Introduction In January 2012 the authors visited Haima Hospital in the Jiddat-il-Harasiis, Al Wusta province, Sultanate of Oman (Figure 1). It is the most remote secondary health care service in the country--nearly five hundred miles from the capital, Muscat, and five hundred miles from Salalah in the south (Figure 2). The visit was part of a larger research initiative to document contemporary life among the Harasiis pastoral camel- and goat-herding nomads and those Harasiis families newly settled in the government-built 'tribal centre' at Haima. This initiative followed on from the original United Nations Development Programme (UNDP) project to extend government services to pastoral nomads in the interior deserts of Oman without forcing them to settle. The UNDP project helped support the development of weekly boarding schools, mobile primary health care and expanded immunization initiatives as well as the establishment of social affairs offices, veterinary support and other government initiatives (Chatty 1996: 92). The Harasiis are a mobile herding tribe of approximately five thousand people spread out over a traditional territory, which they have occupied for several centuries, of about forty-two thousand square miles, an area about the size of Scotland, along the edge of the Empty Quarter (Rub' al-Khali). For several decades, the government of the Sultanate has tried to extend meaningful health services to this largely mobile if not entirely nomadic population. Over the years several hospitals have been built on this site; and mobile services have been initiated and just as suddenly stopped. Difficulties in maintaining a consistent level of use have meant that it has been very hard to retain staff and the services offered at these institutions have generally shrunk to the bare minimum, making the hospitals at times no more than primary health care units. This report attempts to examine the difficulties of providing secondary health care services to a widely dispersed population and makes a number of suggestions for enhancing and improving health care delivery to remote and widely dispersed populations in general. Background Basic health care provision for pastoral peoples in the Middle East has been difficult to provide due to their remoteness and mobility. These marginal mobile or recently settled populations have had limited access to government health care provision. In addition, the populations of the Middle East have experienced particularly rapid socio-economic change over the past forty years, due largely to the discovery and exploitation of oil and the consolidation of the nation state. The basic social, political and cultural rights of the pastoral populations of the peninsula have largely been ignored, in part due to their remoteness and inaccessibility, but also due to the very fact of their mobility. Government services, based upon Western models, are designed for fixed, permanently domiciled populations. The organization of pastoral societies, with their mobile and constantly shifting households, does not fit into existing paradigms of Western-inspired development. A shortage in the resources and funds of government ministries has restricted public health services and the establishment of mobile clinics. Furthermore, pastoral societies' communal, traditional pattern of land use has not been understood by states in the region. This has resulted in serious societal upheaval, loss of control over vital grazing lands and often coercive pressure to settle and farm or enter the unskilled labour market. In the arena of health care, these marginal, mobile and remote populations have largely been excluded or have excluded themselves from government initiatives. Those that have settled have had only limited provision within or nearby their rural villages. In addition, the providers are largely focused on curative aspects rather than health promotion and disease prevention. [FIGURE 1 OMITTED] [FIGURE 2 OMITTED] Many of the Harasiis have moved into social housing provided by the government in the tribal centre at Haima. …
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