Time for the renaissance of medicine in the Middle East

Abstract

The Middle East is the most neglected health arena in the world today. That this is so is no surprise given its constant media portrayal as a centre of violence and terror—especially at this tense time of finalising the Hamas government in Palestine, the Israeli elections, and the third anniversary of the start of the Iraq war. It is understandably easy to be gloomy, but The Lancet this week presents an alternative, more positive, yet still challenging, portrait of the region. Those working in the privileged world of western medicine all too easily forget the origins of the profession. Much of the credit for early medical discoveries is owed to physicians from the Middle East in the first millennium. Perhaps the most famous example is Avicenna (whose real name, Ibn Sina, better reflects his Persian nationality). He was the author of The Canon, the 10th Century textbook hailed as the “medical bible” and the first to discover the contagious nature of pulmonary tuberculosis. He also emphasised the importance of dietetics, climate, and the environment in health. The Persian born Al-Razi (more commonly referred to as Rhazes) who advocated an ethical framework for medical practice, is also credited with the first accurate account of smallpox. Ibn Al-Nafis, born in Damascus in 1213, was the pioneer of scientific peer review, and the first to describe the pulmonary circulation, although it remained largely unknown until the later dissections of William Harvey. These early achievements should serve as a reminder of the intelligence and innovation originating from health professionals in the Middle East. Unfortunately, the status of health and medicine in the region today is often compromised by political unrest and compounded by public-health, infection-control, and educational challenges. This complex situation was analysed by the UN in a trio of Arab Human Development Reports that focused on “the three deficits of the Arab world”: knowledge, women's empowerment, and freedom. Poor education has resulted in large numbers of illiterate people, and this region, once a leader in research, has fallen behind the rest of the developed world in scientific breakthroughs and clinical advancement. Gender inequality is endemic—UN reports conclude that one in every two Arab women can neither read nor write. These problems, in addition to the disruption to public services, including hospitals, caused by ongoing conflict in many areas, show that a radical change in local and international attitudes towards health in the Middle East is long overdue. Promisingly, many laudable efforts are already underway. In direct response to the UN development reports, the first national gender mainstreaming effort in the Arab region was launched on March 8, coinciding with International Women's Day. Also this month, WHO announced that Egypt is now “polio-free” following concerted efforts and international collaborations to prevent the disease over the past 3 years. The UN Programme of Assistance to the Palestinian People (PAPP) now triumphantly claims that a health education programme for the improvement of personal hygiene and health awareness has been established for children in schools throughout the Palestinian territories, and more than 100 health clinics in the area have been established or renovated since 1980. Encouragingly, Kuwait has shown enormous progress in the race towards the Millennium Development Goals, having already reduced the rate of under-five child mortality from 13 per thousand in 1993 to 9·9 per thousand in 2003. For true success, however, these achievements from oil-rich countries such as Kuwait, must also be replicated in their less wealthy neighbours. It is reassuring to know that successful international collaborations are emerging between countries in the Middle East and the west: the Cedars-Jebel Ali International Hospital in the United Arab Emirates has recently teamed up with the Klinikum Stuttgart Teaching Hospital in Germany to develop a doctor-exchange programme and a postgraduate nursing school. Whilst these individual initiatives should be applauded, a more comprehensive and ambitious approach is needed to scale up improvements in the health and wellbeing of all populations in the Middle East. As one time world leaders in science and medicine, the exceptional contributions made by physicians from the Middle East must be respected and remembered. Global interest in health can be used as a tool to depoliticise this troubled region and to forge partnerships without always looking through a prism of violence. Only then will current embryonic health initiatives serve as catalysts for the renaissance of medicine in the Middle East—a true and lasting benefit for all people in the region and beyond.