How Deteriorating Health Conditions Reflect Middle East Dynamics in 2024
Traditional military and political shifts are no longer the most significant threats to the security and stability of Middle Eastern countries. Instead, unconventional threats arising from demographic phenomena, economic challenges, and health crises have escalated. Epidemics, for instance, are now increasingly undermining the safety and security of individuals and communities across the region in unprecedented ways. This is particularly true in light of the extraordinary surge in the spread of certain diseases in some countries within the region, a situation expected to worsen with the ongoing cross-border labor movements and migration amid rising multi-sovereignty and fluid borders among many regional states.
Revealing Interactions
In such a context, the diseases that emerged in the region during 2024 have highlighted the centrality of the interactions that the Middle East has witnessed, as follows:
1. The Continued Power Struggle Between the Sudanese Army and the Rapid Support Forces: The war between the Sudanese army and the Rapid Support Forces has led to the spread of several diseases in various regions within multiple states, especially in the east of the country (Kassala and Gedaref states), most notably cholera. The deteriorating environmental conditions and lack of safe water are significant contributors to this outbreak. The disease causes severe diarrhea and dehydration, which can lead to death within hours, according to the World Health Organization (WHO). By mid-August, it had already resulted in the deaths of 300 people, with expectations that the actual numbers are higher than reported.
In this context, Sudanese Health Minister Ali Adam stated in media remarks on August 19, 2024, that “the ongoing war between the army and the Rapid Support Forces for over 16 months has directly influenced the emergence and spread of the disease.” WHO official Margaret Harris also indicated that the humanitarian crisis caused by the civil war in Sudan exacerbates the spread of diseases like cholera.
Similarly, the president of Médecins Sans Frontières (Doctors Without Borders), Christos Christou, in remarks on July 17, 2024, highlighted the link between the war in Sudan and the collapse of the health system. He said, “We operate in 8 states in Sudan, one of which is Khartoum, where millions have been displaced. We are trying to restore some of the health facilities that were affected by the war. Over 70% of health facilities in Sudan are non-operational due to destruction, looting, or lack of supplies and staff.” He added that communication with existing medical facilities and the Ministry of Health services is ongoing, but cooperation with both warring parties (the army and the Rapid Support Forces) is necessary to ensure the safety and security of the staff.
Therefore, the rise in cholera cases can be attributed to the failure and inability of Sudanese authorities to provide appropriate treatment services to patients in a timely manner due to the weakness of the health system. Additionally, the wards designated for isolating cholera patients in most hospitals are inadequate given the nature and rapid spread of the disease. Moreover, there was a lack of transparency from the official authorities in declaring the cholera outbreak, as expressed in a statement by the Sudanese Doctors’ Syndicate on the platform (X), which noted that the publicly available information about the outbreak pertains only to safe areas. There is a lack of accurate information about the epidemic situation in states experiencing active military operations, especially amid severe shortages of staff, medications, vaccines, and equipment.
2. Struggles in Libya to Recover from Institutional Collapse: Libya continues to suffer from multiple sovereignties and a dual-headed authority in the east and west, affecting the restoration of the role of institutions and the functioning of facilities and agencies in the health sector, despite calls for a focus on health following the collapse of the Derna dam. In this context, the head of the Government of National Unity, Abdul Hamid Dbeibeh, during the inauguration of the Golden Misrata Clinics Complex on November 25, 2023, after its renovation and re-equipping, expressed aspirations for 2024 to be a “Year of Health in Libya,” committing to work toward that goal.
The head of the government, unrecognized by the Libyan parliament, indicated that the inauguration of this health facility aims to take another step toward reforming and renewing the deteriorating health sector, reflecting efforts by the Administrative Centers Development Authority to develop health and educational facilities as part of the “Return to Life” plan. However, the absence of political agreements and the widespread presence of armed militias hinder Libya’s recovery from the ongoing cycle of violence.
3. The Lack of a Resolution to the Fifth Gaza War: Despite ten months having passed since the October 7, 2023 attacks, which led to the Gaza war between Hamas and Israel, there are no indications of an imminent ceasefire or end to the conflict, despite efforts by mediating parties, particularly Cairo and Doha, to achieve a truce. In such a situation, skin diseases, for example, are spreading in Gaza due to the horrific conditions in overcrowded camps housing hundreds of thousands of Palestinians displaced from their homes. Furthermore, more than one million cases of acute respiratory infections have been reported since the war began.
In July 2024, the WHO revealed a significant risk of a polio outbreak across the Gaza Strip and surrounding areas due to the dire health situation and the deterioration of the sanitation system in the war-ravaged Palestinian territory.
On the Israeli side, it is apparent that the prolonged Gaza war, coupled with the lack of a clear timeline for ending the fighting amidst Israeli military officials’ references to a complex and extended war, is placing Israeli soldiers under immense stress, leading to psychological conditions ranging from depression and anxiety to suicidal tendencies and post-traumatic stress disorder (PTSD). These chronic conditions require lengthy treatment and mental health services, as noted in investigations by “The Jerusalem Post” and “Haaretz.” Some analyses even suggest that the Israeli army is facing its “biggest mental health crisis” since 1973.
4. Vulnerable Social Groups Affected by Prolonged Conflict Cycles: Children, women, and the elderly are among the most affected by ongoing conflicts in the Arab region. A UNICEF report dated August 19, 2024, highlights a 34% increase in the number of children under five suffering from severe acute malnutrition or wasting in all areas under the control of the Yemeni government, compared to 2023. This situation impacts more than 600,000 children, including 120,000 suffering from severe acute malnutrition.
This sharp increase is attributed to the combined effects of disease outbreaks (cholera and measles), rising food insecurity, limited access to safe drinking water, and economic deterioration. Additionally, the same population segment includes about 223,000 pregnant and lactating women suffering from acute malnutrition in 2024. Investing in prevention and treatment efforts and expanding them is now more critical than ever to protect the most vulnerable women and children.
This situation is not confined to areas under the control of the legitimate government but also affects those under Houthi control. Nine years of Yemeni conflict have left widespread destruction in health infrastructure, and more deadly diseases and epidemics are emerging, with expanding health needs for millions of displaced people and children who are now targets of many deadly diseases like cholera, dengue fever, and polio. Yemen’s health system has become extremely fragile.
5. Mitigating the Spread of Epidemics to Neighboring Countries: Some epidemics cross borders, particularly amid political transitions and armed conflicts within certain countries. Following the Sudanese Ministry of Health’s announcement of the cholera outbreak, Egyptian Assistant Minister of Health, Hossam Abdel Ghaffar, stated on August 19, 2024, that the country has heightened its level of alertness and intensified monitoring at land crossings with Sudan. Additionally, precautionary measures have been tightened at airports as part of Egypt’s preparations to confront the spread of cholera in Sudan and to prevent any infection from crossing into Egyptian territory, thereby safeguarding public health. This includes addressing a range of diseases feared to spread between countries, especially after the monkeypox outbreak in Congo.
The WHO and the African Union’s health agency declared monkeypox an emergency health situation in Congo and other parts of Africa, marking it as the highest level of alert, with confirmed cases among children and adults in more than 12 countries and the spread of a new virus strain. August saw an update to the guidelines for dealing with monkeypox, which was distributed to all hospitals and preventive medicine units across Egypt to update information on the disease, prevention methods, and treatment. The guidelines issued by the Preventive Medicine Sector included details about the epidemic spread of monkeypox, modes of transmission, symptoms, and signs of the disease, along with preventive measures to reduce the risk of human-to-human transmission.
6. Increased Demand for the Role of Médecins Sans Frontières: The post-Arab Spring period has seen a significant increase in the role of Médecins Sans Frontières in Libya, Yemen, Syria, and Sudan due to the targeting of hospitals and doctors by conflicting parties and the need to fill funding gaps. The president of Médecins Sans Frontières, Christos Christou, stated on July 17, 2024, “UN organizations are experiencing a significant funding shortage, and non-governmental organizations are unable to come due to security risks. Médecins Sans Frontières will increase its activities in Sudan to fill the existing gaps due to the lack of funding.”
Pressing Contexts
In conclusion, the diseases in 2024 have been revealing of the interactions within the Middle East, both internally and regionally, highlighting the negative impacts of armed conflicts on health systems and the effectiveness of medical teams. This is exacerbated by extreme poverty, the absence of humanitarian interventions to provide safe water, the prevalence of dilapidated sewage systems in residential areas, and the lack of transparency from official authorities in several regional countries in disclosing cases of this
or that disease. Vulnerable social groups, particularly those in displacement camps fleeing conflict zones, are especially affected. Additionally, the demand for the role of Médecins Sans Frontières and other organizations has increased, although their response has not met the urgent needs to curb the spread of epidemics and treat the afflicted in a timely manner.
