Mohamed Ezz‏‏

Traditional military and political transformations are no longer the most significant threats to the security and stability of Middle Eastern countries. Instead, non-traditional threats stemming from demographics, economic problems, and health crises, such as the spread of pandemics, have escalated. These threats now pose an unprecedented risk to the foundations of individual and community security in the region's countries. This is especially true given the exceptional surge in the spread of certain epidemic diseases in some regional states, which are expected to increase in light of cross-regional labor flows and interregional migration movements, amid rising multiple sovereignties and border fluidity among many countries in the region.Revealing InteractionsIn such a context, the diseases witnessed in the region during 2024 have revealed the centrality of interactions in the Middle East, as follows:1. Continued Power Struggle between the Army and the Rapid Support Forces in Sudan: The war between the Sudanese army and the Rapid Support Forces has led to the spread of several diseases in different areas across many states, especially in the east of the country (Kassala and Gedaref states), most notably cholera, due to deteriorating environmental conditions and lack of safe water. The disease causes severe diarrhea and dehydration, which can lead to death within hours, according to the World Health Organization. This has resulted in the death of 300 people by mid-August, with actual numbers likely higher than reported.In this context, Sudan's Health Minister Ali Adam stated in media on August 19, 2024, that the war between the army and the Rapid Support Forces, ongoing for more than 16 months, has directly contributed to the emergence and spread of the disease. World Health Organization official Margaret Harris also indicated in media that the humanitarian crisis caused by the civil war in Sudan exacerbates the spread of diseases, including cholera.Additionally, Médecins Sans Frontières (MSF) President Christos Christou revealed on July 17, 2024, the link between the war in Sudan and the collapse of the healthcare system, saying they operate in eight states in Sudan, including Khartoum, which has seen millions displaced. Additionally, they strive to restore the functioning of some health facilities affected by the war, where more than 70% of health facilities in Sudan are non-operational due to destruction, looting, or lack of supplies and staff. He also noted that MSF communicates with existing medical facilities and the Ministry of Health services, but more cooperation is needed with both warring parties (the army and the Rapid Support Forces) to ensure the safety of the MSF staff.Thus, the rising cholera infection rates can be attributed to the Sudanese authorities' failure and inability to provide appropriate medical services to patients promptly due to the weak health system. Moreover, most cholera isolation wards in hospitals are not equipped to handle the rapid spread of the epidemic. Furthermore, there was a lack of transparency from the official authorities in announcing the cholera epidemic, as expressed in a statement issued by the Sudanese Doctors' Syndicate on X.com, which indicated that the information released about the epidemic only pertains to safe areas. It also pointed out the lack of accurate information about the epidemic in states experiencing active military operations, especially amid severe staff shortages, medicines, vaccines, and equipment.2. Challenges in Recovering from Institutional Collapse in Libya: Libya continues to suffer from multiple sovereignties and dual-headed authority in the East and West, impacting the restoration of institutions' roles, particularly those in the healthcare sector, despite calls for prioritizing health after the Derna Dam collapse. In this context, Prime Minister of the National Unity Government Abdul Hamid Dbeibah stated during the inauguration of the Misrata Golden Clinic Complex on November 25, 2023, after the completion of maintenance and refurbishment, that they "aspire for 2024 to be the year of health in Libya, and will work towards achieving this."The head of the government, not recognized by the Libyan parliament, indicated that the inauguration of this health facility aims to take another step towards repairing and renewing the deteriorating health sector, reflecting the efforts made by the Administrative Centers Development and Modernization Authority to improve health and educational facilities within the Life Return Plan. However, the lack of political consensus and the spread of armed militias stand in the way of Libya recovering from its prolonged cycle of violence.3. Lack of Prospect for Ending the Fifth Gaza War: Despite ten months passing since the October 7, 2023, attacks that led to the Gaza war between Hamas and Israel, there are no signs indicating a near ceasefire or the end of the war, despite efforts by mediators, particularly Cairo and Doha, to achieve a ceasefire agreement. In such a context, skin diseases, for instance, are spreading in Gaza due to the horrific conditions in overcrowded camps that house hundreds of thousands of displaced Palestinians, in addition to more than a million cases of acute respiratory infections reported since the war began.In July 2024, the World Health Organization warned of a significant risk of polio outbreak in Gaza and surrounding areas due to the difficult health situation and the deteriorating sewage system in the war-ravaged Palestinian sector.On the Israeli side, it can be said that the prolonged war on Gaza, with no clear timeline for ending the fighting amid military reports of a complicated and extended war, is placing Israeli soldiers under the pressure of suffering from mental health disorders, ranging from depression, obsessions, and suicidal tendencies to post-traumatic stress disorder (PTSD), which are "chronic" symptoms requiring long-term treatment and mental health services. Investigations in the Jerusalem Post and Haaretz even suggest that the Israeli military is facing "the biggest mental health crisis" since 1973.4. Impact of Extended Conflict Cycles on Vulnerable Social Groups: Children, women, and the elderly are among the most affected by the ongoing conflicts in the Arab region. A report by UNICEF on August 19, 2024, indicated a 34% increase in the number of children under five suffering from severe acute malnutrition or wasting compared to 2023 in all areas under the control of the Yemeni government, affecting more than 600,000 children, including 120,000 with severe acute malnutrition.This sharp increase can be attributed to the combined effect of disease outbreaks (cholera and measles), rising food insecurity, limited access to safe drinking water, and economic deterioration. Additionally, in the same population zone, it was found that approximately 223,000 pregnant and lactating women suffer from severe acute malnutrition in 2024. To protect the most vulnerable women and children, investing in prevention and treatment efforts and expanding them is more critical than ever.This situation is not limited to areas under the control of the legitimate government, as the severe impact of disease outbreaks, rising food insecurity, and limited access to essential services also exists in areas controlled by the Houthis. After nine years of the Yemeni conflict, which has left widespread destruction in the health infrastructure, epidemics and more lethal diseases are increasing, with an expanding circle of health needs for millions of displaced persons and children who have become targets for many deadly diseases such as cholera, dengue fever, polio, and others, as the health system in Yemen has become extremely fragile.5. Mitigating the Cross-Border Spread of Epidemics: Some epidemics cross borders, particularly amid political transition turmoil and armed conflict within some countries. Egyptian Assistant Health Minister Hossam Abdel Ghaffar revealed in a press statement on August 19, 2024, following the Sudanese Health Ministry's announcement of the cholera outbreak, that the country has raised the level of alertness and intensive monitoring at land crossings with Sudan, in addition to tightening precautionary measures at airports, as part of the country's preparations to confront the cholera outbreak in Sudan and prevent any infections from entering Egyptian territory and to safeguard public health, particularly in preventing the spread of diseases feared to transfer between countries, especially after the monkeypox outbreak in Congo.The World Health Organization and the African Union Health Authority declared the monkeypox outbreak in Congo and other parts of Africa a global health emergency, the highest level of alert, with confirmed cases among children and adults in more than 12 countries, and the spread of a new strain of the virus. In August, an update to the "Monkeypox" disease management guidelines was issued and distributed to all hospitals and preventive medicine units nationwide in Egypt, updating information on the disease, its prevention, and treatment. This guide, issued by the Preventive Medicine Sector, included details on the epidemiological spread of "monkeypox," transmission methods, symptoms, and preventive measures to reduce the risk of human-to-human infection.6. Increasing Demand for Médecins Sans Frontières' Role: The post-Arab Spring phase saw a noticeable increase in Médecins Sans Frontières' role in Libya, Yemen, Syria, and Sudan due to the targeting of hospitals and doctors by conflict parties and the filling of funding gaps. MSF President Christos Christou stated on July 17, 2024, that "United Nations agencies are facing significant funding shortages, and non-governmental organizations are unable to come due to security risks," noting that MSF will increase its activities in Sudan to fill existing gaps due to the funding shortfall.Pressing ContextsIn conclusion, diseases have revealed the interactions witnessed in the Middle East during the first two-thirds of 2024, both domestically and regionally, highlighting the negative impacts of armed conflicts on health systems and the effectiveness of medical teams, with the spread of extreme poverty and the lack of humanitarian interventions to provide safe water and the widespread sewage system deterioration in residential neighborhoods, along with the lack of transparency from official authorities in some countries in the region in announcing cases of this or that disease. Vulnerable social groups, particularly in refugee camps fleeing conflict hotspots, have been the most affected, with increasing demand for the role of Médecins Sans Frontières and other organizations that have not responded as required, given the urgent need for their intervention to curb the spread of epidemics and treat the afflicted.

How Do Deteriorating Health Conditions Reflect Middle East Interactions in 2024?