The first WISH report on tackling antimicrobial resistance (AMR) was published more than a decade ago. Section 1 of this report reviews progress on recommended actions in the five areas identified by the 2013 report.

This study provides a detailed examination of the ethical implications of artificial intelligence (AI) technologies, with a special focus on the context of the Gulf Region and the broad Arab-Muslim world where Islamic values are an integral part of the moral world of these societies. For an in-depth and systematic analysis of the Islamic bioethical deliberations on AI, mainly focusing on the concept of medical accountability, this study is divided into three main Sections:

• Section 1. AI in healthcare explores the integration of AI technologies into medical practice. It assesses how AI can enhance diagnostic accuracy, treatment efficacy, and overall patient care. This section provides a comprehensive analysis of how AI technologies are transforming traditional healthcare paradigms and the implications for medical practice, while also addressing the challenges and limitations associated with its adoption.
• Section 2. Bioethical perspectives delves into the ethical implications of AI, as examined in the Western, dominantly secular, bioethical literature. It explores the ethical challenges posed by AI in healthcare, particularly in relation to medical accountability. The traditional physician-patient relationship, where the physician is the primary decision-maker, is disrupted by AI technologies. This section analyzes key ethical issues, focusing on the accountability of developers, clinicians, and healthcare systems. It highlights how the complexity of AI, its ‘black box’ nature (we cannot see how AI makes decisions or learns), and biases in algorithms complicate responsibility and decision-making. Other concerns include the digital divide, data security, patient privacy, and the impact of AI on doctor-patient relationships, all of which demand a reevaluation of ethical standards in healthcare.
• Section 3. Islamic ethical perspectives offers a comprehensive analysis of the concept of medical accountability, reexamining the roles of the three key stakeholders – God, the patient, and the physician – that have always been central to the Islamic moral tradition. Pre-AI insights are revisited in light of the profound ethical changes introduced by the AI revolution, as following: 1. Divine creator of the human body (God)In Islamic belief, God is the sole creator and genuine owner of the human body, with humans regarded as trustees of their bodies. The Qur’an emphasizes God’s authority and the sanctity of the human body, with medical procedures permitted as part of divine wisdom. Medicine, whose efficacy is linked to understanding and employing the consistent natural laws established by God, is considered a legitimate and religiously sanctioned practice. While AI-enhanced medicine does not challenge the religious permissibility of medical practices, it cannot alter the core principles of accountability. Among all beings in our visible world, only humans are deemed religiously accountable. AI may influence medical decision-making processes, but it cannot assume the divinely endowed mental capacity granted to humans, which is necessary for moral responsibility.
  2. Custodian of the human body (patient) In Islamic ethics, patients are trustees of their bodies, authorized to make medical decisions. Physicians must obtain informed consent before interventions, barring exceptional cases such as emergencies or public health risks. The physician-patient relationship is contractual, requiring clear communication and agreement. Scholars debate physician liability for procedures consented to by patients but not sanctioned by God. With AI in healthcare, these principles persist. Physicians are still required to obtain patient consent, and they may need to inform patients about the use of AI, as it is considered an emerging technology. The concept of charitable giving (ṣadaqa) might apply to using patient data for AI training, allowing ‘data donation’ by patients, while setting conditions to ensure that divine authority over their bodies – and, by extension, the data derived from examining those bodies – will not be violated. 3. Professional intervener in the human body (physician) Physicians are obligated to uphold ethical integrity and professional competence in their practice. The use of AI tools should aim to enhance the quality of medical care and must not be exploited for unethical purposes. This study explores the implications of AI on physician competence, particularly the potential shift in liability toward new and non-clinical stakeholders. It also examines the ethical challenges posed by the ‘black box’ nature of some AI-operated technologies, emphasizing the need to strike a balance between transparency and the efficiency and precision of medical interventions. In conclusion, in the era of AI-enabled medicine, we explore whether the collective liability shared by involved stakeholders, or the corporate liability of institutions will offer a more appropriate framework for addressing the risks and potential injuries associated with AI-driven healthcare. As AI technologies continue to evolve, new stakeholders – such as data scientists, AI developers, and institutions responsible for licensing AI-enabled tools – may also assume a share of the responsibility for medical accountability.

Breast cancer is the most common cancer among women in the World Health Organization (WHO) Eastern Mediterranean Region (EMR), with around 130,000 new cases and 53,000 deaths in 2022. Cervical cancer also poses a significant challenge, with nearly 17,000 new cases and 11,000 deaths within the same year. The societal and economic burden of these cancers is dramatically high, due to resource limitations, low awareness, sociocultural barriers, and health system disruptions due to conflict and instability in many EMR countries and territories. Breast cancer also has the highest age-standardized incidence rate of all cancers in both sexes combined, which results in women dying prematurely (that is, before the age of 70 years), with their lives and livelihoods being disproportionally affected compared to men. Breast and cervical cancers represent substantial public health and health equity issues, yet they are largely preventable. Governments across the globe have showed increasing interest and commitment to countering this trend, and have demanded tailored economic evaluation to guide decisions and prioritize the most cost-effective interventions. As a response, the WHO Regional Office for the Eastern Mediterranean (EMRO) developed a regional investment case on women’s cancers, quantifying their significant socioeconomic burden, as well as the economic return from investing in evidence-based cost-effective interventions. According to the investment case, the economic burden of both cancers was $15 billion in 2020, and is expected to accrue to $379 billion by 2040, with premature mortality accounting for 96.4 percent of this burden. However, the investment case also displayed significant health and economic benefits from scaling up cost-effective interventions, generating an 82 percent decrease in incidence and high return on investment (ROI) as a result of human papillomavirus (HPV) vaccination – between $2 and $6 gained for each dollar invested. Comprehensive treatment interventions for breast cancer are projected to reduce mortality by 26 percent and to yield almost $8 for each dollar invested. The study highlighted key recommendations, including:

• Significantly increase investments in scaling up cost-effective interventions – especially HPV vaccination, early detection programs, and comprehensive treatment of breast and cervical cancer – and design programs according to country context.
• Address bottlenecks across the continuum of care and maximize efficiency using and strengthening existing women’s service delivery platforms.
• Invest in data systems to better plan and regularly monitor progress and evaluate program performance.The time to act is now. There is a critical need for a co-ordinated, well-resourced approach to tackle the growing burden of cervical and breast cancers in the EMR, emphasizing the economic and health benefits of early intervention and integrated healthcare strategies. By investing in proven, cost-effective measures now, we can create a future where fewer women in the EMR suffer from these preventable cancers, ultimately transforming the landscape of women’s health in the region for generations to come.

Women are the face of the global health workforce, constituting an average of 67 percent of those employed in the health and social care sector globally.1 However, this global average often conceals significant regional and national differences, particularly in terms of labor force participation, employment and gender equality. The World Health Organization (WHO) Eastern Mediterranean Region (EMR) is a region where, on average, men form the majority of those with paid employment in the health and care sector.2 These regional and national differences in women’s participation in labor markets, especially in the health sector, indicate a need for context-specific policies explicitly linked to women’s economic empowerment. This policy paper aims to examine women’s employment in health in the EMR to expand the evidence base and understand the factors influencing women’s representation in the health workforce. Section 1 provides an overview of women’s participation in the health workforce. Limited evidence exists on the drivers of women’s employment in health in the Eastern Mediterranean Region. Section 2 examines what drives and the factors that constrain women’s participation. The report analyzes data through a gender lens to explore the relationship between overall female labor force participation and employment in health. It also investigates differentials in working conditions, such as pay for women and men in the health and care sectors. Three detailed case studies examine how political, cultural and social norms influence women’s engagement in the health labor market. This combined evidence identifies policy opportunities to enhance women’s participation and economic empowerment across the sector. The report underscores significant regional variations in women’s participation in the health workforce. Section 3 concludes with lessons learned and the policy implications. Despite challenges, the report concludes that employment in health in the Eastern Mediterranean remains appealing for women, even in countries with low overall female labor force participation. Targeted actions can catalyze women’s empowerment in these contexts.

In the aftermath of the COVID-19 pandemic, community engagement has resurfaced as a necessary condition for emergency preparedness, response and recovery efforts in global public health. Yet there is ambiguity and a lack of consensus on definitions and scope, and significant gaps in evidence on how community engagement can be successfully achieved. In traditional community engagement approaches, ‘community’ is often treated as a geographical location, or a group of people with lived experience of an issue; while the process of engagement is defined as an exchange of information. However, developments in scientific knowledge suggest that the concept of ‘community’ should be expanded to encompass the entire range of social connections – from early childhood attachment to ongoing social interactions throughout adolescence and into adulthood. This broader perspective acknowledges that people are inherently part of multiple, interconnected communities throughout their lives – each influencing their identities, emotions, decisions, behaviors and health. The health and care workers’ community is also part of this larger context. This renewed focus on community engagement is central to a primary healthcare (PHC) approach, and it aligns with the Ottawa Charter for Health Promotion which calls for health systems to address individuals’ total needs. ‘Relational community engagement’ emphasizes improving relationships among health and care workers, and between them and the people they care for. Governments are recommended to: 1- Promote relational leadership, management, and governance

• Invest in adaptive transformative leadership models to drive whole-system learning.
• Develop political commitment to adopt a relationship-focused approach to community engagement as an inherent way of working in health systems and across sectors.
• Engage the health and care workforce and civil service across sectors to develop a renewed vision for public sector values and ways of working.

2. Strengthen relationship-building capabilities in health systems

• Strengthen communication and collaboration in health systems, setting relational competency benchmarks, and invest in local capacities of communities to address power imbalances.

• Develop participatory skills in multi-disciplinary teams and interprofessional practice.
• Integrate social and contextual data in health service design and delivery.

3. Invest in transdisciplinary research and practice development

• Fund research using the Integrated Change Framework (ICF) to foster collaboration across the sciences, technology, and the arts.