The final Law Update of 2022 is here, and it’s packed full of articles. The double edition features two focus areas, first is a spotlight on Energy and Resources and second we feature a collection of articles on Transport and Logistics. The developments occurring in these sectors in the MENA region are unprecedented and our lawyers cover vast themes for you.
The Energy and Resources focus features topics such as diversifying energy resources, solar PV, mining in the Middle East, renewable energy and green hydrogen. From a transport perspective, we draw attention to the Bahrain metro project, discuss the challenges and remedies associated with the repossession of an aircraft, and there is advice on what to consider should a party vary the terms of a shipping contract.
This edition navigates you through updates from across jurisdictions such as, Oman, Jordan, Saudi Arabia, Egypt, Iraq, Qatar, and the UAE. Each article is timely and provides insights into legal issues and cases that are affecting these sectors across the region.Read the full edition
The Centennial 2071 project launched by the Cabinet of the United Arab Emirates aims to place the United Arab Emirates (‘UAE’) as the best country in the world by 2071.
In order to be the best country in the world, the UAE must have a healthy population with access to the highest standards of healthcare in the world. The COVID-19 pandemic puts healthcare at the forefront of human existence, and there is no time to be lost in navigating out of the crisis and putting in place a national health strategy that will defeat COVID-19 whilst outlining the objectives for the healthcare sector that will support the UAE in becoming the best country in the world by 2071.
The government’s healthcare policy is both inward and outward looking (and paraphrased) as follows:
It is undeniable that the UAE has built an impressive health infrastructure consisting of hospitals, clinics, home care services, and diagnostic laboratories, providing for the healthcare needs of the population and growing new areas of clinical experts; for example, in diabetes care, cancer treatment, and cardiology services, to name but a few. The transition from public to private sector services has been led through private sector investment, insurance provision, and more recently public-private-partnership projects, currently placing the split at 65/35 per cent in favour of the private sector.
Important collaborations with global brands, such as Cleveland Clinic, Mayo Clinic, Johns Hopkins, Mediclinic, Imperial College London, Kings’ College London, amongst others, all play a significant role in bringing care to international standards, building trust, improving quality of care and offering medical tourism services.
Medical tourism is a key pillar of the UAE healthcare strategy. The medical tourism strategy is built upon the concept of inward tourism, building hospitals, some operated by respected international brands, that create a package of services (including concierge) that bring medical tourists to the UAE for treatment. The key question now is, ‘has this strategy been successful and is it the best strategy for the future?’
There is no doubt that the medical tourism strategy has been successful. As a result of a huge amount of political will, and efforts by both public and private infrastructure investment in hospitals, the UAE has recently made it into the top 10 list of globally ranked medical tourism destinations. According to the Medical Tourism Index, the world’s most attractive countries for medical tourism are Canada, the United Kingdom, Israel, Singapore, and Costa Rica. Dubai is currently ranked sixth and Abu Dhabi eighth. With the UAE-Israel normalisation of relations treaty signed in September 2020, the UAE has an opportunity to collaborate with Israel with a view to improving its ranking and moving up into the top five of world ranked destinations for medical tourism.
The UAE is in a good position to improve its global ranking. However, improvements in certain areas will be required. Statistics indicate that, in some cases, hospitals were either not receiving the volume of tourism patients that were expected, or not able to raise the targeted revenue from those patients. There has been a disconnect between supply and demand, and with competition within the private sector that has resulted in healthcare operators all offering similar services and chasing the same medical tourists. Competition for the same medical tourists has, in some respects, resulted in it taking longer and costing more to achieve strategic goals. 
According to the Medical Tourism Association, the reasons why people choose other countries instead of their own countries for medical treatment are four fold:
The UAE is a comparatively expensive option for medical tourism and, with some variables in capacity, quality, and trust. Arguably, the UAE only scores very well in two out of four of these criteria.  Future-proofing the medical tourism strategy requires corrections to be made in order to give the UAE a better score in those areas where it is not performing as well as expected; quality and cost.
Review the medical tourism strategy and decide what needs to change to make medical tourism more applicable to the current and post COVID-19 environment. We recommend:
With the ‘World Medical Tourism and Global Health Congress’ having taken place in Abu Dhabi in 2019 the spotlight remains upon the UAE to make the required changes in its medical tourism strategy that will continue to make medical tourism successful.
We propose three new strategic goals that could drive the UAE to become a global leader and strategic partner of choice for healthcare science and innovation:
The UAE is investing heavily in health science and technology, tripling its research capacity and productivity in recent years.
Health science institutions in the UAE are actively collaborating with a multitude of intuitions worldwide on a range of life science projects. The Dubai Science Park (a dedicated free zone established to attracting life science and technology businesses) connects international health science institutions with local institutions and supports participation in research projects and clinical trials. Similarly, the Mohamed Bin Rashid University of Medicine and Health Sciences undergraduate programme is heavily research-focused.
Recent examples of groundbreaking research projects include; the American University of Sharjah biomedical engineering programme, which is working in collaboration Rashid Hospital Dubai (funded by Al Jalila Foundation), to improve diagnosis and treatment of epilepsy by using the skills of engineers, scientists and mathematical techniques to localise the source of epilepsy in the brain. Another project, in collaboration with Johns Hopkins, concerns developing quantitative measures to measure brain injury following cardiac arrest through clinical trials on intensive care patients.
The Abu Dhabi Investment Authority and Mubadala Investment Company each have significant life sciences’ investments locally and worldwide. Mubadala Investment Company, in co-operation with a consortium of investors have acquired a majority stake in the Envision Pharma Group, a leading technology enabled scientific communications’ company, expanding UAE access in life science technology across European and Global markets.
The UAE is also making significant strides in finding solutions to COVID-19 through clinical trials and vaccine research. Abu Dhabi state-owned G42 (in which Mubadala recently acquired a stake) is collaborating with both Chinese and Russian state-owned enterprises on COVID-19 clinical trials of an UAE/Chinese vaccine, and the Russian vaccine, Sputnik V. Approval has already been granted for the UAE/Chinese vaccine Sinopharm, with the offer of vaccination to UAE residents. Phase III trials are in progress on Sputnik V. These measures places the UAE amongst the leading global nations offering a vaccine for widespread use, and large-scale production. Using sovereign wealth fund and other investment expertise, the UAE is well positioned to be able to monetise the vaccine and offer a global solution as part of a medical tourism strategy.
COVID-19 led change will force the life sciences’ sector in the UAE to adopt a business-focused approach to its development strategy, and examine a range of business models and the related components needed that give rise to investment opportunities. The pace of change across the industry and markets is now irreversible.
Life sciences’ infrastructure investment needs commitment from the government. In Abu Dhabi, the DOH is regulating and supporting the development of health science innovations using a business-orientated approach through a Health Accelerator programme in partnership with the Abu Dhabi Global Market regulatory framework that facilities investment in health-tech innovation.
Technology will drive better health outcomes at a lower cost. The trends are towards better diagnosis and prevention, and continuous improvements in the management of chronic diseases, such as though remote monitoring of diabetes.
The future strategy requires a cultural change with regards to prevention of illness rather than consuming health services after the onset of illness. Technology will enable rapid access to health information and prevention, through diagnostics, high quality care and treatment: this is key for medical tourism going forward.
The UAE has embraced the concept of telemedicine and, having already sought to create a regulatory framework enabling telemedicine activities, was easily able to approve the urgent and widespread use of telemedicine services in the face of the COVID-19 pandemic, enabling continued access to health advice for those in lockdown and allowing e-prescribing and home delivery of medication. There is no turning back. Telemedicine must be at the centre of the future of healthcare delivery systems for the UAE. The benefits include increasing accessibility, focus on wellness and prevention all of which result in reduced costs.
The use of artificial intelligence (‘AI’) and machine learning in healthcare is essential in order to support e-health delivery systems. AI data prediction tools, machine learning algorithms for image analysis, and robotics will become woven into the fabric of the future vision for healthcare. The use of AI in combination with the increasingly popular use of wearables and remote monitoring devices will underpin the wellness and prevention agenda. Innovation is thought of as expensive but it can be instrumental in decreasing costs over time. Upfront technology and equipment costs lead to downstream benefits, less surgical complications for example, and over the longer term the investment will reap rewards and reduces costs.
UAE regulators are now developing AI policy models setting out the essential requirements of AI in an healthcare framework; ethics, safety, responsibility, and security implications of AI use in healthcare.
Cloud technology offers great potential for enabling large volumes of data to be processed and managed by both regulator-controlled centralised systems and healthcare entities. However, the present policy position in the UAE is for data to be hosted onshore on local servers ensuring greater control and security.
We see there being a place in a future national healthcare strategy for the use of cloud technology in association with adequate security protections. This will be essential as cloud technology works hand-in-hand with telemedicine delivery systems and AI solutions. With greater volumes of personal health information exchanged through technology-led and online communication systems, it is very important that tech companies and telemedicine providers operating in the UAE have effective and secure methods of processing and storing data.
Regulatory reforms must support and boost the health-tech sector. Leaner and faster regulation processes are needed that can be quicker on approving medical devices and pharmaceuticals. Regulation and policy drafting departments need to be more tech-savvy, engage with innovators and create the regulations of the future. Approval processes must be rapid; quicker at providing medical research and clinical trials’ approvals. Better regulation, supporting the use of technology, should be at the heart of the healthcare solution, which will translate into a reduction in costs.
Digital health must be at the core of the 2071 centennial health strategy.
The UAE has done much to bridge the gap between digital health technology advances and drafting regulations enabling digital health, but much more needs to be done.
A best-in-class healthcare system can only succeed with the best talent.
The UAE government, along with health and science intuitions, must recognise the importance of growing and attracting talent both in clinical medicine, and in research and development.
Young students have the opportunity of choosing to pursue a career in medicine and health sciences. There are now opportunities to study within the UAE (such as at the Mohamed Bin Rashid University of Medicine and Health Sciences) but the majority of students must travel abroad to receive education and exposure to working in other healthcare systems. There should be much more investment in our talent of the future.
Funding of research projects is important, along with having processes in place for utilising and supporting the research, and obtaining the consumables needed for research projects. It will be important to create a culture for research with free-flowing dialogue between government and science institutions on the core issue of inspiring the next generation of doctors and scientists.
The vision for 2071 should support growing and educating local talent in parallel with offering funding and grants for sending the best students abroad for the experience of working shoulder to shoulder with internationally recognised physicians and scientists.
Retaining quality healthcare staff remains a challenge. Hospitals that are undersupplied with patients, or where there are insufficient volumes of patients with complex needs requiring clinical specialists, do not create the environment or career development pathways that talented professionals look for in a long-term career destination.
The vision for 2071 must focus on developing centres of excellence, enabling volumes of complex cases to be clustered together, supporting the development of specialists, with associated medical research projects and the opportunity to publish research results: all leading to delivery of higher quality care and better patient outcomes.
In January 2020, H.H. Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai said that the year 2020 would be the year of preparing for the 50 years ahead.
“our responsibility is to maintain development, excellence and continued growth… including in the health… and wellbeing of citizens”
The healthcare vision for 2071 must leverage the momentum in technology and innovation investment that has emerged from the COVID-19 crisis, and launch a national health sciences and technology strategy that prioritises digital health, health sciences, whilst nurturing the most talented physicians and scientists: promoting the importance of building both human and machine learning capabilities and knowledge, inspiring the next generation, and enabling the UAE to participate in the role of global health citizen.