Health in the Middle East
February 24, 2012
The Global Health Policy Center is honored to issue two important new analyses by our colleagues, Jon Alterman and Haim Malka, respectively, scholars in the CSIS Middle East Program. Jon we asked to reflect on the quite special, and remarkable historical relationship which the United States has developed with Egypt in advancing health. Haim we asked to share his insights into the factors that have driven the expansion of Hamas’ health capacities. For each, there are very important considerations of relevance to U.S. global health policy, implications which we believe are often underappreciated. We do hope you will take the time to read these carefully and share with us any reactions you have.
Egypt and U.S. Health Assistance
Few countries have been as successful as Egypt in parlaying its strategic position into an economic asset. At the nexus of two continents, astride the Suez Canal, and with one-quarter of the Arab world’s entire population, Egypt has made itself an object of interest, and often an object of concern, among the world’s great powers for more than a half-century. Since the 1975 disengagement of Egyptian and Israeli forces from the Sinai Peninsula, Egypt has drawn more than $70 billion in U.S. assistance, affecting a wide swath of Egyptian political and economic life. Other assistance has poured in as well, from European countries, from international financial institutions, and in recent years, from other Arab states. Whatever its difficulties at any given time, outsiders have consistently considered Egypt a prize worth winning, and they have contributed funds to make it so.
The U.S. economic assistance program in Egypt—a more than 30-year effort—is unusual in the annals of U.S. development assistance for several reasons. Most importantly, politics successfully insulated the multibillion-dollar effort from challenge for decades. Intimately tied to Arab-Israeli peacemaking, and tied as well to substantial U.S. military assistance to both Egypt and Israel, many in Egypt and the United States came to consider the program as untouchable. Over the years, far smaller U.S. Agency for International Development (USAID) programs were wrapped up or refocused to comport with shifting U.S. global priorities and conditions on the ground, but the USAID program in Egypt continued unabated, almost as if it were an entitlement.
The health sector is a valuable prism through which to examine these phenomena shaping the overall U.S.-Egypt economic aid relationship. Over more than three decades, the United States invested more than $1 billion in health projects in Egypt, and the period of U.S. assistance corresponded to a period of dramatic improvements in Egyptians’ health. Bilharzia was largely eliminated from the rural population, the rate of infant and child death from diarrheal diseases plummeted, and population growth flattened considerably. USAID efforts played a significant role in supporting each of these trends.
Gaza's Health Sector under Hamas
In less than three decades Hamas health care activities have transformed dramatically. This transformation in health care has mirrored Hamas’s own evolution, albeit incomplete, from a militant organization to a de facto government. In the process the Islamic movement has gone from coordinating dozens of medical clinics and charities in the West Bank and Gaza to managing a multimillion dollar health ministry with thousands of employees and hundreds of thousands of beneficiaries. Once seen as a religious duty and a practical recruiting tool, Hamas’s health care agenda is now one of practical governance and political survival.
This paper traces the evolution of Hamas’s health care services from the movement’s origins to its current role as the de facto government of Gaza. The paper focuses primarily on the impact of Palestinian divisions on the development of Gaza’s health sector since Hamas’s takeover of Gaza in June 2007, and it examines how regional trends in 2011 have influenced internal Palestinian dynamics that will likely shape Gaza’s health care sector and the Palestinian population more broadly in the future. Finally, the paper examines the U.S. policy implications of Hamas’s successful management of health services in Gaza.