We need new policies to deal with Coronavirus in the Middle East and North Africa

Nabil Abdo Health

Coronavirus has crippled all aspects of normalcy in people’s lives and the economies in the Middle East and North Africa (MENA), despite the region being relatively spared larger outbreaks as seen in other parts of the world.

But the deficits in basic services and social protection shortfalls, or decent and dignified work, means we must be braced for things to get worse, and soon.

This pandemic has already exposed the many flaws of the current dominant economic systems and impact of decades of harmful austerity policies, but it will worsen because of the existing inequalities and ongoing conflicts within MENA.

Like we have already seen in other countries, the health care sector will be pushed to its limits first. In the countries already beset by conflict, the pandemic will be catastrophic to already fragile health systems.

Underfunded and underequipped

It will be strained not only due to an exponential increase in cases, but because of systematic underfunding or stagnation after years of austerity. World Bank data shows woeful government expenditure on health in the region between 2008 and 2016, at below 3% of GDP, while public social protection expenditure, excluding health, stood at a meagre 2.5% of GDP.

The underfunding of the public health systems has already created health crises across the region in what can be identified as “normal” times. Public hospitals were left short of necessary supplies and equipment and are unable to cater for the needs of the population, to the point where the most well among them are seeking privatized health care.

In this unprecedented moment (at least in living memory), the MENA region healthcare and social protection will not be able to cope with the scenarios we see playing out across the world. In a region where at least 40% of the population is uninsured, and universal health care is not a government or public priority in an era of austerity, the pandemic can potentially take a disastrous toll on people’s lives.

Lockdown is impossible for those living in poverty

The current response to avert the pandemic in the region could also worsen many people’s lives, even helping to spread the virus if inequalities and income vulnerabilities are not immediately tackled with the right policies. A lockdown, while necessary, poses a challenge to workers who cannot work from home and/or do not enjoy paid sick leave, or any leave at all. This is not unique to MENA but it is particularly acute here. A highly informalized labour force in the region, 56.3% of employment is informal in North Africa, and 63.9% in the Middle East means that regardless of the prevailing labour laws there is a fundamental failure to effectively protect most workers. Millions are set to lose a significant income by staying at home with little or no social protection.

In the absence of unemployment benefits, or pensions for older people, if compensation is not made, many will become more vulnerable and forced to risk their lives. In the Middle East region only 27.4% of those over the age of 65 receive a pension. This puts those have the highest mortality rate if contracting Coronavirus at an even higher risk. Too many continue to work after retirement age.

The huge migrant workers population the region relies on, already excluded from labour regulations, will also bear the brunt. Many will risk high exposure rates as they are already vulnerable, by living in very poor housing and cramped spaces. For them and many others, such as refugees and people living in informal housing and settlements, social distancing is a luxury they cannot afford. This of course is the case for refugees in conflict affected countries in the region who are already stigmatized and discriminated against. These inequalities will hit them hard and they are likely to be further affected and scapegoated while fighting this pandemic.

Women will bear the brunt

And of course, of all these groups women will be the most disproportionately affected. They are on the front lines of this crisis. They are they underpaid health care workers, supermarket clerks on minimum wage, and unpaid carers at home. Government responses must provide protection for them too.

This pandemic will show us the dualities lived in the MENA region cannot be maintained when facing this outbreak. The systems of underfunded public health used by the poor and flourishing private health care for the rich are unable to cope with the pandemic that has already forced governments to ramp up the public health infrastructure in the response.

A quality public universal health care system is needed more than ever

It has already exposed the disastrous targeted safety net schemes in the region that turned social protection from a right to a privilege. The unfolding crisis shows us that universality ensures quality of care, while targeting ensures underfunding. The severe deficits in workers’ rights, as well as migrant and refugee rights, harms not only those who endure these violations but society at large. Even the most privileged will not be immune, Coronavirus will spread faster because of these structures of inequality that have been built up throughout the years.

Now, more than ever, international and regional solidarity is needed. Debt suspension and relief is critical for many countries in the region to redirect funds from debt services to health care and emergency cash disbursement. The international community and rich countries in the region should mobilize resources to support the region in its health and economic responses. Countries need to put people at the center of the response through reallocating spending from military and security to social spending.

A combination of solidarity, quality universal basic services for all, strong public health care infrastructure, universal social protection, enhanced workers’ rights, and increased social spending through tax on wealth is strongest response to this pandemic and will usher a just recovery. Years of austerity and increased inequality have proved to be the ideal petri dish for Coronavirus to flourish. A complete reversal of the policies of the past is an urgency for the future.


Nabil Abdo

Nabil Abdo is a Senior Policy Advisor on international financial Institutions at Oxfam International