Conflict and migration may compound harms from climate sensitive infectious disease in the Eastern Mediterranean and Middle East region. Shlomit Paz, Azeem Majeed, and George K Christophides suggest routes to mitigation
The Eastern Mediterranean and Middle East region is characterized by rapid population growth, large differences in socioeconomic levels among countries, mass migration, increased water demands, and ecosystem degradation.  The recent spread of covid-19 highlights unpreparedness in the region, and some countries in particular, for infectious disease outbreaks.
While several rich countries (mainly the Gulf states) are the source of much of the carbon driving climate change, the whole region is experiencing a drier climate, longer and hotter summers, and more frequent and severe heat waves.  It is known that climate change may aggravate existing regional sociopolitical disputes. For example, severe drought and economic deterioration related to climate change were key contributors to displacement of people, food insecurity, and political instability in the Syrian war.  These diverse factors interact in complex ways, which may increase risks for infectious disease epidemics. 
Threats and potential threats
Several vector-borne diseases, sensitive to climatic variations, are common in different parts of the region depending on local conditions, while others are potential threat, including West Nile virus, Rift Valley fever, dengue, chikungunya, malaria, leishmaniasis, cholera, and leptospirosis. [5-7] Climate change also increases risk of food- and water-borne diseases prevalent in the region, such as gastroenteritis, including Salmonella spp. 
Reliable data is essential for targeting prevention measures, for example, test, trace, and isolate policies for containing the current covid-19 outbreak. Large parts of the region lack consistently available, reliable, and systematic data about infectious diseases as well as scientific knowledge about the impact of climate change on outbreaks and transmission.
Future scenarios predict that the region will be warmer and dryer, and climate change is projected to have a greater impact on the transmission of infectious diseases. [2,5] Risk assessment and health preparedness and adaptation strategies are essential. Better vector surveillance is needed in each country. Systematic collection of epidemiological data not only in urban environments but also in poorer and remote areas should be a priority.
Experience from Europe shows that regional cooperation is crucial to tackling infectious disease threats. For example, VectorNet is a European network for sharing data on the geographic distribution of arthropod vectors.  In parts of the Eastern Mediterranean and Middle East, conflicts limit cross border relationships. Nevertheless, collaboration should be a priority for national health agencies, even for countries lacking diplomatic relations. Such initiatives already exist, for example, the Middle East Consortium on Infectious Disease Surveillance (MECIDS) frameworks that operates across Israel, Jordan, and the Palestinian Authority, and the Cyprus government initiative for coordinating climate change actions in the region, spearheaded by the Cyprus Institute.
People in refugee camps are at high risk of infectious disease outbreaks, such as cholera and covid-19, which can spread further. Provision of clean water and wastewater management, disease surveillance, and vaccination programs should be prioritized.
National health authorities should improve access to public health interventions and healthcare for vulnerable populations. Public awareness of behavior change should be strengthened, through education though local media, community leaders, and health workers. For example, the risk of vector-borne disease outbreaks could be reduced through community-driven elimination of small breeding sites.
Without effective interventions and cross-borders cooperation the changing climate will continue to impact on increased level of morbidity and mortality resulted from infectious diseases in the region, with the most vulnerable groups in society at greatest risk.
Shlomit Paz, Department of Geography and Environmental Studies, University of Haifa, Israel
Azeem Majeed, Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
George K. Christophides, Department of Life Sciences, Imperial College London, UK, The Cyprus Institute, Cyprus
Competing interests: None declared.
This article is part of a series commissioned by The BMJ for the World Innovation Summit for Health (WISH) 2020. The BMJ peer reviewed, edited, and made the decisions to publish. The series, including open access fees, is funded by WISH.
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