As droves of migrant workers sweat and die on construction sites and in homes in the wealthy countries of the Arabian Peninsula, a different army of expatriates is quietly laboring away in those countries hospitals and clinics. They are the main providers of health care to populations with blossoming rates of obesity, diabetes and other chronic medical problems.

Saudi Arabia, where 76 percent of physicians are expatriates, and other countries in the Persian Gulf region have few doctors and nurses of their own. A recent report described Middle Eastern countries as heavily dependent on expatriate health care workers, and as rates of chronic diseases in those countries continue rising, some worry that maintaining a medical workforce of expats will be unsustainable in an increasingly burdened health care system. These concerns are especially relevant in a region where at least 30 percent of the population is between the ages of 15 and 29 and leading lifestyles that are increasingly unhealthy, marked by high rates of smoking and growing levels of childhood obesity, all of which could lead to costly health conditions in the near future.

If Gulf countries want to lower their rates of chronic diseases, you cant address that alone by just bringing more people here, because theres an issue of sustainability, saidDr. William Hsu, who leads a team at the Joslin Diabetes Center. The Boston research center is addressing diabetes in the region by working with countries in the Gulf Cooperation Council (GCC), a bloc comprising Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates.You have to sustain a workforce in your country, incentivize, encourage the next generation.

Unemployment in Saudi Arabia stood at 11.5 percent at the end of 2013, but for Saudi youth, or those between the ages of 16 and 29, its far higher, at29 percent. There are a lot of people who are not working but have the potential to be trained, Hsu said, yet theyre employing lots of expat workers, physicians and nurses.

Dependency Issues

Over the past half century, countries in the Gulf region rapidly became wealthy with the discovery, production and exportation of oil. As money poured in, state economies developed and cities modernized. Mere generations ago, those in the region survived a harsh desert environment on little food; today, fast-food restaurants offer home delivery. But other sectors, like labor and health awareness, did not develop at the same pace.

With the new wealth, everything changed, Hsu said. From a biological standpoint, people who survived in truly sparse conditions had to be genetically predisposed to holding on to calories. Now take those genes and put them in an environment of plenty, a virtually limitless amount of food and calories, he said.

In Kuwait, 42.8 percent of the population is obese. Other Gulf nations are not far behind, with 35.2 percent of Saudis and 33.1 percent of Qataris also grappling with obesity. Regional obesity has been tied togreater consumption of fast foods and sugar-saturated beverages like soda, along with poor exercise habits. The region also is facing a diabetes epidemic, with an estimated 20 percent of the population suffering from the disease. Kuwait, Saudi Arabia and Qatar are among the top 10 nations with the highest rates of diabetes. By 2035, nearly 68 million people in the region are expected to have diabetes.

The six countries that make up the GCC have 10 times as many doctors and nurses per 1,000 people as some of the worlds most impoverished nations, like Afghanistan, Sudan or Yemen. But 75 percent of these physicians and 79 percent of nurses are not nationals from the countries in which they work, according to apolicy briefon health worker migration in the GCC published by the Aspen Institute. These statistics are in spite of nationalization programs aimed at injecting local, not expatriate, labor into the workforce. In 2001, after 20 years of Saudization, only 21.7 percent of physicians in Saudi Arabia were Saudi nationals.

Instead, health care workers come from just about everywhere else Asia, Africa, Western Europe or North America. Eight hundred doctors emigrate from Sudan every year, the brief estimated, with 70 percent going to Saudi Arabia and 25 percent heading to other Gulf countries. The brief estimated that in 2020, Saudi Arabia will need to hire 32,660 doctors from outside the country.

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Gulf Countries Migrant Workers: Health Care Providers Are Mostly Foreigners In Saudi Arabia And Neighboring Countries