Healthcare Crisis In The Middle East

According to the World Health Organization (WHO), healthcare is a universal human right. Healthcare is a major expense worldwide and is estimated to account for $3 trillion in spending in the USA, and $6 trillion globally. The combined healthcare spending in the five major world regions is expected to reach $8.7 trillion by 2020, up from $7 trillion in 2015. The global healthcare spending is increasing at an annual rate of 4.1% for the period 2017–2021, up from just 1.3 % for 2012–2016.

What are the healthcare models followed by countries across the globe?

There are 4 healthcare system models adopted by various countries across the globe. They are as mentioned here:

The Beveridge Model

This model is not in the best interests of the people. It relies on very high taxes for basic healthcare, without providing access or incentives for preventative care, thus raising the bar of healthcare expenditure. The lack of individualization forces healthier people to be charged the same amount as the fatally sick. Canada is a nation using a Beveridge Model.

The Bismarck Model

This model uses an insurance system which is usually financed jointly by employer and employees via payroll deduction. This system results in higher healthcare costs and diminishes efficiency. Most healthcare services are covered by a mandatory health insurance; beyond that, the patient co-pays for a portion of care at the time of treatment. This system, utilized in Germany, is flawed as it offers no alternative to compensate individuals for the rising costs implemented by the government, pharmaceutical, and private insurance companies.

The National Health Insurance Model

It is a more-democratic model which uses a government-run insurance program that every citizen contributes to. Citizens can use both public and private-sector providers. Despite the low costs of the National Health Insurance Model, however, there are several drawbacks. In an effort to control costs, patients wait longer to be treated. Britain and Cuba among other countries use this model

The Out-of-Pocket Model

This model applies to a majority of the nations on the planet who lack an organized healthcare system. This system is clearly unregulated — healthcare costs are high and resources are limited. Patients are eligible for medical care only if they can afford the bill at the time of treatment. Otherwise, they get sick enough to warrant a visit to public emergency hospitals where the government has to cover all the costs.

Patients struggle to find the right doctors, and due to high costs are forced to seek physicians overseas who have competitive prices for otherwise expensive local medical care. Cambodia, Burkina Faso, and India default to this method of care.

No healthcare model is perfect, and yes, “some healthcare” is certainly better than “no healthcare”.

From a global perspective, most nations on the planet are too poor, and their healthcare system too disorganized, to provide any kind of efficient mass medical care Such systems go against human ethics and create a disparity between the rich and poor. The rich can afford healthcare, while the poor stay sick or die.

Only the industrialized countries, perhaps 40 of the world’s 195 countries have established healthcare systems. They have a variant or fusion of these models, yet there are still issues in every system.

Healthcare systems around the globe are in trouble and something needs to be done to help move populations towards healthier lives. We are living in an era of global healthcare crisis.

A health crisis is a difficult situation that affects humans in one or more geographic areas from a particular locality to cover the entire planet. They have significant impacts on community health, loss of life, and on the economy. They may result from outbreak of disease, industrial processes or poor policy, Humanitarian emergency, man-made disaster, and complex emergency are all terms used to refer to a crisis which could be due to armed conflict, population displacement, or a combination of both.

The Middle East is a transcontinental region which generally includes Western Asia (except for Transcaucasia), all of Egypt (mostly in North Africa), and Turkey (partly in Europe).

Our focus is on the Middle East which is battling the COVID 19 pandemic, civil wars, floods which has given rise to a health crisis in that part of the world.

We will highlight the healthcare situation of 3 countries namely, Lebanon, Yemen and Syria which are in dire state and needs immediate attention plus help from other countries of the world

Lebanon –

Lebanon is a sovereign state in the Middle East which is surrounded to the south by Israel and the east by Syria, while Cyprus is to the western side right across the Mediterranean Sea. Lebanon's location at the crossroads of the Mediterranean Basin and the Arabian hinterland has contributed to its rich history and shaped a cultural identity of religious and ethnic diversity. It is the smallest recognized nation in Asia which occupies an area of about 4,0452sq miles. 

After the fall of the Ottoman Empire, Lebanon became one of the provinces to fall under the French rule. The Lebanese gained their independence from the French in 1943 and created a political system which involved power sharing based on the religious groups.

It endured a devastating 15-year civil war which raged between 1975 and 1990. Syria dominated Lebanon for 2 decades until the withdrawal of its troops in 2005. It comprises of 4 million Lebanese citizens, 1.2 million Syrian refugees, and half a million Palestinian refugees.

Capital: Beirut . President: Michel Aoun. Prime Minister: Hassan Diab

Population: 6.856 million (2019). GDP: $53.37 billion USD (2019). Official language: Arabic

Total expenditure on health as % of GDP (2014)        6.4

 Healthcare is increasingly becoming scarce:

Most live in the capital city of Beirut. Pricing is a major issue in the country’s healthcare system. The high prices have left about 50 percent of the nation uninsured from any type of health coverage. Other factors, such as a serious lack of medical supplies, have affected citizens healthcare in Lebanon. Hospitals have been reported denying access to those who lack insurance. This has to do with the shortages of hospital beds, medicine and staff.

Syrian refugees have put a strain on resources:

These refugees find themselves sitting in refugee camps where health hazards are a daily occurrence. The influx of people has affected the already crippling inability to access healthcare in Lebanon, affecting both citizens and refugees. The refugees themselves are struggling to find health providers and money to pay for said healthcare services. At the beginning of the refugee crisis, due to the increasing strain on medical supplies, the United Nations High Commissioner for Refugees (UNHCR) became a free provider of healthcare. Soon after, the influx of aid forced the organization to begin charging patients a two-dollar fee to receive care. UNHCR has also lowered the percentage of coverage for emergency patients. The commission formerly covered 85 percent of healthcare costs, but now only covers 75 percent.

Government-funded efforts barely help:

The Lebanese government has tried to implement new ways for citizens to have access to healthcare. The National Social Security Fund was created to allow all those who work to receive healthcare aid. Funding is dispersed based on a citizen’s income. The fund covers 10 percent of hospital costs, along with 20 percent of medicine and exam costs, while 100 percent of coverage is dispersed to patients who are terminally ill.

According to al-akhbar.com, “those enrolled with the National Social Security Fund lose their benefits upon retirement or loss of job, or in other words when they need them the most.” This is an example of how hard it is to receive and maintain healthcare coverage in Lebanon.

Yemen – 

Covering an area of 203,850 sq mi, Yemen is the second-largest country of the Arabian Peninsula after Saudi Arabia. Yemen is bordered by several water bodies, namely the Red Sea, the Gulf of Aden, the Guardafui Channel, and the Arabian Sea. Sitting at the southwestern tip of the peninsula, Yemen's only land borders are with Saudi Arabia to the north and Oman to the east. Sana'a is the capital and largest city of Yemen. The official language is Arabic and Islam is the official religion. Yemen is the poorest country in the Middle East and was decreed the country the most in need of humanitarian aid by the United Nations in 2016.

Capital: Sanaa. President: Abdrabbuh Mansur Hadi. Prime Ministers: Maeen Abdulmalik Saeed · Abdel-Aziz bin Habtour

Population: 29.16 million (2019). GDP: $26.91 billion USD (2018)

Official language: Arabic

Total expenditure on health as % of GDP (2014)        5.6

Lack of access to clean water:

In Yemen, medical facilities lack access to clean water, diseases that are treatable elsewhere become deadly. Approximately 80 percent of Yemeni people are malnourished, forced to drink unclean water and cannot afford health care, making them more susceptible to diphtheria, cholera and other diseases.

Frequent bombing due to ongoing civil war:

Non-stop and continuous fighting leaves little time to address structural damage and meet the needs of the Yemeni people. Families are often required to bring the sick and injured to hospitals without the aid of ambulances. All but one of Yemen’s 22 provinces are affected by fighting.

This puts the Yemeni people, especially children, at risk; 144 children die from treatable diseases daily and more than 1 million children are starving or malnourished. Yemen’s rural populations lack easy access to hospitals and medical care. Rural facilities, such as those in the northern mountains, cannot provide adequate food to patients. The lack of food in many hospitals prevents successful treatment of malnourishment.

Yemen’s cholera outbreak is more severe than any other outbreak of the disease since 1949. Poor water filtration and sanitation triggered the outbreak’s severity. Nearly one million cases of cholera were reported by the end of 2017.

Around 80 percent of Yemen’s population, including 12 million children, require aid. During the first half of 2019, cases of cholera in children rose dramatically. 109,000 cases of cholera in children were reported between January and March of 2019. Nearly 35 percent of these cases were found in children below the age of 5.

USAID cooperates with UNICEF and WHO to provide health care aid to Yemen, with a special emphasis on the health of mothers, infants and children. In 2017, USAID trained 360 health care workers at 180 facilities to treat child health problems. The facilities also received necessary resources from USAID. They also work with the U.N. Development Program to improve working conditions throughout Yemen, including the health care sector.

Between 2015 and 2018, Doctors Without Borders provided aid to 973,000 emergency room patients in Yemen. Volunteers for Doctors Without Borders treated about 92,000 patients injured by violence related to the war, treated 114,646 cases of cholera and treated 14,370 cases of malnutrition. Doctors Without Borders provides vital support to the health care system in Yemen.

The U.S. also funds WASH, a program intended to improve access to water, sanitation and hygiene. The ultimate goal of WASH is to improve health care in Yemen, especially for the rural poor.

Yemen’s health care system is in dire need of aid. The country’s government, overwhelmed by war, cannot serve the medical needs of its people, especially in light of the ongoing cholera epidemic. The efforts of USAID and other relief organizations can provide the support that Yemen’s health care system needs at this time.

Syria –

The Syrian Arab Republic borders the Mediterranean Sea as well as Lebanon, Turkey, Iraq, Jordan, and Israel. Syria covers 71,500 sq mi and has a population of over 17 million. Damascus is not only the capital but also the largest city. Syrian Arabs are the largest ethnic group and 87% of the population are Muslims. Arabic is the official language of the country. Syria has been engaged in armed conflict with nearby nations since March 2011.

Capital: Damascus. President: Bashar al-Assad. Prime Minister: Hussein Arnous

Population: 17.07 million (2019). GDP: $24.60 billion USD (2014)

Official language: Arabic

Total expenditure on health as % of GDP (2014)        3.2

 Syrians who survived a decade of war are now facing an unprecedented socioeconomic crisis and a potentially disastrous COVID-19 pandemic, in addition to other public health risks. More than 12 million people in Syria are in need of humanitarian aid, including over 6 million internally displaced people living in camps or in camp-like settlements.

Displaced Syrians, particularly in the northeast and northwest of the country, live under conditions making them particularly vulnerable to respiratory infections such as COVID-19. Many live-in overcrowded living conditions, and also face physical and mental stress and deprivation due to lack of housing, food and clean water. The humanitarian situation in northwest Syria remains one of the most acute and severe in the world with over 2.8 million people dependent on humanitarian assistance supplied almost entirely via cross-border operations from southern Turkey. Attacks on health care continue, and the risk of ongoing ceasefire violations are of great concern in the northwestern part of the country. This year alone, 16 attacks on health care have been reported, in which 10 people died and 36 were injured, including 6 health care workers.

In the nine years since protesters in Syria first demonstrated against the four-decade rule of the Assad family, hundreds of thousands of Syrians have been killed and some twelve million people, more than half the country’s pre-war population have been displaced.  As the crisis in Syria enters its tenth year, WHO calls on parties to the conflict and the international donor community to put the health and well-being of the Syrian people first. Sustained access via all modalities and sufficient resources are required to enable WHO and partners to meet the health needs of all people across the country.

WHO continues its lifesaving work with partners inside Syria and cross-border from Turkey to respond to urgent health needs, and repeats calls by the United Nations for an immediate ceasefire, easing of sanctions that impede the COVID-19 response, and for a political solution to the conflict, along with the increased investments in health and health system resilience to protect the lives of millions of vulnerable men, women and children. The people of Syria cannot have a future without proper health care.