This blog post is part of a series on Social Protection in the Arab Region. For the other papers in the series, please refer to "related publications" at the end of the page.

This series also includes a blog post in Arabic, accessible via this link.

Introduction

Health crises have long shaped national histories, remodeling countries’ developmental trajectories and leaving long-lasting imprints on the health and socio-economic well-being of populations. The COVID-19 pandemic is no different, in that its social, economic, and political ramifications have wreaked havoc around the world, undermining particularly most vulnerable economies and communities by compounding individual and societal insecurities. Indeed, the health crisis has had far-reaching consequences, exacerbating existing disparities and disproportionately affecting most marginalized populations, including populations exposed to forced displacement. This blog explores the profound impact of the pandemic on the Arab region as it navigates the complexities of the pandemic’s aftermath and lays out how nuanced challenges and successes in addressing this health crisis can form the basis upon which to develop targeted strategies to address health disparities, strengthen healthcare systems, and foster social cohesion. The lessons learned from this crisis can shape the region's path towards a more resilient and equitable future, where the health and well-being of all individuals are safeguarded.

The struggle for health equality in the Arab region has far preceded the COVID-19 pandemic. Crises of social, economic, and health disparities have been recurrent and particularly taxing on most vulnerable communities, lacking political, social, and economic capital. Socio-economic factors such as income, education, employment, and access to resources, are particularly salient social determinants of health. Politically and economically marginalized communities, including ethnic and religious minorities, refugees, and rural populations, often face limited access to quality healthcare services, nutritious food, clean water, and adequate sanitation. These disparities create barriers that in turn hinder their ability to maintain good health, by increasing vulnerability to diseases, and to access necessary healthcare.

In many countries, the “Arab Spring” represented a turning point in elevating the importance of safeguarding the right to health and increasing global public awareness concerning stark differences in healthcare access and outcomes based on social class, geographic location, and economic status. As millions of people took to the streets, their grievances against oppressive regimes also echoed demands to redress substantial socio-economic disparities. While political freedom and human rights were central to these movements, the lack of accessible and quality healthcare, coupled with the glaring disparities between the elite circles and the majority population, became emblematic of the wider societal injustices that plagued societies and fueled the demand for social protection and justice.

A syndemic of disease and inequality

As one of the worst health crises in modern history, the recent COVID-19 pandemic has magnified these demands. Nearly one-third of the population is expected to be falling below the headcount poverty rate in the Arab region as a result of the pandemic, bringing the total number of poor in these countries to 115 million people, with an additional 9 million people expected to fall into extreme poverty. The substantial rise of poverty and the decline of living standards across the region was most strongly felt amongst lowest-income households. Daily-wage workers in the informal sector with little job security are particularly exposed to the economic shocks resulting from such health emergencies, given the lack of access to social protection benefits, including health insurance and sick leave. Additionally, most of the latter have been working in the industries that have been hit the hardest by the pandemic, including extractive industries, tourism, and transport, and had limited resources to resort to during lockdown. The International Labour Organization (ILO) estimates that the number of working poor increased by 20% in 2020, meaning an additional 3.6 million people could not earn enough to lift themselves and their families out of poverty. Lebanon’s informal sector serves as a stark example, as the economic downturn has pushed many informal workers into extreme poverty, intensifying issues of food insecurity and educational disparities.

Geographical disparities within countries also highlighted the stratification of most Arab countries. Cities contending with a high concentration of urban poverty, overcrowding, lack of sanitation, and substandard housing, provided a fertile ground for the rapid spread of the virus. For instance, sprawling urban centers like Cairo in Egypt struggled to maintain social distancing measures, further driving infection rates and straining a health system that had increasingly been inaccessible to many due to privatization policies.

The socio-economic repercussions of the pandemic have dealt a severe blow to the most vulnerable members of society. The burdens faced by already marginalized populations grew heavier, and the cycle of vulnerability and disadvantage tighter, almost unescapable. The very same groups which have long endured the hardships of poverty, limited access to healthcare, and dire living conditions, found themselves grappling with the harshest consequences of the pandemic. The health crisis has indeed further deepened the marginalization experienced by minority communities. In certain countries, the rise of state and police violence has endangered these vulnerable groups even further. Numerous migrants and refugees found themselves stranded in host countries, lacking necessities like food, shelter, and essential services, whilst still being unable to return to their home countries nor reach asylum countries where they can seek protection. Many migrants and refugees faced the risk of becoming undocumented or falling into an irregular status due to their inability to meet legal requirements or access visa processes during lockdown and travel restrictions. More aggravating, the COVID-19 pandemic has exacerbated stigma, xenophobia, and discrimination, with migrants being unjustly blamed for spreading the disease or unfairly benefiting from access to social services. Such risks were particularly salient for vulnerable populations, including those in irregular administrative situations or lacking proper documentation, individuals with low-income and no shelter, those without family or community support, children, persons with disabilities, and stateless individuals.

Populations in conflict-affected countries were equally experiencing a double epidemic of violence and disease. In Syria, the use of violence against civilians and their infrastructure, along with the restriction of their access to basic needs like food and water, has become commonplace since the radicalization of state violence and repression in 2011. The deliberate use of health as a weapon of war, through targeted attacks on healthcare infrastructure and personnel, has weakened the ability of infrastructure and health systems to respond to large-scale disasters, thus preventing a large share of Syrians from receiving necessary medical care. Coupled with the erosion of living standards and widespread displacement resulting from the conflict and insecurity, the lack of access to healthcare services amidst rising exposure to diseases like polio, tuberculosis, cholera, and COVID-19, resulted in substantial preventable loss of life.

Strengthening resilience to future crises

The COVID-19 health crisis has exposed deep-seated inequalities and unearthed substantial socio-economic as well as political vulnerabilities, highlighting the need for immediate policy responses to confront inequality and vulnerability head-on. The COVID-19 outbreak serves as a cautionary tale. Averting future health and socioeconomic crises requires a reengineering of short-term policies, to include capacity-building projects that provide the adequate infrastructure, human resources, and capital needed to ensure populations have access to basic necessities such as food, water, adequate shelter, and medical resources, but also to social, educational and financial opportunities. While tailored approaches are necessary for each country, there are overarching measures that can be adopted to mitigate the impact of future crises.

The urgent need for universal healthcare systems cannot be overstated. Governments must prioritize investments in healthcare infrastructure, enhance primary healthcare services, and fortify disease surveillance and response capabilities to ensure that equitable access to quality care is guaranteed for all and not conditional upon income. Additionally, implementing robust social security schemes is paramount in shielding vulnerable populations during crises. By providing income support, unemployment benefits, and access to healthcare, governments can alleviate the socio-economic impacts of health crises and prevent the deepening of inequalities, which are strong drivers of insecurity and violence. This further requires confronting the structural disadvantages that perpetuate inequality, and which are reflected in the social and economic marginalization of the informal sector for instance, to foster more inclusive and sustainable economic development. The COVID-19 health crisis demonstrated that governments must actively encourage formalization, extend universal social protection, support small and medium-sized enterprises, and invest in job creation, with a particular focus on marginalized communities, including refugees, internally displaced persons, and minority groups. The latter might require tailored interventions that specifically address the unique challenges they face. These measures should prioritize equitable access to healthcare, education, and employment opportunities while ensuring the protection of their rights and combatting violence and discrimination.

In conflict-afflicted countries, the pandemic further highlighted the importance of prioritizing relief efforts and the humanitarian response to rapidly address emerging disease outbreaks. Given the extent to which the weaponization and politicization of health responses represented a challenge to respond to the pandemic, securing the impartial distribution of humanitarian aid and medical supplies in all areas regardless of territorial control emerged as a key future policy recommendation for the containment of outbreaks, paralleled with a focus on reinforcing the capacity to treat cases and prevent complications, as well as strengthening surveillance systems to trace cases and improve reporting accuracy.

Conclusion

While COVID-19 has laid bare the deep-seated inequalities and vulnerabilities that persist within our societies, it also imparted valuable lessons that we must heed. It serves as a stark reminder of the urgent need for policy design that champions equality, inclusivity, and resilience. As the multiplier effect of burdens has unleashed a wave of adversity for marginalized populations, resulting in long-lasting socio-economic and political consequences, the reversal of decades of progress in poverty reduction, education, and health improvements, possibly claiming more lives than the direct health effects of COVID-19, policymakers must redouble their efforts to strengthen healthcare systems, ensuring that they are equipped to serve all members of society. The provision of comprehensive healthcare, accessible even to the most marginalized, emerged as a non-negotiable fundamental pillar of social security and well-being. In tandem with these measures, the establishment of a universal social protection system and progressing towards more inclusive economic development must be prioritized. By tackling the structural issues that perpetuate inequality governments can pave the way for more equitable growth, in addition to actively combating marginalization, exclusion, and violence against minority and marginalized groups, protecting their rights and fostering social cohesion.

 

The views and opinions expressed in this blog article are those of the authors and do not necessarily reflect those of the Arab Reform Initiative or the Arab Region Hub for Social Protection.