The number of people known to have been infected with Covid-19 in the Middle East and North Africa passed the three million mark at the end of October. Across the region as a whole the level of new infections continues to rise, averaging more than 25,000 a day during the past week.
Among the 20 countries monitored, Iran recorded the largest number of new infections during October, followed by Iraq, Morocco and Israel.
At the other end of the scale, Syria, Sudan and Yemen reported very low numbers but the official figures from those countries are widely regarded as not credible.
The list below shows the daily average of new Covid-19 infections reported by each country during October:
The list below shows the month-on-month increase or decrease in new infections, comparing October's daily average with that of September:
It can be seen from this that Iran recorded the biggest rise in new infections, followed by Jordan, Morocco and Tunisia.
Israel, where a second wave of infections is now subsiding, recorded the biggest decrease, and smaller decreases were reported from Iraq, Bahrain, Saudi Arabia, Palestine and Algeria.
The situation in Qatar, Egypt and Kuwait was largely unchanged.
Looking at the region as a whole, the Middle East has fared rather better than many other parts of the world: three million confirmed cases among a total population of around 508 million. That works out at just over 6,000 confirmed cases per million inhabitants.
For comparison, the US has more than 28,000 per million, Brazil 26,000, Russia 11,000 and the UK just under 15,000.
Clearly, there are various factors that account for these differing figures – not least, the levels of testing and the effectiveness (or otherwise) of preventive measures.
One point worth noting, though, is that most countries in the Middle East were quick to recognise the danger posed by the coronavirus and took action at an early stage. For many of them the first step was to close their borders – a move which slowed the development of transmission within the local community.
Most also imposed strict preventive measures which worked for a while, but they have also had to grapple with non-compliance by sections of the public and as time goes on some of them are finding it difficult to hold the line.
● Previous regional updates: October 3; September 26; September 19; September 12; September 5; August 29; August 22; August 15; August 8; August 1; July 25; July 18; July 11; July 4; June 27; June 20.
● Official figures from around the region can be found in the statistical spreadsheet which is updated daily.
Algeria's outbreak peaked towards the end of July when more than 600 new infections were being recorded each day. Numbers declined through August and September, reaching a low point of around 134 cases a day in the second week of October, according to the official figures. Since then they have been rising again, averaging 295 new cases a day during the past week.
On October 24 Algeria's APS news agency reported that President Abdelmadjid Tebboune, who is 75, had been advised to spend five days in isolation after "many senior officials" had shown symptoms of Covid-19. He was said to be well and carrying out presidential duties remotely. On October 28 he was transferred to a hospital in Germany for what state TV described as medical checkups. It's unclear whether he has the virus.
The number of tests carried out has not been disclosed but is thought to be low. This may be one reason for the relatively low numbers of recorded infections. However, Algeria has been slower than many countries in easing restrictions – which may be another explanation. A note posted by the US embassy in Algiers on October 23 gives details of the restrictions still in place:
● A night curfew (11pm to 6am) is still in place in 29 of Algeria's 48 provinces, including the capital itself.
● All land borders remain closed and non-cargo transport by air and sea is still suspended, though there are some exceptions for repatriation flights.
● There are various travel restrictions within the country.
● Face masks must be worn in public.
For more information see: Covid-19 in Algeria
Confirmed cases: 57,942
New cases in past week: 2,062
Active cases: 15,777
Tests carried out: (unknown)
After several ups and downs, Bahrain's outbreak reached a peak in the third week of September when new cases were averaging more than 700 a day. There has been a sharp drop since then and new cases in the past week averaged 239 a day.
Bahrain has recorded more than 47,000 cases per million inhabitants. This makes it the world's second most infected country (the tiny state of Andorra is first). However, Bahrain has also carried out very high numbers of tests in relation to the size of its population.
For more information see: Covid-19 in Bahrain
Confirmed cases: 81,645
New cases in past week: 1,670
Active cases: 2,605
Tests carried out: 1.75 million
Official figures show Egypt's outbreak has has been relatively stable since early August, with new infections rarely rising above 200 a day. This week's average was 165 a day compared with almost 1,600 a day at the peak in June.
The official figures are surprisingly low considering Egypt's large population (103 million) and the often crowded living conditions. It's also unclear how many tests are being carried out because the government has not issued any figures since May when the total stood at 135,000 tests.
For more information see: Covid-19 in Egypt
Confirmed cases: 107,555
New cases in past week: 1,158
Active cases: 1,837
Tests carried out: 135,000
Iran was the first country in the region to be seriously affected by the virus. An initial wave of infections peaked at the end of March. It subsided during April, but Iran continued reporting relatively high numbers of new cases – mostly between 2,000 and 3,000 a day. Numbers increased sharply in October, averaging 7,152 a day during the past week. This is the highest level so far recorded anywhere in the region.
Iran has reported more coronavirus-related deaths than any other country in the region – currently one death every four minutes.
Confirmed cases: 612,772
New cases in past week: 50,067
Active cases: 95,978
Tests carried out: 4.9 million
According to the official figures Iraq's epidemic developed relatively late. It was not until the second half of May that new cases rose above 100 a day, but that may have been due to a lack of detection. Iraq's official figures are widely believed to understate the scale of the epidemic. Many cases go unreported because of social stigma. Compliance with preventive measures appears to be low and health services are inadequate.
By September 10 officially-recorded cases were averaging more than 4,500 a day. There has been a small improvement since then with new cases averaging 3,354 a day during the past week.
For more information see: Covid-19 in Iraq
Confirmed cases: 472,630
New cases in past week: 23,477
Active cases: 62,065
Tests carried out: 2.9 million
After coming close to bringing the epidemic under control, Israel has been hit by a second wave much larger than the first. The first wave peaked at around 600 new cases a day in early April. Efforts to control it were intially successful and by the second half of May new cases had dropped to about 15 a day.
However, the virus surged back when lockdown restrictions were lifted and by the end of September new infections were hovering around 6,000 a day. A second nationwide lockdown began on September 18 and continued for a month. As a result of that, new infections dropped sharply during October, and the average during the past week has been only 716 a day.
There are still local lockdowns in heavily-infected "red zones" and some restrictions continue elsewhere.
Confirmed cases: 314,422
New cases in past week: 5,009
Active cases: 10,473
Tests carried out: 4.6 million
For several months Jordan appeared to be the most successful Arab country in controlling the virus. Local transmission had virtually ceased and almost all the new cases were detected among people arriving from abroad.
The level of new infections remained low until mid-September when it passed the 100-a-day mark. Since then, local transmission has grown rapidly and new cases averaged 3,122 a day during the past week – the highest level so far.
The government is seeking to avoid another nationwide lockdown but has decreed a "comprehensive curfew" every Friday for the rest of this year. There is also a general night-time curfew and local lockdowns are imposed in heavily affected areas. Education continues by remote learning.
On October 12 King Abdullah appointed a new prime minister and in the resulting cabinet reshuffle Nathir Obeidat replaced Saad Jaber as health minister. Dr Obeidat is a specialist in respiratory diseases and previously served as spokesperson for government’s Covid-19 taskforce.
For more information see: Covid-19 in Jordan
Confirmed cases: 72,607
New cases in past week: 21,857
Active cases: 64,178
Tests carried out: 1.9 million
New infections peaked in late May at just over 1,000 cases a day. Since then the numbers have fluctuated between 500 and 800 a day. New cases during the past week averaged 714 a day.
For more information see: Covid-19 in Kuwait
Confirmed cases: 125,926
New cases in past week: 4,999
Active cases: 8,285
Tests carried out: 917,000
Lebanon's outbreak has occurred against a background of political and economic turmoil, plus the devastating explosion in Beirut on August 4.
Numbers of confirmed cases began rising significantly towards the end of July. A two-week lockdown, which began in mid-August when new cases had not yet reached 400 a day, seems to have had little effect and numbers have continued to rise. The average during the past week was 1,617 new cases a day.
Several factors appear to have contributed to this situation. One is the lack of a clear government strategy for dealing with the virus in the midst of political chaos. Preventive measures have been ineffective due to poor implementation and non-compliance, and there are said to have been problems with contact tracing.
For more information see: Covid-19 in Lebanon
Confirmed cases: 81,228
New cases in past week: 11,322
Active cases: 38,967
Tests carried out: 1.2 million
Libya is in its tenth year of internal conflict. The UN-backed Government of National Unity in Tripoli is challenged by Field Marshall Haftar's forces based in the east of the country. There are also numerous militias. This leaves the country ill-equipped to cope with a major epidemic. Growing levels of insecurity, political fragmentation and weak governance have led to a deterioration of basic services, particularly in the health system. At least 28 health facilities have been damaged or closed by fighting and some have been attacked directly.
Official figures show new Covid-19 infections currently averaging 960 a day during the past week but the true scale of Libya's outbreak is likely to be much higher. A recent report from the UN's Office for the Coordination of Humanitarian Affairs (OCHA) said:
"Throughout September, cases continued to increase in some of Libya’s largest cities, in Tripoli, Zliten, Misrata in the west, and in Benghazi and Ejdabia in the east. While the number of cases reported in the south is lower than the number reported earlier in the year, the near exhaustion of testing supplies and limited capacity of health facilities in the south likely explains the decrease, not that the virus has been brought under control there.
"Libya’s fatality rate is likely underestimated due to the absence of a functioning mortality surveillance system in the country. The number of known deaths (559) includes only confirmed Covid-19 patients who report to health facilities. The real number of deaths (from undiagnosed infections in communities) is unknown. Even with under-reporting, Libya has recorded 80.19 deaths per 1 million population, which is higher than the rates reported in neighbouring countries.
"While capacity for testing continued to slowly increase, with an additional three labs in September, only 15 labs are operational out of a total of 25 and testing remains concentrated in Tripoli and Benghazi. Furthermore, many primary health care (PHC) facilities that were functioning prior to Covid-19 have since been closed. For example, out of 92 PHC facilities in Tripoli functioning before the outbreak, only 54 are still operational. Closures are due mainly to shortages of PPE and infection, protection and control measures, as well as delays or cuts to staff salaries."
For more information see: Covid-19 in Libya
Confirmed cases: 61,095
New cases in past week: 6,721
Active cases: 25,208
Tests carried out: 318,000
Morocco had some success during the early stages of the outbreak and by early June a strict lockdown had reduced new cases in Morocco to around 40 a day. New cases began increasing rapidly towards the end of July, however, and the situation has continued to worsen since then. The past week's average was 3,518 new cases a day.
For more information see: Covid-19 in Morocco
Confirmed cases: 219,084
New cases in past week: 24,623
Active cases: 34,114
Tests carried out: 3.3 million
New infections peaked in mid-July with just under 1,600 cases a day but dropped back sharply in August. There have been a few rises and falls since then, but not to the previous level. New infections reported during the past week averaged 371 a day (though there have been no updates since October 29).
For more information see: Covid-19 in Oman
Confirmed cases: 114,434
New cases in past week: 2,597
Active cases: 10,166
Tests carried out: 377,000
Palestine's outbreak reached a peak in the third week of September when almost 900 new cases were being recorded daily. The Palestinian enclave of Gaza was relatively free of infections until late August when a sudden spate of cases caused the Hamas authorities to impose a lockdown. Up to that point there had been only 117 confirmed cases in Gaza – mostly imported. Limited health facilities in Gaza have raised fears that a large-scale Covid-19 outbreak could be disastrous but that has not happened so far. Gaza's confirmed cases account for about one-tenth of the Palestinian total.
During the past week new infections in the Palestinian territories averaged 524 a day – well below the September peak.
Saeb Erekat, a senior Palestinian figure, is being treated in an Israeli hospital after being diagnosed with Covid-19. His condition is reported to be critical.
For more information see: Covid-19 in Palestine
Confirmed cases: 65,308 (West Bank 42,874, Gaza 6,545, East Jerusalem 11,787)
New cases in past week: 3,669
Active cases: 6,728
Tests carried out: 522,000
Qatar has recorded most than 47,000 infections per million inhabitants – which makes it the world's third most infected country (after Andorra and Bahrain). Migrant workers have been disproportionately affected. Qatar's epidemic reached a peak in the first week of June but infections have fallen since then.
Since the beginning of August the numbers of new cases have been relatively steady, ranging between 200 and 300 a day. The average during the past week was 227 a day.
For more information see: Covid-19 in Qatar
Confirmed cases: 132,556
New cases in past week: 1,591
Active cases: 2,741
Tests carried out: 976,000
Saudi Arabia has the largest number of recorded cases among the Arab countries. New infections reached an initial peak in the fourth week of May, then dropped back slightly before rising to a higher peak in the third week of June.
Since then, though, there has been a substantial improvement. New cases dipped below 500 a day at the end of September and continued on a gradual downward path during October. The past week's average was 390 cases a day.
For more information see: Covid-19 in Saudi Arabia
Confirmed cases: 347,282
New cases in past week: 2,730
Active cases: 8,038
Tests carried out: 8.1 million
The coronavirus struck Sudan in the midst of a political transition following a popular uprising against the regime of President Bashir and the country is ill-equipped to cope with a major epidemic. Testing is very limited and official figures don't reflect the full scale of the outbreak. The health ministry appears to have stopped issuing daily reports.
Covid-19 is only one among a number of infectious diseases causing problems in Sudan.
For more information see: Covid-19 in Sudan
Confirmed cases: 13,804
New cases in past week: 62
Active cases: 6,203
Tests carried out: (unknown)
According to official figures fewer than 6,000 cases have been recorded in areas controlled by the Assad regime but the authorities' lack of transparency fuels suspicions that many cases are being concealed. There is also some evidence that people with Covid-19 symptoms are reluctant to contact the authorities. While there are plenty of signs that the true figures are higher than those issued by the regime, it is unclear how high they really are.
In September the Covid-19 Response Team at Imperial College London issued a 46-page report which estimated that only 1.25% of Covid-related deaths in Damascus during July and August were officially reported.
The UN's Office for the Coordination of Humanitarian Affairs (OCHA) has reported a sharp rise in infections in areas of north-west Syria which are outside the Assad regime's control. On September 8 there were only 138 cases in the area but by October 19 the figure had risen to 2,865, it says in its latest report. Of those cases, 1,476 are in the Idlib area and 1,389 are in northern Aleppo governorate.
For more information see: Covid-19 in Syria
The following figures relate to regime-controlled areas only:
Confirmed cases: 5,728
New cases in past week: 369
Active cases: 3,464
Tests carried out: 26,572 (by 24 August)
In June, Tunisia appeared to be almost free of the virus and began promoting itself as a safe holiday destination. Since August, though, new infections have been increasing again and during the past week they averaged 1,784 a day.
For more information see: Covid-19 in Tunisia
Confirmed cases: 59,813
New cases in past week: 11,014
Active cases: 54,735
Tests carried out: 355,000
UNITED ARAB EMIRATES
The UAE's epidemic reached an initial peak in May when new infections were running at more than 900 a day. Numbers of new cases declined throughout the summer, apart from a small blip in July, but then rose to new heights in September and October, peaking at 1,578 on October 27. During the past week they have averaged 1,121 a day.
The UAE has carried out more tests per head of population than any other Arab country and ranks sixth worldwide in terms of tests carried out.
For more information see: Covid-19 in the UAE
Confirmed cases: 132,629
New cases in past week: 6,989
Active cases: 3,232
Tests carried out: 13.2 million
There have almost certainly been a lot more Covid-19 cases than the 2,000 shown by official figures. In a report issued last week, the UN's Office for the Coordination of Humanitarian Affairs (OCHA) said:
"While the number of cases reported continues to show a decline, indicators suggest that the virus is still spreading and the number of confirmed cases and deaths reported are an underestimate.
"A lack of testing facilities and official reporting, people delaying seeking treatment because of stigma, difficulty accessing treatment centres and the perceived risks of seeking care, are some of the reasons behind the low number of reported cases."
Because of the ongoing war, Yemen already faced a humanitarian crisis before the coronavirus arrived. Millions are malnourished and vulnerable to disease, and health services are inadequate. Diseases that are rare in better-off countries, such as cholera, diphtheria, dengue fever and chikungunya, are common in Yemen.
For more information see: Covid-19 in Yemen
Confirmed cases: 2,066
New cases in past week: 3
Active cases: 98
Tests carried out: (unknown)