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ORIGINAL ARTICLE
The impact of crisis and disasters risk management in COVID-19 times: Insights and lessons learned from Saudi Arabia
R. Jaziri
a,b,∗, M.S. Miralam
aaCollegeofBusiness,UniversityofJeddah,AsfanRoad285,P.O.Box:42801,Jeddah21551, SaudiArabia
bLAREMFIQLaboratory,UniversityofSousse,Tunisia
Received26January2021;accepted25June2021 Availableonline16July2021
KEYWORDS COVID-19pandemic;
Crisismanagement;
Disasterrisk management;
Disasterrisk reduction;
SaudiArabia
Summary
Background.—AllcountriesallovertheworldstrivetofighttheoutbreakofCOVID-19pan- demicandtheirgovernmentsarefacingunprecedentedstrainsandchallenges.SinceCOVID-19 hasengenderedsocioeconomicrecessionandthedeteriorationofhealthsystems,Insightsand lessonsfromsomecountriescanillustratevariousapproachesdesigningtheirpeople-centric health and socioeconomic policies. The kingdom of Saudi Arabia has implemented various measuresandstrategiestomitigatethespreadofpandemicandtosavethelivesofpeople.
Therefore,weinvestigatetheroleoftheSaudidisasterriskreductionsystem(DRRS)tofight thevirusoutbreakandprovideasafeenvironmentforthewell-beingofitsinhabitants.
Methodology.—We use aqualitativecase study methodology todocumentand analyzethe crisisanddisastersriskmanagementframeworkwithinthehazardmanagementprocess.The casestudymethodologyissuitableininvestigatingaphenomenoninitsreal-lifesettingsand contexts.Thus,weoutlinelessonslearnedfromSaudidisasterriskmanagementexperiencein combatingCOVID-19pandemic.
Results.—DuringCOVID-19disaster, we found thattheSaudi disasterriskreductionsystem (DRRS) isstructured intothree mainlevels: strategic,operational andtactical.The strate- gic levelrepresents thestrategicplanningdivisionandrunsaudit andmonitoringofoverall decentralizedunitsofcrisismanagementatoperationalandtacticallevels.Thefindingsshow thattherearethreepolicyimplications:keepvigilanceatthepublicnationallevel,remaining flexibleinanationalmanagementstructureandgoodgovernanceatlocaladministrationlevel.
∗Correspondingauthorat:CollegeofBusiness,UniversityofJeddah,AsfanRoad285,P.O.Box:42801,Jeddah21551,SaudiArabia.
E-mailaddresses:[email protected](R.Jaziri),[email protected](M.S.Miralam).
https://doi.org/10.1016/j.jemep.2021.100705
2352-5525/©2021ElsevierMassonSAS.Allrightsreserved.
Conclusion.—TheapplicationofdisasterriskreductionframeworkinCOVID-19timesrequires theuseofmulti-levelstrategiestoprotectvulnerablepeoplesduringthefourstagesofmiti- gation(readiness),preparedness,response(implementation)andrecovery(post-COVID).
©2021ElsevierMassonSAS.Allrightsreserved.
Introduction
Givenitsstrategicgeographicpositionatthecrossroadsof threecontinents:Asia,EuropeandAfrica,KingdomofSaudi Arabia(KSA)isluckyenough tobesafeguardedfrommain naturaldisasterssuchasstorms,tsunami,seismicandvol- canicactivities.Nevertheless,thisdoesnotimplythatthe kingdomissecuredfromdisasters.In2020,thepopulationof SaudiArabiais34,898,530,basedonUnitedNationsdata.1 Overthepastdecade,KSA’sGDP(grossnationalproduct)has grownbyabout520billionUSDduetoitspositivetradebal- ance.Moreover,SaudiArabiaisconsideredastheheart of theArabandIslamicworlds.TheKingdomishonouredasthe landofthetwoholymosquesandthepreferreddestination ofallMuslimsallovertheworldforHajjpilgrimage.Theseri- ousdeadliestHajjpilgrimagedisasterinhistoryhavetaken placeinMina,on24September2015,owingtoa‘‘crushand stampede’’causeddeathsof717pilgrims.Furthermore,KSA is additionallyat risk of bothhealth andnatural disasters suchasfloodingandepidemics[1].
Duringhishistoryof90years,SaudiArabiahasbeenvul- nerableandsubjectedtoseveralnatural disasters(floods, epidemic,earthquakes)andman-madecrisis(overcrowding, terroristattacks).Moreover,thekingdomhasexperienceda littlenumberofhealthdisasterssuchastheMiddleEastres- piratorysyndromecoronavirus(MERS-CoV),whichappeared inJanuary2019andthenovelCoronaviruspandemic(COVID- 19)emerginginMarch2nd2019.Fortunately,theoutbreak waseventuallycontainedthroughaseriesofrisk-mitigating measures introduced by the Saudigovernment andthere- fore theresponsiveness of all citizens andresidents. Itis imperative to illustrate that these risk-mitigating mecha- nisms,togetherwiththepublic’scompliance,werequickly used todeal withthe unpredictableconditions especially whenadditionalepidemiologicalcaseswererevealed.
Throughoutthisarticle,wepresentthehazardmanage- ment system of Saudi Arabiaaswell asthe lessons taken fromtheriskmanagementexperienceofthekingdomwith relevantreferencestotheCOVID-19pandemic.Weuseda triangulationtechniqueofdifferentresearchmethodologies to attain ourresearch objective. To recognize the values andproceduresofSaudi’sdisasterresponsetodisasterrisk management,weconductaretrospectivestudybycollect- ing data from specific Saudi government departments as
1https://www.worldometers.info/world-population/saudi- arabia-population/.
wellasfrominternationalorganizations,literaturereviews, quantitativeand qualitative analysisof economic effects.
We have used the case study methodto illuminate Saudi Arabia’sapproachto managingdisaster risk while fighting COVID-19pandemic.
Referring tothe hazardapproach adopted by KSA,the casestudyseemstobesuitabletoexplaincontextualsocioe- conomicdisparities.Theaimofthiscasestudyistoillustrate thelessonslearnedfromexperiencesinaparticularcontext andtimelinefromwhichwecan concentratemoreonthe risks’natureandtheimpactsofbothdisasterriskmanage- mentand publicpolicies intervention.We alsoconducted interviewswithprincipalhealthpolicydecision-makersand expertsfor moreunderstandings of thephenomenon. Our mainobjectiveistoguaranteeviathisrigorousmethodology consistentandoperatingrecommendations.
We thinkthat our contributionis interesting as itpro- vides empirical evidence of the public policies taken by Saudigovernmenttocombatrisk extenuationofCOVID-19 pandemic.Thedominantviewpointstatesthatthegovern- mentmustbeabletoexertbruteforceandenforceitswill onthepopulation [2]. Furthermore,asour paperdemon- strates,thisdominantviewpointisincomplete,becausethe government’sexerciseofauthorityandcontrolisnotauto- maticallysufficienttocontaintransmissionoftransnational communicablediseaseSuccessinfightingepidemics,asone would agree, is also based on a concerted collaborative effortbetweengovernmentalauthoritiesandinhabitants.
Thisarticleisdividedonfourmainparts.The firstpart offersbackgroundonthehistoricalframeworkofdisasters inSaudiArabia.Thesecond part,scrutinizetheregulatory frameworkandpublicfundsdistributiontoalleviatedisaster riskinKSA.Thirdpartisdedicatedtooutlineacasestudy ontheexperienceof Saudi Arabiain combatingCOVID-19 pandemic and the socioeconomic effectof the pandemic onthekingdom.Thelastpartrevealsrecommendationsto publicdecision-makerstoimprovedisasterriskmanagement policiesandfurtherinsightsforfuturestudies.
Historical framework of disasters in Saudi Arabia
Different international instances have adopted the same definitionofdisaster.ForexampletheUnitedNationsInter- national Strategy for Disaster Reduction’ (UNISDR) have defined the concept of disaster as ‘‘a serious disruption of the functioning of a community or a society causing 2
widespreadhuman,material,economicandenvironmental losses which exceed the ability of the affected commu- nity/societytocopeusingitsownresource’’[3].
Since its establishment in 1932, The Kingdom of Saudi Arabiahasundergonea numberofhealth andnaturaldis- asters (Table 1). As a result, we describe concisely the historicalbackgroundofthedisasterriskinSaudiArabiasuch asfloods,pandemicsandearthquakes.
TheCentreforResearchontheEpidemiologyofDisasters (CRED)hasbeenfounded35yearsago,tofocusoninterna- tionaldisasterandtoconductepidemicsstudies.CRED[4]
haveclassifiedadisasterasacatastropheonlyifitfulfilsthe followingcircumstances:10ormoredeadvictims,100per- sonsareaffected,invokeanationalstateofemergencyand aninternationalcallforhelp.Table1illustratesanoverview ofthedisastersexperiencedintheKSAfrom1941to2019, aswellasthenumberofdeadvictims,affectedpeopleand injuries[1,5].
According totheEmergencyEvents Database(EM-DAT), which publishedhistorical disasterstatistics,Saudi Arabia hasexperiencedonlytwoepidemic-causeddisasterevents [6].In2012,SaudiArabiasufferedfromthelargestMiddle East respiratory syndrome coronavirus (MERS-CoV), which has affected over 1030 peopleand caused 453 deaths. In September2012,TheWorldHealthOrganization(WHO)has reported 1626 confirmed cases of Middle East respiratory syndromecoronavirus (MERS-CoV)infection from26coun- tries causing 586 deaths. Reported cases have essentially beenfromMiddleEastcountriesandafewnumberofEuro- peanandEastAsiancountrieshavereportedindividualswho hadtravelledtotheMiddleEast[7].
While,in2020,COVID-19pandemichasaffected321,456 inhabitants in Saudi Arabia and killed 4107 victims. The novel Coronavirus diseasehas infected morethan 34 mil- lionpeoplearoundtheworldandhascausedmorethanone milliondeaths,21%inUSA.Facingtheexponentialaugmen- tation of COVID-19 victims and the lake of ICU Beds and ventilators,the pandemic hasimposedan ever seen ethi- caldilemmarelatedtomedicaltriagedecision-making[8].
As a result,COVID-19 pandemic was deemed asthe most destructivedisasterinSaudiArabiatodate.
Institutional framework of disaster risk management in Saudi Arabia
Conceptual framework of disaster risk management (DRM)
Disaster risk management is defined by United Nations International Strategy for Disaster Reduction [3] as‘‘The systematicprocessofusingadministrativedirectives,orga- nizations,andoperationalskillsandcapacitiestoimplement strategies,policiesandimprovedcopingcapacitiesinorder tolessentheadverseimpactsofhazardsandthepossibility ofdisaster’’.
The DRM includes three stages: pre-disaster, during- disasterandpost-disaster:
• pre-disaster:thisphaseencompassesfoursteps:
◦ identificationandvaluationoftherisk,
◦ riskprevention,mitigationandreduction,
◦ risktransfer,
◦ preparedness;
• during-disaster: it is to guarantee that the wants and requirementsofvictimsaresatisfiedtominimizedistress.
This stageencompassemergencyreactionincludingsal- vage,reliefandrecovery;
• post-disaster:thisphasecoversresilienceandreconstruc- tion.Whenthedisasterisover,it’saboutquickretrieval toavoidthereproductionofvulnerablecircumstances.
The main purposesof DRMcomprise firstly thedeploy- mentofresilienceagainstdisasters.Secondly,istoreduce damagesviatheestablishmentandimprovementofsustain- ability. Thirdly, DRM aims todiminish disaster risks, fight vulnerabilitiesandsetboth aninstitutionalandanorgani- zational context. Finally, DRMoutline attributions, duties andresponsibilitiesofallthestakeholders.
Enemark[9]arguedthattheInternationalFederationof Surveyors [10] reportedthat DRMis a process or a cycle composedofthesevensteps.Inrelationtodisastermana- gement,Chirisaetal.[11]arguedthecycleisasequential processmade up of four steps: mitigation,preparedness, response and recovery. However, the lessons learnt will beinvestigatedusingfourstagesfromtheframeworkand guidelinesofWHO[12].Thesestagesare:
• readiness: to ready disaster response systems, for ins- tance,torisethecapabilitytoidentifyandtreatCOVID-19 patients and to guarantee that hospitals provides the requiredhealthcareservices;
• preparedness: toprepare aresponseinordertoreduce thespreadofthedisasterandtopreventtheoutbreakof COVID-19;
• implementation: toevaluatethe risk of health disaster andtoimplementpromptlytherequiredactions;
• post-COVID 19: to decrease the pandemic effect on healthcaresystemsandonsocioeconomicactivities.
Fig. 1 summarizes all the above elements as a con- tinuing loop of activities associated with the previous circumstances(riskidentification,prevention,alertnessand preparedness),through(emergencyrescue plan)andpost- disaster(recovery,reconstructionandresilience).Moreover, the reaction conducts to amelioration and resilience of vulnerablepopulationsand contribute todecrease poten- tial forthcoming risks leading tosustainable development [5,13].
Itshowsthatbothgoodgovernanceandcapacitybuild- ingarethecornerstoneoftheimplementationofDRMand ofsustainabledevelopment[14].Furthermore,theusageof earlyalertingsystemsprovidingarealtimerelevantinfor- mationisdeemedasthebasisofthecapabilityandreactivity to manage natural disasters. Moreover, the implementa- tionof institutional structuresand regulatory frameworks arekeystonesof establishing political commitmentfor he applicationofdisasterriskreduction(DRR)intotheadmin- istrationsystems.
The current disaster risk reduction system (DRRS) in KSA
Disasterrisk reduction(DRR)strategy systemhas progres- sively becoming among the most crucial topics of the
Table1 MajordisastersinKSAfrom1964—2019.
Year/disaster Natureofdisaster Numberof
affectedpersons
Numberofdead victims
1964/Flashflood Natural 1000 20
1975/FireduringHajj Human N.A. 200
1979/OccupationofMosque inMakkah
Human/terroristattack 600 250
1985/FloodsinNorthwestof Kingdom
Natural 5000 32
1990/PilgrimsStampede insidetunnel
Human N.A. 1426
1994/PilgrimsStampede insidetunnel
Human N.A. 270
1997/YanbuandAsirfloods Natural N.A. 26
1997/FireduringHajj(Mina) Human 1555 343
2000/RiftValleyfever epidemic
Natural 1700 179
2002/Makkahfloods Natural N.A. 31
2005/Medinafloods Natural 43 29
2009/Jeddahfloods Natural 11,640 163
2011/Jeddahfloods Naturel 5000 10
2012/MiddleEastrespiratory syndromecoronavirus (MERS-CoV)
Natural 1030 453
2012/Riyadhtruckcrash Human 135 26
2013/Floods Natural — 25
2019/COVID-19pandemic Natural 334,605 4768
KSA:KingdomofSaudiArabia.NA:notavailable.Source:authors’elaborationbasedondatafromUnitedNationsOfficeforDisaster RiskReduction(https://www.undrr.org/).
UnitedNationsconferenceonSustainableDevelopment2012 (Rio+20) which took place in Rio de Janeiro, Brazil from 20 to 22 June 2012 [15]. Being awareof the importance and repercussionof this issue, the kingdom of Saudi Ara- biahasmadeofDRRoneofitspriorities.Thegovernment of the kingdomhasalways showeda strong political will- ingness to implement both the HyogoFramework in 2015 and the Arab Strategy for Disaster Risk Reduction 2020 [15,16].Furthermore, underthepatronagethe Council of Arab Ministers Responsible for the Environment (CAMRE), theSocioeconomicCounciloftheLeagueofArabStateshave approvedthestrategyofDRRdeploymentin2011.Moreover, theGulfCooperationCouncil(GCC)adoptsananticipatory mechanism in order to enhance and implement a Disas- terRiskReductionSystem (DRRS)(Table 5).Consequently, the secretary-general of the GCC called for a sustainable regionalengagementinDRRbydiminishingvulnerabilityand reinforcingrecovery andresilience todisastersofall GCC members.As aresult,itislegitimatetoaskthefollowing question:HowthegovernmentofSaudiArabiahavefaced andmanagedtheCOVID-19pandemichazards.Eventhough disasterriskreductionisvitalandessentialtorealize sus- tainabilityin the kingdom,thereisnecessity toelucidate theconceptofDRRandassessthelevelofreadinessofthe kingdom to fight COVID-19 pandemic and to enable good reactivitymanagementoffuturedisasters.
The disaster risk reduction (DRR) is defined by [3] as
‘‘Theconceptandpracticeofreducingdisasterrisksthrough
systematiceffortstoanalyzeandmanagethecausalfactors of disasters, including through reduced exposure to haz- ards, lessened vulnerability of people and property, wise managementof landand the environment, and improved preparedness for adverse events’’. This definitionof DRR leads to divisive debate as the concept of disaster has been widely controversial and the phenomenon has not been adopted in the same way by researchers. In other word, the definition has technically used the same term
‘disaster’ to define disaster’. However, empirical studies proposethat DRRfocusonscrutinizing andmanaging haz- ardstolessenvulnerabilitytodisastersincludingmeasures thatreinforcereadiness,preventionandmitigation.More- over,Saudi Arabiaisaware aboutthe realcontributionof DRR in sustainable development at make it as a priority.
Various empirical research have confirmed that DRR may lessendisasterthreatssuchaspandemichazards,decrease operationalvulnerability, increase theabilities tomanage disasters,andameliorateactionstoacclimatizetodisaster risks[17—20].
To fight disastersthegovernmentof Saudi Arabiahave implementedacross-ministerialstructure for disasterrisk reduction and disaster management [15]. This multidisci- plinarystructureoutlinesaframeworkthatseekstoincrease riskperceptionamongallSaudi’sgovernmentministriesand agencies,andhelpstoregularlyrecognizethefullspectrum of risks. Moreover, in order toprotect public health dur- ingandafterthedisaster,allgovernmentsmustactthrough
Figure1. Keyelementsofdisasterriskmanagementreduction.
Source:authors’elaborationbasedonInternationalFederationofSurveyors(FIG)(2006).
multi-sectoral collaboration[21]. Additionally, the frame- workoftheDRRSSdefinescross-departmentstructurethat mayhavedroppedduetoprogramdiscrepancies.ThisSaudi DRR framework comprisesMinistry of Health (MOH) espe- ciallyNationalCrisisandDisastersControlCentre(NCDCC), MinistryofInterior(MI),GeneralDirectorateofCivilDefence (GDCD), Ministry of Defence (MD), Ministry of Municipal andRuralAffairs(MMRA)andpublic-privateemergencypre- paredness partnerships.Saudi Arabia’s DRR policy system worksin times ofstability andcrisis. It referstoan inte- gratedapproachwhereallrelatedministriesandagencies worktogetherinafixedstructure,withsmoothcollabora- tionandriskmanagementcoordination[5,15,22].
Statistical considerations of COVID-19 outbreak in Saudi Arabia
InMarch2020,theCoronaviruspandemiceruptedSaudiAra- bia.Latein2ndofMarchonherreturnfromIranviaBahrain, the firstSaudi national toacquireCOVID-19 washospital- ized. Yet, what started as a few isolated cases quickly became a national public health emergency withina few short weeks reaching 1563 positive cases at the end of March.
The COVID-19 pandemic has reached and expanded in all countries of the Middle East and North Africa (MENA) region[8]. In lateOctober 2020, thehighest total deaths inMENAregionwasreportedrespectivelyinIran(13,421), Iraq(11,795),Egypt(6481)andSaudi Arabia(5710),while
thelowestfatalitiesareregisteredrespectivelyinDjibouti (61),Qatar(235)andBahrain(337)(Table2).
The geographicanalysisof themost COVID-19infected regionsin the kingdomshow characteristics of thesespa- tialunits. GeoDa software.The 13Saudi regions included inouranalysisareshowninFig.1informofquantileand naturalbreaksmaps,whichareelaboratedonthebasisof theJenksNaturalBreaksalgorithm(DeSmithetal.,2009).
Fig.2showstheoutbreakofCOVID-19pandemicinallSaudi regionsattheendofSeptember2020.Basedonthequan- tile map, the most Covid-19 infected regions areeastern (alsharqiya)andMeccaRegionswherepositivecasesrange from63,532to73,849.Whilethelessinfectedregionsare Al-JawfandNorthernBorders(AlhududAlshamalia)witha numberofinfectedpeoplebetween791and1695.However, thedistributionofdeathsshowsthattheregionsofRiyadh andMeccahavetheintensivenumberofCOVID-19victims between300and1304deaths.Inasecondlevel,theEastern region(alsharqiya)reportedbetween 117and300deaths.
Onthecontrary,thelowlevelofdeathsisassociatedwith regionsofAl-Jawf,NorthernBorders(AlhududAlshamalia), Ha’il,Najran andAl-Bahahwithtotalfatalitiesbetween4 and26people.
Fig.2illustratesalsonaturalbreaksmapsrelatedtothe distributionoftotalconfirmedcasesanddeathscausedby COVID-19pandemic indifferentSaudiregions.Thenatural breaksmapsprovideamoreadequateinsightintotheregion affectedbythepandemiccomparedtothequantilemaps.
Thequantilemapshidesthetruthofmany‘‘dark’’regions.
Thatistosay,manyregionsseemedtobeamongthemost
Table2 COVID-19statisticsintheMENAregion(October18th2020).
Country Totalcases Totaldeaths Totalrecovered
Iran 801,894 13,421 546,500
Egypt 111,284 6481 101,288
SaudiArabia 354,208 5710 341,515
Algeria 70,629 2206 46,326
Iraq 526,852 11,795 455,176
Kuwait 138,337 857 129,839
UAE 154,101 542 145,537
Morocco 306,995 5013 253,351
Oman 121,129 1360 112,014
Qatar 136,441 235 133,473
Tunisia 81,726 2445 56,748
Bahrain 85,008 337 82,900
Djibouti 5656 61 5548
Lebanon 110,037 852 62,528
Jordan 163,926 1969 94,896
Palestine 66,186 589 56,843
MENA:MiddleEastandNorthAfrica.Source:authors’analysisofdatafromWTOhttps://www.worldometers.info/coronavirus/.
COVID-19 infected regions suchas‘Asir. Innatural breaks maps, the distribution of regions indicates that the num- berofmostinfectedregionsis3,whilethereareonly2in quantilemap.
Based onTable 3,we remark thatthe low intensity of COVID-19regionalinfectionrate(RIR)isreportedinNorth- east regions such as: Al-Jawf (0.32%), Tabuk (1.35%) and Al-Baha(1.2%).Whilethe largestRIRis registeredrespec- tivelyinMecca(24.52%)andRiyadh(20.47%).
Concerning theaverageregionaldeathrateat national level (ARDR),while thelargestis reportedrespectively in Mecca(38.59%)andRiyadh(21.83%),thelowestoneisregis- teredinAl-Baha(0.01%).Nevertheless,thehighestregional death rate (RDR) is reported in Al-Jawf (4.05%) and the lowest one is in Medina (0.5%). However, with regard to the regional recovery rate (RRR), we see that all Saudi regions have recovery rate more than 90%. However, the averageregionalrecoveryrateatthenationallevel(ARRR) isrecordedintheEasternRegion-alsharqiya(24.72%).This positivetrendcanbeattributedtotheeffortsoftheking- dom government to fight the COVID-19 pandemic in all regions.
COVID-19’s impact and measures taken by Saudi government in combatting COVID-19 pandemic
To illustrate the Saudi government’s approach to disaster management,weuseaqualitativecasestudymethodology;
datawerecollected throughobservationsanddocuments.
We try to demonstrate the learning policy and lesson- drawing for a public policy in a particular context and timeline.Therearethreepartsofthecasestudy.Firstly,we outline theeconomic, cultural,healthcare,andpsychoso- cialconsequencesof COVID-19pandemic onSaudiArabia.
Secondly,weelucidatetheriskmitigationstepspursuedby
theSaudigovernmenttocontrolthepandemic.Thirdly,we explainthegovernmentStepstoregulatepublichealth.
Manyscholarsacknowledgetheurgencyoftakingurgent short-termactiontointensifyglobaleffortstocombatthe COVID-19crisis [23,24].Inastronglyglobalizedworld,the effectsofthediseasebeyondfatalityandmorbidityhasbeen developedsincetheoutbreak.Sincethedeceleratingofthe worldeconomywithdisruptionsofproduction, theopera- tionsofworldwidesupplychainshasbeendisturbed[25].In thissectionwewillelucidatedtheinitiativestakenbythe SaudigovernmenttotackleCOVID-19pandemic.
Initiatives of the kingdom to tackle COVID-19 pandemic
TheSaudigovernmenthastakenmanyinitiativesinresponse totheimpactoftherepercussionsofthenovelCoronavirus pandemic. In addition, to emphasize the support of the medicalsectoraswell asstimulatingtheprivatesectoras an essential partnerin the growth of theSaudi economy.
Besides, the government helps the stability of the Saudi citizen,contributes to adding value to local market con- sumptionandallocateadditionalamountstothehealthcare sectorasneeded.Thegovernmentsupporttothehealthcare sectorreachedanadditional47billionriyals,withtheaim ofraisingthesector’sreadiness,securingmedicines,oper- atingadditionalbedsandprovidingthenecessary medical supplies(Table4).
COVID-19’s impact on the healthcare system and its psychosocial consequences
COVID-19reducedserviceandtreatmentratesinSaudiAra- bia’s healthcare system as the government mobilized its medicalservicestotackletheCOVID-19outbreak.Theflood ofpositivecasesintohospitalsandclinicsovercrowdedeven other patients with less urgent care medical conditions.
Figure2. QuantileandnaturalbreaksmapsofCOVID-19infectedcasesanddeathsinSaudiregions(endofSeptember2020).
Source:authors’elaborationusingdatafromhttps://covid19.moh.gov.sa/(ArcGisandGeoDasoftwareoutputs).
Nevertheless,theSaudiMinistryofHealthhasorderedciti- zenswhofeelshavingCOVID-19symptomstogoimmediately tothenearestprivateclinicstobetreatedforfree.
COVID-19alsoseriouslyimpactedthehealthcareworkers inSaudiArabia.Therewasashortageofmedicalandnursing practitionersatthepeakofCOVID-19fromJune2020toJuly 2020.Therewasashortageofmedicalandnursingpracti- tionersastherewasasignificantriseindemandforCOVID-19 patients. Moreover, there was a reduction in healthcare workers,assomewerealsoaffectedbytheoutbreak.Hos- pitals and other public health facilities have experienced ahighrateofworkerabsenteeismandfounddifficultiesin sustainingregularoperations.Thiscontributedtoafurther decreaseinserviceefficiency[26].
The limited medical understanding of the novel coro- navirus have exacerbated COVID-19’s psychosocial effect on citizens. In response to the threat of transmission of
disease,thegovernmentof SaudiArabiahasimplemented several stringent public policies, such as social distanc- ing,quarantine and isolation,as risk mitigationsteps.All thoseregulation mechanismscreatedfor thegeneralpop- ulation an instinctive detachment fromsociety. This lead to a public behaviour in avoiding human contact with crowds in public places. Saudi Ministry of education had closedall educationalinstitutionsespeciallyprimary, sec- ondary and higher schools and they shift to e-learning mode.
Community activities have been postponed to prevent directinteractionamongcrowds.Allcitizensandresidents were told to respect the lockdown and stay home for a period of time to prevent the pandemic outbreak. Harsh punishmentswereleviedonthosewhoviolatedquarantine orders,suchaslargefinesofmorethan10,000riyals.Kel- manand Harris [27] argued that the use lockdown in UK
Table3 COVID-19statisticsbySaudiregions.
Saudi regions
Totalcases Recovered Deaths
352,160(1) 339,114(2) 5605(3)
Total(4) Regional infection rate
%=(4)/(1)
Total(6) Average regional recovery rate (%)=(6)/(2)
Regional recovery rate (%)=(6)/(4)
Total(7) Average regional death rate=(7)/(3)
Regional death rate=(7)/(4)
Riadh 72,112 20.47 69,772 20.57 96.75 1224 21.83 1.69
Mecca 86,369 24.52 83,357 24.58 96.51 2163 38.59 2.5
Medina 28,317 8.04 27,302 8.05 96.41 143 2.55 0.5
Qasim 13,380 3.79 12,735 3.75 95.17 177 3.15 0.13
Eastern region (alsharqiya)
86,736 24.62 83,856 24.72 96.67 725 12.93 0.83
‘Asir 27,400 7.78 26,783 7.89 97.74 350 6.24 1.27
Tabuk 4780 1.35 4630 1.36 96.86 78 1.39 1.63
Northern Border
2353 0.68 1980 0.58 84.14 80 1.42 3.39
Jizen 12,022 3.41 10,835 3.19 90.12 397 7.08 3.30
Najran 6269 1.78 6066 1.78 96.76 59 1.05 0.94
Al-Baha 4256 1.2 4032 1.18 94.73 56 0.01 1.31
Ha’il 7007 1.98 6684 1.97 95.39 106 1.89 1.5
Al-Jawf 1159 0.32 1082 0.31 93.35 47 0.83 4.05
Inbold:keyresults.Source:authors’calculationusingdatafromhttps://covid19.moh.gov.sa/.
contributedtoreducingthelimitedaccessibilityofhealth- caresystemsinceCOVID-19casespeaked.
The effect of social distancing remains uncertain, but thesepreventivemeasureshavebeensuggestedbytheWHO depending on theseverity of the disease,the risk groups affected and transmission epidemiology [28]. Saudi MOH supportedsocialdistanceactivityduringCOVID-19outbreak.
Themainpurposeofsocialdistancingwastorestrictphysi- calinteractionsandtohaveapsychologicaleffectonclose contactinspecificpublicareas.Thepracticeofsocialdis- tancinghasledtoasocialreactioninindustriesthathave suffered from economic losses. COVID-19 has longer last- ingpsychologicaleffects.Themostseriousanddevastating consequenceswerethelossoflovedones.
The role of Saudi risk reduction management framework
OneofthemostimportantlessonslearntfromtheCOVID- 19outbreakbytheSaudiArabiagovernmentwasthevital role thatthe bureaucracy has playedin disaster manage- ment.The institutionalsystemtheninplacewasseriously inadequatefor copingwithasituationthatwasbothcom- plexandunprecedented.ThebattleagainstCOVID-19also neededmorethanamedicalsolution,asresourceshadto be drawn from governmental bodies other than MOH. In responsetoCOVID-19,athree-tierednationalcontrolstruc- turewasestablishedanddefinedbytheCouncilofMinisters (CM).Withinthissection,weoutlinethecrisismanagement
structureofSaudiArabia,thelegalframeworkforcombat- ingCOVID-19,aswellastheriskmitigationinitiativeswithin cultural,healthcareandpsychosocialperspectives.
DuringnovelCoronavirus,thekingdomgovernmentinsti- tutional structure involved in fighting COVID-19 pandemic encompassedthreemainlevelsespecially:strategic,oper- ationalandtactic. The strategiclevel of thedisaster risk reductionstrategysystem(DRRSS)headedbytheCouncilof Ministers.Thetopcrisismanagementleveldemonstratesthe StrategicPlanningDivisionandrunsauditandmonitoringof overalldecentralizedunitsofcrisismanagementespecially bodiesof state administrationin operational andtactical levels(Fig.1).
The strategic level of DRRSS is deemed as the front- line of crisis management system in Saudi Arabia. It is responsiblefor planningand controllingallkinds ofdisas- tersaffectingthekingdom.Therearevariousgovernmental bodiesinvolvedincrisis managementwithdifferentroles.
Therearedifferentcrisismanagersattheoperationallevel who supervise the implementation and management of resources. The government of Saudi Arabiakeeps related ministriesresponsibleaccordingtotheextentandseverity ofthedisaster.
TheSaudiCouncilofMinistersisthemajorplayerinrisk mitigationatthestrategiclevelandthecivilianemergency managementisalmostembodiedingovernmentriskmana- gement policy. The Saudi Civil Defence Authority (SCDA) is the leading operating force in the kingdom for public incidentsprotection. The ministry of Health (MOH) oper- atesattheoperationallevelinfightingCOVID-19pandemic,
Table4 TheinitiativesoftheKingdomtotackletheCOVID-19.
Governmentalbody Initiativesandmeasures
CouncilofMinisters RapidactivationofCabinetResolutionNo.649tocompelcompaniesinwhich thestateownsmorethan51%ofitscapital,bytakingintoaccountthegeneral principlesandrulesforofferingbusinessandpurchasesandgivingpreferenceto localcontentandsmallandmediumenterprises
SaudiArabianMonetary Agency
Aprogramworth50billionriyalsaimedatsupportingtheprivatesectorand enablingittoplayaroleinpromotingeconomicgrowth
MinistryofHealth Providingfreetreatmentforcoronavirusforallcitizens,residents,andviolates ofresidencyregulationsinSaudiArabia
MinistryofMunicipal andRuralAffairs
Postponingthecollectionofmunicipalservicesfeesdueontheprivatesector foraperiodof3monthsformorethan1400economicactivities
MinistryofCommerce Postponingthepaymentoffeesforcommercialrecordsformorethan116 thousandcommercialrecordsforrecordsendingintheperiod18/3/2020to 16/6/2020foraperiodof90daysfromthedateofexpiry
MinistryofHuman ResourcesandSocial Development
Liftingthesuspensionofwagesworkduringthecurrentperiod&liftingthe suspensiontemporarilyfromtheprivatesectorestablishmentstocorrectthe activityandliftingthesuspensionduetonotpayingthefinescollected&
calculatingtheemploymentofSaudisinrangesimmediatelyforall establishments
MinistryofEnergy, IndustryandMineral Resources
30%discountonthevalueoftheelectricitybill.Inthecommercial,industrial andagriculturalsectorsforaperiodoftwomonths(April—May),withthe possibilityofextensionifnecessary
Optionalallowanceforsubscribersintheindustrialandcommercialsectorto pay50%ofthevalueofthemonthlyelectricitybillforthemonths’bills (April—May—June)providedthattheremainingdueswillbecollectedindivided installmentsforaperiodof6monthsstartingfromJanuary2021ADwiththe possibilityofpostponingthepaymentperiodiftheneedarises
HumanResources DevelopmentFund (Hadaf)
Allocating5.3billionriyalstosupportprivatesectorestablishmentstoemploy andtrainSaudisaspartofthegovernmentsupportinitiativetoenablethe facilitiesanddeveloptheirperformance
SocialDevelopment Bank
Asubsidyof12billionriyalstosupportcitizens,familiesandsmalland emergingenterprisestofacetheeffectsoftheCoronavirusandtheeconomy GeneralAuthorityof
Transport
Supportingindividualsworkingdirectlywhoarenotundertheumbrellaofany companyandregisteredwiththeGeneralAuthorityofTransportintheactivities ofpassengertransportandwerestoppedduetotheprecautionarymeasuresof theCoronavirus,bypayinganamountoftheminimumamountofsalariesto them
TheGeneralAuthority forSmallandMedium Enterprises
‘‘Monshaat’’
AllowpersonalandSMEsloanpaymentstobepostponedforayear,starting from3/17/2020
with the association of Saudi Arabian Monetary Authority (SAMA)andthegovernorates.Infact,theMOHisresponsi- bleforoverseeingandorganizingthehygienicandsanitary protocols of risk management during the pandemic life cycle.WhiletheprinciplemissionofSAMAistoensurethe monetary equilibriumusingsuitablefinancial policies,the governoratesoperatesasacatalystfortacticprotagonists.
Nevertheless,incaseofCOVID-19pandemic,theSAMAhas quicklyactivateabudgetaryprocessesandfundinglinesand ensurethatthoselinesareproperlyresourcedwithsufficient financialcapacity.
The Ministry of Interior (MI) and specially the SCDAis giventheauthoritytocoordinateallresponseemergencies forces.However,theSaudi DataandArtificialIntelligence Authority (SDAIA) launched the ‘‘Tawakkalna’’ applica- tion to manage electronic permits during the period of
‘‘curfew’’.OnJune14,2020,SDAIA,incooperationwiththe MinistryofHealth,launched‘‘Tabaud’’applicationtonotify usersthattheyhadcontactwithapersoninfectedwiththe emergingcoronavirusCOVID-19,and‘‘Sehaty’’application toregisterforvaccinewhereAvailable[29].TheMinistryof HajjandUmrahhaslaunchedtheapplication‘‘Eatmarna’’
toenablepilgrimstobookanappointmenttoperformUmrah ortovisittheTwo HolyMosques.DisasterHealthManage- ment(DHM)wasbeenasystemiclandmarkforSaudiArabia’s approachinfightingtheCOVID-19outbreaktoreducingrisk andmanagingdisasters[1].
The COVID-19 outbreak has questioned the traditional systemofcrisisanddisastermanagement,asthepandemic transcendedthecontrolofdisasterhealthmanagement.The policymakersinthekingdomrealizedthatarobustsystem fordisastermanagementwasrequiredtofighttheCOVID-19
Figure3. SaudiGovernmentRRMFrameworkinfightingCOVID-19pandemic.
pandemic.Asaresult,aclearframeworkofmulti-sectoral governance wasdeemed necessary todeal withCOVID-19 pandemic(Fig.3).
Many countries have developed their own DRRS to fight devastating accidents and disasters such as China [30],Philippines[31],Oman[32],Singapore[2]andCzech Republic [33]. For instance, since the crisis of severe acuterespiratory syndrome(SARS),China hasmodernized itsnational emergencymanagement system(NEMS) which revealed its efficacy in fighting COVID-19 pandemic. The ChineseNEMSwasbeenorganizedbyverticaladministrator- sector lines’ [34]. However, after 2003 SARS crisis, China rebuiltanewNEMSbasedon‘‘oneplanandthreesubsys- tems’’ [35].The Saudi institutional frameworkof DRRS in comparisonwithotherinternationalsystems,showsthatis verysimilartothatofSingaporethatisstructuredinamulti- levelgovernanceandwhichshowsitssuccessinfightingSARS pandemic[2].
As the COVID-19 pandemic outspread at the beginning of March 2020, causing an enormous impact on health- care servicesand onsocioeconomiclevel in thekingdom.
As a result, the Saudi government has applied severer measures to combat the spread of the virus. Fig. 4 Elu- cidate some of the stricter measures taken by the Saudi government.
Based onthe effortsmade bytheSaudi RiskReduction ManagementFrameworkbetweenSeptember2020andJan- uary 2021, Fig.5 in form of dot density maps shows the outbreakofCOVID-19pandemicinallSaudiregionsbefore
(September2020)andafter(January2021)thestrictmea- surestakenbySaudigovernment.
Government steps to regulate public health
Monitoringand monitoring is crucial in the battleagainst COVID-19pandemicsasithelpstoprovideearlynoticeand alsotopredictpotentialoutbreaks.Themonitoringmethod includessearchingforpotentialvariationsofvirulentstrains anddiseasesbothwithintheboundariesofacountryandat majorbordercrossings[1,8,37—39].
The existence of the virus was largely unknown when COVID-19firstappeared.Asaresult,healthandhealthcare professionalsacrosstheglobewereincreasingly unableto identifyandtracksuspiciouscases.Yet,SaudiArabiaman- agedtodevelopidentification andreportingprotocolsina timelymannerwiththeassistanceofWHO technicaladvi- sors.Inaddition,theMOHhasextendedtheconceptsofthe WHOforreportedCOVID-19cases(includinganyhealthcare staffwithfever and/or respiratory symptoms)tobroaden thesurveillancenetwork[40].
Although these monitoring measures were laudable, COVID-19alsorevealedtheshortcomingsofthefragmented epidemiological surveillance and reporting processes in SaudiArabia[26].Anumberofnewsurveillanceinitiatives wereimplemented asa major part of the lesson-drawing in the post-COVID-19 pandemic period to incorporate
Figure4. SomestrictermeasurestakenbytheSaudigovernment.
Source:adoptedfrom[36]andmodifiedbyauthors.
Figure5. DotdensitymapofCOVID-19beforeandafterSaudigovernmentmeasures.
Source:authors’elaborationusingdatafromhttps://covid19.moh.gov.sa/(ArcGisandGeoDasoftwareoutputs).
epidemiological data and classify Current virulent strain evolvingmorerapidly.Oneofthemostprominentwasthe developmentof aclinical database andinfectious disease warningsystemtoincorporateessentialclinical,laboratory
andcontact tracing information. The monitoring program currentlyhasthreemajoroperationalelements, including group surveillance, laboratory surveillance, and external surveillance.
Infection prevention at hospitals
To limit the risk of transmission in healthcare institu- tions once the COVID-19 epidemic broke out, the MOH implemented a series of stringent infection-control mea- sures to which all healthcare professionals and hospital visitors had to adhere. It has made the use of personal protective equipment compulsory. Visitors to public hos- pitals inthoseareaswere barredhealthcareprofessionals activitiesinpublichospitalshavealsobeenheavilyprohib- ited.Sadly, theseessentialsteps werenotenforcedin all healthcaresectorsuntiltheendofMarch2020,andthisfail- ureresulted in anumber ofintra-hospital infections [26].
Moreover, theapproach of limiting healthcareprofession- als and visitors’ movements to hospitals has been taken further.Patientmovement betweenhospitals,meanwhile, wasstrictlyrestrictedtomedicaltransfers.Thenumberof visitors tohospitals wasalsolimited andtheir particulars recordedduringeachvisit.
It is alsoimportant to note that strong public support and cooperation were needed for these rather stringent control measures. Indeed, if these two elements had been missing their implementation would not have been successful.
Public contact and education
Public educationand communication aretwo keycompo- nents of handling health emergencies [41,42]. Communi- cation difficulties are likelyto complicate the challenge, particularly when there is no existing, high-status entity that can serve as a centre for gathering and disseminat- ing information. Hence, critical information needs to be disseminatedtransparentlytothetargetedpopulation.The SaudiMOHmaintainedahighdegreeofopennessduringthe COVID-19outbreak,whenitshareddetailswiththepublic.
Nonetheless,theMOH’ssimpleanddistinctcommunications have greatly contributedto raisingthepossibility ofpub- lic panic. The MOH has workedclosely withthe mediato provide daily, timely reports and advisories on health. In additiontothe media(e.g., television andradio),knowl- edgepamphletswere distributedtoevery household,and theSaudiMOHwebsiteprovidedthepopulationwithregular alertsandhealthadvisories.
Notably, a government information portal was estab- lished (https://covid19awareness.sa/en/home-page)when the WHO released a global warning, dedicated toprovid- ingtimelyupdates.Aseriesofdedicatedawareness-raising televisionspotstoprotectagainstCOVID-19waslaunched.
AcommonmessagereceivedduringtheCOVID-19outbreak has been the importance of social responsibility and per- sonalhygiene,inordertotreatnewCOVID-19positivecases, such aspublic hospitals and localclinics. Childrenat the schoolweretoldtowashtheirhandsdailyandchecktheir bodytemperature.Theytoldthepublictowearmasksand topostponenon-essential traveltoothercountries. Saudi educationpoliciescorroboratewiththestudyperformedin Japanby[43],whichanalyzedtheCOVID-19responseinthe educationsector using theSendai Frameworkfor disaster riskreduction.
Social distancing and measures of psychosocial affairs
DuringCOVID-19outbreaktheSaudiMOHpromotedtheprac- ticeofsocialdistancing.Ofcourse,thesolepurposeofsocial distancing was to restrict physical encounters and near communicationinpublicplaces,thusslowingtheCOVID-19 transmissionrate.Asaresult,from9March2020allprepara- tory,primaryandsecondary schools anduniversitieswere closed.Inthemeantime, SaudiMOHalsourgedbusinesses totake social distancingsteps,suchasencouragingwork- erstoworkfromhomeandusepeerproductionplatforms.
Thosemostathigherriskofcontractingcomplicationswere transferredifinfectedandremovedfromfrontlineworkto otherlocationswheretheywerelesslikelytocontractthe virus.As mentionedearlier,thepracticeofsocialdistanc- ingalsodrew strongcriticisms fromthosebusinesses that sufferedeconomiclossesasaresult.Apartfromproviding economiccompensation,measurestomitigatepsychosocial impactsarealsoimportant.
Asmentionedabove,thegovernment’spublichealthcon- trol measures drew strong criticism from businesses and the public during the COVID-19 outbreak because of the invasivenatureofthoseactions.Besides these,totaljobs andpersonalincomehavebeenaffectedbyeconomicslow- down.Inresponsetopublicconcerns,KingSalmanagreedto exemptborrowersfromtheSocialDevelopmentBank,who aremostinneedespeciallypeoplewithdisabilitiesandthe elderly.Heofferedeconomicassistancetothoseindividuals andbusinessesthathadbeenaffectedbyhomequarantine orders.
At the same time, the MOH worked with various gov- ernment ministers to provide essential social services to thoseaffected bythelockdownorder.Forexample,hous- ing was offered to stranger residents those who lives in crowded houses. During their lockdown, the Saudi Arabia CivilDefence Forceopenly offeredemergencyservices to thoseundergoingquarantineathometoseetheirphysicians.
Notonlywerealloftheseriskmanagementstepseffective incombatingtheoutbreak,buttheywerealsorelevantfor applicationsinmanagingdisasterrisks.
Research implications
Thissectionoutlinesthelessonlearningfromtheexperience ofSaudiArabiaincombatingtheCOVID-19outbreak,anddis- cusstheimplicationsofdisasterriskmanagementforfuture research.The implicationsareexplainedinthreeaspects:
staying vigilant at the level of the community, remaining flexibleinanationalmanagementstructureandcollabora- tivelocalgovernance.
Stay alert at community level
It remains unclear that the strict health protection mea- surestakenby Saudigovernmentmightnotbeacceptable orreplicableinothercountries.Theevidencesuggeststhat punitivegovernmentpoliciessuchasthesetoutofnewfines for COVID-19breaches, the lockdownandtravel bans are
lesseffectivethanvoluntaryinterventionsforinstancegood personalhygieneandthevoluntarywearingof facemasks [26,44].Recalling thepublictomaintain ahigh degree of vigilanceandpromotingindividualsocialresponsibilitymay be a technique of coercion by the government authority tocontrolandexertpressure.Nevertheless,nottocompli- catethepolicywithindividualsorgroups[45,46].Promoting socialresponsibilityisthereforecrucialintermsofslowing thepaceofCOVID-19infectioninallsettingsthroughgood personalhygieneandwearingrespiratorymasks.
To accomplish this goal, two essential components of health crisismanagement(HCM)arepublicawarenessand risk communication [41,42]. The community needs to be awareofthenatureandextentofthedisasters.Theyneed tobeinformedaboutthevalueofemergencypreparedness andengagementindrills,trainingandphysicalpreparations.
Institutionsandcapacitiesareestablishedandstrengthened at community level, which in effectcontribute systemat- ically tothe vigilance against potentialrisks. This is best demonstratedinthegoodcommunicationpolicyofthegov- ernmentofSaudiArabiaforavoidingpublicfearandpanic during COVID-19outbreak[47]. Throughoutthe epidemic, theSaudigovernmenthassteadfastlyraisedthelevelofper- sonalhygieneandawarenessofsocialresponsibility.Ithasto dependinlargepartonpublicawarenessandcoordination ofthreats.Politicalleaderswereseenasdoingandinitiating aseriesofcountermeasurestoreassurethepublic,inorder toeffectivelydisseminatetheideaofvigilance acrossthe public.
Byshowingthepeoplethatgovernmentleaderspracticed whattheywerepreaching,theexamplesservedtonatural- izeandlegitimizethesocialresponsibilitypublicdiscourse for all Saudi citizens and residents.Through showing the peoplethatpolicyofficialswerepracticingwhattheywere teaching,theexampleshelpedtonaturalizeandlegitimize thepopular debateonsocial responsibilityfor all citizens andresidents.The evolvingcircumstanceisadapting flex- ibly, and even more quickly than in the case of disease transmission.
Staying flexible within a national coherent strategy
Alllocalemergencyresponsebodieswilloperateunderthe authorityofasingleNationalManagementsystemtoorga- nizemulti-institutionalcooperationinemergencyresponse anddisastermanagement.Inadditiontopromotingstrong inter-institutional cooperation, the power of this robust frameworkliesin itsabilitytoensurea rapidresponseto suchdiseaseoutbreakthroughthemoreeffectiveandeffi- cientexecutionofriskreductionsteps.
Structural versatility includes the rapid deployment of forcestomitigatetheaccidentatthetacticallevelandthe provisionof professionalguidanceattheoperational level toreduce life and propertyharm. The endogenousversa- tilityof thismanagement structurefacilitates leadtothe buildingoftrustbetweenthegovernmentandpeople.This in effect ensures timely acceptance by the population of policyinitiatives.
As shown in this article, the Saudi MOH has been entrusted by the government and designated as the
publichealthemergencyincidentmanager.Whereasudden incidentinvolvespublichealthoralarge-scalelossoflife, theMOH isresponsible for theplanning,coordinationand implementationofarangeofdiseasecontrolprogramsand activities.
During the COVID-19 outbreak a national management andcontrolsystemwascreatedbytheSaudi government.
This national framework was able to respond to rapidly changing circumstances emerging from the outbreak. As morecasesofCOVID-19wereidentifiedandbetterepidemi- ological knowledge became available, the Saudi Council ofMinistriesquicklyformedanInter-institutionalcoopera- tiontoensureplanningandimplementingallriskreduction steps. Although this overarching system of governance is moreorlessordinaryworldwide[48].
FromtheexperiencesofSaudiArabiainfightingCOVID-19 pandemic,we learnedthat anational managementstruc- ture’s strength lies in its flexibility to connect relevant ministriesonthesameframework.Theselinkagesguaran- teeatimely,coordinatedresponseanddeliveryofservices.
Beingflexibleinstructurewasnottheonly reasonbehind COVID-19’ssuccessfuldefeat.InthecaseofSaudiArabia,we alsonotetheeffectivenessofhavingtodependonexpansion capacitytowithstandanunexpected,high-impactcatastro- phe.
The need for expansion capacity and collaborative regional governance
Inthecontextofthispaper,thecapacityforsurgerefersto theabilitytomobilizeresources(healthprofessionals,facil- ities,medicaldevices,vaccines,etc.)tocombatapandemic outbreak.The strategic responsiveness of SaudiArabia to COVID-19 illustrates the importance of rapidly increasing thecapacitytodealwithanoutbreakofinfectiousdisease.
Thisproblemcontinuestohindertheabilityofmanycoun- triesto counter infectiousdiseases. It is a matter offact formany publichealthorganizations thattheyareunable tocopewithpandemicsbecausethemeansfordoingsoare clearlylacking[49,50].
In the meantime, there is evidence suggesting that expanding capacity alone is not the full answer. For ins- tance, abundant resources during the COVID-19 outbreak contributetoasignificantbutnotall-encompassingfactorin thefightagainstthispandemic.Whenitturnedout,asdif- ferentstakeholdersbroughttheirspecificskillsetsandtools to the task-at-hand, they simply complicated the battle becauseoftheirlackofsynergy.Indeed,abundantresources without collaborationcould potentially undermine collab- orative efforts. Therefore, the ability to connect various stakeholdersneeds tobecomplemented bysome formof synergybetweenthem.Theseabilitiescanbeimprovedby closecooperation. This takes us tothe third concept for disastermanagement:nationalcollectivegovernance.
Thetransboundarycomplexityofdisastersneedsapre- paredandorganizedstrategyforsuccessfulrescueandrelief operationstodisasterresponse[49].Combatingepidemics includesclosecoordinationbetweenvariousstatesandgov- ernmentbodies[1,51,52].
It is also clear that various stakeholders’ collabora- tiveabilityisessentialtothebattleagainsttransboundary
Table5 Disasterriskreductionframework.
Keyrecommendations 1.Mitigation/readiness
Atthestrategiclevel,governmentneedstooptforstrictquarantinemeasuresforpeoplecomingfromotherred zones
Thereisanecessitytoestablishvillagecommitteestofurnishbasichealthcareandhygieneinformationusing doorto-doorcommunication
Atoperationallevel,thereisaneedtoconvincethepopulationabouttheneedtotakevaccineandtofight againstdisinformationandfakenews
Communityvolunteers,attacticallevel,canbetrainedtomakequickCOVID-19teststhatdeliverquickresultsor thegovernment,atoperationallevel,canmakerecruitmentofhealthcareprofessionalstoachievethis
ThereisaneedtogivesubventionstoprivatelabstorisethenumberofCOVID-19testsbydecreasingthecosts forthepopulation
2.Preparedness
Atastrategiclevel,thereisaneedtobuildapandemicinsurancesolutionforthecommunitytocoversignificant economiclosses
Healthcarefacilitiesneedtoprovidefreevaccinetomorethantwo-thirdofinhabitants
Governmentbodies,atoperationalandtacticallevels,havetoobligeindividualstorespectsocialdistancing Itisinterestingtoprioritizethefundingofthemostaffectedventuresbythepandemic
3.Response/implementation
Healthcareprofessionalshavetobewellrewardedbythegovernment,attheoperationallevel,fortheirbrave effortsduringthepandemic
Thegovernmentcanuseinformationandcommunicationtechnology,inpublicplaces,torecognizeindividuals whoarenotwearingmasksandwhohavefever
Thegovernment,atastrategiclevel,cancontinuetosupportsmallandmediumenterprises(SMEs)tosurvive duringCOVID-19crisis
Saudibankshavenoliquidityshortageandcanpermitcompaniesineconomicdifficultytopostponeloanpayment Attacticallevel,securitiesofficialscanbegivenmoreauthoritytoforceindividualstorespectsocialdistancing 4.Recovery/post-COVID-19
AftertheCOVID-19pandemic,itisnecessarytothinkabouthumancapitaldevelopmentespeciallyinthe strategicfieldsofeducation,healthcarefacilitiesandagriculture
Inthefuture,thereisaneedtodevelopbilateralcooperationagreementswithotherdevelopedcountriesto managescientificresearchproject,shareknowledgeandtechnology
Atthestrategiclevel,Saudigovernment,needtoreviewitsmonetarypolicybyreducingtaxesandexpenditures ItisimportanttohelpmanySMEsaffectedbythepandemicbyprovidingthemreasonableloanstosupporttheir resilienceandtoboosteconomicgrowth
communicable diseases [49,53]. Although advanced eco- nomic development member states usually lead these efforts,itisimportantandultimatelyunavoidabletoinclude otherdevelopingcountriesandorganizations.Indeed,with theassistanceofregionalcooperation,significantcounter- measuressuchasborderprotectionandsurveillancearealso madepossiblesuchastheGulfCooperationCouncil(GCC), whichadoptsananticipatorymechanisminordertoenhance andimplementadisasterriskreductionsystem(DRRS).
Discussion, conclusions and policy recommendations
The COVID-19isnotonlyahealthcrisisbut alsosocioeco- nomicandpoliticalcrisisthatwillhaveseriousrepercussions insocietiesandpeople.Lossofjobsandincomesaremain challengesfacinggovernments.Theimmediatelessonfrom Saudi experience in fighting the pandemic is about the needtoreiteratetheoperationalresponsivenessoftheRisk Reduction Management system in dealing with crisis. Vil- larin and Basilio [54] argued that local government and
political-administrativestructure areonthefront line for COVID-19preparedness.BogatiandGautam[55]showthat rapidrecoveryafterCOVID-19crisisrequiresthecapability ofgovernmentsandlocalcommunitiestomobilizediverse stakeholders andmanaging available financial and human resources.
Todaytheworldismuchmoreinterconnectedthanever before, owing to globalization, international trade and cross-bordermigration.Nonationissparedbeingdirectlyor indirectlyaffectedbycatastrophes.SaudiArabiaisvulner- abletoboth naturalandman-madedisastersalongside its remarkableeconomicgrowth.Inresponse,theSaudiArabia governmentadoptsanapproachofintegratedriskmanage- ment,aconcerted,coordinatedeffortbasedonauniversal nationalresponse.
We observed the disasterrisk reduction system (DRRS) of Saudi Arabia in this case study, with clear references to the COVID-19 outbreak. In its combat against COVID- 19 pandemic, The Saudi health authority was sufficiently responsivetotakeactionwhenitrealizedthattheflexible inter-institutionalwassuitabletofacilitate closecoopera- tionbetweenvariouskeygovernmentbodiestotacklethe
on-going health crisis. So, a crisis management structure wasestablishedquickly.Thenatureofaversatilemanage- ment system,the wayandextent it wasuseddetermines howeffectively an outbreakwas managed.Flexibility has actuallyimprovedthepotentialoforganizationsbymaking organizations moreproductiveundersomecircumstances.
Epidemicpreventionstrategiessuchassurveillance,social distancingandlockdownneedbroadpublicsupportfortheir efficacy. SaudiArabia’sCOVID-19experiencestronglyindi- catesthatrisk reductionstrategiescan onlybesuccessful when anumberof partners andstakeholdersareinvolved such as ministries, civil society (associations) participate appropriately.Thisisalsoimportantforcontrollingriskofa disaster.Whetheralltheseaspectscanbetransferredelse- whereinfutureresearchneedstobeassessed.
Today, this particular approach has definitely helped SaudiArabiaperiodicallyrecoverfrompublichealthcrisis.
SaudiArabia’sresponsetotheCOVID-19outbreakprovides usefulinsightsintothekindsofstrategiesrequiredtobattle futurepandemics.Furthermore,[56]confirmthat,theuse ofaframeworkfor DisasterRiskReduction,needstheuse ofwide-rangingstrategiesthatprotectvulnerablepeoples duringthefourstagesof Mitigation(readiness),prepared- ness,response(implementation)andrecovery(post-COVID) (Table5).
Human and animal rights
Theauthorsdeclarethattheworkdescribedhasbeencar- riedoutin accordancewiththeDeclaration ofHelsinki of the World Medical Association revised in 2013 for experi- mentsinvolvinghumansaswellasinaccordancewiththe EUDirective2010/63/EUforanimalexperiments.
Informed consent and patient details
The authorsdeclare thatthisreport doesnot containany personalinformationthatcouldleadtotheidentificationof thepatient(s)and/orvolunteers.
Funding
Thiswork didnotreceiveanygrantfromfundingagencies inthepublic,commercial,ornot-for-profitsectors.
Author contributions
AllauthorsattestthattheymeetthecurrentInternational Committee of MedicalJournal Editors(ICMJE) criteriafor Authorship.
Disclosure of interest
Theauthorsdeclarethattheyhavenocompetinginterest.
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