Human vulnerability in Arab countries at the time of a pandemic
— by Adel Abdellatif and Ellen Hsu
Pandemics have historically shaped human civilizations, but with one-third of the world’s population and 81% of the global workforce in full or partial lockdown for the foreseeable future, there is no doubt that we are witnessing an unprecedented moment in history that promises to set apart COVID-19 from its predecessors. Beyond its ultimate death toll, the current pandemic is a multidimensional crisis that will have long-ranging consequences on our societies and trigger structural changes at all levels of our economies and governance systems, leading some analysts to speak already of a “new epoch” or a “historical divide”, before and after corona. While figures of the projected economic fallout and stock market downfalls continue to dominate news headlines, the human cost has only been presented in medical terms: number of confirmed cases, number of deaths, number of hospitalizations, etc. Far too little light has been shined on the other human facets of this crisis, including the women and children who are at risk of increased domestic violence, the unemployed and informal workers who are not covered by any social safety net or the refugees living in camps who lack access to basic WASH (Water, Sanitation and Hygiene).
Crucially, our understanding of COVID-19 has been informed so far by the experience of relatively well-endowed countries such as China, South Korea, Italy or the United States who have much greater institutional capacities than most of the countries we support as the UNDP Regional Bureau for Arab States. Moving forward will first require further clarity on the prevalence of the disease in the Arab States region beyond the official numbers, which is yet to be known due to lack of testing capabilities, in particular in crisis countries where the low number of cases may be dissimulating a starkly different reality.
Data is one of the most powerful tools that governments can hope to leverage in response to the pandemic; yet Arab countries suffer from chronic data deprivation, manifested by the scarcity of disaggregated data produced in a consistent and sustained way, which leaves policymakers to prepare development strategies and plans in the dark. This so-called “data fragility” poses an additional obstacle for countries to respond effectively and jumpstart their recovery post-COVID. According to the World Bank, the region’s statistical capacity is among the lowest in the world, second only to sub-Saharan Africa, with Arab countries performing worse in terms of sources (48 out of 100 on average in 2019) and methodology (59 out of 100) compared to periodicity and timelines (72 out of 100). In the past decade, reversals have happened unsurprisingly in war-torn countries such as Syria, Libya and Yemen, but also in middle-income countries like Morocco or Egypt. Identifying and reaching the hardest hit citizens will remain a challenge as long as data gaps persist and accelerating the data revolution, hand-in-hand with digital transformation, is not only needed in the context of this pandemic but has also been called for in Agenda 2030 as key to monitoring progress on the Sustainable Development Goals (SDGs) and ensuring that no one is left behind.
In the meantime, the Non-Pharmaceutical Interventions (NPIs) swiftly implemented by governments to curb the spread of the virus have been much more straightforward: lockdowns, curfews and school closures may not necessitate any data, but they are proving to be a dangerous double-edge sword. Since daily life has been brought to a standstill in Arab countries, much like elsewhere in the world, the drastic impacts on some of the most vulnerable segments of the population have begun to emerge in quantifiable terms. Although our discussion will focus primarily on urban slum-dwellers, refugees, informal workers and the young learners, many other groups will also suffer disproportionately from this crisis, and the adverse effect on gender inequalities, discrimination against people with disabilities and minorities as well as other forms of exclusion remains to be seen.
Densely populated urban areas, and in particular informal settlements, where it is more difficult to enforce social distancing and basic hygiene practices, have the potential to become hotspots for virus transmission. Rapid urbanization in the past 30 years has doubled the number of cities over 1 million across the region, and among the 247 million urban residents today, a quarter live in slum conditions, with at least one of the following characteristics: lack of access to improved drinking water, lack of access to improved sanitation, overcrowding (three or more persons per room) or dwellings made of non‑durable material. This situation is compounded in crisis countries and for refugees that may lack even the most essential infrastructure. Access to handwashing facilities, including soap and water — a key prevention method against the virus, is available to 70% of the population in Arab countries, but to less than half of the population in Yemen (50%), Sudan (23%) and Somalia (10%). Similarly, access to electricity is not universal in all countries: in Somalia, Sudan and Djibouti, the figures are at 33%, 54% and 60% respectively. UNHCR also estimates that over half (57%) of Syrian refugee households in Lebanon are living in shelters that are either overcrowded, have conditions below humanitarian standards and/or in danger of collapse. In Jordan, 64% of Syrian refugees are severely vulnerable vis-à-vis accessibility to water. Hence, not only can we expect inequality between countries to deepen in the aftermath of the crisis, but also within, as the impact of COVID-19 is mediated through existing inequalities.
Meanwhile, the livelihoods of the most vulnerable, including informal workers who represent more than 50% of the labor force in many middle-income Arab countries, are threatened by physical distancing measures. Using mobile location data, Google’s Community Mobility Reports reveal significant decreases in mobility trends around workplaces from a 45% decrease compared to baseline in Egypt to a 81% decrease in Jordan, as of April 11. The region has also seen the largest decline in working hours, by 8.1% compared to 6.7% worldwide. Informal workers are less likely to be covered by health insurance, in a region where out-of-pocket spending in all but the high-income countries, exceeds 20% of total health spending, the threshold above which households are likely to get poorer as a result of paying for health care. A survey ran by UNDP in 2019 across 12 middle-income and crisis Arab countries showed that affordability is a significant barrier to receiving health services for respondents, especially the poorer ones: 22% said they could not get medical advice because it was too expensive, including 21% of the poor and 14% of the more affluent. More worryingly, 45% of the poorest segment said they did not get the medical treatment they needed because it was too expensive. In the short-term, localized support in the form of social solidarity and the creation of exceptional social safety nets are critical. A real-time review of social protection responses reveals that as of April 17, eleven Arab countries have already implemented such protective policies, in the form of paid sick leave, cash transfers, in-kind food vouchers or unemployment benefits, with Egypt, Jordan, Morocco and Tunisia among the ones having targeted the informal sector specifically.
Finally, all 96.2 million enrolled learners in the region, from pre-primary to tertiary, are at risk of losing out on educational gains if remote learning is not available to them. However, the number of fixed broadband subscriptions, identified by the 2019 Human Development Report as an “enhanced capability”, is still stubbornly low in Arab States, at a rate of 5.1 per 100 inhabitants compared to a global average of 14.1 and an average in developing countries of 10.4. The shift from “basic” to “enhanced” capabilities in the human development approach reflects a new set of capabilities that are becoming increasingly fundamental to empowering lives in the 21st century and this crisis is bringing to the forefront the issue of unequal access to digital technologies leading to greater divergence in opportunities. For the 253 million under-30s in the region, 42% of which reside in crisis countries, missing out on capabilities will have significant impact beyond today, reducing the set of opportunities available to them in the future.
In a BBC interview last month, Oxford Martin School Professor of Globalization Ian Goldin shared his hope that the world will come out of the COVID-19 crisis recognizing how interdependent we are and embracing greater multilateralism. In his own words, “there is no wall high enough to keep out climate change, a pandemic or a financial crisis, the answer is we have to manage this system we built, to ensure we coordinate action, understand the ‘bads’ and build the institutions and capabilities to manage them”. His call echoes the strong message sent out by the Secretary-General of the United Nations on March 31: shared responsibility and global solidarity are needed in response to COVID-19 to protect the most vulnerable and safeguard progress towards the SDGs.
This entails, first and foremost, putting an end to violence and hostilities, which have claimed more lives in the Arab region than anywhere else in the world, with close to 400,000 battle-related casualties between 2010 and 2018. During that same period, military spending exceeded 1.1 trillion US dollars while the average number of military personnel per capita in the region is 8,000 times the average number of physicians per capita. Solidarity must start at home and Arab governments can seize this opportunity to repurpose their budgets, prioritizing human security over state security, as no number of tanks or military aircrafts can help fight a virus invisible to the human eye. Today, 159 million people continue to live in crisis countries and by 2030, if the on-going conflicts are not resolved, projections show that they will make up 40% of the total population in the region. While the pandemic continues to highlight the deficiencies in Arab countries’ resilience, renewed attention should be paid to the social agenda, starting with health, a key pillar of human development, which has been neglected in recent years by government expenditure, as evidenced by per capita spending that is below the average of each country’s respective income group.
The past decade in the Arab region has been marked by turmoil and political instability, from the 2011 uprisings to civil wars, foreign intervention, terrorism and the most recent protests in 2019. The COVID-19 pandemic is thus happening in a context where Arab countries are already facing many economic, social and financial pressures, most manifestly stagnating economic growth and high unemployment rates. In their efforts to adjust to a new normal and achieve higher growth, governments will need the support and engagement of their citizens, which can only be secured by rebuilding trust in state-society relations. The aforementioned UNDP survey found that corruption was seen as the root cause of many socioeconomic woes, cited for instance as the top reason for increasing inequality, worsening employment opportunities as well as deteriorating violence, crime and justice. This sentiment seems to support the latest Arab Barometer’s findings, with over 70% of respondents claiming that corruption exists to a large or medium extent within national state agencies and institutions. Although some of the demands voiced by citizens during the 2011 Arab uprisings have been acknowledged, the rewriting of a new social contract is still a work in progress that this crisis can hopefully help push forward, including by shifting focus to localized solutions, which have been multiplying. In Morocco, NGO INSAF has been delivering essential supplies to single mothers but also to isolated villages in rural areas. In Beirut, the Baytna Baytak — Our house is your house — initiative is connecting healthcare workers with residents to help them find free accommodation that is close to their place of work. E-grocery startups in the Gulf are stepping up to fill the surge in demand for deliveries.
Finally, in the coming months, even if we expect financial assistance from advanced economies to decrease as they weather their own economic recessions, the international community will continue to play an important role in the recovery of the region, for example through much-needed debt alleviation programs. Indeed, central government debt as a percentage of GDP has reached unprecedented levels in Sudan and Lebanon most notably, at 212% and 151% respectively. On April 13, the IMF announced the first round of debt service relief for 25 countries, including Comoros and Yemen. As Arab countries enter the decade of action to deliver the SDGs by 2030, we need to help them anticipate the transformations to come as well as future new shocks, by starting to identify where progress has been the most affected by the pandemic, including among the most at-risk communities, and by drawing vital lessons that can be applied in the face of other pressing threats, like climate change.
 Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Palestine, Somalia, Syria, Tunisia and Yemen.
Adel Abdellatif is Deputy Director a.i. at the UNDP Regional Bureau for Arab States. Ellen Hsu is a Researcher, at the same Bureau.