It was just over two years ago—on January 5, 2020—that the World Health Organization (WHO) reported “cases of pneumonia of unknown etiology” based on information coming out of the WHO China country office. At the time, data was limited. Outside of China, few had heard of what seemed, briefly, like a localized incident. Even in China, reported cases only numbered in the dozens. The WHO’s assessment at the time was reserved but cautious: “There is limited information to determine the overall risk of this reported cluster of pneumonia of unknown etiology… the symptoms reported among the patients are common to several respiratory diseases… however, the occurrence of 44 cases of pneumonia requiring hospitalization clustered in space and time should be handled prudently.”
These 44 cases have now become, at the bare minimum, 366 million cases around the world, of which nearly 6 million have led to death (and the lack of testing and reporting means we are likely vastly undercounting). Every aspect of modern life has been disrupted, with varying degrees of lockdowns and contamination measures. New variants have evaded vaccine effectiveness, and only 62.4 percent of the global population has received at least one dose of vaccine. Misinformation and conspiracy theories about the virus, the vaccines, and even the practice of medicine itself are running rampant. Despite the rapid development of multiple effective vaccines, many epidemiologists and public health officials believe the pandemic is worse today than at any point since March 2020, when global lockdowns began.
As data emerged about how detrimental to health COVID-19 would be, especially to vulnerable populations, many analysts and health officials were particularly concerned about the Arab region. Several factors motivated this concern: a high concentration of conflict-affected and refugee populations with little health access, poor pre-existing public health infrastructure across the region, and low trust in government and other institutions. Initially, the Arab world outperformed expectations; most countries instituted robust lockdowns, and because fear of the relatively unknown virus was high, many populations complied. Yet, in May 2020, many lockdown measures were lifted as the region entered the Muslim holy month of Ramadan, when social gatherings are common, and the summer season, a time that usually sees many weddings and other large events.
Initially, the Arab world outperformed expectations; most countries instituted robust lockdowns, and because fear of the relatively unknown virus was high, many populations complied.
Many Arab countries have very recent experience with another strain of coronavirus: Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Although it emerged in 2012, several Arab nations, especially Saudi Arabia and other Gulf states, saw significant spikes in 2014, with cases ongoing in much smaller numbers in recent years. Unlike COVID-19, however, MERS-CoV was not easily transmitted through communities; it took close contact with infected animals or people to contract the virus. Thus, it required much less effort to contain than the virus that causes COVID-19, SARS-CoV-2. How has the region handled this highly contagious and extremely disruptive novel coronavirus in the past two years, and what might be the long-term effects?
The Arab World’s Mixed Response to COVID-19
The Eastern Mediterranean region, where many Arab states are classified, has reported nearly 18 million cases of COVID-19 and over 315,000 deaths. Like all health outcomes, risk of infection, hospitalization, or death from COVID-19 depends on a combination of individual, local, and national factors. The Middle East has a largely young population, with most countries reporting a median age in the low 20s. While this presents a challenge for a host of other economic, political, and social reasons, these demographics offered some protection from the worst health effects of COVID-19, which seemed to be concentrated in older populations. But on a state level, Arab countries are highly diverse in the other social determinants of health that would influence how the country might fare with such a virus. Iraq had the most reported cases, at just over 2 million, while Yemen reports close to 11,000 cases—but this is likely due to a widespread lack of testing. The countries with the most deaths include Iraq, Tunisia, and Egypt—although, again, these are only the deaths reported as an outcome of COVID-19. It is likely that many cases and deaths related to COVID-19 went unrecorded.
Countries with the strongest pre-existing health systems, or who at least responded swiftly and consistently around containment measures, performed the best, at least initially.
Countries with the strongest pre-existing health systems, or who at least responded swiftly and consistently around containment measures, performed the best, at least initially. These countries included Tunisia, Jordan, and Morocco and reported relatively low rates of infection in the first wave of the pandemic. The Gulf states, especially Bahrain, Saudi Arabia, and the United Arab Emirates, leveraged their wealth and imposed significant population restrictions, even significantly scaling down the Hajj in the case of Saudi Arabia. Initially, they, too, saw low numbers of infections among their citizens (it is important to note that data surveillance was lacking regarding their significant migrant worker populations). Yet despite these initial successes, as the pandemic continued, populations and governments grew weary of pandemic restrictions, and all have seen spikes in infection and hospitalization rates in the years since. This latest Omicron wave has hit the region particularly hard, even in the highly regulated Gulf states. Officials have again reinstated mask mandates, banned public events, and increased requirements for proof of vaccination for nonessential activities.
The conflict-affected countries faced additional hurdles during the crisis. Testing, contact tracing, and vaccination efforts were greatly stymied by active conflict or lack of infrastructure, and the crowding of poor and vulnerable populations offered perfect conditions for untracked virus transmission. In Syria, a decade of bombing has led to a health system decimated beyond description. In 2021, the WHO estimated that only 59 percent of hospitals and 54 percent of primary health care centers are functional to full capacity in Syria. In Yemen, decades of neglect and poverty, along with years of a Saudi-led bombing campaign of civilian sites across the country, have also led to an inadequate health system. Yemen had just barely emerged from a crippling cholera outbreak that affected millions, and widespread famine has also challenged the most marginalized Yemeni groups. In the besieged Gaza Strip, the territory’s only COVID-19 lab, along with water treatment facilities, thousands of homes, and road networks, were damaged in Israel’s bombings during May 2021, and Israel blocked and disrupted Palestinian efforts to contend with the virus across the occupied West Bank and East Jerusalem. Libya, with only two labs able to test for COVID-19, has also seen its health care sector targeted in recent warfare; the situation there is exacerbated by tens of thousands of internally displaced people, significant supply and personnel shortages, and a primary health care system functioning at less than 30 percent capacity, nearing collapse. Iraq, beleaguered by decades of war, sanctions, occupation, and corruption, also saw significant backlash against health care workers, prompting the Iraqi president to ask the United Nations General Assembly for help in managing “mounting violence towards the medical community.”
Social, Economic, and Political Effects of COVID-19
COVID-19 tested the governmental capabilities of even the most responsive, transparent, and accountable nations. In the Arab world, where conflict, corruption, and poor public infrastructure reign, many governments were caught off guard, unprepared for a wide-ranging crisis for which they could blame no group or opponent. Countries there rely heavily on imports, especially for medical supplies and the personal protective equipment needed in massive quantities at the beginning of the pandemic. Outside of urban areas, there are also many pockets of poor internet access or little technology availability, which limits public outreach efforts and digital contact tracing. With poor public health services, testing capacity was limited; and low public trust has led to high levels of vaccine hesitancy. In addition, significant segments of the populations in many Arab states said they preferred vaccines from specific countries or were unwilling to get any vaccine at all; in Iraq and Tunisia, around 60 percent of respondents to a recent survey claimed they would refuse vaccination. Low public trust also fueled rampant spread of misinformation and conspiracy theories throughout the region, especially through social media like Facebook and WhatsApp, with popular rumors suggesting that the vaccine made men infertile or that treatments with various foods, herbs, or even water would prevent infection.
Every country has felt economic shocks from the pandemic. In the Arab world, COVID-19 is the fourth major economic crisis to hit the region in the past ten years, preceded by the Arab Spring, the 2014-2016 oil price declines, and the protests of 2019.
Every country has felt economic shocks from the pandemic. In the Arab world, COVID-19 is the fourth major economic crisis to hit the region in the past ten years, preceded by the Arab Spring, the 2014-2016 oil price declines, and the protests of 2019. Yet COVID-19 has been more damaging than any of these events due to its interference with every aspect of life. It is estimated that by the end of 2021, COVID-19 will have cost the economies in the Middle East and North Africa (MENA) region more than $200 billion, with regional GDP dipping by 3.8 percent in 2020. While there was some moderate GDP growth (2.8 percent) forecast in 2021, the appearance of highly contagious new variants and the waning effectiveness of vaccines has the World Bank estimating an “uneven” recovery. We are already seeing signs of this unevenness, as some of the oil-rich Gulf states appear to be exceeding growth expectations and, in some cases, are even recovering to pre-pandemic levels. Of course, recovery potential is highly dependent on the emergence of new variants of the virus and other unpredictable obstacles in the future.
Long before the pandemic, economic indicators across the region were a cause for concern: soaring unemployment rates, high levels of corruption and nepotism, low economic growth, serious poverty and food insecurity, large gender disparities in the workforce, a lack of stable and high-paying quality jobs, heavy reliance on cheap foreign labor, and poor infrastructure for private sector development. Combined with the pandemic, which shuttered many industries, paused travel, and infected many workers (forcing them to stay home for days or even potentially lose their jobs), the results have been devastating. The World Bank found that the pandemic has impoverished many middle-class households that were not in poverty in early 2020, describing them as “the new poor”—an estimated 14 million people.
One industry that took a significant hit is tourism, which accounts for 5.3 percent of GDP and nearly 7 million jobs across the region. National airline carriers have faced difficulties, especially Egypt Air, Royal Air Maroc, and Air Algeria. The widely lauded carriers from the smaller Gulf states, like Emirates, Etihad Airways, and Qatar Airways, which offer few domestic trips and rely heavily on international travel, also struggled and required heavy state financial support to remain solvent. Countries that rely heavily on tourism, especially Egypt, Lebanon, Morocco, and Tunisia, have struggled as tourist arrivals fell by around 60 percent. The Gulf states, which have increasingly become known for hosting lavish expos and other events that attract a wealthy global clientele, have had to cancel major events, although they had some success in reopening between variants. In the occupied West Bank, most of the tourism centers around visits to Bethlehem around Christmas. Since the beginning of the pandemic, this has essentially stopped, crushing local businesses that depend on tourist dollars. One shopkeeper lamented, “For two years, no business. It’s like dying slowly.”
Women’s employment rates in the MENA region, which are already among the lowest in the world, also decreased during the pandemic.
Women’s employment rates in the MENA region, which are already among the lowest in the world, also decreased during the pandemic. Women were expected to take on even more caregiving duties, especially as children stayed home from school or family members got sick. Even in countries with alarmingly high male unemployment, the female unemployment rate was consistently worse—double the rate of men, in many cases. Women make up most health care workers around the world (except as doctors), and the MENA region is no different. These workers are among the most vulnerable to COVID-19 infection as they are regularly exposed to ill patients, yet they are also among the most marginalized. Because many health workers are public employees, economic shocks can result in reduced salaries or missed paychecks, unsafe working conditions, or low stocks in needed medical supplies and medications.
Is a Regional Reset Possible?
In such challenging and unpredictable times, it is tempting to hope that the region will emerge stronger and more resilient. Many Arab countries have long relied on authoritarian governance, a heavy security presence, and an understanding that the most marginalized populations have little agency or recourse. Their economies have been dependent on bloated public sectors and the ability to import many needed goods, including foods and medicines. The pandemic has shown just how fragile this arrangement has been.
While many of the effects of the pandemic will linger and have long-term effects, some analysts have found some possibilities for growth and transformation in a region in desperate need of both. Human security is about much more than a robust military and an economy that benefits the elite of the country while allowing much of the rest to barely hobble along. This tenuous period presents a prime opportunity for Arab states to reinvest in genuine human security, including public health infrastructure, secure and affordable housing, widespread internet and technology access, opportunities for decent and dignified work (including for women), and diversified economies that meet the needs of the 21st century. This also includes formalizing mechanisms of support for the region’s most vulnerable: the conflict-affected populations, refugees and internally displaced people, and migrant workers. Lastly, the consequences of low public trust have only allowed the pandemic to persist; governments that are inclusive and accountable, along with a flourishing civil society, will not just help the region emerge from COVID-19, but they will go far in preventing the worse outcomes of whatever the next regional crisis will be.
Two years in, the COVID-19 pandemic appears far from over. The world has collectively learned much about the physiological effects of the virus and has developed effective treatments and vaccines to combat it. Yet there is a lag in finding treatments for the broader ailments of society, like inequality, marginalization, and corruption. While Arab countries are not unique in displaying these ailments, they have historically been among the most ill-equipped to manage them. Can the COVID-19 pandemic, which has wrought such pain and suffering, offer a chance to rethink old and ineffective paradigms? Let us hope so.