Family Medicine in the Middle East—From Fragmented Systems to a Unified Vision for Primary Care and Healthy Aging

Family medicine in the Middle East and Eastern Mediterranean Region (EMR) is undergoing a profound transformation. The collection of papers in this issue offers an impressive, multi-layered narrative that spans diverse national contexts—from Oman’s internationally recognized primary healthcare achievements to Egypt’s ambitious system-wide reforms, Kuwait’s structured and expanding residency programs, Jordan’s evolving training pathways, Iraq’s post-conflict rebuilding efforts, and the broader region’s response to demographic transition and dementia. Together, these contributions form a compelling statement: the future of sustainable healthcare in the Middle East rests on the strength of family medicine and its integration into national primary care systems.

The collective insights across the papers reveal not only the historical roots and evolving competencies of family medicine but also the challenges that continue to impede full realization of its potential. Importantly, they present a shared roadmap for progress—one grounded in evidence, regional collaboration, and the emerging needs of aging populations. This editorial synthesizes the key themes emerging from all contributions and situates them within a broader vision for the future of family medicine in the region.

A Region Rich in Progress Yet Marked by Uneven Trajectories
The central review, Advancing Family Medicine in the Middle East, provides the foundation for understanding the regional mosaic.

From Lebanon and Bahrain’s early adoption of family medicine in the 1980s to Oman’s establishment of one of the earliest academic departments in 1987, the region has achieved milestones that position it well for future integration of primary care as the first point of contact. Yet, as the review highlights, this progress is uneven—shaped by political instability, economic constraints, and differing levels of policy commitment.

The country-specific papers deepen this picture:
Egypt
Egypt’s model illustrates the complexities of scaling family medicine in a large, heterogeneous nation. Since the 1970s, reform efforts—including expansion of training programs, the Egyptian Fellowship, University-based departments, and the Universal Health Insurance Law—have strengthened primary care capacity. Yet challenges persist: limited faculty numbers, inadequate undergraduate exposure, and fragmented public perception of family medicine’s role.

Kuwait
Kuwait’s experience showcases a robust and structured postgraduate training ecosystem. Its Family Medicine Residency Program, developed with the Royal College of General Practitioners (MRCGP INT) and expanded to 60 specialized training centers with over 420 enrolled residents, stands as one of the region’s most comprehensive. Innovative projects—such as the Ideal Family Medicine Clinic model—demonstrate how operational redesign can reduce waiting times, enhance continuity, and improve patient satisfaction. Yet systemic gaps remain in academic leadership, digital integration, and continuity of care.

Oman
Oman provides a narrative of pioneering success. With widespread PHC coverage, early academic leadership at Sultan Qaboos University, and WHO recognition for health system performance, the country exemplifies what long-term investment in PHC can achieve. However, Oman too faces growing pressures related to chronic disease burdens, geographic disparities, and the need for digital transformation in primary care.

Jordan
Jordan’s well-structured, four-year FM residency programs accredited by the Jordan Medical Council form the backbone of the country’s PHC workforce. Yet training capacity remains insufficient for its rapidly expanding population and refugee-resettlement pressures. Public awareness and academic visibility continue to lag behind the demonstrated effectiveness of family medicine in delivering comprehensive, preventive care.

Iraq
Iraq’s family medicine system is shaped by years of conflict, political transitions, and economic constraints. Despite this, the country maintains thousands of PHC centers, established family medicine boards, and growing WHO-supported diploma pathways. The resilience of Iraqi family physicians—delivering care through home visits, telemedicine, and community outreach during crises—highlights the specialty’s adaptability and essential role in health system recovery.

Together, these papers remind us that family medicine in the Middle East is not a static specialty but a dynamic, context-responsive discipline shaped by economic cycles, conflict, migration, and demographic transitions.

Shared Challenges: Workforce, Structure, and Systemic Barriers
Despite meaningful progress, the concurrent challenges identified across submissions are strikingly consistent:
1. Workforce Shortages and Training Gaps
Every country reports an insufficient number of trained family physicians relative to population needs. This shortage is exacerbated by:
• limited training positions
• shortages of qualified trainers
• inadequate academic departments
• emigration of specialists
• limited incentives for graduates to choose family medicine

Egypt, Jordan, and Iraq highlight stark demand–capacity gaps, while Kuwait and Oman acknowledge the need for expanded postgraduate pathways and academic autonomy.

2. Limited Public Awareness and Misconceptions
Across the region, patients frequently bypass family physicians to directly access specialists—a reflection of healthcare culture and structural issues. Jordan and Lebanon, for example, report persistent misconceptions about the scope and qualifications of family physicians.

3. Fragmented Systems and Weak Gatekeeping
Most EMR countries lack a true gatekeeping system, leading to:
• duplication of services
• unnecessary specialist referrals
• higher costs
• compromised continuity of care
Kuwait and Egypt note that despite structured programs, large segments of care remain hospital-centric.
4. Insufficient Use of Digital Health and Data Systems
Although Kuwait, Oman, and some Gulf states have made progress, the region generally lacks integrated electronic health records and data systems essential for chronic disease management and coordination.

International Partnerships: A Cornerstone of Regional Success
One of the strongest and most hopeful themes running across all papers is the transformative role of global and regional partnerships.

The Arab Board of Health Specializations, RCGP collaborations, WHO-supported training, and international academic exchanges have strengthened curricula, standardized competencies, and facilitated cross-border knowledge sharing. Lebanon, Oman, Bahrain, and Kuwait have benefited immensely from these long-standing collaborations.

Jordan, Syria, and Iraq emphasize how partnerships are particularly vital in crisis settings—providing training opportunities, access to updated curricula, and reinforcement of PHC service delivery. These partnerships are not simply educational—they form the backbone of capacity-building, system strengthening, and professional identity.
The continuing integration of WONCA, international research networks, and cross-country residency pathways reflects a region increasingly committed to global alignment and harmonization of competencies.

Family Medicine and the Challenge of Dementia: A New Frontier
The paper, Genetics and Risk Factors of Dementia , situates family medicine within one of the 21st century’s greatest health challenges: the rising burden of dementia.

The paper emphasizes a crucial paradigm shift—dementia is not purelya result of aging but a multifactorial condition shaped by:
• genetic predispositions
• modifiable vascular and metabolic risks
• lifestyle factors
• psychosocial and environmental determinants
With dementia cases in MENA expected to rise by 125% by 2050, family physicians will be at the forefront of screening, prevention, early diagnosis, and longitudinal management.

The review highlights the importance of:
• APOE genotyping and risk counseling
• the life-course model of brain health
• management of modifiable risk factors such as hypertension, obesity, hearing loss, diabetes, smoking, and social isolation

The integration of dementia knowledge into family medicine curricula, screening programs, and public health strategies is urgently needed. This aligns naturally with the broader regional vision of strengthening PHC for chronic disease and aging.

A Unified Vision for the Future
Drawing on the evidence across all contributions, a shared roadmap for strengthening family medicine in the Middle East becomes clear:
1. Establish family medicine as the foundation of PHC
• Mandate family physicians as the first point of contact
• Expand gatekeeping systems
• Integrate PHC networks with hospital services

2. Strengthen academic infrastructure
• Establish independent family medicine departments in all medical schools
• Expand training capacity
• Integrate FM into undergraduate
curricula
3. Scale up workforce development
• Incentivize FM residency enrollment
• Offer fellowships, research pathways, and academic career tracks
• Enhance trainer qualifications

4. Leverage digital transformation
• Implement integrated national electronic health records
• Use digital platforms for chronic disease management
• Expand telemedicine and home-based care

5. Advance healthy aging and dementia prevention
• Train FM physicians in risk assessment, screening, and counseling
• Incorporate the MIND diet, physical activity, and social engagement into PHC counseling
• Develop memory clinics and community-based geriatrics programs

6. Deepen international and regional partnerships
• Expand joint training initiatives
• Strengthen collaborations with RCGP, WHO, WONCA
• Support cross-border faculty development

Conclusion: A Region Poised for Transformation
The papers in this issue collectively affirm that family medicine is not merely a specialty—it is the backbone of a resilient, equitable, and cost-effective healthcare system. Across the Middle East, the momentum is unmistakable. Despite structural barriers, financial challenges, and geopolitical instability, countries are investing in PHC, expanding training, and embracing international collaboration.

At the intersection of rising chronic disease burdens, demographic aging, and the need for accessible community-based care, family medicine emerges as a transformative force. The integration of dementia prevention and brain-health frameworks further positions the specialty at the forefront of tomorrow’s public health agenda.

This issue, through the contributions of leading educators, clinicians, and policymakers across the region, provides not only an academic analysis but a blueprint for action—one that moves the Middle East closer to the vision of resilient, people-centered, and future-ready healthcare systems.

Warm regards,

Dr. Abdulrazak Abyad
Editor-in-Chief
Middle East Journal of Family Medicine
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