The Middle East Response to the Coronavirus

The Middle East Response to the Coronavirus

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from Member Conference Calls

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Coronavirus

Public Health Threats and Pandemics

Middle East

Panelists discuss the Middle East response to the COVID-19 pandemic, the challenges countries in the region are facing, and the long term effects this will have on stability, governance, and economics. 

Speakers

Steven A. Cook

Eni Enrico Mattei Senior Fellow for Middle East and Africa Studies and Director of the International Affairs Fellowship for Tenured International Relations Scholars, Council on Foreign Relations; @stevenacook 

Leonard Rubenstein

Professor, Department of Epidemiology, and Director, Program on Human Rights, Health, and Conflict, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health

Ray Takeyh

Hasib J. Sabbagh Senior Fellow for Middle East Studies, Council on Foreign Relations

Presider

Deborah Susan Amos

International Correspondent, NPR

AMOS: Thank you. And hello to everybody, and—Groundhog Day—coronavirus. Welcome to today’s Council on Foreign Relations Conference Call on “The Middle East Response to the Coronavirus” with Steven Cook, Leonard Rubenstein, and Ray Takeyh. I’m not going to read their bios. You can see them. We have an hour, so I’m going to get right to it. I’m Deb Amos, international correspondent for NPR. I’d like to remind you that this conference is on the record.

It’s a good time to be talking about this. The WHO has sounded the alarm about a spike in corona cases across the Middle East, fifty-eight thousand cases reported. I’d like to start with Steven Cook just for a roundup of the kind of things that you’ve been looking at.

COOK: Very much a significant worry about what’s going on in the Middle East. And I could—I could go—I could spend the entire hour going through each country, but let me just offer some broad remarks and then a few sentences about a couple of places that I’m particularly concerned about.

It is, obviously, a region that has repressive governments, fragile public-health systems, and in a variety of important cases not a lot of resources in order to deal with it. Many of the countries, after getting a slow start, have taken some prudent steps of varying degrees of effectiveness like banning flights to and from certain countries, shuttering borders, instituting curfews, and doing their very best to marshal medical gear. But overall, like the United States, most of the countries in the region have been relatively slow. And as I indicated, resources are generally thin.

There are outliers to this. The United Arab Emirates has a lot of state capacity, and they’ve thrown a lot of money and organization at this. At one point a number of weeks ago the airport in Abu Dhabi had tested more people than people had been tested in the entirety of the United States.

But the countries that I’m quite concerned about are Egypt, Turkey, Iraq, and Idlib province in Syria that’s been so much in the news for other reasons. I’ll also add a sentence or two about what’s going on in Israel.

But in Egypt, which actually does have some experience with viruses and outbreaks, it is just a huge population of a hundred plus million people, an extremely fragile public-health system, limited resources, a capital that is extremely densely populated. Very, very hard, especially in the poorer sections of Cairo, for anybody to even consider social distancing. You have a leadership that rules predominantly through coercion and force. And as a result, there is a fair amount of evidence that they’ve been holding back on the number of actual cases they have. They’re reporting 865 cases and fifty-eight deaths, and the belief is that it’s much, much bigger than that. One of my best Egyptian interlocutors wrote me and said, quote, “the Egyptian government privately argues that if they convey the truth in a nation that has a large population and a large number of illiterate citizens, chaos will spread everywhere and the nation will collapse.” That is quite worrying.

Turkey. The parallels between the Turkish response and the American response are really quite striking. The Turks were very, very slow to respond. To date they have not had a nationwide lockdown. President Erdoğan has said that he’s leaving it to people’s best judgment. Istanbul, like New York City, has 60-plus percent of the cases and is quickly finding that it doesn’t have the resources to deal with the number of new cases. So far Turkey’s reporting a bit shy of four hundred deaths. That is likely to change dramatically in the coming weeks. And one of the big problems in Turkey has been the mixed messages from the leadership over a period of time, and infighting between authorities in Ankara and mayors in big cities like Ankara and Istanbul and others that are held by the opposition party. At the same time, Turkish business leaders, the Turkish president, the president’s son in law have been much concerned with the state of the Turkish economy, and as a result have not wanted to order a nationwide lockdown. When medical professionals and the press have dared to speak out about the coming crisis in Turkey and the shortages in terms of protective equipment, ventilators, and so on, they’ve been arrested or intimidated or forced to publicly apologize for besmirching Turkey’s good name.

The last two, very quickly, is Iraq, a country that’s already in terminal collapse, doesn’t really have a government, doesn’t have much in the way of resources, has large number of refugee and IDP camps that—throughout the country, and people living on top of each other, as well as large numbers of Iranians that have come across the border and very little means to test people who are coming and going and staying in Iraq.

And then, of course, there’s Idlib. This is, quite obviously, a war zone, and there are large numbers of Iranians, Turks, Russians, journalists from Europe, and aid workers in the area. Medical care in Idlib is threadbare at best. There’s really two scenarios for Idlib: Idlib becomes locked down, actually it becomes a cordoned sanitaire (ph), and lots of poor people there will die; but more likely, the virus can’t be contained—as we see, it doesn’t—it doesn’t respect borders—and it fuels continued outbreaks in Turkey, Lebanon, Jordan, Iran, Russia, Greece, and Europe, beyond.

Before I close in my overview, just one quick—a few quick notes about Israel. Israel has a significant number of cases—seven thousand, with thirty-nine deaths. The Israelis have significant more capacity than its neighbors, and they’ve been dealing with it relatively well. Still, they have about four thousand soldiers in quarantine, and as of yesterday fifty-eight confirmed cases of COVID-19 in the IDF. This raises questions about the readiness of a force that has been ready and has to meet the challenges of both the surrounding countries, Hamas, Islamic Jihad, as well as now has been thrown into the coronavirus—the effort to contain coronavirus. There have been some instances of significant Palestinian-Israeli cooperation on this issue, which is good to see, but it seems unlikely that’s going to extend much beyond the current pandemic.

I’ll stop there because we don’t have that much time, and hand it back to Deb. Thank you.

AMOS: OK. Leonard, you see things in a different way because you are an epidemiologist. Can you give us an overview of the Middle East as well?

RUBENSTEIN: I’d like to focus—thank you, Deb. I’d like to focus on some of the war-torn regions. Steven mentioned Idlib, but we also have Yemen, Libya, Gaza, Afghanistan, and it’s really hard to avoid apocalyptic thinking when you look at these regions, as well as the millions of refugees in Jordan, Turkey, and Lebanon, and then all the internally-displaced people in the region. The number of cases reported in most of these countries is in the hundreds or fewer, but everybody knows much worse is coming. And while each country—you know, region has its own story, there’s a lot in common.

The first thing is that there has been tremendous destruction of the health systems in these—in these regions. Steven mentioned weak health systems in the Middle East, but in these countries—in Yemen, in Libya, Gaza, and of course Syria—the violence committed against health care, including shelling and bombing hospitals, has basically destroyed whatever capacity there was. WHO recently reported that in Libya the outbreak response capacity is nonexistent. Afghanistan, which some people don’t think is the Middle East but in WHO practice it is, has escaped a high level of physical violence but its system is still undeveloped and weak and absent in many insecure areas.

The numbers of displaced people, of course, is staggering. More than—in need of humanitarian assistance: twenty million in Yemen, six million in Iraq, and, of course, the millions of refugees throughout the region. There are huge shortages of health workers, mostly because of flight, a tiny fraction of the protective equipment, intensive care beds, ventilators. They need testing capacity, no labs, and they have to compete with the West in getting the equipment. For example, the WHO can’t procure equipment in Turkey because Turkey needs it. So they get—so all this equipment for Syria they have to go elsewhere.

It’s very hard to know projections of what this is going to be like, but the numbers that have been put out there are pretty frightening. The Ministry of Public Health in Afghanistan projected up to twenty-five million cases, which is hard to get your head around. It’s less a fantasy when one considers in the last month a hundred forty thousand Afghans have returned from Iran because of the crisis there, and they’re all going through Herat to their own communities and likely spreading the disease throughout the country. Herat, by the way, has ten doctors, one hospital, one specialist, and mostly nonworking ventilators.

In Gaza, there are estimates of 20 percent of the two million people there contracting the virus and a projection they need a hundred thousand beds. There are only 2,500 beds. Yemen has had no reported cases but it’s likely because Iran Revolutionary Guards have a pretty significant presence there and they’re bringing it with them from Iran. And I’m sure as you all know, Yemen already had two million cases of cholera over the past couple years, which is the largest outbreak in recorded history. And, of course, all these places lack clean water and appropriate soap and sanitation.

There are also tremendous obstacles to procurement. Some I’ve mentioned. But, for example, Syria has just done a complete accounting of every shipment that goes in, just like it did with eastern Ghouta with terrible consequences. Meanwhile, Resolution 2165 of the Security Council, which allows access into Syria from Turkey, expires in July and it’s not clear whether Russia will allow it to be renewed.

Israel shut down the permit system allowing Gazans to go to east Jerusalem Palestinian hospitals and also has not lifted the blockade for medical equipment in parts. In Yemen, commercial air services shut down and humanitarian access within the country is curbed by restrictions on travel. And it’s also not clear whether counterterrorism restrictions on aid will be applied. In OCHA, we know, the U.N. humanitarian agency, is very concerned about that.

I don’t have time to talk about refugees but I just want to mention one dimension of the problem. In Lebanon, 80 percent of the million and a half Syrian refugees are unregistered and they fear deportation if they seek medical care, even at a checkpoint getting to medical care, and, in any event, can’t afford the treatment in the private hospital system there.

All these countries are trying to deal with this through similar mechanisms that we are using for restrictions on movement and social distancing, and there have actually been some positive developments. Hamas has established twenty-four quarantine centers in Gaza. The Taliban in Afghanistan are trying to be helpful.

But, as we know, trying to contain the virus in the really crowded and often squalid conditions that people are living in are very difficult. The World Health Organization is mobilizing in every one of these places. It’s trying to provide testing kits, ventilators, PPEs, training health workers. But the need so dwarfs the capacity it’s very difficult to see how this will happen. And in terms of funding, the U.N. now has a $2 billion humanitarian response plan. But it’s not clear that Western donors are going to need it in any—in any way. The U.S. has only pledged a hundred million. Of course, the U.S. is always the largest donor.

So, in response, it’s really left to communities which are going to have to take the lead. In the humanitarian world, there’s already a lot of radical thinking about shifting in approach. For example, instead of the way we’re trying to prevent the spread in the West they’re thinking about what they’re calling shielding or green zones where people at higher risk are housed and they’re separated from people at lower risk.

It’s all theoretical now. It’s not clear that it would work. But it does demonstrate that the best we can do is rely on communities. At the same time, some of the policy issues about access and restrictions in aid have to be addressed and, of course, the funding has to come.

I’ll stop there for now.

AMOS: OK. Thank you, Leonard.

And, Ray, I’m assuming that you will be talking about Iran, one of the hardest hit in the region of all.

TAKEYH: Yes. I think at the beginning of the call it was mentioned that there were fifty-eight thousand reported cases in the Middle East. The Iranian government suggests, I think as of this morning, that it has fifty-three thousand of those cases, 3,400 dead. They also claim that eighteen thousand people have recovered. Now, these numbers, I think, WHO has suggested are grossly understated maybe by a factor of five. But that’s, essentially, what they’re reporting.

I think the Iranian response is not that different from other places in the region, although I would have to preface by saying that the country did have within the context of the region a rather well-developed public health infrastructure in a sense that it had managed to have hospitals and clinics even in remote parts of the country. So unlike, perhaps, Iraq and others, it had a greater degree of infrastructure to respond to this.

However, its response has been characterized by confusion, complacency. You can’t talk about that country by not suggesting conspiracy theories and, actually, some measure of competence. Confusion—this began. The regime was downplaying it. It did not engage in shutting down the shrine city of Qom, where it originated, and it began to gradually spread. And there were people in the government that were actually denying it.

Then came the conspiracy theories. The most notable ones was, of course, the leader, Ali Khamenei, who suggested that perhaps United States has manufactured this crisis to weaken the country. And today, there is some degree of complacency. This virus coincided with the two weeks of Iranian New Year where everybody travels all over the country, and instead of trying to shut down that travel, President Rouhani said yesterday as something he was boasting about that the travel across the country during the New Year was to reduce by 30 percent. It should have been reduced by much larger figure than that. And many people now soon will be beginning to come home. So if this—if this virus has spread it’s going to spread even more.

At this particular point, the narrative in the country seems to be that although this is a problem that is a serious problem but it is beginning to be contained and the country is beginning to turn the corner. Whether that’s true or not, I don’t know. I suspect that it is not. The country seems to suggest that it has all it needs to handle this.

President Rouhani said yesterday that, quote, “Iran has no problems in providing foreign currency until the end of the year.” That’s next year, March 2021. Quote, “We have good reserves in essential commodities for the next month. Agriculture and trade ministers have given very promising reports for the situation during the coming year. The minister of health has made similar professions.” I can’t believe any of that is actually true.

I would say two things are also happening that are going to affect the response of Iran and the response of the region to Iran. Number one, this is beginning to be aspect of the political polarization within Iran itself. Many members of the hardline community are beginning to—who at first actually denied this virus and insisted on maintaining open public places, are now suggesting that the Ministry of Health was too slow to respond to the disease, and they’re using it as another critique of President Rouhani’s government or whatever is left of it as it limps towards it end by the next year, spring of next year. So it’s beginning to be subject of some degree of domestic political contention, where different people are blaming each other for the spread of disease.

As I suspect that this virus is going to be aggravated as opposed to mitigated in Iran, belying some of the happy talk you see from the officials, I suspect that domestic polarization will become even more acute, with people seeking to shift blame to each other. President Rouhani, who speaks on this issue in a variety of ways and often contradicting himself, at one point suggests that the situation is under control and at some point in the same press conference suggests that this disease will probably be with us for another year.

The other aspect is, of course, the fact that, as was mentioned, whether it’s in Afghanistan, whether it’s in Iraq, whether it’s Idlib or what have you, a lot of this can be blamed by Iran’s regional detractors on Iran itself, which was an incubator of this virus. And given the transnational nature of its foreign relations, it has been one of the greater transporters of this across the region. The one country that wasn’t mentioned that seemed to be doing relatively better at handling this than its neighboring countries is Saudi Arabia. One reason is they have no—(laughs)—no traffic back and forth with Iran. That’s not the case with Afghanistan. That’s not the case with Iraq, not the case with Syria. So I think to some extent Iran’s regional relationship(s) are going to be aggravated by the fact that it, justifiably or unjustifiably, is going to be blamed for the spread of this contagion. In many places you’re already beginning to see it even exacerbate sectarian tensions, where it is being called a Shia virus because it essentially originated in Iran and spread through pilgrims and mercenaries and soldiers and militias and all the things that constitutes Iran foreign policy.

This all happens, of course, at a time when Iran’s economy is already prostrate. The country seems to suggest—the country’s leadership—that they need—that they have all they need, but then even there’s mixed messages in that. The Foreign Ministry and others suggest they need external assistance. The supreme leader and the president suggest they don’t. The minister of health suggests they do on Tuesday and Wednesday; on Thursday and Friday it’s a different position. So, again, we see what we often see with the Iranian regime: multiplicity of voices making different arguments, often in contradiction of one another. I suspect, though, that, you know, Iran will be—as one of the hardest-hit countries on this, Italy and others—will be one of the last to recover, but it probably has a better chance of eventually mitigating the consequences of this than other neighboring countries such as Afghanistan and Iraq, whose public-health infrastructure is much weaker and in some cases—as was mentioned, Libya—basically nonexistent.

And I’ll stop there.

AMOS: OK. I think what I’m going to do—I only have two minutes to ask you questions; doesn’t make any sense. I’m going to open this to a Q&A. So I’m going to invite members to join the conversation with their questions. A reminder that this meeting is on the record. Please limit yourself to one question. Keep it concise to allow as many members as possible to speak. And I’m now going to turn this call over to the operator, who will explain to members how to ask questions.

OPERATOR: Thank you. At this time we will be begin the question-and-answer session.

(Gives queuing instructions.)

And we will take our first question, and that is from Barbara Slavin. Please go ahead.

Q: Hi, guys. This is Barbara Slavin.

I guess this is a—it’s a question for Ray, maybe for others as well. First, there’s a story on the Iranian Students News Agency suggesting that Nowruz trips are down 67 percent. So I don’t know; you can pick your statistic. But I guess the question is, would you say that the—how would you describe the impact of sanctions on Iran’s ability to respond? And are there things that the United States could do that would make it easier for Iran to deal with the virus?

And then for others, just what will be the impact of this on Iraq, given its lack of oil revenues now, its lack of a government now, the fact that the United States and Iran are—have come to blows in the country? What do you anticipate happening in Iraq? Thanks.

TAKEYH: I suppose I can start. In terms of the level that is down, the level of travel across the country, I am citing actually what President Rouhani said. He said that travel is down 30 percent, but he does say to his—to the benefit that most of the travel across the country is actually not being done by public transport. The statistic he cited is that train travel is down 94 percent, by buses 75 percent, and by airplanes 70 percent. So those are—that’s from President Rouhani’s news conference.

As far as the sanctions is concerned, there’s a debate about that that is taking place. The level of trade that Iran has had in terms of medical supplies from European countries have remained relatively the same. And I would say there is this channel that is established by the United States that give(s) access to the Iranians over humanitarian—(inaudible). I do understand that channel has been itself very contentious because of banking regulations.

Ultimately, I think if the Iranian government believes that it requires sanctions relief from the United States in order to help it fight that particular virus, they should actually petition the United States government. Other countries have done so. The Iranian government at the leadership level can contact the American government and say this is how your sanctions are essentially hurting our ability to fight a contagion that is actually global pandemic. It’s not an Iranian pandemic. It’s not a Shia virus. And the United States would have to take that request into consideration seriously and I hope sympathetically.

At this point the Iranian government has made no such request. It has petitioned IMF for a $5 billion—for $5 billion in assistance, which in and of itself is rather unprecedented. Now, the problem with that, as I understand it, is in 1996—(laughs)—Tom Lantos had introduced legislation which essentially suggested that the executive branch of the United States government cannot accept or concede to the—to the Iranian request without—because it would be a violation of the—of the law. And this essentially came up during the time of—during the time of some earthquakes where the Bush administration was not capable, or similarly. So there’s legislative dimensions to this as well in terms of the Iranian request to IMF. It’s not a purely executive-branch decision.

As far as Iraq, I’ll leave it to others to comment.

COOK: Yeah, let me—let me jump in on the Iraq situation. Let’s just go through the challenges that Iraq faces to begin with. It doesn’t have a government. This is a country that is in a terminal state of collapse. It has dwindling resources, large numbers of refugees and internally-displaced people within its territory, extremism, and a conflict between the United States and Iran and its proxies on its territory.

There is nothing about the global pandemic—coronavirus and its related disease, COVID-19, that makes any of those things better. And Iraq is in a particularly vulnerable position because it doesn’t have a government, it has dwindling resources given the oil war that is going on between Saudi Arabia and Russia—although there seems to be some movement towards ending that. But still, given that Iraq relies so much on oil revenues to make the government run, a major outbreak—and I think that it’s likely that we’ll see one, and it’s already probably happening; the difference between known cases and actual cases is almost certainly large—that Iraq could face any number of political outcomes: society-wide panic, uprising—which was already going on in Iraq, collapse; further, coup d’état, entrenchment of authoritarianism. I think these are the kinds of things that we need to be prepared for, a range of possibilities in a place like Iraq.

RUBENSTEIN: If I could just add one point, the very political instability in Iraq is making it very difficult to have successful movement restrictions. There have been restrictions put into place, but people are going out there to join demonstrations and get in the street.

AMOS: Can I ask a question in the silence here, and that is are there governments surprisingly getting it right? I mean, Jordan, you know, clamped down the entire country, including pharmacies and bakeries. I mean, nobody was allowed out of the house. Do you see that there are some regions where, you know, the authorities figured it out, did it fast, and those are the places that are going to do well?

COOK: I’ll take a stab at this and then others can. Yeah. You know, I spoke to friends in Jordan not long after they had a clamp down and it was well before we did anything even close to that here in the United States, and they seem to have, at least at the moment, be handling it quite well.

United Arab Emirates, which I indicated before, it has a number of cases that are creeping up. But they—this is a function of how open the Emirates is. It’s got about, let’s see, almost a thousand active cases.

And then Ray mentioned before Saudi Arabia. Now, there are some things that we have to be careful about in terms of Saudi Arabia. But Saudi Arabia and, in fact, the Gulf countries have some experience in dealing with Middle East Respiratory Syndrome, another corona—another corona disease that went through the area a number of years ago.

Still, one of the things that concerns me about the countries in the Gulf in particular is what happens in these large numbers of foreign nationals, guest workers, especially the ones at the lower end—the armies of Bangladeshis, Indians from Kerala, Filipinos—who do all the menial labor in these countries. They are a black hole in terms of the spread of the virus and testing.

So, yes, in some of these places things seem good and have done some good things. But I don’t think that they can make the argument or anybody can make the argument that these countries are in a situation where they don’t have to worry about it. I noticed yesterday that Emirates Airline wanted to start limited passenger service again. That may be a little too soon, given Emirates’ global reach and the fact that the airport in Dubai really truly is a crossroad of the world.

TAKEYH: I will say one of the things the Saudis have done—that are doing positively is we’re getting into Ramadan season and Hajj pilgrimage. They seem to have canceled that. That is not something that the Iranians do.

COOK: They will cancel the Hajj. They haven’t done it yet but they absolutely will cancel the Hajj.

TAKEYH: Yeah. And that’s something the Iranians didn’t do. For a long time they kept open the Friday processions and so on and so forth. So that’s a positive thing because that’s—that is highly a transnational global pilgrimage site. They have canceled it in the past, like civil wars and so on. It’s one of the pillars of their faith. So I am glad that they actually will, as Steven suggested, cancel it.

AMOS: Can we talk about Lebanon? Hezbollah was slow in the beginning and allowed Iranians to continue to come. But it looks like they’ve also slammed the brakes there.

COOK: Ray?

TAKEYH: I think you’re seeing that across the board. I mean, even Iraqis have tried to regulate their border with the Iranians. I’m not sure about Hezbollah, which has been, of course, implicated in a variety of the Iranian misdeeds across the region and is now belatedly trying to address some of the problems in Lebanon.

But, as I said, this’ll exacerbate Iran’s relationship with its neighbors, Iran’s relationship with its allies, whether it’s the militias and all that and Hezbollah being case in point. I don’t think that’s necessarily a relationship that’s going to be damaged or attenuate. But it does reflect the fact that the reach of Iranian government to some extent is being circumscribed, at least for now, because of the fact that this virus seems to have originated in Iran, at least in the Middle East portion of Iran, and spread through all the Iranians who traveled across the region, whether in terms of transnational or clerical relationships, whether in terms of militia, of the Guards, the pilgrims, and so forth.

I mean, Iraq was one of the first countries that tried to shut down its borders with Iran. Whether that border is still porous or not, of course, remains to be seen. But I would say one of the things about all these governments in the region, if not globally, they all reacted a bit too slowly to this and so everybody’s trying to play catch up.

OPERATOR: OK. We do have phone questions at this time if you’d like to continue those.

AMOS: Yes.

OPERATOR: All right. We’ll take our next question and that is from Aaron Miller. Please go ahead.

Q: Terrific panel.

I have a question for Steve on Israeli politics. Is it fair to say, Steve, in your view, that a cruel and merciless virus succeeded in accomplishing what three elections in barely a year could not, the possibility of an emergency maybe disunity government but a functional Israeli government?

COOK: Well, Aaron, you can probably answer your own question better than I can. But, yeah, I think that that’s—I think it’s pretty clear that this emergency in Israel, as I said before, it has over seven thousand cases, four thousand soldiers in quarantine. It’s got a problem with regard to Gaza and the West Bank in terms of the coronavirus as well as the usual issues that challenge the Israelis and the Palestinians.

So it also seems to me that, anecdotally, lots of Israelis who were not necessarily supporters of Prime Minister Netanyahu actually liked the demonstration of leadership on his part in the early part of the crisis and that, you know, they wanted to stick with Netanyahu, and this suggested—and Benny Gantz not the world’s best politician and everybody wanted to avoid a fourth poll—that this provides a good opportunity to produce a national unity government.

Now, the idea that Gantz will become the prime minister eighteen months from now seems somewhat farfetched. The crisis will have passed. Netanyahu is a shrewd political operator. So, as you point out, it is more likely to be a national disunity government but will, certainly, for the short period of time that they’re dealing with coronavirus, put the political uncertainty that has plagued Israeli politics for over a year now or just about a year now behind them.

Q: Thanks, Steve.

COOK: Thank you, Aaron.

OPERATOR: Thank you, and we’ll move on to our next question and that’s from Norman Roule. Please go ahead.

Q: Good afternoon, and thank you for an interesting discussion.

I would like to ask if you three could suggest what opportunities present themselves. The United States has made an offer of aid to the Iranians. Rejected, but it’s a—it’s a statement or a gesture by the United States. Is there anything else that we should be doing, working with the region, to prevent future pandemics in the future or to tighten the region or—and also, what best practices are we seeing in the region which we could import either to the United States or use to work with other countries to develop a response against future pandemics? Thank you.

AMOS: Anybody? Can I ask Ray one question about the U.S. offer of aid to Iran? I had read that they were trying to open a channel with the Swiss but the quid pro quo is that Iran had to release four or five dual citizens that are in jail. Is that—am I correct about that?

TAKEYH: I have heard that, too. I’m not sure if it’s accurate. There is—there is a humanitarian channel that has been established and the Europeans, of course, have their own. I think some $20 million medical supplies have already gone to Iran. And in terms of the regional response, I think Leonard can speak about this issue more authoritatively, given the fact that he looks at the entire region. I do think, as a prelude to what he can say, is that this gives an opportunity to create a greater degree of cooperation between the region’s health ministries, at least, in terms of coordination of some sort of a response, and that establishes a platform and a network for future such activities. Whether they can overcome their regional—their political differences and actually have this discussion as some sort of a regional-based organization, I’m not entirely sure.

But it does lend itself—this is a virus—as one of President Rouhani’s advisors said. He said: This is a global pandemic. If it’s not curtailed in Iran, it will spread elsewhere. And so it behooves the regional actors themselves to use whatever region-based organizations they are to try to address this issue irrespective of their political differences. It is a regional actually that is riddled with conflict, civil war, suspicions, and so on. But whether there’s a room for expansion of some sort of a regional network, I think Leonard can speak to that more authoritatively.

RUBENSTEIN: It’s actually a fascinating suggestion. As you said, it hasn’t happened. And beyond that, health ministries tend to be fairly weak within their governments compared to other ministries. But there is an opportunity now. And we haven’t seen any movement yet, but I think that is a possibility.

I want to mention one other opportunity. And it may not be directly responsive to the question. But one of the key issues in humanitarian relief in this region over the last decade or more has been the counterterrorism restrictions in aid. It’s really affected Syria, Yemen, other places, Gaza. And many of these restrictions are so overbroad and irrational, but there hasn’t been the political will to deal with them because of the whole focus on counterterrorism. But in a crisis, there may be an opportunity to deal with the issue and have more realistic restrictions, and licensing procedures, and the rest of it, to allow humanitarian aid to reach the people in need.

OPERATOR: And we can move onto our next phone question, if you would like.

AMOS: Yes.

OPERATOR: OK. We’ll move onto our next question. And that is from Peter Galbraith. Please go ahead.

Q: Hi. First, thank you for an extremely good and very depressing depiction of the situation in the Middle East.

I’d like to ask about the conflicts in—the impact of this on the conflicts in Iraq and Syria, both—or parts of them. With regard to the fight against the Islamic State in northeast Syria and northern Iraq, and also whether Sunnis are now going to feel that the non-functional Iraqi government is not serving their interest, and this will lead to a revival. And then related to that, the conflict between Turkey and Rojava, and whether this means that there may be a prolonged—that may be quiet for a period of time, or an opportunity that somebody might take advantage of.

COOK: This is Steven. I’ll take the piece on Turkey and Rojava and the fight against the Islamic State. I know that people are thinking that, you know, out of crises come opportunities for change, and positive change. And I’d like to think that as well. And there’s some—there’s some, you know, glimmers of this that are happening throughout the region. The Israelis have allowed Palestinian security personnel in the eastern portion of Jerusalem, for example, to help keep order. The Emirati foreign minister expressed solidarity with the Iranian people. Perhaps there is an opportunity going forward for countries around the world to strengthen their Ministries of Health, including in the United States.

But you know, perhaps it’s the terminal cynicism in me, but even though the Turks are going to go through something along the lines if Italy or worse, especially where Istanbul really is a COVID-19 bomb that is exploding before our eyes, I don’t think that this is going to diminish the kind of hostility towards Kurds that is really baked into Turkish political culture. It may provide an opportunity for a pause in what the Turks are doing, although I should point out that the Turks keep deploying force down to its southern borders. It may be an opportunity for a pause in that conflict, but I don’t think that this is something that will bring it to an end. And to the extent that this impacts the ability to fight the Islamic State, it is—again, I think I don’t see how the crisis of COVID-19 is going to alter the interests and views of the elite across the board in Turkey that is going to ease up pressure on the Kurds in Syria.

On this question of Iraq, I think the Sunni community has been holding itself out as partners of the United States in Iraq, but that the United States has wanted to, in learning from mistakes in the past, take a real backseat in the process of government formation. And the risk here, especially as deal with—as the Iraqis will be unable to deal with coronavirus, is that communities within that country start looking to themselves for protection. And it puts further fragmentary pressure on Iraq.

AMOS: OK, Ryan (sp), next question.

OPERATOR: Thank you. And we’ll move onto our next question. And that is from Jim Dingman. Please go ahead.

Q: Thank you. Thank you for your panel.

Can the panel go into the kind of facts we’re learning the hard way about the logistics of handling pandemics, and how it applies to the Middle East? That is, for example, how many ventilators are in each of these societies? What’s the PPE numbers in these societies? Where do they get it? How prepared have they been? How have they learned from the MERS crisis that happened in the past? What is the actual tactical ability to respond to this in reality throughout the region?

TAKEYH: Let me just start out by suggesting that one of the things that the Islamic Republic has done over the past forty years is to try to develop a sort of a national public health infrastructure, with free clinics, hospitals, and so forth. So the capacity of the country has expanded over the years. Now, I don’t know if any country has the capacity to deal with this particular virus. And certainly I do believe that Iranian figures are being underreported. President Rouhani has suggested in his last—one of the last press conferences that they had, and I’m looking at it, sufficient ventilators. He says they’re producing sufficient N95 masks. And they do have a relationship with China that I think they may be getting something from there. But essentially, he suggests that the country has sufficient capacity in terms of PPEs and ventilators to deal with the crisis.

Now, given the fact that these numbers are underreported, or they may not even be aware of the scale of the problem that they face—maybe their models and projections are off—because one of the things that Ministry of Health officials are saying is Iran is beginning to turn a corner. I don’t think that’s true. I hope it’s true. But they seem to suggest that they have sufficient degree of internal production of all these things to meet them, with some assistance from China. I would say Iran is probably among the regional actors, with the exception of Saudis and others, that has had, within the context of the region, a fairly robust public health measures.

You’ve seen and deal with problems of, as they view it, the national problems pertaining to health, with some degree of success. In the 1980s and ’90s, they dealt with the problems of overpopulation by reducing the level of births and so on by establishing clinics and information. In this particular case, the problem with the virus is becoming politicized in the country, with different factions blaming each other. And the Ministry of Health, as has been suggested, in this country and others, are weak. And that—the politics of the country may retard its ability to effectively deal with this issue.

COOK: This is Steven. And let me just add, I think it varies from place to place. There are countries that have, you know, significant state capacity and have equipment. Then there are places like the Gaza Strip, where there are ventilators for two million people. Egyptian health authorities are particular concerned about sourcing things like gloves, masks, swabs, reagents because they don’t have a lot of resources and they have to get in line behind the United States and the European Union in trying to source these kinds of things. So I think it varies across the region, like health care across the region varies. I’ve gotten, you know, very good care in hospitals in Israel, Syria, and Turkey. I don’t want to go to an Egyptian hospital. But like I said, it’s going to be—the amount of resources that are available to these countries and places and what they can source where. But certainly those that are not already well-organized are getting in line behind a lot of other big players with lots of money to throw at this problem.

Q: Thank you.

OPERATOR: And we will move onto our next question. And that is from Judith Miller. Please go ahead.

Q: Thank you very much for the panel. Sorry I had to tune in a little late because of the COVID situation down here in Florida.

But I wanted to ask about the credibility of the numbers that we’re—that you’re citing. I was in Oman when this thing began. And the Omanis were, you know, giving me numbers down to the individual in various provinces, until it became clear that they didn’t have testing capability. So Steve, et cetera—(laughs)—at you all, could you just evaluate the credibility you would assign to the numbers we are hearing, especially from Saudi Arabia and Egypt, for example?

COOK: Yeah, I guess that’s a question for me. It’s Steven. I think that Egypt is quite worrying to me because of the initial—their first tendency is to hide the numbers. Not quite different from what the Chinese Communist Party did when it came to the outbreak in Wuhan. And that journalists both foreign and domestic have been arrested and foreign journalists have been thrown out when they’ve tried to report on the extent of the infections in Egypt. The entire state apparatus in Egypt trying to undermine a model developed at the University of Toronto that suggested that Egypt’s infection rate is much, much higher than it is.

And so this leads one to believe that the Egyptian authorities, and since you called in late, Judy, I quoted a well plugged in Egyptian interlocutor who said: Basically the government is lying because they’re afraid of imminent collapse and the panic that would produce collapse if the real extent of the infections is known. Now, but numbers are a problem all over because of the lack of testing. Egyptians don’t have the kinds of tests that one would want in order to really have surveillance and pinpoint where there are hot spots. They’re doing—actually the Ministry of Health, which is weak, is doing what they can and have been following up in trying to do tracing and so on and so forth. But the Ministry of Health in the rank order, as you well know, of who wields power in the Egyptian system, is way, way, way down.

Saudi Arabia has the advantage of having money. Or, did have money before the misbegotten oil war. And has experience with Middle East Respiratory Syndrome. But again, it’s very unclear how much of—how much there was spread of the virus in Saudi Arabia before the Saudis took the steps that they did. They were relatively early in shutting down, you know, malls, and parks, and so on and so forth. And the Saudis don’t announce these things like we do here on, you know, a Wednesday and say: Everybody has to be off the streets by Friday at 10:00. It was kind of immediate.

But as we’ve seen from around the world, that all—as Ray pointed out—all these things have been a little bit too slow. And Saudi Arabia’s infection rate, it seems to be, based on my reading of the Hopkins map, which I—which is the first thing I open every morning these days to see what the horror story is everywhere—the infection rate is, tends to be—tends to be creeping up.

TAKEYH: And if I could just add to that, I think the point that—there are two factors to take. One is, those countries that are hiding their numbers—I think Iraq is another example, Syria is another example. But then there are the countries that have so little capacity to test that we have no clue. For example, zero in Yemen. It’s hard to believe there are zero in Yemen. But they don’t have the capacity to test. And in northwest Syria, testing is also very, very limited. So we don’t know in a lot of the more unstable and conflict-affected places what the numbers are.

Q: Thank you.

OPERATOR: We’ll move onto our next question. And that is from Lyric Hale. Please go ahead.

Q: Yes, hi. This is Lyric Hale in Chicago.

My question, I wanted to underline what Ray said about Ramadan. And that’s coming up April 23. I think preventing a Hajj is one thing but preventing families from celebrating iftar every night for thirty days will be much more difficult. Also, there are unprecedented attacks against U.S. medical supply and health care companies that are ongoing. And it looks as if they’re coming from Iran. Do you think this is an effort, a backdoor effort, to get sanctions lifted? And finally, this came to Iran because of Iran’s close cooperation with China, and trading relationship. Do you think the Belt and Road project is dead in the Middle East after this is over? Thank you.

TAKEYH: I’ll take that and others can chime in. I was always skeptical of the efficiency of Belt and Road. I think we tend to Chinese too much credit. They are baffled by politics of the Middle East as much as we are. They don’t understand why Iranians take the revolution seriously long after they stopped doing. They cannot figure out the politics of Pakistan and the relationship between Pakistan and India. They’re confused about everything that’s happening in Egypt. And they could never figure out their way out of Iraq. So Belt and Road was already a bumpy road to begin with, but it will have problems.

The level of trade with Iran has declined in terms of the oil purchases, which is the level of the things that happen between the two countries. I think projections are that Iran will sell about 160,000 barrels of oil to China, which is its primary customer, down from about 227(,000)-230(,000). So I do think in our imagination we have kind of exaggerated the impact and import of China. They are having as many problems trying to figure out the Middle East politics as we did, and the British before us.

COOK: Let me just—let me just get in on this issue of Ramadan. And I think it’s a really quite important issue. And this is one of the things that keeps me up at night about Egypt, having lived in Egypt and spent as much time, including during Ramadan, in Egypt. Is not just the families getting together, but the Ramadan tables in the street, and the fact that in Egypt Ramadan is a month-long kind of—after the sun goes down—a month-long big party where people get together. And, you know, Abdel el-Sisi had demonstrated significant ability to coerce his population, but it may be very, very hard to do that during Ramadan.

And one can imagine that if he tries, that you then you have other problems on your hands, people taking exception to this. Even if it’s for, you know, public health reasons, people taking exception to it. And one misstep leads to much larger, larger problems in terms of the stability of Egypt. So Ramadan is—the fact that Ramadan is coming up should be cause for concern, especially in these big countries that have traditions of large gatherings and, like I said, a month-long people on the move together, eating, and especially in the poorer parts of these—of the big megacities of the region.

AMOS: Ryan (sp), we have time for one more question and then we’re done.

OPERATOR: OK. And we’ll take our final question. And it’s from Ronald Tiersky. Please go ahead.

Q: It’s interesting that most of the discussion so far has been about response at the top and policies. Let’s look at the bottom, and in a very particular way. It was mentioned that there could be widespread panic. What is the situation, say, with the supply of food? What is the response that you might expect if there’s a glut of people trying to get into hospitals?

COOK: I guess I should take that. This is Steven. One of the things that’s worrying to me about a place like Egypt, or a place like Iraq, a place like Turkey, is not so much—I’m not as worried about food supply in places like Turkey, or even Egypt for that matter. But what I’m worried about is there’s the decades-long attack now, and even longer, on civil society in these places undermines what should be a shock absorber to help these societies cope. And there’s very, very little capacity of these organizations—some of which were better than others, and entirely indigenous, to do those things now because their leaders are in jail, their resources have been confiscated, and they don’t really exist.

So one would like to think from the bottom there would be a lot of help. And I think that really what it is, it’s going to be families seeking care of their families without much support from the state or civil society support. And what we know is that, you know, one infected member of the family can have a disastrous effect on the rest of the family, and then on, and on, and on, and on, and on. So all of these—as I said at the top, if you think about the challenges in the Middle East, the political pathologies, the problems at a societal level that are multilayered and complex, the coronavirus pandemic complicates this by significant factors. I don’t want to put a number on it, but it really adds to what we’re already seeing in the region, which is not a pretty picture in most places.

AMOS: Thank you, Steven.

My job is to call this to an end, which I’m sorry to do. But those are the rules, folks. So I’d like to thank you for joining the conference. Thanks to Steven, Leonard, and Ray. Please note that the audio and the transcript of today’s call will be posted on the CFR website. We hope you can join us for our next call on Monday, April 6, “The World After Coronavirus.” Let’s check in to see if they have a date. It’s a look at the end of the outbreak and the impact it has on globalization and foreign policy in the months to come. Thanks, everybody, for joining. Stay safe. Stay home.

COOK: Thank you.

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