How can Trade Help to Rebuild and Enhance the Economies of the Southern Mediterranean Countries?

Arab countries are experiencing major changes in their governance systems. While the features of the new era are still unclear, what is certain is that a new development paradigm will be adopted and significant efforts will be made to rebuild the economies of these countries, which have been seriously disrupted due to the revolutions and their aftermath. This article seeks to answer the question of how trade can play a significant positive role in rebuilding and enhancing the economies of these Southern Mediterranean Countries

The roots of economic challenges facing Egypt in the aftermath of the 25th January revolution. Jean Monnet Occasional Paper No. 9/2014

Introduction. Since the 25th of January 2011 revolution the Egyptian economy has been suffering on all fronts. Almost all the economic indicators have been pointing towards a deteriorating situation, and in many cases have reached the trough. Yet, the economy is still surviving. This is mainly due to the unprecedented support of some of Arab Gulf countries, whose unconditional aid has helped to mitigate the deteriorating economic conditions. The economic challenges facing Egypt have been exacerbated after the 20th of January revolution mainly because of the deteriorating political and security conditions which have interrupted the functioning of the economy. Yet, this is not to say that revolution has caused these challenges. In fact, the challenges that the Egyptian has been facing have deep roots in its socio-political-economic context, which this paper aims to explain. The revolution and its aftermath have brought to the forefront challenges which have always been mitigated by short-term solutions that never dealt seriously with their roots. Moreover, the revolution has brought additional problems associated with the macroeconomic imbalances. As a result, the challenges became more complex especially in light of the need to balance the social and economic aspects. The paper proceeds as follows; in section one we pinpoint the main challenges faced by Egypt where we identify the symptoms and causes of such challenges. In section two we discuss the roots of such challenges. Finally, we conclude and provide our understanding of how Egypt is expected to face its challenges in the near future

Shallow versus Deep Integration between Mediterranean Countries and the EU and within the Mediterranean Region

The paper aims at assessing the specific impact of shallow versus deep integration between Mediterranean (MED) countries1 and their partners in the European Union (EU) as well as between the MED countries themselves. It relies on dataset developed for this project concerning tariffs (as a proxy for shallow integration) and Non Tariff Measures (NTMs)2 (as a proxy for deep integration). Additional data are also included in order to take into account other trade costs, especially transport costs and logistics costs. In this regard, an original dataset of maritime freight cost (Maersk, 2007) is introduced as well as the trade logistics performance (TLP) index produced by the World Bank. Such datasets are useful for providing additional insight into deep integration. The paper starts by calculating the magnitude of NTMs in terms of ad valorem tariff equivalent (AVEs). The estimation of NTMs through ad valorem equivalents (AVEs) shows that Algeria and Jordan have the highest value of AVEs, whereas Tunisia, Morocco, and Egypt have the lowest value. A gravity model is then estimated with special emphasis on trade costs which are the crucial point in our research study. Given the limitation of data on NTMs, the gravity model is estimated for only one year (2001), and for each MED country. Trade costs are represented by tariffs, AVEs of NTMs, and transport and logistics costs. The idea is to test which of the three elements of trade costs are the most impeding to bilateral trade between MED countries and EU countries as well as amongst MED countries. The model shows that tariffs, NTMs, and trade and logistics costs have a significant impact on trade, but is highly vivid in countries suffering from high tariff rates, prevalence of NTMs, and trade costs. A number of simulations are carried out trying to differentiate between the impact of partial liberalization and full liberalization on trade creation. The results obtained show that full liberalization has a significant effect whether it is only related to shallow integration (tariff removal) or deep integration (NTMs and trade and logistics). The effect is higher if trade costs and logistics are improved. The results are far less if only partial liberalization takes place and in several countries is insignificant implying that marginal reductions in NTMs or tariffs cannot always help to create trade. Finally the study shows that there is a huge potential for enhancing trade amongst MED countries if trade costs are lowered, logistics is improved, and NTMs are abolished.Regional Trade Agreements, Regional Integration, Non-Tariff-Measures, Deep versus shallow integration, South Mediterranean countries, European Union Trade Agreements

Shallow vs. Deep Integration in the Southern Mediterranean: Scenarios for the region up to 2030. MEDPRO Technical Report No. 13/March 2012

This research develops a quantitative analysis aimed at simulating the trade effects of various integration scenarios between the EU and its Mediterranean Partners (MPs). Results for shallow integration show that the completion of tariff removal is expected to produce limited gains, except in Algeria. However, further steps toward deep integration would lead to much more significant gains. In this regard, the elimination of non-tariff barriers is expected to increase EU exports to MPs up to 60%. In addition, MPs’ imports and exports to the EU could also considerably increase due to an improvement of logistics performance in these countries

The roots of economic challenges facing Egypt in the aftermath of the 25th revolution

Since the 25th of January, 2011 revolution the Egyptian economy has been suffering on all fronts. Almost all the economic indicators have been pointing towards a deteriorating situation, that in many cases have reached the trough. Yet, the economy is still surviving, even if all indicators have been pointing towards a near collapse. This is mainly due to the unprecedented support of some of Arab Gulf countries, whom their unconditional support has helped to mitigate the deteriorating economic conditions. The economic challenges facing in Egypt have exacerbated after the 25th of January revolution mainly because of the deteriorating political and security conditions which have interrupted the functioning of the economy. Yet, this is not to say that revolution has caused such challenges. In fact the challenges that the Egyptian economy has been facing have deep roots in the socio-political-economic context, which this paper aims at explaining. The revolution and its aftermath have brought to the forefront such challenges which have been always mitigated by short term solutions that never dealt seriously with the roots. In addition, the revolution has brought additional problems associated with the macroeconomic imbalances. As a result, the challenges became more complex especially in light of the need to balance the social and economic aspects. The paper proceeds as follows; in section one we pinpoint the main challenges faced by Egypt where we identify the symptoms and causes of such challenges. In section two we discuss the roots of such challenges. Finally, we conclude and provide our understanding of how is it expected that Egypt will face its challenges in the near futurepeer-reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially