Cover: Pulse-Check


Exploration of Early COVID-19 Pandemic Health Care and Public Health Responses in Select Middle East Nations

Published Mar 24, 2022

by Hamad Al-Ibrahim, Nasma Berri, Emily Hoch, Nazia Wolters, Kristin J. Leuschner, Mahshid Abir

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Research Questions

  1. What common challenges did the selected countries face in their responses to the COVID-19 pandemic?
  2. What health care system strategies and innovations were used to address pandemic-related challenges?
  3. How can Middle East countries leverage their pandemic experiences to improve their health systems' responses to the ongoing COVID-19 pandemic and future public health emergencies?

This report presents the findings of a quick-turn study conducted between February 2021 and May 2021. During this time frame, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 83 million confirmed infections and more than 1.8 million deaths worldwide. In the Middle East, there were close to 21 million cases reported and 336,000 COVID-19 deaths. Many countries in the Middle East struggled with health care capacity and access prior to the pandemic, and this crisis has placed significant additional strain on health care delivery in the region. Evaluating strategies used by health care systems and public health and policies implemented by governments in the Middle East during the ongoing pandemic is critical to understanding and disseminating successful approaches to meeting the health care demands of populations in the region.

This report outlines the results of an exploratory analysis of five Middle East countries — Iran, Jordan, Lebanon, Qatar, and Tunisia. Drawing from a literature review and qualitative data collected from focus groups and one-on-one interviews conducted between March 2021 and May 2021, the authors identify common challenges regarding COVID-19 faced by the countries studied, highlight successes and innovations in addressing these challenges, and recommend strategies for strengthening internal infrastructure and regional cooperation between countries. This work should be of interest to regional and international stakeholders as they continue to combat the pandemic, and its findings could inform future research around pandemic response.

Key Findings

Many of the countries studied had strained health care systems prior to the COVID-19 pandemic

  • All countries studied faced shortages of personal protective equipment either in the beginning or during other periods of the pandemic.
  • All countries studied had some challenges related to a lack of standardized protocols for dealing with COVID-19 in health care facilities.
  • Although there were some examples of telehealth use, telehealth was not used in a systematic way as a strategy to increase health care capacity in any of the countries studied.
  • Although all countries studied implemented mask mandates, they all experienced varied degrees of difficulty in enforcing public health measures.
  • Some countries in the study faced challenges in rolling out their vaccine campaigns.
  • The populations of all countries studied faced challenges with behavioral health issues, including depression and anxiety. Among health care workers, mental health issues contributed to burnout.
  • The majority of countries studied were challenged by politicization of the pandemic and the spread of misinformation about the pandemic and vaccines, especially through social media.

All the countries studied had some success in increasing health care system capacity

  • Iran recruited and retained staff to support the health care system surge.
  • Jordan used data to track hospital bed and staff availability and to designate quarantine hospitals.
  • Lebanon cared for patients in their homes and expanded use of online health resources.
  • Qatar used a central command structure to oversee the health care system surge.
  • Tunisia established a national committee to support COVID-19 prevention, detection, and early treatment.


  • Engage in advance planning.
  • Develop telehealth infrastructure.
  • Ensure that public health measures incorporate data, training, and enforcement considerations.
  • Support the health care workforce.
  • Build communication strategies into public health planning.

Research conducted by

Funding for this project was provided by the generous contributions of the RAND Center for Middle East Public Policy (CMEPP) Advisory Board. This research was conducted within the RAND Center for Middle East Public Policy, a center within International Programs.

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