Responses to “A questionnaire to collect health, population, and air quality monitoring and management data in the Eastern Mediterranean Region” were received from 12 out of 22 EMR countries (Afghanistan, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Morocco, Pakistan, Sudan, Tunisia and Yemen). Responses to the questions are summarized in Table 2. According to the survey, in eight of the 11 responding countries with a constitution, the right to clean air for the people is mentioned there. In most of these countries, also a national or subnational or multi-national/regional air quality action plan (AQAP) exists (the exceptions are Sudan and Yemen). The health component is included in the AQAP of six countries. In nine countries, the implementation of the actions is a shared responsibility of both the Department of Environment (DoE) and the Ministry of Health (MoH), while in Iraq and Pakistan just the DoE is responsible for AQAPs implementation. Such responsibilities are assigned also in Yemen, where no AQAP is formulated.

A part of the WHO/CHE questionnaire was related to SDS and transboundary air pollution (TAP). Actions on these important sources of particulate matter air pollution were included in the AQAP and/or a subject of intergovernmental cooperation in two countries (Table 3). More common were the studies on the contribution of SDS and TAP to air pollution, reported from five countries. Early warning systems and/or other actions to reduce population exposure to SDS were implemented in four countries, also in those (Egypt and Jordan) missing comprehensive action plans on SDS or TAP. Specific control measures to control SDS in natural, rural, or urban areas were implemented in recent 5 years in Egypt, Jordan, and Kuwait. In two countries, health sector was involved in implementing the actions.

An important element of air quality management is air quality monitoring, providing essential information on the magnitude of the air pollution problem as well as on the effectiveness of any actions undertaken to combat air pollution. Availability and accessibility of data from such monitoring in the EMR countries has been assessed through review of the most recent (released in April 2022) global air quality data base, created by WHO through gathering data directly from the member states as well through the search of a variety of publicly available sources (web pages, publications and reports). Before the data base is released, each member state is requested to review its contents and, if necessary, amend or correct the data related to this country. The data base contains information on annual mean concentration of PM_2.5, PM₁₀ and NO₂ in 13 of the EMR countries (Supplementary Table S4), including Bahrain and UAE from which WHO/CHE has not received responses to its questionnaire survey. In most countries with data, the monitoring is available from a few cities only, but the coverage is much more extensive in Kuwait and Iran. Also in Egypt the number of monitoring locations is reported to be much larger (more than a 1000) but PM₁₀ data are available in an aggregated form for just two regions (Delta Region and Greater Cairo). For most of the countries, the most recent data are from 2019 or even from 2020, indicating timely processing and publishing of the monitoring results. For the other countries, or from some cities, only older data are available. Completeness of the data is not always reported or shows that the annual mean is based on less than 75% of days in a year, decreasing the precision of the reported estimates of the pollution level.

Reduction of population exposure to PM_2.5 to the NAAQS level in the EMR countries where such standards have been established would bring significant health benefits. However, when we compare the set values of NAAQS for the classical ambient air pollutants in the countries of EMR with the WHO AQGs (2021) and its interim targets, it is evident that the standard values in these countries do not protect population health sufficiently. Therefore, it is important, from a population health perspective, to aim at lower air pollution levels than current standards in line with the recommendations of WHO AQGs, especially for PM_2.5, e.g., by adopting time-specific goals for achievement of consecutive interim targets of the WHO AQGs (19–21, 24, 25). For instance, the countries of Iran, Saudi Arabia, and Pakistan with the 24-hour NAAQS values equal to 35 μg m⁻³ for PM_2.5 could consider the WHO’s interim target-4 as their standards. To achieve this value, they would need to adopt and implement stricter air pollution abatement measures, particularly to tackle SDS as one of the most important sources of ambient air pollution in the EMR countries.

SDS are capable of transporting sediments over thousands of kilometres (26–28), meaning that this phenomenon has transboundary impacts. The EMR is one of the dustiest in the world due to the local dust sources and importantly its proximity to the Sahara Desert (26, 27). Windblown dust contributes ca. 51% of the mean population exposure to PM_2.5 in North Africa and the Middle East, reaching 77% in Libya, 73% in Oman, and 66% in Kuwait and Morocco (29). Source-apportionment studies conducted in the EMR and reviewed by Faridi et al (2022) and a global assessment by McDuffie et al (2021), confirm a significant contribution of dust to PM_2.5 levels in all countries in the region (14, 29). Nevertheless, other emission sources directly related to the combustion of fossil fuels contribute significantly as well. Energy production contributed ca. 12% of PM_2.5 exposure in EMR, reaching 24% or 22% in Bahrain and Qatar, respectively. Road transport contribution was relatively smaller (7% on average in the region), reaching 11% in Iran (29). Studies reviewed in Faridi et al. (2022) also indicate a broad range of important PM sources, pointing also to a significance of secondary aerosols (29). Consequently, we believe that the use of source-specific air quality monitoring is needed to better specify sources of ambient PM_2.5 and PM₁₀ air pollution in SDS-countries and to address all of them in air quality management policy.

Concern regarding SDS is increasingly growing with regard to their huge impacts on human health, the environment, and even the economy (26, 30). Moreover, dealing with SDS and its far-reaching consequences has become one of the leading priorities within the global community and authoritative public health bodies (25, 27). By contrast, just two countries in the EMR (Iraq and Kuwait) have adopted intergovernmental cooperation actions to combat this important source in the region. Our analysis, based on the replies to WHO/CHE questionnaire and availability of air quality monitoring data, shows that the overall capacities of a large part of the EMR member states to cope effectively with air pollution, and in particular with SDS, are limited. Designing and implementing an integrated policy to deal with SDS and other pollution sources could improve ambient air quality in these countries. The detailed information on approaches to combat SDS is presented elsewhere (25–27). Designing and adopting an integrated coalition policy and/or action plan and cooperation agreement to tackle regional air pollution problems due to SDS events in the EMR countries supplementing the management and control of the local sources in each of these countries seems to be the most urgent task. Furthermore, using and following the scientific and well-documented solutions published by the global community and authoritative public health bodies would facilitate implementation of the actions in the region. Some of these publications are listed as Refs (25, 26, 30). Also section “4.4 Sand and dust storms” of the WHO global air quality guidelines contains relevant good practice statements on SDS (25).

Improvement of air quality management, including international collaboration and prioritization of SDS, supported by an update (or establishment) of NAAQSs are essential elements for reduction of air pollution and its health effects in the EMR. Air quality monitoring, conducted with reliable methods and providing easily accessible data, facilitating identification of pollution sources, must be established or upgraded in most of the EMR countries to guide the actions and evaluate their effects.