Health, Economic and Social Gender Impacts

Rita Stephan, North Carolina State University[i]


The global health crisis is widely recognized as COVID’s first order impact. Indeed, the health crisis is felt around the globe, placing an extraordinary strain on health systems and interrupting essential health services. In contrast, five other impacts became the residual category of second-order: Macroeconomic and mobility shocks, household impacts (including poverty, inequality, food security, and education), shifts in democratic governance and civic engagement, and climate change, according to USAID’s landscape analysis.[ii] While global trade supply chains proved to be resilient, emerging markets and developing economies experienced recessions and massive straining of governments’ fiscal capacity. Also, the pandemic has had devastating impacts on households and reinforced the connection between climate and health. It presented new national security threats such as digital authoritarianism, cyber security threats, and disinformation; and it led to uncertainty surrounding governance, democracy, and stability in many countries.[iii]

The pandemic had a devastating social impact, especially on gender equity. However, most of the available analysis has focused on the Global North, neglecting women’s lived experiences in the Global South. By adopting a gendered lens to analyze COVID’s impact in the Middle East and North Africa, this paper highlights the first-order health impact on women, unpacks the second-order gender economic impact, and introduces a gender-specific third-order impact: social vulnerabilities. The increased domestic and intimate partner violence during the pandemic, especially among displaced populations, was both expected and preventable. USAID estimates that “For every three months that the lockdown measures continue globally, an additional 15 million cases of gender-based violence are expected.”[iv] Other vulnerable populations included individuals with a disability or chronic illnesses, victims of domestic violence, children—especially young girls, members of LGBTIQ+ populations, individuals living in extreme poverty, and refugees and displaced populations.

As the outbreaks of COVID-19 spread throughout the Middle East and North Africa (MENA), health systems were stretched beyond capacity, notwithstanding “regional disparities in terms of access to health care, and the shortage of medical professionals” (Abouzzohour and Ben Mimoune 2021).[v]  The variation in MENA government responses to the COVID pandemic’s first, second and third order impacts has had a detrimental effect on women’s lives. In response to the health crisis, high-income states like Qatar offered high-quality health and social care to their citizens. Some reported luxurious treatment of COVID patients quarantining in five-star hotels. But foreign workers did not receive such benefits.[vi] Middle-income countries like Lebanon provided health services only to those who could afford them. Low-income and conflict countries, without a functioning health system, in many cases failed to devise any official response to the pandemic.

Governments’ readiness to address COVID’s health challenges depended in part on the infrastructure of their health system, but only those who could sustain their economies during the shutdown were able to deliver welfare services. Almost none of the MENA countries, regardless of their economic resources, addressed COVID’s third-order social impact. Domestic violence, discrimination and marginalization increased tremendously since 2020.

Health Impact

Globally, sex-disaggregated data suggest that fewer women than men contracted or died from the virus. The ratio of contraction is 2:1, and, on average, men comprise two-thirds of COVID-related deaths compared to women (61.8 percent and 38.2 percent respectively) (Worldometer). Men are also less likely to receive the vaccine or take a COVID test.[vii] It is not clear whether those patterns also existed in the MENA region.  Reliable data is lacking in most Arab countries because countries do not publicly report comprehensive and disaggregated epidemiological data on COVID-19. As Ghinwa al-Hayek shows in this collection, governmental expenditure on health services is limited and the available digital tracking technologies are underutilized (Wehbe et al., 2020).

Women’s global infection rate was 30 percent on average in June 2021, and 50 percent by December 2021. In MENA, the percentages of confirmed cases among women were higher than the global average in June, but continued with consistent rates through December, ranging from 43 percent in Iran and Iraq to 56 percent in Tunisia. High income MENA states that reported sex-segregated data showed significantly low rates of confirmed cases among women, possibly due to the social seclusion of women (Bahrain 12%, Oman 30%, Qatar 15%, and Saudi Arabia 25%). However, at least 69 percent of Lebanese women with confirmed cases of COVID died, the highest in the world.[viii]

These findings do not consider unusual cases or individuals with special needs. As health budgets and resources are dealing with COVID, at least 60 million individuals with disabilities in the Arab region are at a disproportionate risk of suffering. Women living with disabilities face an even higher risk of violence than other women (UN 2020, 14). Other female-specific life and health conditions, such as pregnancies and maternity, received insufficient reproductive health services due to the limited access to health resources. These safety risks have increased women’s vulnerability in many countries.

The Economic Fallout

As countries are gearing up to return to pre-pandemic life, McKinsey and Oxford Economics estimate that women might take two full years to recover in advanced economies (Ellingrud and Segel 2021). By the time schools resumed, 80 percent of the 1.1 million people who exited the workforce were women in the US. By the end of 2020, women accounted for all net job losses (Ellingrud and Segel 2021).  The UN reports that MENA countries witnessed the world’s only increase in extreme poverty since the spread of COVID, with women expected to lose 700,000 jobs (UN 2020, 2-3) and to fall into poverty more than men.

Given women’s higher proportional participation in informal and insecure labor (constituting 61.8 percent of workers) and their limited access to, or control of, financial resources, the pandemic has furthered economic gender inequalities. Deeply-entrenched gender roles in the region have led to an even heavier double-burden of work on women who serve as caregivers for households. Given that many women work in manufacturing and service industries, women will be most affected by the repercussions of the pandemic. They may either lose their jobs or be forced to accept unfair work conditions.

During the outbreaks, women’s access to information and their ability to seek services has been severely constrained, as the bulk of communication is conducted through online platforms and cell phone messaging. Nearly half of the female population is not connected to the Internet or has access to a mobile phone (AbiRafeh 2020). Despite monumental progress in girls’ education, persisting illiteracy rates, especially among older women and women in rural settings and conflict-ridden countries, affect their ability to access comprehensive information about the crisis regarding prevention, response, and seeking help.

Yet, the economic fallout has affected families and women differently within and across countries. While overall the economy was sustainable in high-income states, first-time female job seekers (Chartounie and Pankratova 2020), young women (Levi 2021), and non-citizen migrant female workers were disadvantaged the most. In the middle-income states, healthcare was not the only malfunctioning and underfunded system. Many of these states lacked the welfare ability to offer fair wages, social security, or unemployment benefits. Women were more vulnerable to economic disruption, especially those employed without contracts (Kokas et. 2020).  For instance, women in Algeria suffered from multilevel disparities and faced significant obstacles in obtaining employment (Abouzzohour and Ben Mimoune 2020). Poor states experienced an economic freefall with governments struggling to secure basic necessities while conflict countries secretly hoped for prolonged lockdown to diffuse their citizens’ discontent with their policies. Women, of course, endured a heavy economic burden in these countries.

In addition to social and cultural restraints to women’s rights, pre-COVID barriers to women’s participation in the workforce included lack of safe working environment, anti-harassment laws, affordable and reliable child care, and safe transportation. In this volume, Youakim (2022) cautions that structural measures are absent for working women at large. As she points out, “While some MENA state responses extended gender supportive measures, such as flexible working arrangement for women with children or paid time off work, work from home was complex—especially for women with care responsibilities.” However, organizational trends data is still needed to understand how and why the working environments for women might be (or not be) sustainable in the long term (Youakim 2022). COVID exposed the need to include women in the decision-making process, involve the private sector, and facilitate women’s re-entry into the workforce with family-friendly policies and safe work environments (Khurma 2021).

Third-Order Social Vulnerabilities

Before COVID-19 struck and in the aftermath of the Arab Spring, women had made substantial strides in rights and representation in many MENA countries (Stephan and Charrad 2020). However, attitudes and behaviors changed as the pandemic kicked in. “Confinement, loss of income, isolation and psychosocial needs” increased, topped by “unpaid work” and “care” that women provided in the family. (UN 2020, 15). Moreover, school closures increased the rate of girls’ dropout, early marriage, and extra care responsibilities. Simultaneously, numerous social welfare programs such as old-age pensions, health insurance, disability, maternity, and sick leave were eliminated or seriously affected.

Socioeconomic deprivation, psychosocial stress, and containment measures led to substantial increases in gender-based violence (GBV), which 37 percent of MENA women experienced before COVID and many more after it.  However, the pandemic made it difficult for domestic violence survivors to seek and receive help due to movement restrictions and the limited availability of services. Many Arab countries had limited services for survivors of domestic violence, such as shelters and hotlines, prior to the spread of the pandemic; all of which stopped during the lockdowns.

While a few countries in the world issued policies and measures to mitigate the social impact of the pandemic, community initiatives and women’s organizations were better at providing alternative health care, economic inclusiveness, and violence interventions. Like responses to second-order impact, high-income states issued military responses and implemented harsh and dismissive policies (e.g., Israel). Poor states loosely enforced lockdown measures, but without attention to social or economic effects (e.g., Syrian refugees). Middle-income states struggled to balance health safety and economic hardship, failing to address social problems (e.g., Lebanon and Tunisia). One factor that differentiates middle-income states from others is the presence of civil society organizations and women’s organizations. Though lockdowns and shrinking resources restricted them, they, especially well-established organizations, succeeded in mitigating the third-order impact of the pandemic where states failed to do so. However, these organizations are at threat with shrinking civil liberties and freedoms. Youssef and Yerkes, in this volume, find it paramount that feminist organizations and pro-democracy groups must overcome the growing political polarization and build broad coalitions with shared interests and objectives to challenge the state and continue offering voice, outlets, and services to vulnerable populations (Youssef and Yerkes 2022).

Numerous local and international women’s organizations have been begging for prioritizing the prevention and response to violence against women and girls, involving women in leadership and decision making on COVID response, engaging men and boys in dialogue to change social norms, strengthening engagement in caregiving roles, increasing investment in mental health and psychosocial services, and collecting robust gender-disaggregated data on the impact of COVID-19 (e.g., ESCWA, UN Regional Issue-Based Coalition for Gender Justice and Equality).[ix] [x] When the states failed to respond, many took matters into their own hands, sometimes defying curfews and challenging authority.


Social policies were differentiated by states’ prosperity. Despite their limited economic resources, middle-income states with strong civil society presence capitalized on the intervention and assistance they offered in mitigating COVID’s second-and third-order impacts. High- and low-income states might have saved women’s lives but they failed to protect them economically and socially. Overall, none of the MENA states’ responses to COVID were gender-centered. Ironically, conflict-inflicted states did not have a worse impact on women and COVID than other states.

The increased securitization of the pandemic response and the increased repression of movements and rights did not consider gender but led to the deterioration of women’s rights overall. A new approach in international and local politics is needed in considering how the narrative changes when women are involved. Any post-COVID remedies and policies must be thought through a gender lens, but not without the women present at the decision-making table.



AbiRafeh, Lina. “For Arab Women and Girls, The Crisis Is Just Beginning.” AlJazeera, May 4, 2020.

Abouzzohour, Yasmina and Nejla Ben Mimoune. “Order from Chaos: Algeria must prioritize economic change amidst COVID-19 and political crisis.” December 2, 2020.

Chartounie, Carole and Katerina Pankratova. “How the coronavirus pandemic affects Saudi women.” July 23, 2020.

Ellingrud, Kweilin and Liz Hilton Segel. “COVID-19 Has Driven Millions of Women out of the Workforce. Here’s How To Help Them Come Back.” Fortune Magazine. February 13, 2021.

Gausman, Jewel and Ana Langer. “Sex and Gender Disparities in the COVID-19 Pandemic.” Journal of Women’s Health, 29, 4, 2020: 465-6. DOI: 10.1089/jwh.2020.8472.

Khurma, Merrisa. “Women, Work and COVID-19 in MENA: Towards an Action Agenda.” October 22, 2021.

Kokas, Deeksha, Gladys Lopez-Acevedo, Abdel Rahmen El Lahga, and Vibhuti Mendiratta. “How COVID-19 is impacting Tunisian households.” December 22, 2020.

Levi Gali. “Israel’s COVID-19 Era Labor Market: Three Main Challenges Facing Women.” November 11, 2021.

POMEPS (Project on Middle East Political Science). “The COVID-19 Pandemic in the Middle East and North Africa.” April 2020.

Stephan, Rita and Mounira M. Charrad. Women Rising: In and Beyond the Arab Spring. New York: New York University Press, 2020.

  1. 2020 July. “Policy Brief: The Impact of COVID-19 on the Arab Region An Opportunity to Build Back Better.”

Wehbe S, Fahme SA, Rizk A, et al. COVID-19 in the Middle East and North Africa region: an urgent call for reliable, disaggregated and openly shared data. BMJ Global Health 2021; 6: e005175.

Worldometer. “Age, Sex, Existing Conditions of COVID-19 Cases and Deaths.” May 13, 2021.

[i] Disclaimer: The views expressed in this paper are those of the author and do not represent the views of, and should not be attributed to the U.S. government or the United States Agency for International Development (USAID).


[iii] Ibid.