These days, environmental, social and governance (ESG) criteria have become important for most and PR agencies are no exception. If businesses use child labor, burn forests or bribe politicians, many suppliers, buyers, investors and other stakeholders stop engaging with them. This focus on ESG has profound implications for PR agencies. Many expect them  to stop taking on clients with poor ESG records. For instance, some demand that PR agencies should stop taking on fossil fuel companies such as Chevron or Shell as clients.

Such an argument raises key questions. As businesses, should PR agencies shut off a key source of revenue? What if they go bust? Are PR job losses desirable? Many businesses cause environmental damage. Should PR agencies also not accept mining companies and automobile manufacturers as clients? Should the burden of responsibility of accepting or not accepting clients rest on individual PR agencies?

Public Pressure on Public Relations

The outcry against PR agencies acting for fossil fuel companies has a context. Many believe that these agencies have downplayed scientific data revealing the scale of climate change to help the cause of their clients. Recently, a global coalition of over 450 climate scientists signed a calling on PR agencies and advertising firms to end relations with fossil fuel companies. These scientists want them to get behind legislation for climate change mitigation.

In 2021, highlighted hundreds of elaborate campaigns purportedly designed by PR agencies to hinder climate action. Their clients include Shell, Chevron and other fossil fuel entities. Around the same time, the Clean Creatives collective published an open calling on Edelman, the world’s largest PR agency,  to end the ‘greenwashing’ of fossil fuel clients. 

������������’s to the climate emergency emphasized working with partners to accelerate climate action, develop best practices, and hold clients as well as itself accountable for mitigating climate change. The agency also promised many other changes but stopped short of dropping its energy clients.

The Pickle Over Climate Change

To casual observers, these actions by Edelman might be indicative of an industry that uncompromisingly prioritizes profit above ethical standards. Despite the unquestionably sales-driven nature of the business, such a conclusion is too simplistic and a bit unfair. Like other sectors, PR has professional bodies that set ethical for the industry. Ethical competence is a prerequisite for membership. Of these, the International Public Relations Association’s (IPRA) code of is one of the most comprehensive. Among its many provisions, the code states that practitioners must not intentionally disseminate false or misleading information.

Last November’s United Nations Climate Change Conference (COP26) inspired IPRA to form a to heighten professional knowledge of climate-related issues. In doing so, the organization seeks to enable members “to play a valuable part in furthering communications aspects of climate change.” Neither IPRA nor this specific chapter urge PR professionals to cease business with fossil fuel clients, making it unlikely that Clean Creatives and climate change scientists will stop criticizing them.

PR agencies are in a bind. When they work with fossil fuel producers, they have to abide by a code of conduct that might limit what they can do for their clients. The other option for PR agencies is to drop these clients altogether.

Dropping fossil fuel companies might not be an entirely good idea though. If Shell sets its of becoming a net-zero energy business by 2050, PR agencies could help. From developing communications strategies to running press offices, these agencies can help achieve this goal. They can also help in a crisis. Crisis communications helped citizens after  an off the coast of Peru.

Ethics Matter and Might Be Good Business

Any PR professional worth their salt knows that emphasizing the industry’s ethical charters and practices alone is unlikely to cut it with climate activists. For them, such is the severity of the climate emergency that PR agencies should just cease working with fossil fuel companies. Finding a way forward that will satisfy all sides, and suitably addresses climate change communication, remains challenging.

For starters, some consultants may need to get better at managing some of their clients’ expectations. PR agencies might consider the value of emphasizing how they don’t support harmful aspects of oil and gas production. It goes without saying that PR agencies do promote oil and gas producers in . However, they do not represent oil refineries on the continent, which cause much pollution and drain state coffers. The risk of expulsion from trade associations and the fall of a leading firm like are very real for PR agencies. These businesses might upset their critics but they play by their own rules and do not cross thin lines in the sand.

Many PR agencies might also find inspiration from ESG business successes. In the 1990s, the UK’s Co-Operative Bank ran a powerful , promising not to invest their “customers’ money in countries with oppressive regimes.” This advertisement was part of a that highlighted the bank’s commitment to ethical finance. The bank’s compelling ads had hard hitting and often harrowing content about landmines, fossil fuels and more. In 2021, the Co-Operative Bank was  named the high street bank for ESG. Such sort of clients might represent the future of PR agencies.

Fossil Fuels Are Legal and Essential, So Are Their PR Needs

It is unlikely that PR agencies could run advertisements like the Co-Operative Bank for all their clients. Such campaigns would certainly not work for oil and gas producers. Giving them up as clients might not be the right business move. In fact, if PR agencies did  what the likes of Clean Creatives say and jettisoned these clients, climate change would still go on.

The Russia-Ukraine conflict provides a timely reminder that fossil fuels still power the global economy. As essential players in the global economy, oil and gas producers need strategic communications support. They are not Colombian cartels operating in the shadow economy. If nothing else, these companies have to maintain crisis communications preparedness for public interest reasons. What happens if there is an oil spill? How does an oil company communicate about such a spill to the public? As long as we depend on oil for cars and on gas for power, PR agencies have a role to play for bona fide legal businesses.

The views expressed in this article are the author’s own and do not necessarily reflect 51�Թ�’s editorial policy.

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Over the past three decades, Belarusian domestic politics has been defined by its predictability. Despite the emergence of opposition candidates around election time, President Alexander Lukashenko’s grip on power was such that there was only one outcome. Yet, as with so much of 2020, life as Belarusians know it has been turned on its head.

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While the has been called into question, a mixture of political complacency and COVID-19-related turmoil has breathed new life into Belarus’ opposition movement. Beyond disputing Lukashenko’s winning margin in July’s poll, hundreds of thousands of ordinary Belarusians have taken to the streets calling for change. Mostly born after the collapse of the Soviet Union, this generation does not regard the stability offered by Lukashenko as an asset. As they see it, state control of Belarus’ economy and society is incompatible with their aspirations.

Lukashenko’s response to what has effectively become a matter of life and death for his regime has fluctuated between incoherency and heavy-handedness. The president’s disappearance from the public gaze at the start of the unrest, coupled with the disproportionate use of force against demonstrators, suggests that he did not seriously consider the possibility of mass protests. Continued police brutality and opposition candidate Svetlana Tikhanovskaya’s make it difficult to use “external forces” as justification for the crackdown.

“Family” Comes First

Much like , the Gulf states have relatively young populations, particularly Saudi Arabia, where of citizens are under the age of 35. Many have benefited from to higher education systems that have grown exponentially since the early 2000s, both in terms of state and private universities. With this in mind, the region’s political elites can use the lack of meaningful opportunities for so many Belarusians to underscore the importance of their development plans and national visions.

Designed to meet the specific needs of Gulf countries, these strategies nevertheless have several objectives in common. In an effort to counter faltering prices and technological obsolescence, the region is attempting to diversify its dependence on oil and gas revenues by facilitating in different industrial sectors. Doing so also requires the greater incorporation of indigenous populations into national workforces at the expense of expatriate workers. In this respect, Kuwait’s plans to drastically offers a glimpse into the future shape of the Gulf’s workplaces. While never explicitly mentioned in strategic documents, the Gulf states anticipate that encouraging their own populations’ development will offset opportunities for the type of political dissent that’s currently gripping Belarus and which almost a decade ago.

The Gulf’s rulers have no appetite for an , a scenario that some warn is a distinct possibility thanks to COVID-19. Accordingly, local development opportunities will continue to be encouraged during these chastened times. When it comes to wider political participation, Kuwait will remain something of an outlier for the foreseeable future.

The Gulf states’ responses to COVID-19 also merit consideration. Once dismissed by Lukashenko as an ailment that can be treated with , Belarus was among the last in Europe to enact lockdown measures. While it remains to be seen what impact will have on infection rates, a spike in cases could be used by Gulf states to justify their no-nonsense approaches to tackling the virus. Qatar, for example, was one of the first to completely lock down all but the most essential public services. The country’s return to normal rests on the with a four-phase reopening plan.

Don’t Annoy Next Door

International reaction to the political crisis in Belarus has so far been muted, with presidents Vladimir Putin of Russia and China’s Xi Jinping for Lukashenko’s re-election. For its part, the European Union’s response has been cautiously led by the likes of Lithuania and Poland. Their approach reflects two important points. First, the protests are highly internalized and not about pivoting Belarus further East or West. Second, direct support for the opposition risks a Ukraine-type scenario whereby Moscow directly intervenes to safeguard its interests.

Point two is of particular relevance to the Gulf states, whose economic ties with one of Russia’s closest allies continue to grow. Cooperation between Belarus and the United Arab Emirates is a case in point. According to , the volume of trade between both countries amounted to $121 million in 2019, up from $89.6 million the previous year. Minsk has also made regarding joint manufacturing opportunities and the re-export of products to neighboring markets.

Saudi Arabia undoubtedly has the most to lose from antagonizing Russia in its own backyard. Last April, the kingdom 80,000 tons of crude oil to Belarus. This purchase, first of its kind, not only reflects Minsk’s determination to lessen its reliance on Russian supplies, but also happened against the backdrop of faltering demand and an oil price war between Moscow and Riyadh. Since then, both sides have brokered a designed in part to ensure that OPEC+ members respect industry-saving production cuts.

Accordingly, the “softly, softly” approach currently being employed by the EU’s eastern flank provides a blueprint for how the Gulf states should continue to manage their responses to the Belarus crisis. Not only does it offer the best chance of maintaining economic relations irrespective of the final outcome, but it also keeps regional oil supplies in still uncharted waters at a time of great uncertainty in global markets. Antagonizing Russia with even the most tacit support for Belarus is, put simply, too risky a proposition.

Belarus’ unfolding crisis is ultimately about replacing an unmovable political leader and system that have dominated the country for decades. In a region defined by its own version of long-term political stability, a similar scenario among Gulf states is unpalatable. Fortunately, the region still has resources at its disposal to prevent this from happening and protect much-needed economic victories in new markets. While always important, the Gulf’s indigenous populations are increasingly being reconfigured as the most essential features of the region’s future prosperity and stability.

*[51�Թ� is a  partner of .]

The views expressed in this article are the author’s own and do not necessarily reflect 51�Թ�’s editorial policy.

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Well documented is the Somali National Army’s (SNA) decline from one of Africa’s most effective fighting forces into corruption and inefficiency. Efforts to breathe new life into the country’s military nevertheless took a turn for the better following the of a National Security Architecture. Signed by the federal government and member states in April 2017, this outlines the size and scope of Somalia’s security forces. The agreement also adds further definition to international efforts to redevelop the SNA’s capabilities.

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High-quality training provided by the United States, the African Union (AU) and others has enabled the SNA to score some notable victories over the Islamist militant group al-Shabaab, including the of resource-rich Middle Juba as well as towns and villages that were out of reach for years. However, Somalia’s armed forces are by no means the finished article, with US military personnel continuing to provide for special forces operations. A recent Pentagon report also highlights with Operation Badbaado, a joint SNA-AU mission to retake Somalia’s southern provinces from al-Shabaab.

Concerns also remain over the SNA’s lack of numbers (approximately 20,000 personnel), poor quality hardware and continued susceptibility to . Furthermore, despite the emergence of the National Security Architecture, forces loyal to Mogadishu are not necessarily under the same flag. Back in February, SNA with members of the Ahlu Sunnah Wal Jamaa, a moderate Sufi militia that has also taken the fight to al-Shabaab. The skirmish prompted warnings that internal rivalries are slowing Somalia’s efforts to defeat the insurgency.

Ties Unbind

It would be naïve to assume that the UAE is oblivious to the current state of the SNA and the narrow capabilities it would bring to Yemen’s conflict. This also extends to providing humanitarian relief for Somali migrants caught in the of the warring factions and allegedly mistreatment at the hands of their “hosts.” The UAE knows this because, prior to the Gulf crisis that erupted in mid-2017, Abu Dhabi was also a major provider of military support to Somalia.

Back in 2014, the Emirates embarked on its to train and mentor Somali troops. This arrangement started to unravel following Mogadishu’s refusal to take sides in the ongoing . The final nail came April 2018, after Somali security forces $9.6 million from a plane recently landed from the UAE. Despite Abu Dhabi’s protestations that the money was to pay the troops it was training, Mogadishu suspected the cash was to be used for more insidious purposes.

With an irksome SNA now effectively someone else’s problem, the UAE recalibrated its support for Somalia’s semi-autonomous regions. This included military and police training and the construction of an at the Somaliland port of Berbera. Situated just 300 kilometers away from Yemen, the city is a strategically important location for a country heavily involved in the conflict, not to mention determined to cement its influence around the Red Sea.

However, the UAE’s relations with Somalia’s autonomous states are by no means perfect. On March 4, Abu Dhabi the cancellation of its construction of military bases in Somaliland. While presented as its own decision, it is that Somaliland President Muse Bihi Abdi actually called time on the arrangement. Some analysts have mooted behind-the-scenes tensions over the UAE’s regional presence as a possible reason. Elsewhere, Puntland’s policymakers have expressed dissatisfaction at DP World’s developing the Port of Bosaso. Arbitration between the federal government and a freight company is scheduled for this month.  

For its part, Somalia’s President Mohamed Abdullahi Farmajo offset poor relations with the UAE by drawing closer to Qatar and Turkey. Over the past decade, Doha has $4 billion in the country and recently struck a deal to at Hobyo on the Bab-el-Mandeb. While Turkey has also poured billions into Somalia, Ankara’s most significant investment comes in the shape of , Turkey’s biggest overseas military base. Costing approximately $50 million, this Turkish facility assists in the training of SNA recruits. It also underscores Ankara’s growing influence across the Horn of Africa region.

Meet the Opposition

Just as Abu Dhabi knows all about the SNA’s limitations, it also knew its request for Mogadishu to become involved in the Yemen conflict would be rebuffed. Beyond Somalia’s brotherly affinity with its neighbors across the Gulf of Aden, the aforementioned investments demonstrate the depth of its relations with two of the UAE’s biggest strategic rivals. However, this could change once the country is in a position to hold parliamentary and presidential elections.

Originally scheduled to take place on November 27, 2020, and February 8, 2021, both elections have victim to COVID-19, flooding, internal security, constitutional challenges and technical issues. Once these problems resolve satisfactorily, Farmajo and his Tayo Party’s main rival will most likely be the Forum for National Parties (FNP). Formed in November 2019, the alliance six political parties opposed to the “blatant violation of the constitution and other laws by the current government.”

Among the politicians on the FNP ticket are two former presidents, Sharif Sheikh Ahmed and Hassan Sheikh Mohamud. Both have difficult relations with Qatar. After being elected head of Somalia’s transitional federal government in 2009, Doha urged Sharif Sheikh to with all warring factions, only for Sharif Sheikh to eventually accuse Qatar of supporting al-Shabaab. Despite funding Hassan Sheikh’s 2012 presidential bid, Doha eventually with his government, accusing it of being as ineffective as its predecessors.

Accordingly, the UAE and other blockading states seemingly have a cohesive Somali opposition movement to throw its weight behind come election time. Electoral success could result in the redrawing of Mogadishu’s relations with the Emirates at the expense of Somalia’s partnerships with Turkey and Qatar. While the FNP will fight both elections on an anti-corruption and pro-constitution platform, the potential to spin the UAE’s request to join the Yemen conflict is unmissable. By failing to support its neighbor, Somalia has deprived itself of much-needed investment and access to health care just when it needs it most.

As the Emirates Policy Center , the Somali opposition’s failure to align behind one candidate will keep Famajo in power. To overcome this, the FNP might just be the political movement to offer the incumbent president a serious run for his money. If so, then the UAE might have already signaled what it wants in return for its moral and material support: at least a token SNA presence in the Yemen conflict and the normalization of ties with Abu Dhabi. Achieving both will strengthen the UAE’s influence in a region of critical strategic importance to Gulf powerhouses.

*[ a partner organization of 51�Թ�.]

The views expressed in this article are the author’s own and do not necessarily reflect 51�Թ�’s editorial policy.

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It seems the world is falling back in love with cocaine. According to the United Nations’ latest , total production in 2015 stood at 1,125 tons, a return to 2008 levels that’s been driven in part by a . There are currently over worldwide; much less than cannabis, but arguably in line with cocaine’s status as the drug of choice for the rich and famous. Yet there have also been subtle, but nonetheless significant, shifts in regional consumption trends.

While cocaine use is again increasing in its established markets in Western Europe and North America, there are signs that the drug is gaining a foothold in Asia, with the Middle East now accounting for approximately 3% of . Previous UN reporting also reveals that the region accounted for between 2009 and 2013. This figure increased to 49% the following year.

Unsurprisingly, the oil-rich and expat-heavy states of the Gulf Cooperation Council (GCC) have become a major hub and endpoint in cocaine’s eastward expansion. None more so than the United Arab Emirates (UAE), which has witnessed an increase in seizures at its airports and interceptions of traffickers that have swallowed to escape detection. However, coke’s “arrival” in the Gulf is about more than changing tastes and habits. It is also a reflection of the cartels’ growing business interests in difficult neighborhoods.

“Obvious” Causes

In some respects, the upsurge in cocaine consumption in such an economically important part of the world is to be expected. Just over are currently based in GCC states, making a contribution to the that stretches beyond the corporate world to include the service sector, domestic help and more. Many of these expats bring with them a more relaxed attitude toward entertainment and drug use that are at odds with the GCC’s rulers and religious outlook.

The stakes are undoubtedly high for those that dare to flout the region’s laws and customs. At the beginning of July, UAE authorities prosecuted two British nationals for possessing and supplying cocaine in Dubai. One can expect after his two-year sentence is completed, the other could be . Both will be added to the growing number of people , which increased from 173 in 2015 to 391 last year.

It would be naive to assume, however, that the UAE’s hardline approach reflects the entire region’s attitude toward drugs. Given that foreign nationals account for more than 50% of the population in several GCC states, it’s difficult to prevent locals from interacting with expats and participating in social activities. This is particularly true in Bahrain which,��following the construction of the King Fahd Causeway, earned a reputation as a weekend hotspot, particularly for the Saudis. Meanwhile in Qatar, where foreign nationals outnumber locals by four to one, officials have warned that between 3%��and 5%��of the emirate’s indigenous population suffer from .

A more troubling development is the use of crack cocaine by Oman’s youth. Following a recent visit to the sultanate, Johan Obdola, president of the , warns that schoolchildren as young as 12 are using the cheaper and more addictive variant of the drug. This revelation, in turn, suggests that the of the GCC’s are also contributing to the region’s increased cocaine use. If so, then the drug will have to be factored into to enhance development and employment prospects in a region from a slowdown in economic growth, austerity and popular unrest.

Familiar Responses

To date, the GCC has relied on tried and trusted methods to combat the spread of cocaine. From a law enforcement perspective, the region’s security agencies seem determined to build upon the Middle East’s growing reputation for tracking and seizing the drug. In April, Saudi authorities seized hidden in a consignment of frozen chicken at King Abdullah Seaport. This was followed last month by the arrest of entering the kingdom on Umrah visas. In Kuwait, customs officials followed their recent interception of a by discovering a consignment of cocaine hidden in .

The Gulf region also continues to benefit from multinational efforts to combat trafficking. These include the Bahrain-based Combined Maritime Forces based out of America’s 5th��Fleet headquarters in the archipelago sheikdom. Recent seizures made by its Combined Task Force 150 include the interception of of cocaine by USS Hue City. The UAE has also played a lead role in international counter-trafficking activities. In response to the Emirates’ warning of an increase in trafficking, Interpol triggered a purple notice that helped to uncover a transportation route between Ethiopia and the Arabian Peninsula.

GCC states are reacting to the cocaine influx. At the beginning of 2017, Saudi Arabia’s Ministry of Health confirmed that the drug addicts in a range of healthcare institutions. Its efforts will eventually be supported by a government-approved treatment plan. At around the same time the UAE was opening its first in Dubai. The event was accompanied by assurances that locals and expats seeking rehab will not fall victim to the Emirates’ anti-drug laws.

Given Oman’s problems with crack cocaine (and other substances), it is perhaps unsurprising that the sultanate has one of the GCC’s more robust rehabilitation programs. This is underpinned by a and a $200-million government program to . Charity workers warn, however, that the prevents many Omanis from accessing treatment. To some observers, this state of denial also masks the true nature and extent of not just Oman’s drug scene but the entire region’s narcotic problems.

Inertia Creeps

The GCC’s coyness regarding drugs does not end with the cultural mindsets of its citizens. Since his first visit in 2010, Johann Obdola has witnessed a reluctance among security and intelligence officials to acknowledge the full impact that drug abuse is having upon the region. With its clarion call for and commitment to the recently-formed GCC-POL (a GCC-wide Interpol) may yet result in more joined up approaches to counternarcotics. However, transforming laissez-faire attitudes remains a formidable challenge given that most as their main security challenge, a point underlined by Qatar’s over its ties with the Islamic Republic.

The current lack of “cooperation and unity” between GCC states also clouds their ability to fully comprehend a key motivation behind the cocaine cartels’ growing presence in the region. It’s not just about their ambitions for the opened between South America and Qatar and the UAE. Neither is it solely to do with the relative ease with which the cartels can their product from West Africa to markets in Europe and the Middle East. Mexico’s Los Zetas cartel, Colombia’s FARC and other groups are also interested in investing and washing their profits in the Gulf’s businesses and zero-tax regimes.

Real estate and transportation are thought to be among the for the cartels’ investment activities. This is hardly surprising given the $2.7 trillion worth of currently at the planning or delivery stage across the GCC. The cartels might also be as encouraged by the UAE’s comparatively high placing on the as the Gulf’s downward trajectory on the . Transparency International attributes in part to the ruling families’ firm grip on the levers of economic and political power. Either way, conditions on the ground are providing the cartels with opportunities to make their financial muscle discretely felt throughout the Gulf region.

Obdola also highlights the cartels’ no-nonsense approach to due diligence and related business practices. He’s convinced that some of their sharpest minds are now based in GCC states, building knowledge and gaining an appreciation of the local business environment. It is also likely that the cartels are fostering strategic partnerships with the region’s terrorist groups and criminal enterprises. And while hard evidence of interactions is difficult to come by, Latin America’s drugs gangs regularly factor states that are into their business strategies.

Make the Connection

Indeed, the “arrival” of cocaine to the Gulf also suggests that the likes of Hezbollah and are comfortable with the cartels’ presence in their backyard in much the same way as the in their respective patches. The GCC’s security and law enforcement agencies should take note. As stated above, good working relations between the cartels and have facilitated the relatively trouble-free trafficking of cocaine across the continent because of the inability of states to police their customs and border controls. The consequences of a similar arrangement in the Gulf are plain to see: even more cocaine and potentially more revenue for organizations that appreciate in financing and facilitating conflict.

As things stand, the GCC’s efforts to tackle cocaine trafficking seem fragmented. It’s the job of GCC-POL to convert member states’ individual efforts and successes into a cohesive and region-wide strategy. The ongoing diplomatic spat between Qatar and the rest of the GCC makes the chances of this happening any time soon remote. No doubt the cartels will be watching how the crisis evolves with great interest. Doing so will help them to shape and refine their regional business interests and criminality.

The views expressed in this article are the author’s own and do not necessarily reflect 51�Թ�’s editorial policy.

Photo Credit:����/

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Not so long ago, Médecins Sans Frontières made a shocking discovery in the Democratic Republic of Congo: Hundreds of patients had unwittingly taken Haloperidol instead of Diazepam to treat malaria-induced seizures, meningitis and other illnesses. The side effects caused by this powerful antipsychotic were horrific. Many victims suffered facial cramps, contorted upper bodies and other equally bizarre symptoms.

It’s the type of backyard horror story that’s inspired the governments of the Middle East and North Africa (MENA) to regularly remind citizens of the dangers of counterfeit medicines. Warnings are often attached to media coverage of seizures, as well as updates on state-led initiatives to combat a trade worth an estimated $200 billion a year. And with good reason: While the scourge of fake pharmaceuticals affects all parts of the world, the problem is growing in the MENA region, where health care can be in short supply but in high demand.

According to the , the MENA region’s population is expected to increase from approximately 360 million in 2011 to almost 500 million by 2030. However, rather than being driven by a consistently high birthrate, the region’s demographic changes will be more attributable to life expectancy, which the increased from 46 to 72 years between 1960 and 2014. As a result, MENA states will increasingly face the type of health problems associated with the ageing populations of Germany, Japan and other advanced high-income countries.

MENA’s growing diabetes burden certainly warrants close attention. The predicts that disease rates throughout MENA states will increase from 35.4 million in 2015 to 72.1 million by 2040. Countries with high diabetes prevalence include Kuwait and Saudi Arabia, especially when it comes to annual incident rates of Type 1 diabetes in children. Other key triggers, such as obesity and tobacco use, are also increasing, particularly among more affluent and female populations. Consequently, in the upcoming decades, the region’s health services are likely to encounter more cases of hypertension, heart problems and other chronic diseases.

An altogether different concern is the MENA region’s high level of HIV infection, which, according to , has increased by 31% since 2001. Of an estimated 240,000 people living with HIV across the region, over 50% of new cases are attributable to intravenous drug use. HIV prevalence among users that inject drugs ranges from zero to 1% in Kuwait and Lebanon to 87% in Libya. Access to opioid substitution therapy also varies with only the likes of Iran, Israel and Morocco offering a credible package of treatment options.

While medicines used to treat diabetes, drug addiction and other conditions are, in theory, easily accessible, chronic underfunding and patchy health services have hampered efforts to introduce them en masse in the MENA region. Between 2006 and 2011, 8.2% of their budgets on health care; the global average was approximately 10%. There are also obvious disparities, with Gulf Cooperation Council (GCC) states relatively free to spend more on health than conflict-affected Iraq and Syria. For MENA’s poorer states the implications are twofold. First, specific health care functions must compete for scant government resources. Second, many households face the choice of paying for up to 40% of their treatment or foregoing it altogether.

Unhelpful Solutions, Unhelpful Sources

It’s hardly surprising then that the MENA region is susceptible to overtures from a highly-lucrative trade in counterfeit medicines that fall well below accepted standards of efficacy and quality. The that approximately 35% of the pharmaceutical market in the Middle East could be illicit. If so, then the region is potentially awash with medicines that contain no active pharmaceuticals and harmful additional substances such as rat poison and cartridge ink. The consequences of taking these drugs can be devastating with brain damage and cardiovascular problems among the side effects regularly cited by health-care professionals.

Fortunately, WHO monitoring for the eastern Mediterranean region indicates that seizures of counterfeit diabetes and HIV drugs across MENA remain low. But that’s no reason for complacency. In late 2016, two Indian pharmaceutical companies were charged with hiding fake medicines in legitimate commercial transactions. Customers included near neighbors, Bangladesh and Pakistan. Michael Deats, a group lead with the WHO’s Safety and Vigilance (SAV) Team, also warns of a growing trade in HIV medicines with falsified packaging between southern Europe and East Africa. It��bucks a common trend of sending this counterfeit product to markets in northern Europe where medicine prices are often higher.

Recent seizures in Saudi Arabia and the United Arab Emirates of treatments and the also suggest that manufacturers are increasingly in tune with the “modern” health concerns of local populations. The same might also be said of , an amphetamine-based stimulant that remains widely available across the MENA region despite being banned since the 1980s. Usage now stretches beyond the nightclubs of the Middle East to Syria’s war zones, where all sides use it to remain sharp and focused on the battlefield. Some veterans claim that Captagon makes combatants “unafraid of anything” and full of “great courage and power.” A former Free Syrian Army fighter also told the BBC that some��would stop providing food for their families in order to feed their habit.

Not that any of this will influence the traffickers and suppliers — a nebulous criminal network attracted to the low risks and high rewards offered by counterfeit medicines. Paul Newton, a professor of tropical medicine at the University of Oxford, attributes this to the for manufacturing and distributing fake drugs compared to those for human and narcotics trafficking. Despite being a worldwide problem, building a global consensus on what exactly constitutes an illegally-manufactured counterfeit medicine remains notoriously difficult. Worse still, the United Nations Office on Drugs and Crime (UNODC) warns that the lack of analytical studies on organized criminal groups is undermining efforts to coordinate responses to illicit medicines.

At least governments and international organizations have a better idea of how traffickers saturate the MENA region with fake pharmaceuticals. The journey usually begins somewhere in Asia, with the UNODC labeling China as the “” for 60% of global counterfeit seizures between 2008 and 2010. Poor regulatory frameworks and oversight also make India a major production hub for fake medicines. To make matters worse, Beijing’s and New Delhi’s efforts to stem the flow of fake medicines have been offset by the moving of production to other parts of the continent, particularly Southeast Asia.

From Asia, fake pharmaceuticals tend to make their way to consumers via well-established trading routes, including the internet and, increasingly, the dark web, where anonymity and encryption help counterfeiters of all persuasions to hide in plain sight. Circuitous and time-consuming journeys along sea routes are also used, with the UAE’s free-trade zones prime locations for the “sanitizing” of illicit goods. Not surprisingly, traffickers have turned the MENA region’s war zones into distribution routes. None more so than Iraq, where conflict, porous borders and the collapse of regulatory frameworks have facilitated illicit smuggling, sales and distribution.

Fighting Back

Although the overwhelming majority of MENA states participate in the WHO’s Global Surveillance and Monitoring System (GSMS), it is perhaps unsurprising that the GCC has stolen the march in local efforts to combat fake pharmaceuticals. Not only is it home to some of MENA’s largest markets for medical products, member states are also building pharmaceutical industries that they eventually hope will compete with more established manufacturers. One of the best ways to demonstrate that the region has a handle on this sector is to target the influx of counterfeit medicines.

In the build-up to the Second Emirates International Conference on Combating Medicinal Products Counterfeiting, the UAE announced that it is planning to use a device that detects fake medicines within seven seconds. It’s possible that this is a Raman mobile spectroscopy instrument that��relies on non-destructive tests to identify chemical compounds. In addition, the Emirates are determined to update the 1983��Federal Law N°4 on the pharmaceutical profession and industry by the end of this year. This should result in tighter procedures for seizing suspected shipments and harsher penalties against individuals and companies dealing in counterfeit drugs.

These are the type of initiatives that the UAE hopes will keep its health service free of counterfeit medicines and deter traffickers from using its ports to transport fake products. However, success will also depend on like-minded efforts made elsewhere, particularly in Saudi Arabia and other MENA states. The kingdom is home to an estimated 3,000-3,500 pharmacies and nearly 200 companies registered under the Saudi Health Ministry. also accounts for over 60% of the GCC market and has recorded over 4,000 patented and generic drugs. Under Saudi Vision 2030, the kingdom’s pharmaceutical sector through foreign investment.

Like the UAE, Saudi Arabia is also looking to advanced technology to assist in the detection of counterfeit medicines entering ports and leaving manufacturing plants. On the policy front, Riyadh hopes to strengthen its bar code regulations by serializing pharmaceutical products by the end of year. Saudi Arabia is also coordinating its efforts to combat illicit pharmaceuticals with industry giants such as Pfizer. The kingdom’s ��(SFDA)��has been conducting market surveys on behalf of such companies, collecting samples from pharmacies and sending them for analysis.

Cooperation with established pharmaceutical companies will also help to allay concerns over Saudi Arabia’s close ties with Chinese manufacturers. With the encouragement of Saudi Basic Industries Corp. and SFDA, companies have formed partnerships with Chinese counterparts to enhance grains for large-scale husbandry. Mastering such techniques will enhance the kingdom’s efforts to turn its pharmaceutical industry into a major producer of generic drugs. However, as US Federal Drug Agency operatives will confirm, mixing from Chinese manufacturers risks getting closer to fake pharmaceutical products than most companies dare to imagine.

Future’s Bright��… For Some

No embryonic industry can risk the type of public relations fiasco that comes with the distribution and use of counterfeit medicines by health services and humanitarian operations. That’s why the likes of Saudi Arabia and the UAE have adopted a tech-savvy approach to tracing fake drugs, tighter regulatory frameworks and a careful approach to procurement. The WHO’s Michael Deats also praises the GCC’s efforts to improve the quality of information it shares with the Global Surveillance and Monitoring System.

Yet there’s always room for improvement. Deats highlights the need for more joined-up cooperation between MENA states. Greater coordination and knowledge sharing will only benefit the WHO’s monitoring activities and promote a culture of reporting illicit products to regulatory authorities. However, MENA’s most fragile states will continue to provide significant obstacles to region-wide efforts to combat counterfeit medicines. These include Egypt, where seizures of fake hepatitis C treatments are common. Contrasting economic fortunes, scarce government resources and protracted conflict will ensure that MENA’s attempts to tackle counterfeit medicines remain the preserve of its richer and more secure states for the foreseeable future.

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