With the emergence of Covid-19 in 2020, public health systems across MENA were overwhelmed by the pandemic, which came on top of the need to care for patients with non-Covid diseases. Although there is a lot about the Covid-19 outbreak in MENA and elsewhere that we do not understand, it is clear that a health system’s capacity to absorb a sudden increase in patients due to an unexpected health shock remains a key dimension of public health preparedness. Simply put, running out of oxygen tanks, hospital beds, and even doctors and nurses during a health emergency are all symptoms of a lack of resilience.

While MENA was not unique in having faced a dreadful pandemic that exhausted available public health resources, MENA was unique compared to the rest of the world in how it ended up ill-prepared to absorb the shock of Covid-19. The authors of this report argue that three long-term trends left MENA’s public health systems with low capacity to handle emergencies. In the past decade, slow reforms toward market-oriented economic systems and transparent institutions left a legacy of large public sectors that effectively crowded out investments in social services such as public health.

Meanwhile, epidemiological trends left MENA with uncharacteristically high burdens of both non-communicable and communicable diseases compared to their income peers. And rising or atypically high fertility rates yielded a young population that made it seem as though MENA’s citizens overall enjoyed good health while, in fact, the region had a comparatively high number of young people in poor health.