Regional organizations in MENA
Principal regional bodies within the MENA region include the League of Arab States (LAS), the Gulf Cooperation Council (GCC), the currently largely moribund Arab Maghreb Union (AMU), and the cross-regional OIC which includes all MENA states except Israel. Other regional associations and partnership programmes exist linking the region with external partners like the EU, US, Russia and China. Many of these partnerships have been important in supporting pandemic responses, but the focus here is on groupings comprising regional states and on regional states lying outside such groupings. Indeed, one unusual feature of the MENA region, as defined, is that it includes three states which fall entirely outside the relevant (Arab only) regional bodies – Iran, Israel and Turkey. These three countries, which between them have eight Arab neighbours, (more if the Gulf littoral states are included) have individual bilateral relations with some Arab states but are not part of any wider regional framework. Given the region’s hitherto weak record in terms of regional organization, and the absence of any cross-regional platform, it is unsurprising that responses to the pandemic have been uneven and largely reliant on individual states, external partners and multilateral institutions.
The League of Arab States (LAS) is the oldest regional organization, founded in 1945 after the Second World War, comprising the 22 mainly Arab-speaking countries, thereby covering all states of the region except Iran, Israel and Turkey. The latters’ very exclusion from the regional body is one evident limitation but the League’s scope of action in recent decades has been hampered by inter-Arab divides since the two Gulf Wars, the MEPP, the Iraq War and the Arab uprisings. Syria’s membership remains suspended due to disagreement over the status of President Assad’s regime. From its establishment, the LAS has served more as inter-governmental forum rather than a mechanism for promoting integration, but it has coordinated policy on certain issues, notably the Palestine question, and supported some post-conflict operations. Its founding Charter includes a commitment to health cooperation, but given its ongoing weaknesses, the Covid-19 pandemic did not meet with a rapid, or robust response [
21]. Indeed, the League’s scheduled 2020 summit, rather than providing an opportunity for health cooperation, was cancelled. Nonetheless, the LAS has served as a forum for discussion of COVID-19 questions, while issuing several declaratory statements. It hosted an early conference between Arab states and China to share information and discuss collaboration; another ongoing UNDP-sponsored initiative has brought LAS states together with Japan in a series of high-level meetings to address the UN’s Sustainable Development Goals for the Arab world in the light of the COVID pandemic [
22]. Similarly, the UN Office of Disaster Risk Reduction (UNDRR) has co-organized events with Arab countries to share COVID lessons and explore mitigation measures within a wider discussion of risk mitigation measures [
23].
Despite use of the LAS forum to highlight ongoing issues, however, the tendency has been for Arab states to design their own policies, often with the technical support and assistance of outside powers, and here both China and Russia have been important players, promoting their regional interests in what scholars have called ‘vaccine diplomacy’ [
24]. Some Arab countries have provided support to their neighbours and states further afield, with the Gulf states, notably the UAE, particularly active in this regard. Egypt has signalled that once its own vaccine production is underway it will start regional distribution. Still, there is an evident absence of concerted policy or leadership leaving the Arab world ‘between a rock and hard place’ in the words of one commentator [
25].
The Gulf Cooperation Council (GCC), a sub-regional group comprising six Gulf littoral states: Bahrain, the Kingdom of Saudi Arabia (KSA), Kuwait, Oman, Qatar and the UAE, provides a useful point of contrast with the larger Arab body. The GCC, with an overall population of $58.5 m (and GDP of $5.5 bn) has been the most effective regional organization to date, despite inequalities and ongoing divides between two members, Saudi Arabia and Qatar. Formed in 1981, partly to secure the Gulf states against their powerful neighbours, Iraq and Iran, following Britain’s withdrawal from the Gulf region, it includes mostly high-income states, many with comparatively well-developed health and welfare systems. Common regime type, and economic and social linkages have helped to build functional cooperation and business networks, and the GCC has been regarded as the region’s most successful regional organization, until a divisive split occurred between Qatar and KSA in 2017. One important element from a health perspective is the region’s prior experience with MERS, a virus transmitted to humans through infected camels first reported in 2012, with KSA being the most affected state. Research showed variable public understanding of MERS, but preventive regional measures were widely adopted to deal with the outbreak – handwashing and mask-wearing for example - and these were undoubtedly a factor in better regional preparedness for COVID-19 [
26]. In addition, both KSA and Qatar have advanced and well-funded medical research and technology facilities, with both King Abdulla University of Science and Technology and the Qatar National Research Foundation being major players in the field. Both have supported rapid response COVID-19 programmes. Another factor in regional preparedness was the GCC’s experience with managing large scale tourism and migration. Not only does the Gulf, particularly the UAE, attract large numbers of tourists – it also receives millions of religious pilgrims annually in the Saudi case. Though tourism and the annual hajj were both curtailed during the worst periods of the pandemic, advanced monitoring systems using digital technology were already in place to regulate the movement of visitors and citizens which could be repurposed to control movement during critical periods [
27].
Against the above backdrop, there were early responses from GCC countries to successfully ‘flatten the curve’. Promising initiatives at the start of the COVID-19 crisis included the setting up of a Gulf crisis room to coordinate responses and a network to protect food supplies – a critical area given the region’s dependence on external food supply chains [
28]. And, as the economic impact of the COVID epidemic became evident, the wealthier Gulf states, including KSA, Qatar and UAE, introduced billion-dollar stimulus packages to help boost economies facing the heavy cost of lockdowns and falling oil prices. Individual states also made extensive use of innovative technology, with Qatar introducing a nation-wide coronavirus tracing app:
Ehteraz and the UAE rolling out a mass drive-through testing programme [
29]. Kuwait’s new healthcare app for women,
Nabta, also provides users with updated information on COVID-related health issues.
Many of the above measures lie more at the level of individual state policy and do not necessarily provide evidence of enhanced regional, or cross-border cooperation, but given the region’s interdependence, the potential spill-over benefits are considerable. And, there have been other positive indicators, including the lifting of the group’s three-year blockade against fellow member Qatar in early 2021, though for reasons not directly related to the pandemic, freeing the way for bloc-wide cooperation. GCC members have supported negotiations for a ceasefire in Yemen to allow the country better access to humanitarian assistance and respite from its devastating 7-year civil war. There has been increased engagement between Gulf states and Iran, primarily the UAE, which provided Iran early pandemic support, but also, and more tentatively, Saudi Arabia. Relations between these two countries were ruptured in 2016 amid serious differences over competing regional interests in Yemen, Iraq, Lebanon and Syria. Any move to mitigate the Saudi-Iran rivalry will have a positive regional spill-overs and help to support the development of a much-needed regional security system.
The above are piecemeal measures, and, as with handling of the COVID-pandemic, any fully coordinated response has not materialised, despite the potential benefits to all parties. In addition, as noted, pandemic measures have negatively impacted on other areas, like food supplies and labour mobility. Indeed a feature of the pandemic has been to expose the vulnerability of certain sectors of the Gulf population, particularly expatriate workers, on whom states depend for vital services, but who often live in more crowded and less sanitary conditions with unequal access to health provision [
30]. The absence of any region-wide mechanism to manage migration and labour conditions for such informal workers (many of whom are women) was a source of concern long before COVID struck, but the pandemic has brought their situation more sharply into focus, with evidence also suggesting that mortality rates among migrant workers have been considerably higher than among local populations. If the GCC, therefore, provides evidence of good practice and the potential benefits of pooling information, technology and resources, the initiative, as with the LAS, still often lies at the level of individual states with significant disparities between them. And critics have also highlighted some negative impacts of the ‘securitization’ of health policies, including the widespread use of health apps, which have increased the power and scrutiny of centralised authoritarian regimes and restricted individual rights and freedoms.
The
Arab Maghreb Union (AMU), another Arab-only subregional organization, in contrast to the GCC, is remarkable for its failure to design any collaborative initiatives to the pandemic. Founded in 1989, and comprising the five Arab countries of Northwest Africa (Algeria, Libya, Mauritania, Morocco, Tunisia), the AMU displayed early potential in repairing regional divides, building on economic interdependencies and improving relations with European partners. Divisions between key members, notably Algeria and Morocco, over the longstanding Western Sahara dispute, soon resurfaced, however, obstructing progress and keeping leaders away from the summit table. The AMU has existed mostly in name only - as a point of reference for possible coordination but not as an example of it. The World Economic Forum report in 2017 described it as one of the world’s worst performing trading blocs, pointing to multiple lost opportunities [
31]. The COVID-19 pandemic represents yet another missed opportunity for Maghreb cooperation. The low-to-middle incomes of Algeria, Morocco and Tunisia have all implemented far-reaching measures to contain the virus which has negatively affected their economies, and in the case of Tunisia, contributed to sustained political unrest, but despite the gravity of the situation faced by the region, its members have been unable to put aside political differences to support a common approach. The region experienced a high caseload in July/August 2021 and, despite a subsequent decline, Libya, and its (non-AMU) neighbour Egypt, continued to experience high rates of infection, while vaccination rates are uneven. Reuter’s early November data showed that Algeria and Libya had only fully vaccinated 13 and 15% of their respective populations in comparison with considerably higher rates in Morocca (65%) and Tunisia (40%) [
32].
If the
Maghreb – representing Western MENA - is currently a region without effective regionalism, the same is true of the Eastern MENA region, or
Mashriq, the historically and geographically interconnected states of the Eastern Mediterranean, or the Levant – Lebanon, Israel, the OPTs and Syria. Yet despite their many interdependencies, the Levant states lack any relevant grouping or collaborative body. This reflects historic divides between Israel and Arab states, but also between Mashriq states themselves. However, since the bilateral agreements whereby first Egypt (1979), then Jordan (1994), signed peace treaties with Israel, some barriers to cooperation have been removed. (In 2020, the US-brokered Abraham Accords, also saw the UAE and Bahrain enter agreements with Israel.) Israel’s world-leading efforts to combat and contain COVID-19 have been noted, though its early measures did not prevent subsequent waves, and, like other, mainly Western countries, it has been criticised for vaccine nationalism and ‘hoarding’. The conditions in the OPTs differ quite starkly, however, particularly the Gaza Strip with its overcrowded living conditions and limited access to medical supplies and facilities. The OPTs have received support from international bodies like the WHO and the OIC (see below). The situation has deteriorated since the outbreak of new hostilities between Gaza and Israel in May 2021 heightened the disparity of provision and Gaza’s fragile health infrastructure, leading to calls for more robust international and regional action including a rapid roll-out of vaccines to the OPTs. Indeed, the high levels of interdependence between Israel and the OPTs unite them as an ‘epidemiological unit’, making particularly urgent the need for cooperation, whether in respect of medical supplies, data sharing and support for more resilient medical structures [
33]. However, so far the COVID pandemic represents another lost opportunity for more creative diplomacy in the longstanding Israeli-Palestinian conflict [
34].
Among other Mashriq countries, Jordan’s response to the virus has also been robust, though giving rise to criticism of its aggressive policing of lockdowns and borders; Syria remains a country at war with still limited data available on the impact of the pandemic. In October 2021, however, Medecins Sans Frontiers (MSF) reported on the severity of a new wave which hit Northern Syria [
35].
Two other regional states, Turkey and Iran, remain outside any existing MENA grouping (though not the cross-regional OIC discussed below). Like Israel, both have relations with individual Arab states but have also drawn on external support and national self-reliance when it comes to pandemic responses. Though these two countries have experienced the highest caseloads in MENA: 8.1 m and 5.9 m respectively, [
36] Turkish fatalities to date (71,000) have been considerably lower than those of Iran (127,000) for reasons that relate to its early lockdown policy and more advanced healthcare provision, though some have questioned the reliability of reported figures [
37] Turkey had fully vaccinated over 60% its population by early November. The situation in Iran is particularly complex given the early onset and gravity of the pandemic, its relative regional and global isolation amid ongoing conflicts with Arab states, Israel and the West and the punitive effects of US sanctions. Though Iran’s health sector is comparatively well-developed, as is its research and technology base, its economy is particularly vulnerable due to the extent of the pandemic, the effects of declining oil prices and international sanctions which have limited its access to currency and vital supplies. While adopting a variety of lockdown and preventive measures, perhaps delayed because of the March Nowruz (New Year) celebrations, Iran remains the worst-hit MENA country. It has depended hitherto on vaccine supplies from China, Russia and India, as well as the COVAX programme, but initial vaccination rates were low – around 5% in July 2021 [
38]. The locally produced,
COVIran Barakat became available in June 2021, with Supreme Leader Ayatollah Khamenei publicly receiving an early dose [
39]. The expectations were to start producing 3 m vaccines monthly, to be increased to 11 pcm by the end of the year, making it potentially the largest regional vaccine producer and exporter to other states. But Iran’s vaccine roll-out has encountered obstacles, leading to further offers of external assistance, including a significant aid package from Japan, and the reversal of an earlier decision to refuse vaccine imports from the US and UK. Figures indicated that by early November, Iran had come close to vaccinating 50% of its population.
Aside from its own control and prevention measures, any easing of regional tensions would significantly improve Iran’s situation, as would a successful conclusion to continuing talks with the US over the terms of a renewed JCPOA and with it the lifting of international sanctions. Iran has signalled it is willing to engage in regional dialogue, but as 2021 draws to a close, the extent of that commitment, by Iran and other regional and international actors, remains to be tested [
40].
The Organization of Islamic Cooperation (OIC), finally, deserves mention as a body that crosses different world regions, including MENA, providing an umbrella grouping for Islamic-majority states around the world. A loose intergovernmental body, with a general commitment to economic development and well-being, its charter seeks to develop science and technology and encourage research and cooperation among member states [
41]. In this regard the OIC has been an active player in organizing events and workshops, disseminating information and providing support to Islamic states in need. A comprehensive report, issued in May 2020, detailed some of these measures, including assistance to conflict torn and vulnerable states and territories like Palestine and Yemen, creating a platform to encourage information-sharing and good practices, and the launching of a media awareness platform [
42]. A follow up report in October 2021, highlighted the impact of the crisis in the critical area of food security among member states [
43].
Like the LAS, though more effectively, the OIC has hosted online events, including a meeting with rectors of OIC universities to discuss collective strategies in the fight against COVID-19; another to combat fake news – not insignificant among member states where misinformation and vaccine hesitancy is reportedly high. Via its Islamic Solidarity Fund, it has offered tranches of assistance to OIC members; mainly Least Developed Countries or states with urgent humanitarian needs. Finally, it has regularly endorsed and supported individual state policy, for example in the testing and production of local vaccines, or in adopting COVID-compliant measures in respect of religious activity and festivals.
All the above instances of cooperation, both within and without regional and cross-regional organizations in MENA, offer a snapshot of some of the ongoing efforts to address the COVID-19 pandemic. While these are subject to change and review, they evidently fall short of an effective or collective response and need to be considered alongside other state-led and multilateral efforts. There has been no effective coordination of border controls, quarantine measures or procurement and distribution of medical supplies, including vaccines. Given the shortfalls of regional level action, MENA responses have depended heavily on the efforts of individual states and their overseas allies. The most vulnerable states and communities have depended on the COVAX programme and international assistance from a variety of sources. Of course, other regions, including Europe, have been heavily criticised for their slow and fragmented responses to the pandemic. But MENA stands out as a region where cooperative mechanisms are weak and the demand for collective action high, particularly given the prevailing high levels of inequality and conflict. It has performed less well than peers. Here a contrast with a region like Southeast Asia is instructive. The Association of South East Asian Nations (ASEAN) has a comprehensive and updated web page which effectively track the region’s cases and responses [
44]. Another contrast is provided by the far less well resourced, African Union, where the region’s ministers of health have endorsed a coordinated strategy in the fight against COVID [
45].