Pierre Nabeth and colleagues1Nabeth P Hassam M Adib K Abubakar A Brennan R New COVID-19 resurgence in the WHO Eastern Mediterranean region. highlight the resurgence in COVID-19 cases in the WHO Eastern Mediterranean region and identify factors that might have contributed to this rise. They identify changes in testing capacity, mass gatherings, decreased adherence to public health measures, and increased transmissibility of new SARS-CoV-2 variants emerging globally.Alarmingly, Nabeth and colleagues ignore the structural and social determinants of health in the Eastern Mediterranean region, and how these would affect the spread and impact of COVID-19. They did not address the substantial social and economic turmoil taking place in countries across the region. Except for a brief request for a special focus on conflict areas, they neglect the fact that more than a third of countries in this region are active war zones or fragile post-conflict countries.2These 10 countries receive the most refugees. Similarly, any reference to countries in the region being among the largest hosting communities for the chronic and severe refugee crisis is omitted. Additionally, there is no reference to the continuing challenges that these countries face in the aftermath of the Arab uprisings, deteriorating livelihoods, and violations of human rights.3Amnesty International
MENA: repression and violence fail to stamp out Arab activism 10 years since mass uprisings of 2011.Given the severity of socioeconomic effects across the region, Nabeth and colleagues still choose to focus on decreased public adherence to measures, such as physical distancing, which is particularly concerning. No mention is made of political factors such as the public denial of the pandemic among governments,4The Egyptian response to coronavirus: denial and conspiracy., 5A pandemic atlas: no longer in viral denial, Iran struggles. which not only delayed the response but also, catastrophically, further eroded public trust in health authorities.

Most regrettable is the simplistic recommendation for “enforcement of, and adherence to, public health and social measures” by the governments in the Eastern Mediterranean region as the effective approach to address the resurge in SARS-CoV-2 infections, without any discussion of how such enforcement can be applied within these coercive contexts where violence is a key contextual determinant in public health. No consideration is shown of how the livelihoods of Syrian, Lebanese, and Sudanese people, among others, are dependent on daily wages in the informal labour markets, or that many social gatherings in these countries are, in fact, queues for food and medication. Such omissions highlight the real dangers inherent to organisations adopting a narrowly epidemiological approach in a region in which the trajectory of the pandemic is so strikingly shaped by the social and political determinants of health.

I declare no competing interests.

References1.Nabeth P Hassam M Adib K Abubakar A Brennan R

New COVID-19 resurgence in the WHO Eastern Mediterranean region.

Lancet. 397: 1348-13492.

These 10 countries receive the most refugees.

3.

MENA: repression and violence fail to stamp out Arab activism 10 years since mass uprisings of 2011.

4.

The Egyptian response to coronavirus: denial and conspiracy.

5.

A pandemic atlas: no longer in viral denial, Iran struggles.

Article InfoPublication HistoryIdentification

DOI: https://doi.org/10.1016/S0140-6736(21)01237-X

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© 2021 Elsevier Ltd. All rights reserved.

ScienceDirectAccess this article on ScienceDirect Linked ArticlesNew COVID-19 resurgence in the WHO Eastern Mediterranean region

After 7 weeks of falling numbers of COVID-19 cases , a global upsurge was reported during the week of Feb 22, 2021. This case resurgence was observed earlier in the WHO Eastern Mediterranean region, where, between Jan 30 and Feb 26, 2021, the number of weekly cases increased from 158 004 to 207 424 (31%; appendix).

Full-Text PDF Addressing the real trajectory of COVID-19 in the Eastern Mediterranean region – Authors' reply

Our Correspondence1 was based on the analysis of available data on the COVID-19 pandemic in the Eastern Mediterranean region. The objectives were to highlight the upsurge in COVID-19 cases since February, 2021, and to alert about the risk of further degradation of the epidemiological situation due to the evolution of key determinants, such as the decreased adherence to public health and social measures, emergence of more transmissible variants, and insufficient vaccination coverage.

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