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July 18, 2019

Air quality in the Middle East and North Africa (MENA) region has deteriorated dramatically over the last few decades. Recent research on global level of pollution ranked Cairo as the most polluted city in the world. The situation in other major cities in the region is not very different from the Egyptian capital. The region has witnessed major shifts in energy production and consumption trends over the last few decades which contribute to high levels of air pollution.

Urbanization is the dominant contributor to increased pollution in the MENA region. More than 80 percent of the population is currently living in urban areas in Bahrain, Jordan, Kuwait, Lebanon, Qatar, Saudi Arabia, and United Arab Emirates. Following greater economic opportunities in the cities, the urban population in Arab countries grew by more than four times from 1970 to 2010 and will more than double again between 2010 and 2050. The region’s per capita CO2 emissions increased from 4 tons/capita in 1990 to 6.2 tons/capita in 2014. Such high rates of urbanization increased the energy demand and related emissions that deteriorated the air quality in most MENA major cities.

Ambient (outdoor) air pollution is a major cause of death and disease globally. The health effects range from increased hospital admissions and emergency room visits, to increased risk of premature death.” According to the World Health Organization (WHO), an estimated 4.2 million premature deaths globally every year are linked to ambient air pollution, mainly from heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and acute respiratory infections in children. Those deaths cost the global economy about $225 billion in lost labor income in 2013 according to a joint study of the World Bank and the Institute for Health Metrics and Evaluation (IHME).

How the MENA Region is Affected

The 2018 update of the WHO Global Ambient Air Quality Database found that 97 percent of cities in low- and middle-income countries with more than 100,000 inhabitants do not meet WHO air quality guidelines. The Middle East and North Africa (MENA) region and Southeast Asia were the regions that performed worst overall according to the WHO database.

The evidence on airborne particulate matter (PM) and its public health impact is consistent in showing adverse health effects at exposures that are currently experienced by urban populations in almost all major cities in MENA. Airborne PM forms in the atmosphere as a result of complex reactions of chemicals such as sulfur dioxide and nitrogen oxides, which are pollutants emitted from power plants, factories, and automobiles. The range of health effects is broad, but are predominantly to the respiratory and cardiovascular systems.

Fine particulate matter (PM2.5), tiny particles or droplets in the air that are 2.5 micrometers or less in width, is an air pollutant that is a concern for people's health when levels in air are high. High-temperature metallurgical processes (e.g. metal extraction) and combustion processes (e.g. vehicle engines) are common sources of PM2.5. Studies suggest that long term exposure to PM2.5 may be associated with increased rates of chronic bronchitis, reduced lung function and increased mortality from lung cancer and heart disease.

Similarly, PM10 is particulate matter 10 micrometers or less in diameter. Combustion activities such as motor vehicles and industrial processes are common sources of PM10. These combustion activities have increased dramatically in the MENA region over the last few decades with around 94 percent of electricity generation relying on oil and gas and expansion of transportation following massive urbanization trends that led to triple the CO2 emissions from 536 Mt CO2 in 1990 to 1767 Mt CO2 in 2016.

While other regions are experiencing transformative urbanization forces, as the world urban population grew from 751 million in 1950 to 4.2 billion in 2018, the MENA region is experiencing a more complex transformation. War, humanitarian crisis, and the unprecedented rates of refugees and displaced persons are accelerating the rate of urbanization. In 2014, as many as 18 of 22 Arab countries had a higher urban population share than the world average.

The combined effect of fossil-based power plants, automobiles, and urbanization trends made the MENA region suffer from drastic air pollution problems. For example, WHO estimated PM10 concentrations at around 117 μg/m3, which is considered as extremely high compared to their annual limit of 20 μg/m3. Riyadh is considered one of the most polluted cities as the concentration of PM2.5 is 7 times the WHO limit of 10 μg/m3. The city of Al-Ahmadi in Kuwait has very high concentrations of both PM2.5 and PM10.

While pollution-related deaths strike mainly young children and the elderly, premature deaths also result in lost labor income for working-age men and women. In MENA, the annual labor income losses were more than $9 billion in 2013. There is an approach commonly used when evaluating the costs and benefits of environmental regulations in a given country/region context which is called “welfare losses.” In the MENA region, welfare losses related to air pollution were about $154 billion, or the equivalent of about 2.2 percent of regional GDP.

Beyond the financial cost, the human cost is estimated at 194,000 lives lost in the region in 2016 due to diseases associated with outdoor and household air pollution; causing human suffering and reducing economic development. Egypt is among the worst affected countries, both in terms of estimated numbers of deaths and economic costs. In Egypt, total welfare losses represented 3.6 percent of GDP with over $31.5 billion and total deaths attributable to ambient air pollution were estimated as 67,200 deaths. Lebanon had over $2.6 billion, or 3.58 percent of GDP, of total welfare losses in the same year and 3,120 total deaths attributed to ambient air pollution.


The problems with air pollution are widely known. The causes of pollution are also well documented. The MENA region needs practical measures implemented without disrupting development efforts. Local air pollution and its associated health costs have led many societies, especially Asian emerging economies, to recognize the importance of adopting clean energy technologies. Environmental policy reform in Asia includes efforts to combat air pollution and decrease key pollutants, such as sulphur dioxide (SO2) and nitrogen oxides (NOX), without compromising economic growth. A new report by UN Environment Programme proposes twenty-five solutions that can significantly improve air quality on the world’s most populated continent, Asia. They could also be implemented and enforced in other regions as well.

The MENA region can start taking some of these measures that are already adopted widely in Asia and adjust them to local and regional conditions. The Climate and Clean Air Coalition suggests:

These include controls on power stations and large-scale industrial plants; improved emission standards for industrial processes and road vehicles; widespread and effective vehicle inspection; and maintenance and dust control from roads and construction.

MENA countries need to introduce advanced emissions standards in industries, e.g. iron and steel plants, cement factories, glass production, chemical industry, etc. The report also recommends:

Using incentives to foster extended use of wind, solar and hydro power for electricity generation and phase out the least efficient plants.

Some MENA countries suffer from waste mismanagement, such as Lebanon, and it’s important to adopt centralized waste collection with source separation and treatment; including gas utilization. Also, taking measures to reduce the burning of solid waste that leads to the formation of PM2.5 are not yet major components of clean air policies in many parts of the region. Finally, considering the rapid pace of urbanization and motorization in the MENA region, investment in improved public transportation could also shift from private passenger vehicles to public to further lower air pollution.

The adoption of these measures could cut population exposure to PM2.5 and PM10, enhance the air quality in the region, and save thousands of lives lost in the MENA countries each year due to diseases associated with outdoor air pollution. Furthermore, implementing these measures will benefit efforts to mitigate climate change. They could reduce CO2 emissions regionally and contribute to the development agenda.

Further studies are needed to estimate potential savings from lowered welfare losses related to air pollution. These losses are larger than the GDP of Lebanon, Syria, Tunisia, and Yemen combined. They are too large to be overlooked when discussing economic growth and how critical it is to lifting people out of poverty, raising levels of health, and improving general well-being in the region.

Mahmoud Abouelnaga holds a Masters in sustainable energy engineering from KTH Royal Institute of Technology in Stockholm, a Masters in environmental management from Universidad Politecnica de Madrid, and Bachelors in Petroleum Engineering from Suez University in Egypt. He has worked in the energy and environment field in Egypt, Nigeria, and France. Currently, he’s part of the inaugural class of Obama Scholars Program for International Development and Policy at Harris School of Public Policy at the University of Chicago.