Stethoscope Diplomacy in the Middle East

Health care initiatives could be the key to rebuilding U.S. influence in the region—and healthier economies and societies for the region’s citizens.

A patient sits on a bench in front of a coronavirus-inspired mural in Gaza City, Gaza Strip, on Feb. 1.
A patient sits on a bench in front of a coronavirus-inspired mural in Gaza City, Gaza Strip, on Feb. 1. Mohammed Abed/AFP/Getty Images

As the Biden administration works to rebuild U.S. influence in the world, it should look less to the well-worn options of defense or securing oil supplies and rather focus attention on the types of human capital investments proven to make populations better off and more trusting of the United States. In these efforts, the COVID-19 pandemic offers President Joe Biden an opportunity, particularly in the Middle East, where Washington can help the region grow into the health care technology hub it could be. In the process, such efforts would improve the status of women, diversify and revitalize the region’s economies, and create sustainable investments in its most valuable resource: its people.

For decades, Western democracies have invested billions of dollars in the Middle East for various civilian and military development programs. Pre-9/11, good governance and relations between Israel and its neighboring Arab states ranked high on U.S. priority lists for that spending. Post-9/11, much U.S. aid has been directed to Iraq and the Levant to address direct military threats to U.S. interests. Yet the region is still in a precarious state. Iraq suffered its worst economic contraction in 2020—9.5 percent—in nearly two decades, and Lebanon’s currency crisis, provision of health care, and economic inequality have all been drastically worsened by the COVID-19 pandemic.

It is time, in other words, for the United States to rethink its aid to the region. As many studies show, certain kinds of strategic nonmilitary aid—especially aid that decreases economic inequality such as education and public health investment—can increase a country’s economic output, improve its health status, and lower conflict risk. In turn, the Biden administration should look toward bettering the United States’ relationship with the Middle East through a type of stethoscope diplomacy focused on improving countries’ health care infrastructure. If done right, such help would include plans for making Middle Eastern countries an integrated regional hub for advanced medical care, working with international health organizations to harden the region against future pandemics, and creating a robust medical exchange program between U.S. and Middle Eastern training facilities.

Already, several Middle East countries have truly advanced health care systems. The United Arab Emirates and Saudi Arabia, for example, have poured billions of dollars into their health care systems, resulting in hundreds of well-staffed health care centers. For Saudi Arabia, this has resulted in robust public health interventions and much lower reported rates of COVID-19. And the UAE is using its health care system to drive the world’s second-fastest vaccination campaign. But despite this, more needs to be done for their populations to fully reap the returns on those investments in well-functioning and well-funded health systems.

For example, despite Saudi Arabia’s relatively modern health care system, the country’s prevalence of chronic diseases such as obesity and diabetes has been on a steady climb, contributing to almost 60 percent of premature deaths in the country in 2016. The United States, which faces its own chronic disease epidemics, could aid this effort by sharing with Saudi Arabia how it uses integrated care and ancillary services like nutrition education to bring a more successful team-based approach to health management.

Meanwhile, Lebanon, Iraq, and Syria—all marred by years of conflict—have been unable to make much progress modernizing their health care systems. As a result, COVID-19 cases have been quickly climbing in Iraq and Syria, along with hospitalizations and deaths. U.S. aid in those countries should focus on the basics: improving medical equipment, medicine supply chains, and access to effective vaccinations that can be distributed quickly.

Washington can assist not only in closing the health care gap between neighboring countries, but more importantly, it can help those countries connect for health care data exchange.

Washington can assist not only in closing the health care gap between neighboring countries, but more importantly, it can help those countries connect for health care data exchange. In such an interconnected system, a Lebanese patient injured while traveling in Egypt for vacation could be seen by an Egyptian doctor able to electronically receive her medical chart from Lebanon. Furthermore, with fully integrated electronic health record systems and inter-country agreements, a patient unable to be seen in an overwhelmed hospital in her own country could be rapidly sent to a hospital in a neighboring country, which would have full access to her medical records.

In terms of health technology expertise, many members of the Biden team were part of the $35 billion effort under the Obama administration’s HITECH Act to increase electronic health records uptake in U.S. hospitals. These officials could use lessons learned to aid Middle Eastern countries in developing their own robust, data-driven systems that could allow them to share patient outcome data and improve practices.

Perhaps most urgently, the sharing of patient outcome data and disease epidemiology could help build an early warning system for regional health threats. The world is always one major viral mutation away from another global pandemic. That is why strengthening surveillance and collaboration abilities in every highly transited area of the globe is key. In the last few months, the number of COVID-19 infections in the Middle East has risen dramatically. Within its first few weeks of office, the Biden administration could create joint virtual conferences and regional sharing spaces where it could provide advice on vaccine distribution and information on how the U.S. Data Safety Monitoring Board evaluates clinical trials of new vaccines.

Under the umbrella of showing the world that the United States is back, as Biden likes to proclaim, Washington can also take the opportunity to significantly increase training grants for U.S. and Middle Eastern medical school exchange programs. Like other graduate-level foreign service exchange programs, these programs take students at a formative stage and expose them to cultures and populations that they can learn from. Foreign exchange at this level can also help promote equality. Few professions in the West have been able to close the gender gap as quickly as has health care. Allowing students from the Middle East to engage with medical students in the United States, and vice versa, would emphasis the benefits of diverse teams working together to learn from one another while providing patient care.

Successive U.S. administrations have tried lots of different policies toward the Middle East, many of which have left the region worse off. It is time for a more humanistic and practical approach, and few have yielded as proven benefits as strategic investments in health systems and population health. If Biden is serious about “building back better,” he should use the disruption of the COVID-19 pandemic to advance stethoscope diplomacy, which could better help the Middle East—and the world.

Maya Kahwagi, originally from Lebanon, trained in family medicine and geriatrics at the American University of Beirut. She currently provides patient care at Kaiser Permanente in Northern California.

Kermit Jones is a former Navy physician who deployed to Iraq in 2008 and former White House fellow for the U.S. Department of Health and Human Services. He provides patient care in Northern California and advises on health policy.

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