Policies and Interventions in Middle Eastern and North African Countries to Mitigate Heat Stress Experienced by Outdoor Workers: A Scoping Literature Review.

Abstract

BACKGROUND: Despite the significant public health challenges posed by heat stress and rising temperatures for outdoor workers in the Middle East and North Africa (MENA) region, there has been insufficient focus on enforcing adequate policies, identifying effective heat stress prevention interventions, and providing evidence-based recommendations. METHODS: This scoping review synthesizes literature on policies and interventions that protect outdoor workers from heat stress in the MENA region. Studies from 1996 to 2024 were identified in PubMed, EBSCOhost, Web of Science, and Google Scholar. RESULTS: Thirty-nine articles and governmental documents met our criteria and were included in this review. Studies have been conducted in only 9 of the 18 MENA countries. Among the 39 included studies, 19 described formal policies, while all had descriptions of tested interventions or informal practices, and 9 tested the effectiveness of interventions and provided evidence-based recommendations. The most commonly practiced protective intervention was hydration. CONCLUSION: Occupational heat stress policies in the MENA region predominantly rely on administrative controls, such as limiting work hours. However, a more comprehensive approach is emerging in some countries, incorporating measures such as heat exposure monitoring, mandatory worker training, provision of shaded or cooled rest areas, structured acclimatization protocols, and environmental alert systems. These layered interventions offer a more effective framework for protecting outdoor workers, particularly in high-risk sectors such as construction and agriculture. The literature highlights significant gaps, underscoring the need for further research to assess the effectiveness of current policies and to explore innovative interventions for combating heat stress as temperatures in the MENA region become increasingly extreme.