ABU DHABI // The statistics are stark: out of every 1,000 babies born in the UAE, about 75 suffer from a birth defect, the majority of which are of genetic origin.
Those unsettling numbers are forcing a re-examination of the long-held practice of consanguineous marriage - meaning to a blood relative- which is one of the strongest traditions in the country.
It seems, however, that the answers to the problem of increasing genetic disorders need not mean abandoning tradition but rather within advanced and possibly ethically-challenging science.
One of Dubai's leading geneticists, Dr Mahmoud Taleb Al Ali, who is also an Emirati, readily admits it would be a waste of resources to try to discourage interfamily marriages.
"I am a geneticist, I know every principle in genetics and I am married to my cousin," he says. "If you ask me as a scientist, I would say not to allow consanguineous marriages. If you ask me as a person in my culture, I would encourage it. It is part of our identity.
"Tribal living is something that we are very proud of in this country, we are born and brought up with it, and would like to die with it."
The number of genetic diseases diagnosed here stands at more than 270 and the average rate of cousin marriages across the country varies between 40 and 60 per cent.
Figures for Abu Dhabi emirate are slightly lower than the average, with 19.9 per cent of Emirati marriages last year between just first cousins, and 32.3 per cent overall.
According to Dr Al Ali, who is head of Dubai's Centre for Arab Genomic Studies, cousins have one eighth of their genes in common, meaning any child they have together would have a 12.5 per cent higher chance of having a genetic disease (than a child of two unrelated parents).
"Consanguineous marriages is a problem in terms of genetic manipulation of diseases," he says. "But family is important to us, it is something we value. And if the country accepts this, and the people accept that this is the way we should live, then we should be ready to prevent the genetic diseases that go with this."
The 2006 March of Dimes Global Report on Birth Defects ranked the UAE sixth out of 193 countries with children born with birth defects.
Sudan and Saudi Arabia are ranked first and second, followed by Benin, Burkina Faso, Occupied Palestinian Territory and the UAE. Oman is 11, Syria 12, Qatar 16 and Bahrain 17. The lowest rate is 39.7 per 1,000 live births in France, which is almost half of that of the UAE figure. The UK is ninth from bottom, with 43.8.
The report identifies many of the highest rates in poorer countries but "with the exception of countries where common recessive disorders and marriages between first cousins and other close relatives are common".
Instead of focusing attention on reducing the rate of consanguineous marriages, Dr Al Ali says, efforts should be focused on taking measures to reduce the number of "bad genes" in the population. The only way to do this is through premarital screening, prenatal diagnosis and preimplantation genetic diagnosis (PGD).
At present, premarital screening is the main tool used, but experts admit it is a far from perfect solution, and will not work when used in isolation.
"What we need to emphasise is that this should be part of a decision-making process, in terms of actually getting married, not just a procedure for couples to go through," says Dr Farida Al Hosani, manager of the communicable diseases department at the Health Authority - Abu Dhabi (Haad). "We need to raise the awareness of the community and encourage early screening, not just one or two days before the wedding."
Couples are screened for infectious and genetic diseases such as HIV and Aids, hepatitis B and C, the blood disorder thalassaemia and sickle cell anaemia.
Every couple, regardless of nationality, must present a document to court, issued by the relevant health authority, showing they have been tested. The document is valid for three months but the tests are often left until very late, when the chances of it influencing a couple's decision are minimal.
Almost 20,000 people have been screened in Abu Dhabi emirate since April last year. Of these, 1.8 per cent were found to be carriers of the thalassaemia B gene. The disease requires frequent blood transfusions, with symptoms including fatigue, increased risk of infection and bone defects. Some estimates say 8 per cent of the population are carriers.
There are no figures showing what course of action couples took after receiving their results, but Dr Al Hosani says it is incredibly difficult for a couple to call off their wedding at such a late stage.
"It is very difficult, we face such cases where people go ahead [with their marriage]," she says. "Sometimes they decide to take the consequences. We try to explain the consequences and the suffering that might come. In the end, we as healthcare providers cannot stop them from getting married."
In the case of a positive result, the person affected has to choose between sharing the information with their partner, or abandoning their hopes of marrying. The premarital screening report is only issued if a positive result has been shared.
According to a 2009 report by the Centre for Arab Genomic Studies, a respected research body, the UAE is one of a few countries where the rate of consanguineous marriage is rising. But numbers are also increasing in Algeria, Morocco, Oman, Qatar, Saudi Arabia, Sudan and Syria.
In Bahrain, Kuwait, Egypt, Jordan and others, the number is falling.
The report states that maintenance of family structure and property, ease of marital arrangements, better relations with in-laws and financial advantages relating to dowry are all reasons for choosing interfamily marriages.
"It is accepted as part of our culture, so that is not in question," says Dr Al Hosani, an Emirati. "We are not trying to discourage consanguinity, we are trying to encourage them to do the screening."
Another solution in which Dr Al Ali is desperate for the UAE to invest more resources is Preimplantation Genetic Diagnosis (PGD).
This involves in vitro fertilisation screening the fertilised egg before it is implanted in the woman. Defective eggs can be discarded and left to expire naturally in accordance with Islamic law.
Dr Aida Al Aqeel, the Saudi Arabian-based author of Genetic Counselling in the Muslim World - The Challenges, says this sort of genetic engineering is allowed under certain conditions.
According to her 2007 academic paper, an arm of the Muslim World League decided in 1998 that genetic engineering could be used "for prevention, treatment, or amelioration on the condition that such use does not cause further damage".
This method would be most appealing to couples who have already had a child with a genetic disorder, and do not want to take the risk again, says Dr Al Ali, who is also in charge of the Dubai Health Authority's Genetics Centre. "It could give them a healthy baby. If you have already had a child with a genetic illness, you do not want to bring another child into the world who might suffer."
The only remaining option to help couples have a healthy child is prenatal diagnosis, which actually forces more difficult decisions to be made as it involves screening the foetus during pregnancy.
"If they are affected they may choose an abortion," Dr Al Ali says.
Lihadh Al Gazali, a professor in clinical genetics and paediatrics at UAE University, says the debate surrounding abortion makes it easier for couples to choose PGD over prenatal diagnosis, but the success rate was unfortunately lower than conceiving naturally.
Even though UAE law allows a couple to abort a child, Islamic scholars do not always agree, making it a very difficult decision for Muslim couples. "There are two schools of thought regarding Islam and abortion," says Prof Al Gazali. "Some say it is allowed before the spirit is instilled in the body at three months, and some people say it is forbidden even in the first months.
"But preimplantation genetic diagnosis is very much accepted by people in Islam but the problem is it is not easy, and it is expensive. There is a 30 per cent success rate because [the fertilised egg] doesn't always implant."
The law states that a woman can abort her pregnancy if it endangers her life, or if there is evidence the baby will be born with fatal deformities and will not survive. It must be aborted before or during the 17th week of pregnancy.
"This is why PGD is better," Dr Al Ali adds. "But we need to strengthen the facilities here. We need to invest and build state of the art genetic diagnostic facilities."
Prof Al Gazali agreed that the answers lay in advanced science rather than trying to change the marriage traditions in the local population.
"People are still marrying their cousins even though you tell them the science. The important thing is they come forward when they want to marry, especially if they have genetic diseases, there are ways to help them."
The more couples who use science to ensure they have a healthy child, the lower the incidence of genetic diseases will be.
"It will reduce, but it is hard to say eradicate because there will always be new cases. We just need to focus on the right areas."
munderwood@thenational.ae
Game Changer
Director: Shankar
Stars: Ram Charan, Kiara Advani, Anjali, S J Suryah, Jayaram
Rating: 2/5
The Bio
Favourite vegetable: “I really like the taste of the beetroot, the potatoes and the eggplant we are producing.”
Holiday destination: “I like Paris very much, it’s a city very close to my heart.”
Book: “Das Kapital, by Karl Marx. I am not a communist, but there are a lot of lessons for the capitalist system, if you let it get out of control, and humanity.”
Musician: “I like very much Fairuz, the Lebanese singer, and the other is Umm Kulthum. Fairuz is for listening to in the morning, Umm Kulthum for the night.”
Top investing tips for UAE residents in 2021
Build an emergency fund: Make sure you have enough cash to cover six months of expenses as a buffer against unexpected problems before you begin investing, advises Steve Cronin, the founder of DeadSimpleSaving.com.
Think long-term: When you invest, you need to have a long-term mindset, so don’t worry about momentary ups and downs in the stock market.
Invest worldwide: Diversify your investments globally, ideally by way of a global stock index fund.
Is your money tied up: Avoid anything where you cannot get your money back in full within a month at any time without any penalty.
Skip past the promises: “If an investment product is offering more than 10 per cent return per year, it is either extremely risky or a scam,” Mr Cronin says.
Choose plans with low fees: Make sure that any funds you buy do not charge more than 1 per cent in fees, Mr Cronin says. “If you invest by yourself, you can easily stay below this figure.” Managed funds and commissionable investments often come with higher fees.
Be sceptical about recommendations: If someone suggests an investment to you, ask if they stand to gain, advises Mr Cronin. “If they are receiving commission, they are unlikely to recommend an investment that’s best for you.”
Get financially independent: Mr Cronin advises UAE residents to pursue financial independence. Start with a Google search and improve your knowledge via expat investing websites or Facebook groups such as SimplyFI.
Zayed Sustainability Prize
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
The specs: 2018 Chevrolet Trailblazer
Price, base / as tested Dh99,000 / Dh132,000
Engine 3.6L V6
Transmission: Six-speed automatic
Power 275hp @ 6,000rpm
Torque 350Nm @ 3,700rpm
Fuel economy combined 12.2L / 100km
How tumultuous protests grew
- A fuel tax protest by French drivers appealed to wider anti-government sentiment
- Unlike previous French demonstrations there was no trade union or organised movement involved
- Demonstrators responded to online petitions and flooded squares to block traffic
- At its height there were almost 300,000 on the streets in support
- Named after the high visibility jackets that drivers must keep in cars
- Clashes soon turned violent as thousands fought with police at cordons
- An estimated two dozen people lost eyes and many others were admitted to hospital
A State of Passion
Directors: Carol Mansour and Muna Khalidi
Stars: Dr Ghassan Abu-Sittah
Rating: 4/5
The specs: 2018 Mercedes-Benz E 300 Cabriolet
Price, base / as tested: Dh275,250 / Dh328,465
Engine: 2.0-litre four-cylinder
Power: 245hp @ 5,500rpm
Torque: 370Nm @ 1,300rpm
Transmission: Nine-speed automatic
Fuel consumption, combined: 7.0L / 100km
if you go
The flights
Etihad, Emirates and Singapore Airlines fly direct from the UAE to Singapore from Dh2,265 return including taxes. The flight takes about 7 hours.
The hotel
Rooms at the M Social Singapore cost from SG $179 (Dh488) per night including taxes.
The tour
Makan Makan Walking group tours costs from SG $90 (Dh245) per person for about three hours. Tailor-made tours can be arranged. For details go to www.woknstroll.com.sg
The biog
Hobby: "It is not really a hobby but I am very curious person. I love reading and spend hours on research."
Favourite author: Malcom Gladwell
Favourite travel destination: "Antigua in the Caribbean because I have emotional attachment to it. It is where I got married."
Dubai Bling season three
Cast: Loujain Adada, Zeina Khoury, Farhana Bodi, Ebraheem Al Samadi, Mona Kattan, and couples Safa & Fahad Siddiqui and DJ Bliss & Danya Mohammed
Rating: 1/5
The%20specs
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More from Neighbourhood Watch:
'Top Gun: Maverick'
Rating: 4/5
Directed by: Joseph Kosinski
Starring: Tom Cruise, Val Kilmer, Jennifer Connelly, Jon Hamm, Miles Teller, Glen Powell, Ed Harris
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%3Cp%3EFly%20with%20Etihad%20Airways%20from%20Abu%20Dhabi%20to%20New%20York%E2%80%99s%20JFK.%20There's%2011%20flights%20a%20week%20and%20economy%20fares%20start%20at%20around%20Dh5%2C000.%3Cbr%3EStay%20at%20The%20Mark%20Hotel%20on%20the%20city%E2%80%99s%20Upper%20East%20Side.%20Overnight%20stays%20start%20from%20%241395%20per%20night.%3Cbr%3EVisit%20NYC%20Go%2C%20the%20official%20destination%20resource%20for%20New%20York%20City%20for%20all%20the%20latest%20events%2C%20activites%20and%20openings.%3Cbr%3E%3C%2Fp%3E%0A
UPI facts
More than 2.2 million Indian tourists arrived in UAE in 2023
More than 3.5 million Indians reside in UAE
Indian tourists can make purchases in UAE using rupee accounts in India through QR-code-based UPI real-time payment systems
Indian residents in UAE can use their non-resident NRO and NRE accounts held in Indian banks linked to a UAE mobile number for UPI transactions
The%20stats%20and%20facts
%3Cp%3E1.9%20million%20women%20are%20at%20risk%20of%20developing%20cervical%20cancer%20in%20the%20UAE%3C%2Fp%3E%0A%3Cp%3E80%25%20of%20people%2C%20females%20and%20males%2C%20will%20get%20human%20papillomavirus%20(HPV)%20once%20in%20their%20lifetime%3C%2Fp%3E%0A%3Cp%3EOut%20of%20more%20than%20100%20types%20of%20HPV%2C%2014%20strains%20are%20cancer-causing%3C%2Fp%3E%0A%3Cp%3E99.9%25%20of%20cervical%20cancers%20are%20caused%20by%20the%20virus%3C%2Fp%3E%0A%3Cp%3EA%20five-year%20survival%20rate%20of%20close%20to%2096%25%20can%20be%20achieved%20with%20regular%20screenings%20for%20cervical%20cancer%20detection%3C%2Fp%3E%0A%3Cp%3EWomen%20aged%2025%20to%2029%20should%20get%20a%20Pap%20smear%20every%20three%20years%3C%2Fp%3E%0A%3Cp%3EWomen%20aged%2030%20to%2065%20should%20do%20a%20Pap%20smear%20and%20HPV%20test%20every%20five%20years%3C%2Fp%3E%0A%3Cp%3EChildren%20aged%2013%20and%20above%20should%20get%20the%20HPV%20vaccine%3C%2Fp%3E%0A
Formula Middle East Calendar (Formula Regional and Formula 4)
Round 1: January 17-19, Yas Marina Circuit – Abu Dhabi
Round 2: January 22-23, Yas Marina Circuit – Abu Dhabi
Round 3: February 7-9, Dubai Autodrome – Dubai
Round 4: February 14-16, Yas Marina Circuit – Abu Dhabi
Round 5: February 25-27, Jeddah Corniche Circuit – Saudi Arabia
The specs
AT4 Ultimate, as tested
Engine: 6.2-litre V8
Power: 420hp
Torque: 623Nm
Transmission: 10-speed automatic
Price: From Dh330,800 (Elevation: Dh236,400; AT4: Dh286,800; Denali: Dh345,800)
On sale: Now
Our family matters legal consultant
Name: Dr Hassan Mohsen Elhais
Position: legal consultant with Al Rowaad Advocates and Legal Consultants.
Volvo ES90 Specs
Engine: Electric single motor (96kW), twin motor (106kW) and twin motor performance (106kW)
Power: 333hp, 449hp, 680hp
Torque: 480Nm, 670Nm, 870Nm
On sale: Later in 2025 or early 2026, depending on region
Price: Exact regional pricing TBA
Five expert hiking tips
Always check the weather forecast before setting off
Make sure you have plenty of water
Set off early to avoid sudden weather changes in the afternoon
Wear appropriate clothing and footwear
Take your litter home with you
match info
Union Berlin 0
Bayern Munich 1 (Lewandowski 40' pen, Pavard 80')
Man of the Match: Benjamin Pavard (Bayern Munich)
Your Guide to the Home
- Level 1 has a valet service if you choose not to park in the basement level. This level houses all the kitchenware, including covetable brand French Bull, along with a wide array of outdoor furnishings, lamps and lighting solutions, textiles like curtains, towels, cushions and bedding, and plenty of other home accessories.
- Level 2 features curated inspiration zones and solutions for bedrooms, living rooms and dining spaces. This is also where you’d go to customise your sofas and beds, and pick and choose from more than a dozen mattress options.
- Level 3 features The Home’s “man cave” set-up and a display of industrial and rustic furnishings. This level also has a mother’s room, a play area for children with staff to watch over the kids, furniture for nurseries and children’s rooms, and the store’s design studio.
