13 July 2021 – After a decline in COVID-19 cases and deaths across WHO’s Eastern Mediterranean Region for 8 consecutive weeks, several countries are seeing a significant increase in new cases and deaths.  Significant increases in COVID-19 cases have been reported from Libya, Islamic Republic of Iran, Iraq, and Tunisia. Lebanon and Morocco have also started to see a rise in cases, with an exponential increase expected in these 2 countries in the coming weeks. “We are reaching a critical point for COVID-19 in our Region,” said Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean. “Just one week after reaching the grim milestone of 11 million cases, we are now seeing an upward spike in a number of countries. This is being aggravated by new variants circulating – most concerningly the Delta variant --low vaccine availability and uptake, and lack of adherence to public health and social measures.” With the Eid al-Adha feast taking place during the week starting 20 July, traditionally marked by religious and social gatherings, WHO is concerned that the current upsurge may continue to peak in the coming weeks, with catastrophic consequences. “Countries are reintroducing or strengthening social and travel restrictions, but at this stage, increasing complacency by communities means that the virus is winning in the Region. “As variants continue to spread, we need everyone to get vaccinated as soon as they are offered, continue wearing masks, and practicing physical distancing. Although large progress has been made, there remains a shocking imbalance in the global distribution of vaccines, and this leaves millions of people exposed to deadly variants of concern. It’s not too late to turn the course of this pandemic, but it requires much more exerted global, regional, and national efforts,” said Dr Al-Mandhari. The total number of cases across the Region now exceeds 11.4 million, and the number of deaths is more than 223,000, with 19 out of 22 countries now reporting at least one new variant circulating. Note to the editors Tunisia reports the highest COVID-19 mortality rate of the WHO Eastern Mediterranean Region and the African continent. The situation in the country continues to be extremely concerning. Between 8000 and 9500 cases are currently being reported every day, with wide circulation of the Delta variant. In less than one week, the number of deaths almost doubled, from 119 deaths on July 5 to 189 deaths on July 8.  Vaccine coverage is increasing, especially among people more than 60, but the coverage is still low, with 12.7% of the population receiving at least one dose of vaccine, and 6% fully vaccinated. Public health measures have been strengthened, including suspension of social events and closures of businesses. Full lockdown is being implemented in some governorates, but the impact of these measures on the circulation of the virus and daily incidence needs to be strictly monitored.   Oxygen beds are at 90% occupancy and intensive care unit beds are at 95% occupancy. In some governorates, hospital beds are over-capacity. Hospitals are overwhelmed with limited numbers of available beds, and risk of shortage of oxygen supply. They also suffer from limited human resources, with medical staff very dedicated, but exhausted. Support to Tunisia has been remarkable, with countries in the Region and beyond stepping up to deliver field hospitals, medical equipment and oxygen cylinders, and additional vaccines, highlighting the spirit of solidarity and action within the Regional 2023 Vision of Health for All by All.  WHO, like other international partners, is committed to supporting Tunisia in facing this crisis, including by procuring additional oxygen concentrators and generators to hospitals, as well as medical supplies, tests, reagents and PPE, and supporting provision of additional vaccines.  Through the Emergency Medical Teams Initiative, WHO is also reaching out to its network partners for the possible deployment of international Emergency Medical Teams to provide surge support in the areas of intensive and critical care, infection control and infectious diseases. In the Islamic Republic of Iran, the number of cases has been increasing since mid-June. The daily average almost doubled during the past 4 weeks, increasing from 8,539 on week of 6 June to 16,393 on week of 4 July. After 8 weeks of continuous decline, the number of deaths also increased during the past two weeks.  Officials have blamed the surge on mass gatherings and travel during Nowruz, the country’s biggest holiday which took place in late March, saying that compliance with health measures like social distancing and mask-wearing noticeably plummeted over the holiday. In Iraq, cases have been increasing since the end of May with the daily average doubling during the past 5 weeks, increasing from 4,010 cases on week of 30 May to 8,076 cases on week of 4 July. The number of deaths has also increased during the past three weeks. Less than one percent of the population has population received one dose of the COVID-19 vaccine. Efforts by Iraq to contain the pandemic include banning government employees, students, and teachers from working unless they bring a vaccination document or a negative PCR test report on a weekly basis, and a countrywide partial curfew is being implemented.  In Libya, a dramatic upsurge in cases starting on week of 4 July. The daily average of cases increased by 425%, from 246 cases on week of 20 June to 1,293 cases on week of 4 July. Alfa and Beta variants of concern have been officially confirmed in the country, and Delta variant is suspected to be circulating, given its presence in neighboring countries. As a result, borders with Tunisia have been closed for one week. Vaccination coverage is still at low level, with only 5.6% of the population partially vaccinated. Cases in Morocco have been steadily increasing since mid-May, with the daily average increasing from 170 cases on week of 9 May to 1,066 cases on week of 4 July. Alpha and Delta variants of concern have been detected, causing Morocco’s government to announce an extension to the state of emergency until August 10.