COVID-19 in the Arab region: An opportunity for a transformative change

19 Oct 2020

This blog aims at illustrating the COVID-19 experience in the Arab region. According to the World Health Organization (WHO) Situation Report of August 1, 2020[1], the Arab Region has detected 962,861 COVID-19 positive cases representing 5.5 percent of the world detected cases. Saudi Arabia, Qatar and Iraq carry over half of the reported cases. The spread of the infection is significant and the number of reported cases has doubled in the month of July 2020. Some countries show clusters of infected cases, while others are moving with large strides towards community transmission. The total number of COVID-19 deaths till August 1, 2020 is 17,393 which represent 2.6 percent of the COVID-19 global deaths.[2] Fatalities are highest in Egypt, Iraq, Saudi Arabia and Algeria representing 80 percent of the region’s COVID-19 deaths. The case fatality rate (CFR) in the region is around 2.0 percent, if we assume completeness of the death registration, ranging from 0.4 percent in Bahrain to 28.5 percent in Yemen.


Digging more in the reported statistics to compare distributions in the region rather than incidence reveals much inequalities between countries. The countries in which the distribution of COVID-19 reported cases exceeds the population distribution are the high income Gulf Cooperation Council (GCC) countries which reflects the capacity of these countries to implement potent surveillance systems and detect infected cases. However, a deeper look provides evidence that countries in which the mortality distribution exceeds the distribution of COVID-19 reported cases are the low economies (Sudan, Yemen) and middle economies (Egypt, Algeria, Iraq). This piece of evidence does not only reflect inequality in distribution but demonstrates inequity between countries. If disaggregated data were available illustrating the disparities in COVID-19 incidence and deaths by wealth, education or any other social stratification, one would expect similar inequalities to exit within countries disfavoring the most vulnerable, who are more at risk of being infected and have limited access to the healthcare services..


It is worth mentioning that countries across the Arab region are expected to face higher rates of COVID-19 infection and deaths than official reported figures. The official figures in the region could be correct up to the level of the screened individuals, however as is the case everywhere, they do not reflect the real size of the COVID-19 pandemic.[3] Some Arab countries lack completion of the reported data and others suffer from underreporting of actual numbers due to their limited laboratory testing capacity. Even in countries where mass screening is available asymptomatic patients are not tested, the cost of the test discourages many from taking it and guest workers fear expulsion, all of which affect the number of reported cases.[3] The situation is most alarming in conflict affected countries. Very little information is available from Yemen, Libya, Syria and Sudan, as many years of war and turmoil have decimated their healthcare systems and their ability to implement an outbreak surveillance system. Consequently, till present, countries are unable to assess the true magnitude of the epidemic on their territories. A rough estimate of the possible total true number of COVID-19 infections, based on the reported number of deaths[4], postulates around 7 million COVID-19 cases in the Arab region. The results assume that Arab countries have only detected around 14 percent of true cases[1]. This number is still expected to under-estimate the magnitude of the true COVID-19 cases, as several deaths may be missed from the national statistics, and the pandemic may be larger.


The region is still unable to identify the most at-risk populations. The news that the elderly and those with chronic illnesses are at highest risk of COVID-19 morbidity and mortality are evident. These population subgroups are at highest risk of any ill-health condition or death not necessarily because of COVID-19 spread. Despite that many Arab countries have reported COVID-19 statistics on their government portals and through official state media to monitor the spread of the infection, there is no disaggregated data provided to identify who, where and when cases, recovery and deaths occur, masking the true underlying risk factors. Furthermore, there is little attention to the socially vulnerable, who are not necessarily those at risk. Health inequities disfavoring the poor and those in refugee camps and informal settlements should not come as a surprise.


Notwithstanding the human costs, the COVID-19 impact is felt most on the socio-economic and political fronts. Every day, people are losing jobs and income, notably women and those in the informal sector. Almost all national sectors are affected, many examples are palpable. According to the UNESCO data, all Arab countries closed their educational institutions for fear of COVID-19 spread with around 96.2 million learners affected by end of May 2020 (end of academic year). In return, the countries have rushed into online learning and virtual schooling, however, they are struggling to keep pace as in 2019, only 51.6 percent of individuals used internet and 51.9 percent of households had computers. Food security is at risk, in several countries notably the low economies and the conflict affected countries. The food shortage is expected to bring negative impact on the cultivated land and increase food prices. Tourism sector is heavily affected, with dropping hotel occupancy rates and arrival rates empty touristic places and deserted beaches. Several countries, including Iraq, Libya, Syria, and Yemen, are struggling with insurgencies, terror threats, and civil wars, which have led to thousands of casualties and millions of people being forcefully displaced both internally and externally. All Arab countries, as everywhere, suffer from muted production, increasing layoff rates, diminished revenues and significant economic losses.


This pandemic is a wakeup call to all countries to revisit their policies and strategies. The prevailing COVID-19 statistics are just a reflection of the long history of weak information systems. Production and use of evidence for policy decision making is still lagging behind, which is the root cause behind many failing policies.


The COVID-19 has illustrated critical feebleness in the healthcare systems. The already exhausted healthcare systems carry the burden of persistent sustained low investment in healthcare over the past decades.[2] The health systems in several Arab countries, generally, do not have sufficient healthcare infrastructure to cope with such crisis. Hospitals do not have enough beds or isolation units, they are short of trained healthcare professionals and medicine procurement. Many countries cannot support mass COVID-19 screening or hospitalization of all cases. In Syria, Yemen and Iraq, public health infrastructures have not only had insufficient funding and resources in the past few decades, but have also been impacted by the destruction of healthcare facilities during continuous bombing and the death or departure of healthcare providers.[3] In Syria, 46 percent of hospitals and primary health facilities are non-functional or partially functional[5], while in Yemen more than half the healthcare facilities are non-functional or partially functional.[6]


COVID-19 has expressed ineptitude in the development efforts. In low and middle Arab economies, the poor, refugees and displaced people have limited access to clean drinking water, adequate nutrition and sanitation, shelter, healthcare, and education[3] rendering compliance to the national precautionary measures and healthcare services unmanageable, which in turn increases the risk of COVID-19 infection and death.


COVID-19 has conveyed inadequacies of the social protection systems in the region. Many countries have worked on relieving the socioeconomic burden of the poor and those in the informal sector. They have provided shelter and healthcare to the refugees and the displaced. However, the economic toll is huge, and is beyond the low and middle economies. The evidence portrait the health burden in low and middle economies, where the percentage of the out-of-pocket expenditure on health from the total health expenditure exceeds the global average in 8 countries, ranging from 33 percent in Lebanon to more than 70 percent in Sudan and Comoros (World Health organization Global Health Expenditure Database, Arab Development Portal).


COVID-19 pandemic is a global call for sincere attention to build resilient nations “Leaving NO One Behind”, it clearly emphasizes that the piecemeal policies to relieve the health and social sufferings are not sufficient and will fail in front of any emerging crisis. The current package of public policies still produce social and health vulnerabilities with inequitable distribution of power and economic resources. The opportunity has come for transformative policies and reforms which are urgently needed to move the Arab region to a sustainable and resilient path.


In conclusion, the COVID-19 is much more than a health crisis, it is affecting societies and economies. This is the heritage of long years of underinvestment and piecemeal policies. While the impact of the COVID-19 pandemic varies from one country to another, it will most likely lead to economic losses and exacerbated inequities. The COVID-19 pandemic provides an opportunity for a transformative change to save the health and wealth of the Arab region.



[1] World Health Organization. 2020. Coronavirus disease (COVID-19) Situation Report – 194. Available at: [Accessed 3 August 2020].
[2] World Health Organization. 2019. Strengthening health financing systems in the Eastern Mediterranean Region towards universal health coverage: health financing atlas 2018. World Health Organization. Regional Office for the Eastern Mediterranean. Available at: [Accessed 20 September 2020].
[3] Institute for Middle East Studies. 2020. The COVID-19 Pandemic in the Middle East and North Africa. The Project on Middle East Political Science (POMEPS), directed by Marc Lynch, the Institute for Middle East Studies at the George Washington University and supported by Carnegie Corporation of New York and the Henry Luce Foundation. Available at: [Accessed 22 July 2020].
[4] Nick Wilson. 2020. Comments to Author , Amanda Kvalsvig, Lucy Telfar Barnard, and Michael G. Baker. Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality. Emerging Infectious Diseases,, Vol. 26, No. 6, June 2020; Volume 26, Number 6 June 2020. Available at: [Accessed 15 May 2020].
[5] Whole of Syria Strategic Steering Group (SSG). March 2019. 2019 Humanitarian Response Plan (HRP). Syrian Arab Republic. [ONLINE] Available at: [Accessed 27 April 2020].
[6] United Nations Office for the Coordination of Humanitarian Affairs. 2020. Global Humanitarian Overview 2020. [ONLINE] Available at: [Accessed 18 May 2020].
[7] United Nations Research Institute for Social Development. 2017. Transformative Policies for Sustainable Development: What Does It Take? United Nations Research Institute for Social Development, Research and Policy Brief 23. Available at:$file/RPB23-Transformative-Policies-Flagship2016.pdf [Accessed 27 May 2020].
[8] United Nations Educational, Scientific and Cultural Organization (UNESCO). 2020. Global monitoring of school closures caused by COVID-19. Available at: [Accessed 25 August 2020].
[9] International Telecommunication Union. 2020. Global and regional ICT data. [ONLINE] Available at: [Accessed 26 August 2020].



[1] Author’s calculations based on WHO reported data.

Sherine Shawky is a Senior Research Scientist in the Social Research Center of the American University in Cairo. She is a Commissioner in the Rockefeller-Boston University high-level Commission on Health Determinants, Data, and Decision-making (3-D Commission).


The views expressed here are solely those of the author in her private capacity and do not in any way represent the views of neither the Arab Development Portal nor the United Nations Development Programme.

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