The Rise and Fall of Middle Eastern Health Systems

SEATTLE – Much of the progress in the Arab countries of the Middle East and North Africa in recent decades appears to have been reversed by the political unrest and civil wars afflicting the region. This reversal is especially visible in the health systems of Egypt, Jordan, Libya, Syria, Tunisia, and Yemen, which previously had been steadily improving.

Before 2010, these countries were experiencing increased life expectancy as well as reduced infectious disease burdens and infant and maternal mortality. Today, however, disruptions to their health systems have compounded the trauma and misery that have arisen from the region’s many conflicts.

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This is clear from a recent study that I co-authored for The Lancet, which examined data from the Global Burden of Disease Study 2013 to determine the effects of health-system deterioration in Eastern Mediterranean countries.

We found that projected life expectancy has declined across the board since 2010. For example, if the 1990-2008 rate of increase for life expectancy in Syria had continued apace, it would have been five years higher for women and six years higher for men than it is now. In Libya, life expectancy declined by six years for women and nine years for men. And in Egypt, Tunisia, and Yemen, it declined by .25 years between 2010 and 2013.

The larger drop in life expectancy in Syria and Libya is to be expected, given the civil wars in those countries. The United Nations Special Envoy in Syria estimates that 400,000 people have died in that country in the last five years as a result of the violence. Moreover, the turmoil has had less obvious, but equally alarming, downstream effects. For example, after declining at an average annual rate of 5.6% between 1990 and 2010, Syria’s infant mortality rate has risen by 9.3% in recent years.

In war-torn countries, the destruction of infrastructure is generally indiscriminate. Despite international resolutions prohibiting attacks on health-care facilities, such attacks are a regular occurrence. Moreover, amid war and severe social unrest, medical and mental-health professionals often flee to safer environments, depriving those left behind – regardless of their status or income – of basic treatment for everything from physical injuries to drug and alcohol abuse.

In fact, conflicts in the region are especially hazardous for people suffering from mental illness and substance abuse. The rate of total disease burden for psychological and drug-use disorders, measured in life years, increased from 4% in 1990 to more than 7% in 2013, with some countries seeing more dramatic increases than others. With the unrest yet to come to an end, the impact will be even higher in 2016.

Negative health trends are apparent even in countries that have been experiencing economic growth. Both Qatar and the United Arab Emirates are experiencing increased drug and alcohol use, suggesting that the stress of mere proximity to violence elsewhere, combined with increasing openness and massive growth in illicit drug production in conflict zones such as Afghanistan, could push people toward substance abuse as a coping mechanism.

Areas neighboring these zones are also increasingly burdened by the largest refugee crisis in 70 years. The flood of people into camps in Lebanon and Jordan has overwhelmed sanitation measures, leading to outbreaks of infectious diseases and resurgence in some areas of diseases that had been nearly eradicated, such as polio among Syrian refugees in Iraq. Most countries absorbing refugees are simply not equipped to deal with such a massive influx of people who need health and social services.

The rapid deterioration of health-care systems in the Middle East and North Africa in the last half-decade is alarming. But the progress many countries in the region made in prior decades provides grounds for hope that it can be reversed. Larger investments in education, diagnosis, and treatment, for example, would help to reduce the stigma of mental illness that persists in many Arab countries.

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But a resumption of progress in the region is impossible without political solutions that reduce violence and social unrest. As we conclude in our study, “a healthy Eastern Mediterranean Region is a politically stable Eastern Mediterranean Region from which the whole world will benefit.”

Stabilizing a country riven by conflict is a prerequisite for improving its health-care system. Once such stability is achieved, regional and local efforts should be accelerated to improve disease prevention and health-care infrastructure, and to put the region back on a path toward providing better, healthier lives for its people.