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This chapter examines the profound impact of the Arab uprisings on the six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE)). While initially perceived as distant from the epicentre of the unrest, these countries underwent significant economic, political and security transformations as a result of it. It describes key events initiated by the Tunisian revolution, emphasising the interconnectedness of the Gulf region with the wider Arab uprisings. Furthermore, it explores the economic and socio-political conditions in the GCC countries that shaped their responses to the uprisings, particularly in the context of the challenges posed by the oil-based developmental model. In terms of implications, it dwells on the growing polarisation and intra-GCC rifts, particularly the conflict between the Kingdom of Saudi Arabia and the UAE, on the one hand, and Qatar, on the other, between 2017 and 2021, jeopardising regional integration. The Arab uprisings revealed the vulnerabilities of the GCC countries’ status quo, leading to a reassessment of their political and economic trajectory both from the domestic and the external relations points of view.
This chapter delves into the geopolitical landscape of the Gulf Cooperation Council (GCC) states, often considered an ‘island of stability’ amid the turbulence in the broader Middle East. While this notion holds true in comparison to neighbouring countries like Iran, Iraq and Yemen, the chapter highlights that the Gulf region is not immune to internal and external conflicts. It discusses the impact of significant events such as the Iran–Iraq War, the Gulf War and the US-led invasion of Iraq in 2003 on the political dynamics of the Gulf states. The analysis spans four parts, each focusing on a key conflict: the Iran–Iraq War, the liberation of Kuwait, the 2003 Iraq War, and the war in Yemen since 2015. These conflicts have not only shaped the formation of the GCC in 1981 but have also significantly influenced the broader regional system. Emphasising the period since 1979, the chapter explores how over four decades of wars, revolutions and inter-state tensions have affected the security and stability of the Gulf states. Despite a generation passing since the last inter-state war, the ongoing fragmentation of Yemen into civil wars involving regional actors signals a transformation in the nature of conflicts. The chapter also highlights the challenges to regional stability, including the difficulty in reaching a comprehensive agreement addressing Iran’s ballistic missiles programme and its support for non-state actors. As the possibility of increased US disengagement from the Gulf looms, questions about the future security architecture in the region and the role of external participants gain prominence. The chapter raises concerns about potential security vacuums and the responses of regional actors in such a scenario.
The establishment of rapid response teams (RRTs) has gained increasing prominence due to the growing threats of emerging infectious diseases, natural disasters, and other public health emergencies. As a center for Hajj and a regional hub for commerce and travel, the Kingdom of Saudi Arabia (KSA) faces distinct challenges. This study explores the Ministry of Health’s main reasons and challenges in establishing RRTs.
Methods
We employed a cross-sectional qualitative design, utilizing in-depth interviews with key stakeholders and document analysis to explore the historical process of establishing RRTs in KSA and the challenges encountered.
Results
Specialists’ insights revealed that the concept of RRTs was formally introduced and applied following the initiation of the Field Epidemiology Training Program (FETP) in KSA in 1989. However, its primary implementation began after the Middle East respiratory syndrome (MERS) outbreak in 2014. Identified challenges included a lack of trained personnel and resource availability due to unclear governance. There is a need for real-time data collection and technological solutions, improved inter-agency collaboration and information sharing, and governance.
Conclusions
The establishment of RRTs in KSA is estimated to have started with the initiation of the FETP. The challenges encountered provide valuable lessons for future emergency responses.
Palliative and end-of-life (EOL) care is gaining increasing importance in Saudi Arabia due to the rising burden of chronic and life-limiting illnesses. Nurses play a central role in delivering comprehensive, culturally appropriate palliative care; however, their practices are influenced by educational preparation, institutional support, and sociocultural and religious contexts. To date, evidence on palliative nursing care in Saudi Arabia remains fragmented and insufficiently synthesized.
Aim
This systematic review aimed to synthesize existing evidence on palliative and EOL nursing care in Saudi Arabia, with a focus on nursing practices, challenges, cultural and spiritual influences, and patient and family outcomes.
Methods
A systematic literature search was conducted in January 2025 using PubMed, Scopus, CINAHL, Web of Science, Google Scholar, and Saudi grey literature sources. Empirical qualitative, quantitative, and mixed-methods studies addressing palliative or EOL nursing care in Saudi Arabia were included. Study selection followed PRISMA guidelines, and methodological quality was appraised using appropriate critical appraisal tools. A narrative thematic synthesis was undertaken due to heterogeneity among studies.
Results
Fourteen studies met the inclusion criteria. Findings indicated that nurses are actively involved in symptom management, therapeutic communication, psychosocial support, spiritual care, and family-centered care. However, substantial barriers were identified, including gaps in knowledge and training, limited formal palliative education, emotional burden, ethical challenges related to nondisclosure, and inconsistent institutional policies. Cultural and religious norms strongly influenced communication practices and decision-making processes. Studies also showed that structured palliative care services, particularly home-based and multidisciplinary programs, were associated with improved patient comfort, dignity, and family satisfaction, although access to such services varied across regions.
Conclusion
Palliative and EOL nursing care in Saudi Arabia demonstrates commitment and potential but is constrained by educational, emotional, cultural, and systemic challenges. Strengthening nursing education, enhancing culturally sensitive communication and spiritual care training, expanding home-based palliative services, and providing institutional support for nurses’ emotional well-being are essential to improving the quality and equity of palliative care nationwide.
This chapter advances three arguments about the politics of company creation regulation in Saudi Arabia in the first two decades of the twenty-first century. First, the liberalization of these regulations was rent-conditional. The formation and implementation of these policies occurred during periods of rising or high oil rents, but were absent during the downward trend in oil prices between June 2014 and January 2016. Second, relative to earlier periods, the ability of business and religious elites to veto economic reforms was diminished. Third, in light of this shift, the threat of popular unrest to regime stability had a non-trivial, causal effect upon the pursuit and pausing of company creation liberalization. Non-elite pressure on the Al Saud’s rule reached an unparalleled fever pitch during the Arab Spring. Record-breaking transfer payments to appease discontent were feasible in 2011, allowing regulatory liberalization to continue. However, when the fiscal realities of the 2014 oil price slump became apparent, liberalization and public munificence were sacrificed to inhibit the development of economic power outside the regime’s coalition and to maintain comparatively high military spending. Only once oil rents recovered would the reform agenda be revived.
This chapter provides an overview of the core findings of the book. It outlines the key theoretical and methodological insights gained through a qualitative comparison of the politics of corporate regulation and liberalization in Saudi Arabia and Nigeria, including the introduction of the theory of rent-conditional reforms. It further outlines the relevance of the rent-conditional reform theory to ongoing debates around the political and economic effects of natural resource wealth, particularly amid the potential global transition toward a less carbon-intensive economy.
This chapter advances three primary arguments about the politics of corporate regulation in twentieth-century Saudi Arabia. First, that the state’s legislative regulation of company creation was the product of two often-opposing pressures: the private sector’s demand for a domestic regulatory environment that reflects prevailing international norms, and the religious establishment’s reticence to cede their traditional competences. Second, that Ibn Saud’s legislative initiatives in the early 1930s constituted a critical juncture, after which subsequent Saudi kings would promulgate corporate reforms, while the religious establishment would contest their judicial recognition. These tensions pushed judicial institutional development into a pattern of oscillation between unification and separate systems for corporate issues. Third, that the 1990 Gulf War and the contemporaneous liberal and conservative reform movements constitute another somewhat broader critical juncture in Saudi politics. Cross-class movements for greater political influence tangibly shaped corporate regulations, the state’s political institutions, and, consequently, how any future regulations would be formulated.
This chapter introduces the arguments and structure of the book. It surveys how the liberalization of company creation regulations in Nigeria and Saudi Arabia across the first two decades of the twenty-first century defy the predictions of the existing resource curse literature. To explain the political constrains on economic liberalization in resource-wealthy, autocratic and hybrid regimes, the chapter introduces the rent-conditional reform theory. It also details the shortcomings of earlier quantitative studies of economic regulation and liberalization in contexts of resource wealth and outlines the methodological innovations of this book.
This chapter systematizes the comparison of the Nigerian and Saudi cases to offer four primary insights about the past and future trajectories of economic liberalization in resource-wealthy, autocratic and hybrid regimes. First, at the level of political actors, the Nigerian organized private sector appears dynamic and competitive in its pursuit of procedural rents when compared to the ossified Saudi Chambers of Commerce. Second, at an historical level, the Saudi and Nigerian histories of corporate law reform share a common experience of initial foreign importation, before a process of local tailoring and, eventually, their liberalization becoming rent-conditional. Third, at a theoretical level, the diverse causal processes evidenced within the two cases illustrates the potential for greater causal processes within the flexible rent-conditional reform (RCR) framework. Fourth, considering the potential global transition to a lower-carbon economy, the application of the RCR theory suggests diverging future potentials of liberalization in high- and low-cost oil producers, and potential newfound relevance for non-fuel mineral producers.
Crude Calculations charts a ground-breaking link between autocratic regime stability and economic liberalization amid the global transition to lower-carbon energy sources. It introduces the rent-conditional reform theory to explain how preserving regime stability constrains economic liberalization in resource-wealthy autocracies and hybrid-regimes. Using comparative case studies of Nigeria and Saudi Arabia, the book traces almost one hundred years of political and legal history to provide a framework for understanding the future of economic liberalization in fossil fuel-rich autocracies. Drawing from archival documents and contemporary interviews, this book explains how natural resource rents are needed to placate threats to regime stability and argues that, contrary to conventional literature, non-democratic, resource-wealthy regimes liberalize their economies during commodity booms and avoid liberalization during downturns. Amid the global energy transition, Crude Calculations details the future political challenges to economic liberalization in fossil fuel-rich autocracies—and why autocracies rich in battery minerals may pursue economic liberalization.
Current scholarship increasingly argues that international factors and, more specifically, authoritarian collaboration fundamentally affect the persistence of authoritarian rule. In order to generate a better understanding of the nature and effects of these international dimensions of authoritarianism, this article provides a conceptual framework for various aspects of authoritarian collaboration to prevent democracy, particularly the relationship between authoritarian regime types and their international democracy‐prevention policies. It differentiates between authoritarian diffusion, learning, collaboration and support, as well as between deliberate efforts to avert democracy and efforts not explicitly geared towards strengthening autocracy. The article further distinguishes between crisis events and normal conditions where authoritarian rulers' hold on power is not in danger. It is argued that authoritarian powers' motivations to provide support to fellow autocrats are self‐serving rather than driven by an ideological commitment to creating an ‘authoritarian international’: authoritarian rulers first and foremost strive to maximise their own survival chances by selectively supporting acquiescent authoritarian regimes, maintaining geostrategic control and fostering their developmental goals.
Volunteering is growing rapidly worldwide and has been recognized as a significant social force, contributing to social development. Motives for volunteering vary widely, ranging from collectivistic factors to individualistic ones. Collectivism is often identified as a main factor that contributes to volunteering, especially in collectivist societies. Our analysis shows that in Saudi Arabia—typically classified as a collectivist society—individualistic considerations such as learning skills, meeting friends, and releasing guilt mediate the effect that collectivistic motivations (e.g., prosocial personality and community identity) have on the decision of continuous volunteering. This finding is applicable to both males and females, to people in different forms of employment, across ages, and regardless of family members’ volunteering behavior, according to moderation analyses.
The theory of reasoned action (TRA) and the theory of planned behavior (TPB) have been found to have predictive capability in a wide range of personal behaviors. The aim of the study is twofold: firstly, to assess the applicability of the TRA, the TPB, and a newly developed revised version of the TPB in the context of individuals’ monetary donations to charitable organizations; and secondly, to compare the explanatory and predictive power of these three theoretical models. Data relating to intention to give monetary donation, attitudes toward helping others and toward charitable giving, social norms, moral responsibility, and perceived behavioral control were collected in the first phase of the study by means of a self-completion mail questionnaire distributed to 432 residents of Riyadh, Saudi Arabia. In the second phase, 1 month later, telephone interviews were conducted with 221 of the first-phase respondents who had agreed to take part in a follow-up survey of their actual monetary-donating behavior. The findings show that the revised TPB is the best of the three models for predicting individuals’ intention to donate and their future monetary-donation behavior, mainly because moral responsibility is included in the theoretical framework. It thus offers superior explanatory and predictive power.
Saudi Arabia is undergoing a transformational shift, leveraging regulatory reforms to position its non-profit and impact sector as a driving force for national and regional development. This chapter explores how Vision 2030’s ambitious agenda has unlocked new opportunities for philanthropy, impact investing, and catalytic capital, enabling a once-traditional charitable landscape to evolve into a $2.7 billion economic powerhouse.
With the number of non-profit organizations surging from 4,000 to over 62,000 in just seven years, Saudi Arabia is pioneering a new model of impact-driven growth. The chapter delves into groundbreaking regulatory reforms, digital philanthropy, innovative financing models, and multi-sector partnerships. It highlights how Saudi Arabia’s rise as a regional leader in the impact space can set the stage for a more dynamic and globally connected non-profit ecosystem.
In a world demanding climate action, the oil-rich Gulf states face a defining crossroads: can they transform economies built on fossil fuels into resilient, climate-aligned powerhouses? This timely and original study offers a rigorous, multidimensional analysis of how Saudi Arabia, the United Arab Emirates, and Qatar are navigating the high-stakes transition to decarbonization. Weaving together historical political economy, postcolonial state formation, economic pressures, geopolitical realignments, and environmental imperatives, it explores the difficult trade-offs and strategic decisions forging the region's trajectory. Through incisive analysis, it reveals emerging policy innovations, evolving social contracts, and institutional strategies that are redefining the Gulf's energy future—while critically evaluating the macroeconomic consequences of climate-driven transformation. Essential reading for policymakers, financiers, energy professionals, multilateral institutions, and scholars, The Gulf's Climate Reckoning offers an intellectual and strategic framework for understanding the Gulf's climate-industrial transformation and its far-reaching implications for the emerging global energy and governance landscape.
Mental health disorders, including depression and anxiety, pose significant public health challenges globally, and in Saudi Arabia. Despite this, psychiatry suffers from a critical shortage of specialists. This study investigates factors influencing medical students’ career decisions in regard to psychiatry, aiming to enhance understanding of, and address workforce deficiencies in, mental healthcare.
Aims
This study aims to investigate the factors influencing medical students’ decision to choose psychiatry as a future career.
Method
This cross-sectional study conducted an online survey among Saudi Arabian medical students from 28 December 2023 to 28 April 2024, employing validated questions refined through pilot testing. Participant selection included male and female students across preclinical and clinical stages, excluding non-medical students and those outside Saudi Arabia.
Result
This study explores the perceptions and interest of 430 medical students in Saudi Arabia regarding psychiatry as a career. The majority were female (69.3%), with most in their preclinical years (60.2%). Key findings include limited personal connections to psychiatry (9.5% with a family psychiatrist), and primarily influenced by medical school (55.3%) and social media (42.1%). While 65.1% perceive psychiatry as mentally demanding, uncertainties exist about career prospects and stigma persists (39.1%). Gender differences were observed, with more females (34.6%) than males (22.7%) interested in psychiatry (P = 0.014). Early inspiration in medical education significantly increased interest (P = 0.001).
Conclusion
Early exposure, personal connections and gender-specific factors significantly influence medical students’ interest in psychiatry as a career. Integrating psychiatry education early in medical curricula and addressing stigma are critical for fostering positive perceptions and attracting diverse students to the field.
How do secular and religious national role conceptions (NRCs) influence interstate rivalry? To explore this, we examine the rivalry between Iran and Saudi Arabia, two theocratic states. Drawing on scholarship that integrates power politics and religion, we examine how instrumental motivations shape religion-based policymaking. Using semantic network and regression analyses on data from eight official Twitter/X accounts of Iranian and Saudi foreign policy officials (2015–2021), we find that both states’ officials strategically use secular and religious NRCs in response to foreign policy roles adopted by their rival. Our findings underscore the coexistence of these NRCs and their selective application in managing rivalry. Methodologically, the study contributes to foreign policy analysis research by employing quantitative semantic analysis of social media data. It also offers a novel lens for understanding Iran-Saudi competition and the broader intersection of religion and foreign policy.
We identified three centers in Saudi Arabia that implemented observation units (OUs). The presence of an OU helps with patient flow, reduces overcrowding, enhances patient care, safety and experience, and improves daily key performance indicators. Following this chapter, the authors’ own organizations are keen to develop observation units.
To enhance the emergency response preparedness of public health professionals in Saudi Arabia, the World Health Organization Rapid Response Team Advanced Training Package (WHO RRT ATP) was adapted. It was designed to align with local cultural and operational contexts.
Methods
A 2-day workshop was conducted involving experts who reviewed and modified the adapted WHO RRT ATP training materials. The process was structured into 7 phases: needs assessment, stakeholder analysis, cultural tailoring, content adaptation, module selection, implementation planning, and evaluation framework development.
Results
Key challenges revealed included inadequate hospital coordination, shortage of trained personnel and medical services, and insufficient knowledge of disease transmission. Core training modules were adapted, and supplementary materials were reviewed. Key considerations included addressing existing gaps, cultural sensitivity, and current outbreak trends in KSA. Participants’ feedback showed high satisfaction, with 86.7% of participants providing a mean rating of 4.77 on day 1 and 80% of participants giving an average rating of 4.67 on day 2 on a Likert scale of 1-5.
Conclusions
Cultural and country needs were key factors in the workshop’s successful outcomes. The adapted training program is anticipated to significantly enhance the preparedness of health care professionals in KSA to manage public health emergencies.
This chapter examines the implications of Saudi Arabia’s net zero by 2060 goal for domestic politics and on the kingdom’s stature in the international community. The gargantuan task of decarbonizing Saudi Arabia is evident in its disproportionate oil use: The kingdom is the world’s No. 4 consumer of oil, despite overseeing the world’s 20th biggest economy and its 41st largest population. There are legitimate doubts about the credibility of Saudi commitment to net zero, given the regime’s track record of noncompliance with prior clean energy goals. A realistic net-zero undertaking would require an overhaul of a fossil fuel-driven society and economy in less than four decades. Sweeping changes would affect the consumption of energies and services, resulting in enormous shifts in ingrained behaviour and in consuming technologies. Difficulties aside, Saudi Arabia holds major advantages in decarbonization. These include unused land with copious solar radiation, as well as geological storage near carbon emissions clusters. Since the global transition could not happen without the kingdom’s cooperation, a documented achievement of decarbonization milestones would increase global goodwill and provide added credibility required to shape the energy transition in ways that could ensure long-term roles for hydrocarbons.