The Caravan

The Pandemic In The Middle East: Unexpected Results And Pending Shifts

Tuesday, June 16, 2020

As bad as the cumulative impact of COVID-19 in terms of loss of life has been, it has been less devastating than initially predicted. At least such are the results to date, in mid-May 2020. The trajectory of the pandemic may of course still change, and a second wave may yet follow, but the estimation in the Imperial College study of 2,200,000 deaths in the US alone turns out, fortunately, to have been far over the mark; as of today (May 17,2020), the Johns Hopkins Resource Center reports 87,530 US COVID-19 related deaths.

In addition, the dire predictions of the impact of the pandemic in the poor countries of the developing world with their weaker health care infrastructures have proven wrong. So far (and again, things may change) the pandemic appears to have spread mainly from China into Iran, Europe and North America, while the numbers in Africa and elsewhere in the developing world are comparatively low. While further differentiated study is needed, in general –with the exception of China and Iran—the pandemic has appeared to be primarily a “first world problem.” As of mid-April, researchers found that nearly half of COVID-19 fatalities took place in the 27 countries of the European Union, and some 38% in other developed democracies, leaving only 12% in the rest of the world, i.e. developing countries. The statistics for the Middle East bear this out.

Consider these comparisons, drawn from the Johns Hopkins statistics. Egypt has a population of some 98 million but reports only 592 pandemic deaths, i.e. 0.60 deaths per 100,000. In comparison, France with a much smaller population of 66 million counts 27,532 deaths, meaning 41.10 per 100,000. One might object that Egypt may be undercounting due to lack of sufficient infrastructure, but the pattern is corroborated by other comparisons. Let us turn to another example: Turkey has a population of 84 million people and Germany stands at 83 million, so they are nearly equivalent. Yet Turkey totals 4,055 COVID-19 deaths, in comparison to Germany at 7,897; their respective rates per 100,000 are 4.93 (Turkey) and 9.52 (Germany). The numbers for Turkey and Germany are clearly closer to each other than are Egypt and France, but here too the wealthier, more developed Germany fared much worse than the poorer Turkey. What’s more, Germany is an exceptional case, having made it through the pandemic at this point with many fewer losses than other European countries, as is evident by a comparison of the French and German fatality numbers. Germany can be regarded as a very good case (if not the best) in the developed world, but its performance nonetheless lags far behind Turkey’s. That Germany did well in contrast to other European countries or the US is a topic for another context. The point here is that the disease has hit wealthier Europe and the United States in a more devastating way than it has other parts of the world, especially the Middle East.

This relatively lower fatality rate in the Middle East is confirmed when we take a broader view. As a benchmark for a developed country, we can pick the United States which according to Johns Hopkins shows a fatality/100,000 rate of 26.75, interestingly approximately midway between France (41.10) and Germany (9.52). The Middle East contrasts are stark: Saudi Arabia at 0.87, UAE at 2.18, Iraq at 0.30, Kuwait at 2.32, and Jordan at 0.09. At 2.99, Israel clearly behaves more like a Middle Eastern country than a European one. The outlier is Iran at 8.44, much higher than the rest of the region, but still lower than the West. Its special circumstances include stronger ties to China and hence a greater number of infected visitors, plus the reluctance of the authorities in the Islamic Republic to institute social distancing and lockdown, especially at shrines.

These unexpected results need an explanation, bearing in mind of course that the pandemic has not been mastered, and we may yet see an expansion in the developing world, including the Middle East. Nonetheless the results are striking. Any explanation is likely to be multifactorial, but one aspect surely involves the age demographics of the Middle Eastern countries. According to news reports on fatalities in the developed world, the virus proves particularly dangerous to older patients who make up the overwhelming number of deaths. The relative youth of the population in the Middle East may therefore account for some of differential impact. According to the 2018 CIA World Factbook—and to stick with the previous examples—the median age in Egypt is 23.4 years in contrast to France, nearly twice as old, at 41.4; the median in Turkey is 30.8 and Germany 47.1. To the extent that the virus discriminates on the basis of age, the younger developing world turns out to be safer. In other words, the higher fatality rates in the West involve older demographic groups who are relatively underrepresented in the younger, Middle Eastern populations.

It may also be the case that more elaborate health care infrastructure in the developed world, from one angle at least, turned into a negative factor. Nursing homes, i.e. concentrations of older and ill patients, represented particularly concentrated sites of COVID deaths, in part simply because of the age demographics but potentially in part as a result of misguided policies in some US states to place allegedly recovering patients in them, where they contaminated the rest of the population. It would be worth asking whether similar facilities exist in the Middle East and whether they too turned into contaminated centers. To the extent that such centers are less frequent in poorer countries, that might also account for the differential outcomes.

Furthermore, anecdotal reports indicate that at least in some countries, such as Jordan and Israel, authorities pursued a relatively severe lockdown, strictly limiting the scope of the population’s mobility from the formal place of residence. Was there a political capacity to police public behavior more effectively than in the West? Yet on this score, there was variation within Europe as well, with France for example pursuing quite strict measures. More comparative international studies of the management of the lockdown need to be undertaken. Impressionistically it seems also that smaller countries were able to respond better to the pandemic. Greece succeeded to limit COVID-19 fatalities to 1.49/100,00; Poland 2.39; Czechia 2.78 and Hungary 4.52. These outcomes are close to, although higher than some of the Middle Eastern rates, but in any case, far below France, the US, and Germany. The size of the country may matter in the capacity to enforce a protective regimen successfully, and this could help us understand some of the Middle East results (Bahrain at 0.76 or Morocco at 0.53).

Still, skeptics can argue that there may be differences in the ability of different countries to count their COVID-19 fatalities, especially where there are fewer public health resources. It is also possible that there is some intentional undercounting. However, the pattern appears to be so widespread that the overall result is likely to hold up to closer scrutiny.

This pattern of a relatively limited public health impact in the Middle Eastern countries, as compared to Europe and North America, suggests that the political consequences of the pandemic in the region may not turn out to be tectonic. Perhaps one should be looking for micro-effects on political processes, some limited shifts in public opinion polls, and the relative rise or fall of political parties that succeed or fail in profiling themselves in the face of the pandemic. To date, however there is no indication that COVID-19 alone will change a regime, no matter how it may have raised some doubts about leadership in Turkey, Iran or Saudi Arabia. In some countries the pandemic may in fact have the opposite effect to the extent that the government is perceived as having prevented a crisis on the order of what Middle Easterners can see unfolding in Europe.

The primary impact of the pandemic in the Middle East is therefore likely to take another path, more indirectly, to the extent that it has hurt the external actors: the great powers, who have long pursued their own foreign policy agendas in the region i.e., the United State, the countries of Europe and the European Union, Russia and China. All of them have been dealt severe blows by the virus, and all of them face considerable economic challenges, as will the world economy as a whole. The United States and Europe especially have committed themselves to massive stimulus programs to mitigate the impact of the lockdown. While this spending has macroeconomic justification in the face of the crisis, it will also burden these countries with considerable debt, which will have to be serviced in the future. As a result, there will be pressure on future spending in the areas of defense or foreign aid. In other words, western countries will have reduced flexibility in terms of their foreign policies, including in the Middle East. Similar effects are certain to unfold in China and Russia as well, although our insight into their budget processes is limited. The net effect is likely to mean less ability by external actors to pursue ambitious agendas in the region, simply for lack of resources.

For years, there has been speculation concerning American withdrawal from the Middle East, but it has only played out in fits and starts. It could be that the COVID-19 recession so restricts great power budgets that a general withdrawal finally takes place. In any case, the political dynamic between regional actors and their extra-regional benefactors will change. To be sure, the benefit for Russia to reach into the Mediterranean or for China to expand its Belt and Road, or for the West to pursue its own similar interests—all this will continue. Yet in all countries, there will be one overriding question: how to pay for it?