The Eastern Mediterranean’s/MENA preventable blindness crisis isn’t about money or medicine—it’s about political will

In a region defined by conflict, displacement, and geopolitical tension, there is one challenge that transcends borders and affects nearly everyone’s family eventually: preventable vision loss. Approximately 40 million people across the Eastern Mediterranean—from the Gulf to North Africa—live with visual impairment. Five million are blind. The tragedy isn’t that we lack solutions. It’s that we’ve had them for decades and haven’t deployed them.

Consider the numbers: cataract surgery costs between $50 and $300 in our region, restoring sight to someone who might otherwise spend their remaining years in darkness. Compare that to dialysis at $15,000 to $50,000 annually, or cancer chemotherapy. Yet cataract alone accounts for nearly half of all blindness in the region. This isn’t a resource problem. It’s a priorities problem.

The Success Story Nobody Talks About

Here’s something that should give us hope: seven countries in the Eastern Mediterranean have eliminated trachoma, a blinding disease linked to poverty and poor sanitation. Oman did it in 2012. Morocco followed in 2016. Iran in 2018. Egypt just achieved validation in November 2025, bringing the global total to 27 countries free of this ancient scourge.

Egypt’s success proves something important. A country facing economic pressures, with a population of over 100 million spread across challenging geography, systematically eliminated a disease that has blinded people since the time of the pharaohs. They did it through the SAFE strategy—Surgery, Antibiotics, Facial cleanliness, Environmental improvement—combining health interventions with water, sanitation, and education programs.

What made it work? Sustained political commitment. Multi-sectoral coordination. And crucially, accountability—someone was responsible for results.

Why Good Intentions Aren’t Enough

The Eastern Mediterranean presents a paradox. It includes some of the world’s wealthiest nations alongside some of its most impoverished. Saudi Arabia has over 70 ophthalmologists per million people. Somalia has fewer than one. Baghdad hosts three of Iraq’s eleven government eye hospitals while nine provinces have none.

But the problem runs deeper than resource disparities. Even wealthy Gulf states face significant gaps in diabetic retinopathy screening despite having the resources to screen every diabetic patient. Why? Because eye health isn’t politically exciting. Building a cardiac center generates headlines. Screening programs for gradual vision loss don’t.

The diabetes connection should alarm everyone. With 80 to 90 million diabetic adults in the Middle East and North Africa—and nearly a third undiagnosed—the substrate for widespread diabetic retinopathy is vast and expanding. A recent meta-analysis found diabetic retinopathy prevalence of 63.6% in low-development countries versus 22.6% in high-development ones. Same disease, radically different outcomes based purely on whether health systems screen and intervene early.

The Political Economy of Blindness

Let me be direct about why progress has stalled. Medical professionals in many countries resist “task-shifting”—allowing optometrists and ophthalmic nurses to handle routine care that doesn’t require a specialist. Only 29% of optometrists across the region are licensed to prescribe even basic therapeutic drugs. This protects specialist incomes but leaves millions without access to care.

Doctors prefer cities. They earn more, have better facilities, access professional networks. This is rational individual behavior that produces irrational collective outcomes. Without rural service incentives or obligations, the pattern self-perpetuates.

And critically, there are no consequences for failure. Countries can endorse WHO frameworks, sign resolutions, announce ambitious targets—and then allocate minimal domestic resources while facing no sanctions for the resulting gap between promise and delivery.

What Would Actually Work

The WHO’s Integrated People-Centred Eye Care framework provides good guidance, but frameworks don’t treat patients. Implementation requires three things our region consistently avoids:

First, explicit budget lines. Eye care shouldn’t compete annually with oncology and emergency services for whatever’s left over. Countries need dedicated allocations that survive political transitions.

Second, regulated task-shifting. This means confronting professional associations that prioritize member interests over population health. Yes, ophthalmologists will object. Leadership means making the decision anyway.

Third, accountability with teeth. Annual public reporting on cataract surgical rates, screening coverage, workforce distribution. Regional peer review modeled on the successful trachoma elimination process. And something radical: conditioning international assistance on demonstrated progress.

The Gulf states could establish a regional eye health fund supporting lower-income neighbors—contingent on reform commitments. Regional solidarity should combine support with expectations.

Differentiated Solutions for Different Contexts

What works in Dubai won’t work in Yemen. High-income stable countries need to focus on diabetic retinopathy screening, reducing reliance on expatriate specialists, and expanding primary eye care. Middle-income countries like Egypt, Jordan, and Tunisia need eye care included in universal coverage packages with specific rural incentives.

Conflict-affected areas—Yemen, Syria, Sudan, Afghanistan, Somalia—require different approaches entirely: mobile surgical units, NGO coordination under health ministry oversight, aggressive task-shifting to whatever cadres are available. Waiting for health system reconstruction isn’t an option when people are going blind now.

A Fundamental Human Right

Vision loss isn’t just a health issue. Children who can’t see clearly fall behind in school. Working-age adults lose employment. Elderly people lose independence. The economic and social costs compound across generations.

By 2050, vision loss in our region is projected to increase by 86%. We can accept that trajectory, or we can decide to change it.

The solutions exist. Cataract surgery is one of medicine’s most cost-effective interventions. Screening programs work. Task-shifting works where it’s permitted. Trachoma elimination proves that sustained commitment produces results.

What we lack isn’t knowledge or resources. It’s the political will to prioritize invisible problems, confront entrenched interests, and hold ourselves accountable for results.

Forty million people in our region live with impaired vision. Five million are blind. Most of them don’t have to be.

Differentiated Solutions for Different Contexts

What works in Dubai won’t work in Yemen. The table below illustrates how constraints—and therefore solutions—vary systematically across the region:

Waiting for health system reconstruction isn’t an option when people are going blind now.

Seven Countries Eliminated a Blinding Disease. The Rest Have No Excuse.

Trachoma’s defeat proves what political commitment can achieve

Forty million people across the Eastern Mediterranean cannot see properly. Five million are blind. We’ve known for decades how to prevent most of this suffering—cataract surgery costs $50–300, diabetic retinopathy responds to early screening, simple antibiotics cure trachoma. Yet preventable blindness persists.

But here’s proof that sustained commitment works. Seven countries in our region have eliminated trachoma—an ancient blinding disease linked to poverty—through the WHO’s SAFE strategy combining surgery, antibiotics, hygiene education, and sanitation improvements.

Egypt’s achievement is remarkable. A nation of over 100 million, facing economic pressures, systematically eliminated a disease that has blinded people since pharaonic times. If Egypt can do this, why do cataract and diabetic retinopathy remain rampant elsewhere?

The answer lies in political economy, not medicine. Professional guilds resist task-shifting to protect specialist incomes. Doctors concentrate in cities where earnings are higher. Health ministries endorse WHO frameworks but allocate minimal budgets. Nobody faces consequences for failure.

By 2050, vision loss in our region will increase 86%. We can change that trajectory—but only if we demand the same accountability for cataract and diabetic retinopathy that defeated trachoma. Seven countries proved it can be done. The rest have no excuse.