COVID-19 in the MENA Region: Facts and Findings.

BackgroundDonor countries in the Middle East and North Africa (MENA) including Saudi Arabia, Kuwait and United Arab Emirates (UAE) have been among the largest donors in the world. However, little is known about their contributions for health. In this study, we addressed this gap by estimating the amount of development assistance for health (DAH) contributed by MENA country donors from 2000 to 2017.MethodsWe tracked DAH provided and received by the MENA region leveraging publicly available development assistance data in the Development Assistance Committee (DAC) database of the Organisation for Economic Co-operation and Development (OECD), government agency reports and financial statements from key international development agencies. We generated estimates of DAH provided by the three largest donor countries in the MENA region (UAE, Kuwait, Saudi Arabia) and compared contributions to their relative gross domestic product (GDP) and government spending; We captured DAH contributions by other MENA country governments (Egypt, Iran, Qatar, Turkey, etc.) disbursed through multilateral agencies. Additionally, we compared DAH contributed from and provided to the MENA region.ResultsIn 2017, DAH contributed by the MENA region reached $514.8 million. While UAE ($220.1 million, 43.2%), Saudi Arabia ($177.3 million, 34.8%) and Kuwait ($59.8 million, 11.6%) as sources contributed the majority of DAH in 2017, 58.5% of total DAH from MENA was disbursed through their bilateral agencies, 12.0% through the World Health Organization (WHO) and 3.3% through other United Nations agencies. 44.8% of DAH contributions from MENA was directed to health system strengthening/sector-wide approaches. Relative to their GDP and government spending, DAH level fluctuated across 2000 to 2017 but UAE and Saudi Arabia indicated increasing trends. While considering all MENA countries as recipients, only 10.5% of DAH received by MENA countries were from MENA donors in 2017.ConclusionMENA country donors especially UAE, Saudi Arabia and Kuwait have been providing substantial amount of DAH, channeled through their bilateral agencies, WHO and other multilateral agencies, with a prioritized focus on health system strengthening. DAH from the MENA region has been increasing for the past decade and could lend itself to important contributions for the region and the globe.

The main purpose of this study is to measure the technical efficiency of twenty health systems in the Middle East and North Africa (MENA) region to inform evidence-based health policy decisions. In addition, the effects of alternative stochastic frontier model specification on the empirical results are examined. We conducted a stochastic frontier analysis to estimate the country-level technical efficiencies using secondary panel data for 20 MENA countries for the period of 1995-2012 from the World Bank database. We also tested the effect of alternative frontier model specification using three random-effects approaches: a time-invariant model where efficiency effects are assumed to be static with regard to time, and a time-varying efficiency model where efficiency effects have temporal variation, and one model to account for heterogeneity. The average estimated technical inefficiency of health systems in the MENA region was 6.9% with a range of 5.7-7.9% across the three models. Among the top performers, Lebanon, Qatar, and Morocco are ranked consistently high according to the three different inefficiency model specifications. On the opposite side, Sudan, Yemen and Djibouti ranked among the worst performers. On average, the two most technically efficient countries were Qatar and Lebanon. We found that the estimated technical efficiency scores vary substantially across alternative parametric models. Based on the findings reported in this study, most MENA countries appear to be operating, on average, with a reasonably high degree of technical efficiency compared with other countries in the region. However, there is evidence to suggest that there are considerable efficiency gains yet to be made by some MENA countries. Additional empirical research is needed to inform future health policies aimed at improving both the efficiency and sustainability of the health systems in the MENA region.

Myelodysplastic syndrome (MDS) describes a group of bone marrow malignancies with variable morphologies and heterogeneous clinical features. The aim of this study was to systematically appraise the published clinical, laboratory, and pathologic characteristics and identify distinct clinical features of MDS in the Middle East and North Africa (MENA) region. We conducted a comprehensive search of the PubMed, Web of Science, EMBASE, and Cochrane Library databases from 2000 to 2021 to identify population-based studies of MDS epidemiology in MENA countries. Of 1935 studies, 13 independent studies published between 2000 and 2021 representing 1306 patients with MDS in the MENA region were included. There was a median of 85 (range 20 to 243) patients per study. Seven studies were performed in Asian MENA countries (732 patients, 56%) and six in North African MENA countries (574 patients, 44%). The pooled mean age was 58.4 years (SD 13.14; 12 studies), and the male-to-female ratio was 1.4. The distribution of WHO MDS subtypes was significantly different between MENA, Western, and Far East populations (n = 978 patients, p < 0.001). More patients from MENA countries were at high/very high IPSS risk than in Western and Far East populations (730 patients, p < 0.001). There were 562 patients (62.2%) with normal karyotypes and 341 (37.8%) with abnormal karyotypes. Our findings establish that MDS is prevalent within the MENA region and is more severe than in Western populations. MDS appears to be more severe with an unfavorable prognosis in the Asian MENA population than the North African MENA population.

Regional energy and carbon emissions concerns: Towards cleaner energy transition in Middle East and North Africa

ObjectivesDespite the rising risk factor exposure and non-communicable disease (NCD) mortality across the Middle East and the North African (MENA) region, public health policy responses have been slow and appear discordant with the social, economic and political circumstances in each country. Good health policy and outcomes are intimately linked to a research-active culture, particularly in NCD. In this study we present the results of a comprehensive analysis of NCD research with particular a focus on cancer, diabetes and cardiovascular disease in 10 key countries that represent a spectrum across MENA between 1991 and 2018.MethodsThe study uses a well validated bibliometric approach to undertake a quantitative analysis of research output in the ten leading countries in biomedical research in the MENA region on the basis of articles and reviews in the Web of Science database. We used filters for each of the three NCDs and biomedical research to identify relevant papers in the WoS. The countries selected for the analyses were based on the volume of research outputs during the period of analysis and stability, included Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Turkey and the United Arab Emirates.ResultsA total of 495,108 biomedical papers were found in 12,341 journals for the ten MENA countries (here we consider Turkey in the context of MENA). For all three NCDs, Turkey's output is consistently the highest. Iran has had considerable growth in research output to occupy second place across all three NCDs. It appears that, relative to their wealth (measured by GDP), some MENA countries, particularly Oman, Qatar, Kuwait and the United Arab Emirates, are substantially under-investing in biomedical research. In terms of investment on particular NCDs, we note the relatively greater commitment on cancer research compared with diabetes or cardiovascular disease in most MENA countries, despite cardiovascular disease causing the greatest health-related burden. When considering the citation impact of research outputs, there have been marked rises in citation scores in Qatar, Lebanon, United Arab Emirates and Oman. However, Turkey, which has the largest biomedical research output in the Middle East has the lowest citation scores overall. The level of intra-regional collaboration in NCD research is highly variable. Saudi Arabia and Egypt are the dominant research collaborators across the MENA region. However, Turkey and Iran, which are amongst the leading research-active countries in the area, show little evidence of collaboration. With respect to international collaboration, the United States and United Kingdom are the dominant research partners across the region followed by Germany and France.ConclusionThe increase in research activity in NCDs across the MENA region countries during the time period of analysis may signal both an increasing focus on NCDs which reflects general global trends, and greater investment in research in some countries. However, there are several risks to the sustainability of these improvements that have been identified in particular countries within the region. For example, a lack of suitably trained researchers, low political commitment and poor financial support, and minimal international collaboration which is essential for wider global impact.

PurposeThis study aims to investigate the factors contributing to the low adoption rate of mobile money services (MMS) in the Middle East and North Africa (MENA) region compared to other regions. The study focussed on socio-demographic factors and macro-level determinants in several selected MENA and Sub-Saharan African (SSA) regions where MMS have been successful.Design/methodology/approachThis study analysed 23 countries across MENA and SSA to establish the correlation between socio and macroeconomic factors and MMS adoption using a quantitative approach. The analysis used the generalized least square (GLS) method.FindingsThe study revealed that gender and income are factors that positively influence the adoption of MMS in MENA and SSA regions. Additionally, the study found that the affordability index, which measures macroeconomic indicators, correlates with MMS adoption in both regions but in an inversed way. On the other hand, political stability appears to have a positive correlation with MMS adoption in the MENA region. The correlation between the regulatory index and MMS adoption positively impacts the entire study group, although it is insignificant in the SSA region.Research limitations/implicationsFuture studies should assess market competition among MMS providers and the psychological aspect of user adoption behaviour. Additionally, conducting a focus group discussion with stakeholders in the MMS industry can assist in uncovering potential factors contributing to low MMS adoption in the MENA region.Originality/valueThis study contributes to understanding the role of the socio-demographic and macroeconomic determinants in promoting digital transformation through adopting MMS.

Background It is widely perceived that little is known about the epidemiology of HIV infection among people who inject drugs (PWID) in the Middle East and North Africa (MENA). The primary objective of this study was to assess the status of the HIV epidemic among PWID in MENA by describing HIV prevalence and incidence. Secondary objectives were to describe the risk behavior environment and the HIV epidemic potential among PWID, and to estimate the prevalence of injecting drug use in MENA. Methods This was a systematic review following the PRISMA guidelines and covering 23 MENA countries. PubMed, Embase, regional and international databases, as well as country-level reports were searched up to December 16, 2013. Primary studies reporting 1) the prevalence/incidence of HIV, other sexually transmitted infections, or hepatitis C virus (HCV) among PWIDs; or 2) the prevalence of injecting or sexual risk behaviors, or HIV knowledge among PWID; or 3) the number/proportion of PWID in MENA countries, were eligible for inclusion. The quality, quantity, and geographic coverage of the data were assessed at country level. After multiple level screening, 192 eligible reports were included in the review. There were 197 HIV prevalence measures on a total of 58,241 PWID extracted from reports, and an additional 226 HIV prevalence measures extracted from the databases. Findings We estimated that there are 626,000 PWID in MENA (range: 335,000-1,635,000, prevalence of 0.24 per 100 adults). We found evidence of HIV epidemics among PWID in at least one-third of MENA countries, most of which are emerging concentrated epidemics and with HIV prevalence overall in the range of 10-15%. Some of the epidemics have however already reached considerable levels including some of the highest HIV prevalence among PWID globally (87.1% in Tripoli, Libya). The relatively high prevalence of sharing needles/syringes (18-28% in the last injection), the low levels of condom use (20-54% ever condom use), the high levels of having sex with sex workers and with men who have sex with men (15-30% and 2-10% in the last year, respectively), and of selling sex (5-29% in the last year), indicate a high injecting and sexual risk environment. The prevalence of HCV (31-64%) and of sexually transmitted infections suggest high levels of risk behavior indicative of the potential for more and larger HIV epidemics. Conclusions Our study identified a large volume of HIV-related biological and behavioral data among PWID in the MENA region. The coverage and quality of the data varied between countries. There is robust evidence for HIV epidemics among PWID in multiple countries, most of which have emerged within the last decade and continue to grow. The lack of sufficient evidence in some MENA countries does not preclude the possibility of hidden epidemics among PWID in these settings. With the HIV epidemic among PWID in overall a relatively early phase, there is a window of opportunity for prevention that should not be missed through the provision of comprehensive programs, including scale-up of harm reduction services and expansion of surveillance systems.

Purpose This study explores how ethical governance frameworks operate in environmental, social and governance (ESG) areas in Middle East and North Africa (MENA) nations. This study focusses on present systems, cultural changes and outcomes since 2021. This study examines how traditional governance aligns with modern ethical values to promote accountability in the region. Design/methodology/approach This study employed a mixed-methods research design, combining quantitative analysis of governance data from eight MENA countries (UAE, Saudi Arabia, Qatar, Bahrain, Jordan, Egypt, Morocco and Oman) with a qualitative institutional framework assessment. The study used data from the World Bank Governance Indicators, Transparency International Corruption Perception Index and Refinitiv ESG scores for 2022–2024. It analysed 248 randomly selected companies. Findings The findings show that Ethical governance varies significantly across countries. Gulf Cooperation Council (GCC) countries have stronger frameworks, but struggle with transparency. Research limitations/implications This study shows some temporal limits. It covers data from 2022 to 2024 and focusses on eight countries. The numbers may not precisely outline informal governance procedures in MENA nations. There are also challenges with data reliability because the corruption records cover 2023–2024, while other governance indicators cover 2022–2024. Practical implications This study shows that traditional cultural values can enhance modern governance rather than hinder it. It highlights inclusive governance methods that maintain cultural authenticity while meeting international expectations, supporting sustainable economic development in the MENA region. Originality/value This study presents the first comprehensive post-2021 comparative analysis of the implementation of ethical governance across diverse MENA institutional environments. This study develops a novel framework, “Cultural-Institutional Complementarity”, that explains how Islamic ethical principles enhance the effectiveness of governance.

Background: Improving food and nutrition literacy is fundamental to tackling the Middle East and North Africa (MENA) region’s enormous challenges, including malnutrition and food insecurity. To direct initiatives, it is crucial to assess the region’s food and nutrition literacy. Thus, we aimed to review studies on food/nutrition literacy status in the MENA countries and illuminate the region’s research gaps in these areas, in terms of assessment, policy, and program implementation. Methods: PubMed and Google Scholar databases were searched between 18 December and 8 May 2022, to identify relevant articles published up to 2022 in the MENA region. Results: Twelve studies were included in this review. Lebanon, Palestine, and Iran are the only three MENA countries where nutrition and/or food literacy were assessed. People in these countries mostly had inadequate food and/or nutrition literacy levels, especially in the skills rather than the cognitive domain. Food and/or nutrition literacy showed associations with food habits, food-label use, food-consumption patterns, school performance, food security, dietary diversity, and nutrient adequacy. The MENA countries developed no policies or programs to address food and nutrition literacy. Conclusion: This review is a wake-up call for researchers and policymakers to develop a robust approach to combat food and nutrition literacy concerns in the MENA region.

Background and Objectives:Helicobacter pylori (H. pylori) infection is common worldwide and may cause gastroduodenal complications, including cancer. In this review, we examine the prevalence and distribution of various H. pylori genotypes and the risk factors for H. pylori infection, particularly in the Middle East and North Africa (MENA) region. We also introduce different global screening methods and guidelines and compare them to those currently in use in the MENA region. Materials and Methods: We searched the Google Scholar, PubMed, and Saudi Digital Library (SDL) databases for clinical trials and articles published in English. The data collection was mainly focused on MENA countries. However, for H. pylori genotypes and diagnostic methods, studies conducted in other regions or reporting global practices and guidelines were also included to allow a comparison with those in the MENA region. We also included studies examining the prevalence of H. pylori infection in healthy participants. Results:H. pylori infection is highly prevalent in the MENA region, mainly because of the accumulation of risk factors in developing countries. Herein, we highlight a lack of good quality studies on the prevalence of various H. pylori genotypes in the MENA region as well as a need for standard diagnostic methods and screening guidelines. Due to the complications associated with H. pylori, we recommend routine screening for H. pylori infection in all gastroenterology patients admitted in the MENA region. Conclusion: Concerted effort will first be required to validate affordable, non-invasive, and accurate diagnostic methods and to establish local guidelines with adapted cut-off values for the interpretation of the test results.

PurposeDespite the significant role of remittances in the Middle East and North Africa (MENA) region, their impact on income inequality has received limited attention in related research, especially in times of political instability. Therefore, this paper explores the moderating effect of political stability on the strengthening of the relationship between remittance inflows and income inequality in MENA countries over the period 1996–2022.Design/methodology/approachThis paper utilizes the pooled mean group (PMG) approach. For robustness, Dumitrescu and Hurlin’s (2012) panel Granger non-causality test has been conducted, revealing the absence of reverse causality.FindingsThis paper demonstrates that remittance inflows increase income inequality in MENA recipient countries, indicating that most individuals receiving remittances in the MENA region are predominantly from well-off families. In addition, political stability reduces income inequality in MENA recipient countries, while remittance inflows increase income inequality when the polity becomes less stable.Practical implicationsWe recommend addressing obstacles faced by low-income groups seeking migration, especially in countries with high unemployment rates, such as deficiencies in education, skills, information asymmetry and financial constraints. Additionally, supplementary policies, such as directing resources toward pro-poor projects, particularly those that improve education, health and infrastructure, should be implemented to mitigate the adverse effects of remittances on income distribution. Finally, priority must be given to policies that promote political stability to create a business environment conducive to human and physical investments.Originality/valueThe paper addresses the impact of remittances on income inequality in the MENA region, which has received limited attention in previous research.

Background: Meat adulteration poses serious public health, economic, and religious concerns, particularly in the Middle East and North Africa (MENA) and Gulf Cooperation Council (GCC) regions where halal authenticity is essential. While isolated studies have reported undeclared species in meat products, a comprehensive regional synthesis of prevalence, detection technologies, and regulatory responses has been lacking. Methods: This scoping review followed PRISMA-ScR guidelines. A systematic search of PubMed, Scopus, and Web of Science from database inception to 15 September 2025 was conducted using controlled vocabulary (MeSH) and free-text terms. Eligible studies included laboratory-based investigations of meat adulteration in MENA and GCC countries. Data were charted on study characteristics, adulteration types, detection methods, and regulatory context. Results: Out of 50 records screened, 35 studies were included, covering 27 MENA/GCC countries. Prevalence of adulteration varied widely, from 5% in UAE surveillance studies to 66.7% in Egyptian native sausages. Undeclared species most frequently detected were poultry, donkey, equine, pig, and dog. Molecular methods, particularly PCR and qPCR, were most widely applied, followed by ELISA and spectroscopy. Recent studies introduced biosensors, AI-assisted spectroscopy, and blockchain traceability, but adoption in regulatory practice remains limited. Conclusions: Meat adulteration in the MENA and GCC regions is localized and product-specific rather than uniformly widespread. Detection technologies are advancing, yet regulatory enforcement and halal-sensitive verification remain fragmented. Strengthening laboratory capacity, harmonizing regional standards, and investing in portable biosensors, AI-enhanced spectral tools, and blockchain-based traceability are critical for consumer trust, halal integrity, and food safety.

Previous studies have mainly focused on individual mental disorders, and there is no study addressing the total burden of mental disorders in the Middle East and North Africa (MENA). To evaluate the burden of mental disorders in the MENA region from 1990 to 2019. A cross-sectional study. We utilized global burden of disease data to examine the burden of 12 mental disorders from 1990 to 2019 across age groups, genders, and the 21 MENA countries. We collected data on prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALY), including both crude and age-standardized rates per 100,000 people. The DALY rate of mental disorders in MENA countries increased by 13.88% from 1,747.92 per 100,000 people in 1990 to 1990.5 per 100,000 people in 2019. The highest percentage increases in the DALY rates of mental disorders were observed for bulimia nervosa (35.69%), other mental health disorders (34.58%), and schizophrenia (33.02%) from 1990 to 2019. However, the DALY rates for idiopathic developmental intellectual disability (-26.48%), conduct disorder (-23.91%), attentiondeficit/ hyperactivity disorder (-16.46%), and autism spectrum disorders (-4.12%) decreased in the MENA region from 1990 to 2019. In 2019, the highest DALY rates for idiopathic developmental intellectual disability, anxiety disorders, and major depressive disorder were observed in age groups ≤ 4 years, 5-19 years, and ≥ 20 years, respectively. The age-standardized DALY rate of mental disorders was the highest in Palestine (2,396.9 per 100,000), Iran (2,295.8 per 100,000), and Lebanon (2,126.0 per 100,000) compared with other MENA countries in 2019. There has been a slight increase in the burden of mental disorders in the MENA region between 1990 and 2019. National policies should prioritize evidence-based preventive measures and ensure accessible treatment options for mental health disorders in the population, especially in the MENA region.

BackgroundCountries in the Middle East and North Africa (MENA) region have been investing in the development of their health systems through implementing reforms to improve health care delivery for their nations. However, these countries are still facing challenges in providing equitable, high quality healthcare services. There is limited published literature supporting the previous and ongoing attempts that have been made to improve health system performance in MENA countries.AimsThis review aims to describe experiences of health system development efforts in the MENA region, highlight progress, identify challenges that need be addressed and future opportunities to achieve responsive and efficient health systems. It also aimed to provide recommendations to further support these health systems toward evolution and performance improvement.MethodsA literature review was conducted by searching different databases including PubMed, Scopus, Google Scholar and other electronic resources to identify articles and publications describing health systems development in the MENA region from 1975 to 2022. It also included grey literature, reports and policy and planning documents by international organizations. The identified references were reviewed to extract, analyze, organize and report the findings.ResultsThe review revealed emerging evidence describing governmental initiatives to introduce health system reforms at different levels in the MENA countries. These include initiatives targeting the various elements controlling health system reform: financing, payment, organization, regulation and behavior of providers and consumers. There are several challenges facing the health systems of MENA countries including the rising burden of chronic diseases, inequitable access to health services, deficiency in health workforce, shortage in the use of effective health information systems and leadership challenges. The review identified several key areas that can benefit from further improvement to support health system reforms. These include improving the structure, organization and financing of health systems, health workforce development, effective data management and engagement of key stakeholders to achieve adequate health system reforms.ConclusionThe MENA countries have made significant steps to improve the performance of their health systems; yet achieving a comprehensive health reform will require collaboration of various stakeholders including health policy makers, healthcare professionals, and central to the success of the reform, the patients.

In the Middle East and North Africa (MENA) region, Small and Medium Enterprises (SMEs) are now widely recognized as engines of economic development. This paper discusses the importance of SMEs in the MENA economic area and identifies the challenges and barriers facing SMEs in MENA countries. In addition, this study analyses the effects of two &amp;#39;black swan&amp;#39; Coronavirus disease (COVID-19) phenomena and a decline in oil prices on the economy of MENA in 2020. The current study found that the most significant challenges were identified as lack of access to finance, lack of managerial expertise, inefficiencies of government, lack of a well-trained workforce, inadequate infrastructure, corruption and bureaucratic obstacles. Among these challenges, the lack of access to finance appears to be the major challenge and suggests that future research is required to identify the role of Islamic finance models in the financing of SMEs in MENA countries. This research provides all stakeholders with policy implications intended for enhancing the different features of SME improvement in the MENA region and generally in developing countries.