago the Arab world had very little global representation across most of these sectors, this situation has unquestionably changed.
Developing the Healthcare Sector
While pharmaceuticals are a rather narrowly-defined economic sector, the number of industries that fall under the umbrella of “healthcare” are incredibly diverse. They can include services in prevention, treatment, rehabilitation, and palliative care, as well as supplies that can be as basic as catheters and as advanced as genetic testing equipment. The Middle Eastern market for medical technologies alone is estimated to reach $31 billion by 2025. Most of this growth is concentrated in Saudi Arabia, the United Arab Emirates, and Qatar, which are among the few countries in the region that can afford to invest in such an expensive sector. Aside from financial investments, however, countries also require strong regulatory frameworks and associated regulatory bodies, especially if they want to be able to export their products to other countries. Due in part to weak regulatory structures, almost all medical equipment in the Gulf states remains imported—upwards of 96 percent in 2014, with rates having decreased slightly since then. Although sufficient regulatory expansion has yet to be seen, such a prospect is not out of the question since regional leaders see significant economic potential in producing their own equipment, not just for their own populations, but for foreign markets as well.
Although sufficient regulatory expansion has yet to be seen, such a prospect is not out of the question since regional leaders see significant economic potential in producing their own equipment, not just for their own populations, but for foreign markets as well.
Major players in the medical sector are also highly invested in digital healthcare initiatives and products, in part to address a shortage of local healthcare workers and the resulting need for people in the region to travel abroad to obtain certain advanced medical services. Disruptions caused by the COVID-19 pandemic have undoubtedly accelerated telehealth efforts, with the market for such services predicted to increase from $261 million in 2021 to an estimated $380 million in 2029. These efforts are already taking hold across the region. Egypt’s Ain Shams University Hospital, for example, has invested in a virtual hospital model to encourage telemedicine services alongside public health awareness campaigns and health tutorials. Similar efforts are being seen in Jordan, Kuwait, Morocco, Qatar, Palestine, Saudi Arabia, and the UAE, albeit at different scales depending on their ability to invest, as well as other factors such as the ability of patients to access an appropriate device and to enjoy reliable internet access.
The Pharmaceutical Industry
This has been one of the major industries that has seen growth across the Arab region, including research and development, manufacturing, and shipping of medications. This is no surprise, as the region has historically been a key source of medical knowledge and production. The “golden age” of Arab medicine, which stretched from the 9th to the 13th century, saw the establishment of some of the world’s first pharmacies in the major cities of Baghdad, Damascus, and Cairo, as well as the global dissemination of Arabic texts on medicines and medical treatments. Today, the region’s pharmaceutical sector is estimated to reach about $60 billion by 2025, up from $36 billion in 2016. While this represents just a minor portion of the global pharmaceutical market, it is still a significant leap made over just a few years, and current investments indicate that this upward trajectory is poised to continue.
Saudi Arabia, which itself boasted a pharmaceutical sector worth more than $10 billion in 2021, expects to see growth of around 7 percent over the next few years.
Saudi Arabia, which itself boasted a pharmaceutical sector worth more than $10 billion in 2021, expects to see growth of around 7 percent over the next few years. Many of the world’s major pharmaceutical players, including Pfizer, Sanofi, GSK, and AstraZeneca, operate in Saudi Arabia, along with many Saudi and Arab companies, including Jamjoom Pharma, Tabuk Pharmaceuticals, and Jazeera Pharmaceutical Industries. As part of Saudi Arabia’s Vision 2030 initiative, which emphasizes localization across a number of industries, multiple pharmaceutical manufacturing agreements have been initiated, aimed at increasing production within the country.
Tunisia, which established one of the region’s first pharmaceutical warehouses in the late 1930s, is another country with a rapidly growing pharmaceutical sector. From 2014 to 2018 alone, this sector grew more than 45 percent, increasing exports by 7 percent in the same period. This growth resulted from the operations of 120 companies, 33 of which are actively involved in producing medicines for human use, while the others produce single-use pharmaceutical products, veterinary medical products, and supplies such as bandages and gauze. The country has invested heavily in this sector by educating medical and pharmaceutical students, promoting cooperation efforts with pharmaceutical companies across the world, and signing direct agreements with manufacturers.
Jordan is another major player in the pharmaceutical sector, with manufacturing playing a large part of the country’s economy. Jordan has a long history in the industry, and aside from providing up to 25 percent of its own population’s medicinal needs—which makes the country less reliant on imports than most of its regional neighbors—Jordan has the distinction of being one of the few countries in the region with significant pharmaceutical exports, primarily of generic drugs. In 2021, Jordan announced that its pharmaceutical exports had reached 1 billion Jordanian dinars (around $1.4 billion), making it the nation’s only sector to export more than it imports. Today, around 75 percent of pharmaceutical products produced in Jordan are exported.
Does a Growing Healthcare Sector Mean Better Population Health?
Market forecasts for healthcare sectors throughout the Arab world are extremely optimistic, and significant growth is expected in the coming years. This could potentially mean an increase in well-paying jobs, advanced educational opportunities, and a decrease in regional healthcare systems’ dependence on external manufacturers that, as was made obvious during the COVID-19 pandemic, can be unreliable and inconsistent. However, it is unclear whether this will also translate into improved health among the region’s population, especially outside of the Gulf where most of this industry growth is taking place.
While meeting local needs is an oft stated goal in the development of healthcare industries, a significant divide remains between the needs of the average citizen in the Arab world—especially those in the most disadvantaged communities—and the flashy, futuristic promises of the region’s medical and pharmaceutical industries. How beneficial are increased telehealth services to populations without reliable access to electricity or the internet? And how useful are modern and locally-produced diagnostic or treatment devices for populations that lack both proper health insurance and the funds to access the facilities that purchase and operate these devices? Such questions are largely overlooked in the glossy reports that tout the region’s healthcare advances, and that are primarily produced by foreign consultancy and market research agencies.
The World Health Organization defines health as “a state of complete physical, mental, and social well-being.” Health is also a human right, the achievement of which relies on a panoply of life experiences, access to services, and diverse biological factors that are not entirely within our power to control. The continued rise of healthcare sectors in the Arab world may potentially play a part in helping some segment of the population attain that right; but such an outcome is by no means guaranteed, especially if policymakers’ emphasis continues to be placed on achieving economic, rather than health-related goals. Indeed, allowing the growth of these industries in the Arab region to occur without a focus on equity will only foster and exacerbate preexisting inequalities, and will lead to even starker health disparities between those who enjoy access to goods and services and those who do not.