Pesticide exposures and human health in the Eastern Mediterranean Region: a narrative review

Abstract

Introduction Pesticide poisoning is a major, preventable threat in the Eastern Mediterranean Region (EMRO). This review synthesizes human data on pesticide and fumigants exposures to define the burden, dominant agents, and priorities for surveillance, regulation, and clinical care.Methods We conducted a narrative review with systematic elements of peer-reviewed primary studies in PubMed, Scopus, and Web of Science (January 1995–December 2025). We included reports published in English or French with original human data from EMRO countries. We excluded case reports, abstracts, and review articles. Screening proceeded in stages: search for articles, screening titles, and abstract review by two reviewers. Articles in the final set underwent full-text appraisal using a standardized data-extraction tool.Results A total of 2421 records were identified; 360 articles were retained after title screening, 109 after abstract review, and 79 studies met final inclusion criteria. Evidence clustered in Iran, Pakistan, Egypt, Saudi Arabia, and Palestine. Highly hazardous pesticides were predominant, particularly aluminum phosphide and organophosphates, alongside carbamates, pyrethroids, paraquat, and organochlorines. Ingestion was the primary exposure route, including intentional self-poisoning among adolescents and adults and accidental ingestion in children. Occupational dermal and inhalational exposures were common among agricultural workers with limited protective measures. Reported outcomes included severe respiratory failure (paraquat), cholinergic crises (organophosphates and carbamates), and high early mortality associated with aluminum phosphide. Key data gaps included incomplete agent classification and limited surveillance capacity.Discussion and conclusion The burden of pesticide poisoning in EMRO is driven by widespread access to highly hazardous pesticides, weak regulatory enforcement, and limited toxicovigilance systems. Priority interventions include restricting access to aluminum phosphide and other highly hazardous agents, strengthening poison-center networks and surveillance systems, enforcing safe storage and labeling, and enhancing clinician training. Despite heterogeneity and under-reporting, consistent patterns support targeted prevention strategies for rural populations and agricultural workers.