The research team examined twenty-two states across the MENA region, from the wealthy Gulf Cooperation Council monarchies to middle-income countries such as Egypt, Morocco and Tunisia, and to fragile or conflict-affected settings including Yemen, Syria and the West Bank and Gaza. Drawing on demographic, economic and labour indicators from global datasets compiled by the United Nations Department of Economic and Social Affairs and the World Bank, the authors synthesised this quantitative picture with the international literature on long-term care models and regional care dynamics. Their conclusion is blunt: population ageing is outpacing the development of formal care systems across the region, and the costs of that gap are being paid invisibly, mostly by women.

The demographic mechanics behind the warning are well established but often misread. Fertility rates across MENA have fallen sharply over recent decades while life expectancy has climbed, producing the classic stages of a demographic transition. For years, the region enjoyed a favourable age structure, with large working-age cohorts supporting relatively few dependents, a dividend that fuelled growth in labour-abundant economies. That window is now closing. As cohorts born during earlier high-fertility eras move into older age, the share of adults over sixty-five is rising rapidly, and the total age dependency ratio, which measures the balance between people typically outside the labour force and those of working age, is shifting in ways that will strain pensions, health systems and household budgets alike.

What makes the MENA case distinctive is the speed and heterogeneity of the transition. The Gulf states face a compressed version of the challenge, where rapid modernisation, large migrant workforces and citizenship-based welfare systems create peculiar fiscal and social geometry. Middle-income countries such as Egypt and Jordan are ageing before they have become rich, leaving little fiscal room for new social programmes. Conflict-affected states face the starkest picture of all; research cited in the study documents how armed conflict in Syria has directly reduced life expectancy, while humanitarian assessments in Yemen describe older populations with minimal formal support. Any regional strategy, the authors argue, must account for this diversity rather than impose a single template.

At the heart of the analysis is the informal care economy, the vast, unrecorded system in which family members, overwhelmingly women, provide daily care for frail older relatives. Cultural norms across the Arab region place strong expectations on families, and particularly on daughters and daughters-in-law, to care for ageing parents at home. This system has historically absorbed demand at zero fiscal cost, but the study shows it is eroding under its own contradictions. Urbanisation is dispersing extended families, smaller family sizes mean fewer adult children per ageing parent, and rising female education and employment aspirations collide with the assumption that women will provide unpaid care indefinitely.

The consequences ripple through the entire economy. Women across MENA already have among the lowest labour force participation rates in the world, and the burden of informal caregiving is a documented barrier to paid work. The study highlights that women also spend more years in ill-health during old age than men, compounding the inequity across the life course. Every hour a woman spends providing unpaid care is an hour not spent in formal employment, not generating taxable income and not building her own pension entitlements. The authors frame this as a hidden economic cost that never appears in national accounts but systematically suppresses productivity, female economic inclusion and the long-term solvency of social insurance systems.

The quality-of-life dimension is equally serious. Without structured services, older people with dementia, disability or chronic multimorbidity depend entirely on relatives who may lack training, respite or support. The literature the authors synthesise points to elevated risks of elder abuse, caregiver burnout and depression among informal carers, and notes that conditions such as dementia are rising in prevalence across the region as populations age. Respite care, home-based health services and day centres remain scarce or absent in most MENA countries, with a few notable experiments such as Oman’s home health care programmes and Saudi Arabia’s expansion of home care under its Vision 2030 reform agenda cited as early signals of change.

The study’s most provocative argument is that this gap is not merely a liability but an opportunity. Formal long-term care is labour-intensive work that cannot be automated away, making it a potent source of employment, particularly for women. International Labour Organization analyses cited in the paper estimate that expanding care services globally generates employment multipliers well above those of comparable investments. The authors propose that MENA governments build regulated care infrastructure through workforce development, dedicated insurance financing models and public-private partnerships, creating decent jobs for care workers while simultaneously freeing other women to enter the labour market. In their framing, care investment functions like roads or power grids: infrastructure that unlocks broader economic activity.

Financing such systems in a region with tight budgets and large informal economies is the obvious objection, and the authors address it directly. They advocate incremental financing mechanisms that expand coverage gradually, learning from international experience including Japan’s long-term care insurance scheme and cash-for-care experiments in Europe, while adapting to regional realities such as the widespread reliance on migrant domestic workers in Gulf households. Formalising caregiving roles, extending social protection to care workers, and aligning long-term care investment with the Sustainable Development Goals are presented as mutually reinforcing priorities. The paper also points to recent pension reform in Saudi Arabia as evidence that structural social protection change is politically achievable in the region.

The study’s bottom line is a reframing. Ageing in MENA has been treated as a distant problem, perpetually deferred by the region’s youth bulge legacy. Hussein and her colleagues argue that the window for proactive policy is closing now, and that governments which integrate long-term care into national development planning, rather than quarantining it in health or welfare ministries, can convert a looming fiscal burden into a driver of equitable growth. The alternative, they warn, is a future in which ageing households are impoverished by care costs, women remain locked out of the labour market by unpaid caring obligations, and governments confront the same demographic pressures a decade later with fewer options and higher price tags. The choice, on their reading of the data, is between building the care economy deliberately or paying for its absence involuntarily.

Subject of Research: Demographic ageing and long-term care policy in the Middle East and North Africa

Article Title: Ageing and Long-Term Care in the Middle East: Towards Inclusive Development Strategies

Article References: Hussein, S., Ismail, M., & Pallares-Miralles, M. (2026). Ageing and Long-Term Care in the Middle East: Towards Inclusive Development Strategies. Ageing International, 51(4), Article 38. https://doi.org/10.1007/s12126-026-09678-4

Image Credits: AI Generated

DOI: 10.1007/s12126-026-09678-4

Keywords: population ageing, long-term care, MENA, informal caregiving, gender inequality, care economy, demographic transition, labour force participation, social protection, economic development, Gulf Cooperation Council, sustainable development goals

The intellectual foundation of the study lies in the economics of rent-seeking, a tradition stretching back to Anne Krueger’s 1974 analysis of the political economy of rent-seeking societies and Gordon Tullock’s earlier work on the welfare costs of monopolies and theft. Rent-seeking describes the pursuit of income not through productive activity—building firms, inventing products, creating jobs—but through the capture of privileges, licenses, political connections, and state favors. When such behavior flourishes, a society’s most able individuals face a choice: deploy their talents in entrepreneurship and innovation, or redirect them toward securing a slice of an artificially protected pie. William Baumol’s classic 1990 framework formalized this insight, arguing that the supply of entrepreneurial talent in any society is roughly constant, but its allocation between productive and unproductive activity is shaped entirely by the rules of the game.

Jaeck and Kratou extend that logic to international migration. Their central hypothesis is that inequality in a rent-seeking society is fundamentally unproductive in character: it is generated by connections, cronyism, nepotism, and access to power rather than by market performance. The talented young people who observe this system understand that the rewards at the top are reserved for insiders. Paradoxically, this does not push them out of the country—instead, it can anchor them within it. In a crony system, emigrating means forfeiting the chance to join, or benefit from, the protected circles where the real rents are distributed. Highly skilled workers may rationally stay, investing in political connections rather than in productive careers or foreign opportunities.

The empirical strategy is unusually ambitious. The authors assembled a bilateral panel of migration flows linking nine MENA countries of origin—Egypt, Djibouti, Algeria, Iran, Jordan, Mauritania, Morocco, Turkey, and Tunisia—to twenty high-income developed destination countries, covering the period from 1995 to 2020. Migration data were drawn from the World Bank’s World Development Indicators, while the institutional character of each origin country was measured using the Economic Freedom Index compiled by the Fraser Institute. Income inequality was captured through standard distributional measures, and the authors derived a rent-seeking indicator whose value represents the mean for the full 1995–2020 period.

Methodologically, the researchers estimated the interaction between income inequality and rent-seeking using two complementary econometric techniques: ordinary least squares regression and a two-way fixed effects specification that controls for unobserved country-specific characteristics and common time shocks. This dual approach guards against the possibility that the results are artifacts of a single estimation choice. The key quantity of interest is the marginal effect of inequality on high-skilled emigration, evaluated at different levels of rent-seeking, and reported with confidence intervals that allow readers to judge statistical precision directly.

The headline result is unambiguous: when income inequalities are conditioned by rent-seeking institutions, the estimated relationship between inequality and high-skilled emigration turns negative. Higher inequality in a rent-seeking environment is associated with less skilled emigration, not more. In effect, unproductive inequalities reduce emigration among the most talented. This is the opposite of what a simple relative-deprivation model—in which widening gaps spur people to seek better prospects abroad—would predict, and it stands in sharp contrast to the conventional expectation that inequality drives exit.

The finding resonates with a growing body of evidence on institutions and mobility. Prior studies have shown that corruption promotes emigration in many contexts, that governance quality shapes net migration flows, and that a lack of economic freedom pushes workers toward countries offering stymied ambition an outlet. Related work on MENA economies has documented the depth of cronyism in the region, from state capture in Tunisia to the ‘pyramid capitalism’ of Egypt, where politically connected firms dominate regulated sectors and suppress the productivity of unconnected rivals. Jaeck and Kratou add a new dimension: the nature of inequality itself, not merely its magnitude, is what matters for who leaves and who stays.

The policy implications are considerable. If rent-driven inequality traps talent at home while steering it into unproductive careers, the region suffers a double loss: it retains fewer of the innovators and entrepreneurs who drive growth, and those who remain are incentivized to play the connection game rather than build firms. The authors argue that institutional reforms are therefore needed to affect the allocation of talents toward more productive careers—reforms that make market performance, rather than political access, the primary route to prosperity. Competitive openness, transparent regulation, and credible rule of law would convert the region’s inequality from a trap into a conventional signal of opportunity that skilled workers respond to in predictable ways.

For a region contending with chronic youth unemployment, recurring political tensions, and some of the world’s highest emigration intentions among the educated, the study reframes brain drain as an institutional disease rather than a demographic fate. The most talented workers, the evidence suggests, are exquisitely sensitive to the nature of the inequalities they observe around them—and the cure lies not in closing borders or raising wages alone, but in rebuilding the incentive architecture that determines whether talent creates value or merely seeks rent.

Subject of Research: How rent-seeking institutions condition the effect of income inequality on high-skilled emigration from the MENA region

Article Title: Rent-seeking, Income Inequality and Brain Drain: An Empirical Investigation for the MENA Region

Article References: Rent-seeking, Income Inequality and Brain Drain: An Empirical Investigation for the MENA Region. (n.d.). https://doi.org/10.1007/s11293-026-09861-7

Image Credits: AI Generated

DOI: 10.1007/s11293-026-09861-7

Keywords: brain drain, income inequality, rent-seeking, MENA, high-skilled migration, institutions, crony capitalism, economic freedom, talent allocation, entrepreneurship, Atlantic Economic Journal, econometrics