Almost neighbours, both emerging off the mass that is Saudi Arabia and jetting out into the Persian Gulf, and with tantalisingly similar flags, it would be easy to assume that the Kingdom of Bahrain and the State of Qatar were parallel destinations.
Both are temperate, with carefully constructed urban capitals featuring impressive architectural masterpieces, while more rural locations drastically contrast, with sparse infrastructure and deficient transport systems. What’s more, anyone with a basic knowledge of the region’s history will know that recent tensions have placed additional strains on resources and international ties. And factors like this shape the healthcare landscape for international travellers and expatriates.
The State of Qatar has a population of 2.6 million, comprised of 313,000 Qatari citizens and 2.3 million expatriates. With a clear majority of expatriates and one of the highest per-capita incomes in the world, healthcare for internationals is at a relatively high standard in the country.
Most expatriates in Qatar are from India, Bangladesh and Nepal, often working for a lower cost than Qataris, however. There are also many expatriates from Egypt, Pakistan and Sri Lanka, and a few who come from Europe and the US. There are also a significant number of international tourists annually coming to the country to see Doha, the capital of Qatar, which is known for its futuristic architecture and ancient Islamic buildings. Popular sites for visitors also include the beaches along the western coast.
The level of care in GCC states varies from one to another. Health services do not have a level ranking, even within the same country. Rural areas and remote locations sometimes have good capabilities and equipment, but only a limited number of specialists to manage a case. This is why moving a patient from one facility to another becomes a necessity in most cases.
After a huge state investment, Qatar’s public hospitals and clinics are now well equipped and employ highly proficient medical staff, often expats themselves. The public healthcare system operates through the state-run Hamad Medical Corporation, which directs Qatar’s public medical facilities, mostly available for Qatari nationals, or those with Qatari residency status.
A consulting firm explained to Hospitals & Healthcare that due to the investment in healthcare, expats now get a wide variety of treatments: “Expats who previously travelled back to their home country for medical reasons are now choosing to stay for treatment, which is covered through corporate insurance plans. They do, however, continue to opt for treatments of major illnesses in their home country.”
Still, nursing and administration quality are at a comparatively low standard, with a lack of sense for urgency, said Jamil Juma, MENA Region Network Manager at Marm Assistance. He told Hospitals and Healthcare: “It is more important to know which doctor a patient is seeing and not which hospital. Our recommendation is driven by regular audits to medical facilities, understanding their standard operating procedures. When we receive a request for assistance, we activate our point of care at the respective facility to schedule an appointment with the specific doctor, rather than who is on duty. This allows us to control treatment, invoice and outcome. Also, it allows us to manage the case effectively if further treatment is required.”
Public services are accessed through a government-issued health card and, although subsidised public healthcare significantly reduces the cost of treatment, expats may still have to pay some medical costs, which has seen private healthcare in Qatar expanding. Often, employers of expats either subsidise or provide for their medical insurance.
A spokesperson for the consulting firm commented: “Private healthcare caters to primary and secondary care, while the government is focused on providing tertiary care. Private hospitals are mostly driven by insurance patients and government hospitals are driven by local and government-sponsored patients.”
Pharmacies in Qatar are widely available throughout the country and the majority of them are privately owned. Medicines that may require a prescription in other countries can often be purchased over the counter in Qatar. Pharmacists are generally well-trained, but the pharmacist-to-patient ratio is low, which may lead to longer wait times. Juma said: “While the public sector in Qatar is highly developed with the latest high-tech and five-star hospitals, doctors and pharmacists are not necessarily meeting the same standard.”
Sitting very close to Qatar, the small Kingdom of Bahrain has a population of roughly 1.5 million, with almost a quarter comprised of expatriates, who generally come from similar countries as expatriates in Qatar. The gross national income per capita is about US$36,000 annually. The high number of expatriates and the high per-capita income has resulted in a high standard of healthcare; the country has 24 health centres, three clinics, a multidisciplinary medical facility (Salmaniya Medical Complex), a psychiatric hospital, a geriatric hospital and four birthing centres, and the government spends about $2,273 on healthcare per person.
This includes a high standard of care for international patients – it is considered equal to what people would receive in the US or Europe. The government of Bahrain is working on making the country a centre of excellence in health standards and many doctors are expats themselves, with training from their home countries. However, healthcare is only free for nationals, with expatriates usually buying private healthcare.
To access healthcare in Bahrain, patients have to register with a primary care centre. Additionally, like many other Gulf countries, Bahrain is currently implementing mandatory health insurance for all its citizens, as well as for expats and certain visitors. One of the government’s intentions is to relieve employers of the cost of foreigners’ health, which is considered a burden on national finances.
The new law requires all Bahraini citizens, residents and certain visitors to pay monthly contributions to a health insurance fund in order to access health services in public and private hospitals and health centres.
If someone needs specialist care, the GP they are registered with will refer patients to secondary care services, which in Bahrain will probably be Manama’s Salmaniya Medical Complex, which contains the largest public hospital in the country. However, if the patient has private medical insurance, there are many more hospitals to choose from, including the Royal Bahrain Hospital, King Hamad University Hospital and the American Mission Hospital.
The task of regulating the healthcare sector was transferred from the Ministry of Health to the National Health Regulatory Authority (NHRA) in 2009. The NHRA regulates the healthcare sector through licensing and accrediting healthcare facilities and healthcare professionals, registering and pricing pharmaceuticals, licensing drug manufacturers, granting approvals for clinical trials, investigating complaints, and conducting disciplinary hearings for healthcare professionals.
To further emphasise the importance of an independent health regulator, the Supreme Council of Health (SCH) became the Board of Directors of NHRA in 2015. The SCH was established in 2012, and it is responsible, among many other items, for formulating national policies regarding the total number of hospital beds required in the Kingdom of Bahrain; embarking and mandating a policy for financing healthcare services through the enforcement of a Health Insurance System; endorsing standardised policies for health professionals training in hospitals; and estimating the distribution of healthcare facilities throughout the Kingdom.
When it comes to common health problems in the area, Juma sees a lot of health issues related to unhealthy lifestyles: “Common medical conditions are related to lifestyle and hot weather, dryness and poor exercise. So, dehydration, chest infections and asthma, sunburn, diabetes, arthritis and cardiac diseases are common in these countries. “Additionally, some expat families find it difficult to adapt to change in culture and habits, leading to depression and family conflicts.”
A study conducted at the Bahrain International Airport clinic looked at common health-related issues international visitors are facing. The results showed that a total of 3,350 travellers attended the clinic, constituting 0.12 per cent of the visitors who were at the airport throughout the time period. The most common conditions were respiratory problems (24.4 per cent), followed by headaches (19.2 per cent), trauma, musculoskeletal pains (12.9 per cent), and gastrointestinal problems (11 per cent). Only 2.1 per cent of all complaints were referred to secondary care. The majority of cases were handled by the nurse.
Emergency medicine has only been established for a little over a decade in Bahrain, with three emergency facilities now established at the Salmanyia Medical Complex, the Royal Medical Services of Bahrain Defence Force and the King Hamad University Hospital.
Another issue that expatriates and tourists might face in Qatar and Bahrain is gender inequality. For example, in Qatar, the personal status law discriminates against women in marriage, divorce, child custody, and inheritance. The law provides that women can only marry if a male guardian approves of the marriage; men have a unilateral right to divorce while requiring women to apply to the courts for divorce on limited grounds; and a wife is responsible for looking after the household and obeying her husband, according to the Human Rights Watch. Bahraini law discriminates against women in the right to divorce and transmission of Bahraini nationality to their children on an equal basis to men. In healthcare, this might mean discrimination against women by male doctors, longer waiting times for women and lower accessibility to healthcare for women.
Generally, however, both Bahrain and Qatar are safe for international women. Travel website World Nomads recommends women cover themselves in public, including at hospitals or doctors’ offices. On the website, it states: “Bahrain is a very conservative society where most women are either hidden from view or, when in public, are expected to cover their heads and arms. This is indicative of the standards of dress expected in Bahrain and visitors should refrain from wearing tight or revealing clothes, including strapless and skimpy tops and shorts, as they are not appreciated by the majority of people in Bahrain.”
Juma explained: “Two main health issues women could face are abortion and birth registration for unmarried couples. By law in all GCC states, this is not allowed unless indicated by medical condition or reason. Subsequently, women would travel back home or to neighboring countries where they can have this performed. Registration of birth would require a marriage certificate. Failing to have that would lead to complications to register a birth and, subsequently, embassy involvement to issue supporting documents based on a hospital report.”
While travellers could face difficulties accessing healthcare in both Qatar and Bahrain, especially as a woman, both countries are working hard to bring their healthcare systems up to a higher standard. With big investments in public healthcare and free healthcare for residents, both Bahrain and Qatar have significantly improved over the last few years. However, a lot is still to be done, especially regarding the professional standard of the healthcare workforce.