Strategizing Foreign Policy Analysis of the Current Middle East Crisis

Abstract

This article analyzes the persistent conflict in the Middle East by examining the complex interplay of historical context, structural realist dynamics (offensive and defensive), and foreign policy decision-making processes. A multi-layered approach that draws on historical analysis, realist international relations theory, and foreign policy analysis literature, this article seeks to comprehensively understand the enduring drivers of conflict in the Middle East region. The analysis demonstrates that structural realism provides valuable insights into state behavior within the anarchic international system. Analysts should adopt a more nuanced approach for practical foreign policy analysis. This article concludes by offering recommendations for strategizing foreign policy analysis, emphasizing the need for continuous adaptation, a pragmatic utilization of all available instruments of power, and a comprehensive understanding of the interrelatedness of individual, state, regional, and systemic levels of analysis to address the Middle East’s persistent conflicts effectively.

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Dabbagh, F.N. (2025) Strategizing Foreign Policy Analysis of the Current Middle East Crisis. Open Access Library Journal, 12, 1-13. doi: 10.4236/oalib.1112905.

1. Introduction

This article analyzes the persistent conflict in the Middle East, focusing on the interplay of historical context, structural realist dynamics, and foreign policy decision-making. The 20th and 21st centuries have witnessed profound trauma in the region, shaped by colonialism, decolonization, and ongoing power struggles [1]. This historical backdrop informs contemporary international relations, characterized by complex interactions between diverse actors with often conflicting interests. Methodologically, the article employs a multi-layered approach, drawing on historical analysis, theoretical frameworks from international relations (primarily realism, both offensive and defensive), and foreign policy analysis literature. By examining the interplay of individual, state, regional, and systemic factors, the article aims to comprehensively understand the drivers of conflict. The analysis reveals that while structural realism offers valuable insights into state behavior and the pursuit of power and security within an anarchic system, it is insufficient. Practical foreign policy analysis requires considering contextual factors, decision-making processes, implementation capabilities, and the dynamic interplay between power and context. The article concludes that navigating the Middle East’s complex and ever-evolving landscape demands continuous adaptation, a nuanced understanding of the interconnectedness of various levels of analysis, and an employment of all analytical instruments pragmatically. Ultimately, this multifaceted approach is crucial for strategizing sound foreign policy analysis and understanding the persistent conflicts in the Middle East.

1.1. Methodology

This article analyzes the persistent conflict in the Middle East using a multi-layered methodology that combines historical context, structural realism, and foreign policy analysis (FPA). The main question addressed is why regional conflicts have persisted despite efforts at peacebuilding and international regulation. The methodology incorporates historical analysis, exploring power struggles. The methodology also incorporates structural realism, focusing on state behavior in an anarchic international system, and FPA, examining how decision-making processes and the availability of the hard texture of power instruments influence conflict in the Middle East. Furthermore, the methodology relied on a secondary data source such as books, scholarly articles, websites, and research papers regarding the historical regional power struggle in the Middle East, which began with the Balfour Declaration in 1917 to date.

The article finds that while structural realism offers insights into state behavior, it is insufficient alone. It emphasizes the need for a nuanced, multi-level analysis that accounts for regional power balances, historical trauma, and the complex interplay of hard and soft power in shaping foreign policy decisions. The conclusion advocates for continuous adaptation and pragmatic strategies in foreign policy to address the region’s enduring conflicts effectively. The author relies on AI tools like Grammarly, Gemini, and ChatGPT to enhance the quality of the language and avoid unintended plagiarism.

1.2. Significance

This article significantly contributes to understanding Middle Eastern conflicts by integrating historical context, structural realism, and foreign policy analysis. It highlights the importance of multi-level analysis, considering individual, state, regional, and systemic factors in understanding persistent regional instability. Combining offensive and defensive realism theories with practical foreign policy decision-making emphasizes the need for a nuanced approach that accounts for historical trauma and contemporary power dynamics because historical trauma in the region, such as past wars or colonial exploitation, can fuel aggressive policies to prevent the recurrence of perceived vulnerabilities. The article’s insights offer valuable guidance for strategizing foreign policy in complex international environments, fostering a deeper understanding of the forces shaping the Middle East’s ongoing conflicts.

2. Background

The 20th and 21st centuries have highlighted profound trauma for the peoples of the Middle East. From the struggles against colonialism and the often-fraught processes of decolonization to the challenges of nation-building and the persistence of authoritarian rule, the region has endured a series of destabilizing events. The establishment of Israel and the ensuing Arab-Israeli conflict, along with rivalries for regional dominance and external intervention by global powers, have fostered a pervasive atmosphere of insecurity and deep-seated mistrust. These factors and a lack of regional integration and cooperation among diverse social and economic groups have fueled frequent and often violent conflicts and power struggles [2].

Middle Eastern events significantly shaped the early 21st century’s international landscape. The 9/11 attacks, perpetrated by al-Qaeda, triggered the US-led “global war on terrorism,” initially through the UN-backed invasion of Afghanistan, inadvertently bolstering allied authoritarian regimes. However, the 2003 US invasion of Iraq, lacking UN approval, destabilized the region, empowering Iran, fueling sectarian violence, and proving a reconstruction failure. This “political pyromania” exacerbated regional tensions. Mahmoud Ahmadinejad’s 2005 rise in Iran further strained relations with the West, with nuclear program-related threats shaping regional alliances. A “cold war” emerged between a Saudi-led Sunni bloc and an Iranian-led Shiite bloc, including resistance movements. These regional powers supported various state and non-state actors, often shifting alliances depending on the threat, demonstrating Middle Eastern geopolitics’ complex and fluid nature [2].

Following the events of 7 October, Israel’s response quickly escalated to an unprecedented level of scale and violence. The subsequent Israeli ground invasion of Lebanon and the retaliatory actions by the Iran-backed militant group heightened fears of a full-scale war. While the desire to define and categorize this conflict is understandable, traditional conceptions of war as limited contests on defined battlefields are outdated. Today’s conflicts are frequently protracted and multifaceted and involve a complex web of state and non-state actors, blurring the lines between conventional warfare and other forms of violence. Such complexity necessitates re-evaluating how we understand and respond to modern conflict [3].

The contemporary world of international relations involves several actors who interact and sometimes compete in an atmosphere that governs their behavior and foreign policy. However, war is endemic in the Middle East, and the Middle East’s international relations arena has institutionalized war for almost a century. To elaborate on the institutionalized war in the Middle East, take, for instance, the long list of armed conflicts since the mid-twentieth century, such as those in 1948, 1956, 1967, 1973, 1978, 1982, 1987, 2000, and 2005.

War, defined as organized violence between political units, has historically been a tool of state policy. However, it also represents a fundamental disorder within international society, potentially dissolving it into a state of universal conflict and threatening its existence. Paradoxically, the international community has used war to uphold international law, maintain power balances, and even drive perceived just changes to legal frameworks [4].

International society seeks to limit states’ recourse to war, recognizing the inherent danger of war. Hence, international society relies on several mechanisms, such as confining the right to wage war to sovereign states, establishing rules of war to govern conduct, implementing neutrality laws to contain conflicts geographically, and, most importantly, restricting the legitimate justifications for war. This last point has evolved from “just war” to modern legal instruments like the League Covenant, the Kellogg-Briand Pact, and the UN Charter, all aiming to minimize the use of force in international relations [4].

If controversially discussed that war is not an intrinsic element of the Middle East’s international politics, how do we explain the persistent recurrence of armed conflict throughout the region’s history? If war is not inevitable, the sheer volume of historical conflicts demands an explanation. As Wight asserted, “Conflict has been an essential factor in the development of national consciousness and statehood” (p. 103); any foreign policy analysis must explore this question by examining three core concepts, i.e., collective security, balance of power, and the anarchic structure of the international system [5].

Moreover, the assumption that war is an institution within international society holds some validity, particularly when considering collective security. This concept relies on internationalizing shared principles that all nations should uphold. Maintaining compliance with these principles for peace necessitates institutionalized mechanisms for mobilizing force. Chapter VII of the UN Charter addresses using force to resolve or prevent armed conflict. Article 41 allows the Security Council to determine non-military measures, while Article 40 emphasizes provisional measures, urging compliance without prejudice to the parties involved. However, the core aim of collective security is war prevention, not its prosecution.

Consequently, war is organized violence between political units pursuing specific state objectives. As such, it acts as a fundamental instrument of state policy, shaping the international system. This system, in turn, establishes the rules governing the conduct of war and the parameters within which it can be waged [6].

Hence, understanding the persistent presence of conflict in the Middle East requires a multi-layered analysis. Historical trauma stemming from colonialism, state formation, and regional rivalries has created a volatile environment. Events like 9/11 and the Iraq War further destabilized the region, highlighting the impact of external interventions and power dynamics [7]. Contemporary conflicts demonstrate the evolving nature of warfare, involving diverse actors and blurring traditional battle lines (Addressing the Challenges of Modern-Day Conflicts, 2022) [8]. While international society attempts to regulate war through legal frameworks and collective security mechanisms, the Middle East’s experience suggests these efforts have been insufficient. Examining the interplay of individual state interests, regional power balances, the anarchic nature of the international system, and the institutionalization of conflict is crucial. Therefore, a comprehensive understanding of Middle Eastern foreign policy necessitates considering the individual, state, regional, and systemic levels of analysis to fully grasp the complex factors driving conflict in this historically turbulent region.

3. The Spectrum of Realism: Understanding Conflict and Security in the Middle East

The contemporary world of international relations is an arena where several actors interact and sometimes compete in an atmosphere that governs how these actors behave and conduct their foreign policies. Structural realism posits three core concepts: state centrism, anarchy, and self-help. It argues that anarchy and self-help are constant features of the international system, while state centrism is a variable dependent on power distribution. Hence, structural realism contends that a state’s behavior is primarily determined by its relative capabilities within the international structure [9].

The current Middle East exemplifies structural realist principles. The region is a stage for competing state and non-state actors, each pursuing their interests within an anarchic international system where self-help is paramount. State centrism is evident, with powerful states like Iran and Israel vying for regional dominance. The distribution of capabilities—military strength, economic resources, and alliances—shapes their behavior. For example, Iran supports proxy groups as a self-help strategy to project power and counter rivals [10]. The absence of a central authority forces states to prioritize their security, driving actions, and foreign policy decisions [11].

Accordingly, an analysis of the Middle East’s current politics involves defining its boundaries, identifying recurring patterns and regularities, recognizing the key actors within the region, assessing the relative importance of systemic and sub-systemic factors, and understanding how influences and outcomes interact [12]. Within this framework, defensive realism defines political structures based on the interactions between units (primarily states), the distribution of power among them, and the allocation of functions within the system [13]. Defensive realism argues that states are mainly motivated by a desire for security and survival [12]. Thus, Defensive realism emphasizes the importance of the balance of power as a key mechanism in the anarchic international system, where state survival depends on self-help. The emphasis on balancing power leads to polarity, referring to power distribution among states within the system.

On the other hand, Offensive realism identifies three primary drivers of interstate aggression: fear, the pursuit of maximum power, and self-help. It posits that the international system is anarchic and state-centric, characterized by mutual uncertainty regarding intentions, rational state actors, and the paramount goal of survival [12]. Consequently, offensive realism argues that accumulating power enhances a state’s security, with overwhelming power offering the most significant guarantee of survival [14].

Thus, Defensive realism suggests that state security is achievable through a balance of power, particularly within a bipolar international system. Conversely, offensive realism attributes state aggression to fear and uncertainty about other actors’ intentions, driving states to maximize their power to ensure survival. Therefore, offensive realism implies that a unipolar system dominated by a single overwhelmingly powerful state would theoretically result in a more peaceful international order.

For further elaboration, Iran’s foreign policy has been shaped by a complex interplay of factors, including its geographical position, religious influences, historical experiences, concerns about territorial integrity, aspirations for regional dominance, interference from global powers, internal political dynamics, and its wealth of natural resources. Following the Iran-Iraq War between 1980 and 1988, Iranian foreign policy became more “rational,” leading to increased “factionalism” in foreign policy. Khamenei’s leadership emphasized expanding Iran’s influence. While some argue for a pragmatic and comprehensive security strategy, others point to the actions of the Islamic Revolutionary Guard Corps (IRGC) in Syria as evidence of a deep-seated power maximization approach, particularly under Suleimani’s influence [15].

Thus, Iran’s foreign policy is a multifaceted tapestry woven with offensive and defensive realism threads. Defensive realism explains its focus on territorial integrity and regime survival, which is evident in pragmatic diplomacy that addresses national security concerns. This is particularly pronounced after the Iran-Iraq War, where the threat of invasion underscored the importance of self-preservation. Conversely, offensive realism is evident in its pursuit of regional dominance, exemplified by the IRGC’s role in Syria under Suleimani. This reflects a power-maximization strategy aimed at countering rival states and external pressures. The interplay of these theories highlights Iran’s dual focus on security and influence in an anarchic international system.

4. Foreign Policy Decision-Making and Implementation

Effective decision-making, in general, requires appropriate tools that enable decision-makers to formulate and implement sound decisions. The state is typically responsible for foreign policy (FP) decisions as the ultimate defender of national interests. Therefore, the foreign policy decision-making (FPDM) process demands a thorough understanding of available information, the context, and the capabilities and instruments available for implementation. However, the interplay between an actor’s strategy and the context determines FP behavior because the international arena comprises various state and non-state actors with distinct—and sometimes conflicting—interests. Furthermore, the pragmatic nature of FP decisions necessitates caution regarding the balance between the goal and the repercussions or consequences of implementation [16]. As such, the diverse array of actors, their interactions, and the intricate web of their converging and diverging interests create a complex and challenging environment for the conduct of foreign policy [17]. However, even the implementation phase represents an extension of interaction between the domestic and international levels and is an integral phase of the FPDM process.

The ideal flow of the decision-making process begins with identifying the problem, collecting relevant information, and optimizing options and available choices. The logical flow of the process leads to the interpretation of formal decisions into actions, and the decision of ‘no action’ is another form of FP implementation. However, actions are bound to the state’s capabilities in four dimensions: Military, economic, diplomatic, and cultural. However, these capabilities, per se, are not manageable instruments that provide the state with power externally [16]. As the concepts of sovereignty and self-help materialized, the anarchic nature of the system [5], an intimate relationship between FP and the rigid, and the texture of power continued to exist. Substantial military power constantly reminds us of the potential for force should diplomatic efforts fail [16].

Threats of military action are usually common in international relations, but this political tactic might incur costly repercussions due to the unpredictability of others’ reactions. Therefore, power structures are abstract entities. The state economy is one such structure. FP practitioners should analyze the extent to which economic instruments are available to the state and the range of its broad goals, whether as an inducement or punishment.

Accordingly, the implementation of FP should seek to maintain balance during practice, where the population views, security, prosperity, identity, and prestige should be taken into consideration, as the uneven distribution of power on the international level plays a significant role in determining the outcomes for the implementation of FP decisions. Therefore, foreign policy decisions should consider a comprehensive range of instruments, encompassing hard and soft power tools. Moreover, the relational nature between means and ends should also be considered as important as the interaction pattern between the actor and the target [16].

In FP, where international is the arena for various actors, political survival implies dynamic equilibrium through interaction between actors. Nevertheless, the global environment produces input, output, and feedback processes that determine the shape of interactions and interplay between actors. FP implementation develops on two levels: Domestic and International. These levels interconnect in the light of the ends-means relationship [17]. Therefore, the dynamic relationship between context and policy, the balance of power and the means employed to achieve objectives, and the interplay between structures and actors illustrate periods of intense engagement within a continuous cycle of action, reaction, and subsequent action occurring across multiple levels [17].

Finally, effective foreign policy decision-making (FPDM) requires understanding context, available information, and implementation capabilities. Such an understanding is crucial in the current Middle East crisis due to the presence of diverse state and non-state actors with conflicting interests. The interplay between strategy and context and the need to balance goals and repercussions creates a complex environment. While rational decision-making involves problem identification, information gathering, and option optimization, implementation depends on a state’s military, economic, diplomatic, and cultural capabilities. However, these capabilities are not simply instruments of power projection. The anarchic international system and the ever-present potential for military force influence FP. Threats of force, while common, carry risks due to unpredictable reactions. FP implementation requires balancing domestic considerations (public opinion, security, prosperity, identity, prestige) with international power distribution. All instruments of power, hard and soft, should be considered, with attention to the relationship between means and ends and the interaction between actors. Ultimately, FP in the Middle East requires navigating a dynamic equilibrium through constant interaction and adaptation to the global environment.

Moreover, Foreign Policy Decision-Making (FPDM) in the Middle East is fraught with challenges. The region’s complex array of diverse state and non-state actors with conflicting interests and uneven global power distribution creates a volatile and unpredictable environment. Effective FPDM necessitates a sound understanding of this complex landscape, requiring policymakers to align strategies with the dynamic international context while anticipating and mitigating potential repercussions. The inherent limitations of state capabilities, particularly the risks associated with over-reliance on military power, constrain effective policy implementation. Domestic considerations, such as public opinion and internal political dynamics, further complicate the decision-making process, often creating conflicting priorities. The abstract nature of power and its relational and contextual dimensions necessitates a careful analysis of the means-end relationship to avoid miscalculations.

Ultimately, the anarchic nature of the international system, characterized by uncertainty and competition, exacerbates these challenges. To navigate this complex and ever-evolving landscape, FPDM in the Middle East demands constant vigilance, adaptability, and a nuanced understanding of the interplay between domestic and international factors.

5. Summary

The Middle East experienced profound trauma throughout the 20th and 21st centuries, marked by colonialism, destabilizing events, and persistent conflict. This historical context significantly shapes the region’s contemporary international relations, characterized by complex interactions between diverse state and non-state actors pursuing often conflicting interests. This volatile environment necessitates a nuanced understanding of foreign policy decision-making (FPDM).

Structural realism offers a valuable lens for analysis, emphasizing state centrism, anarchy, and self-help as key drivers of state behavior. Powerful states like Iran and Israel compete for regional dominance within this anarchic system, with their actions determined by their relative capabilities. Defensive realism prioritizes security through a balance of power, while offensive realism emphasizes power maximization as the best guarantee of survival. However, effective FPDM requires a thorough understanding of context, information, and implementation capabilities regardless of theoretical perspective.

The implementation of FP involves balancing domestic considerations with international power distribution. All instruments of power, both hard and soft, must be considered strategically, recognizing the dynamic interplay between means and ends. The Middle East’s complex environment requires constant adaptation and dynamic equilibrium to navigate the continuous cycle of action and reaction among actors. This multi-layered analysis, incorporating historical context, structural realist principles, and the intricacies of FPDM, is essential for understanding the region’s persistent conflicts.

5.1. Conclusion

East requires a multifaceted approach that acknowledges the region’s complex historical context, the dynamics of the international system, and the intricacies of decision-making and implementation. The region’s history of trauma, from colonialism to contemporary conflicts, has created a volatile environment where state and non-state actors compete for influence [18]. Structural realism, focusing on state centrism, anarchy, and self-help, provides a valuable framework for understanding state behavior, particularly the pursuit of power and security (Structural Realism in the Modern World: Understanding Power and Strategy, n.d.) [19]. However, FPA must move beyond purely structural explanations to consider the interplay between context, policy, and available instruments of power.

Effective FPDM necessitates a thorough grasp of available information, contextual factors, and implementation capabilities, recognizing the need to balance domestic considerations with international power distribution. A pragmatic approach is crucial for navigating the Middle East’s complex and ever-evolving landscape, considering all instruments of power and the dynamic relationship between means and ends. Iran’s nuclear program exemplifies such a dynamic relationship between means and ends, as Iran’s nuclear program has been a cornerstone of its foreign policy, driven by the dual objectives of enhancing national security and regional influence. Iran has employed a combination of hard power, such as developing nuclear technology as a deterrent, and soft power, utilizing diplomacy to negotiate concessions to achieve these ends.

Ultimately, successful FPA in this region demands continuous adaptation and a nuanced understanding of the interplay between various levels of analysis, from individual actors to the global system.

5.2. Recommendations

The following recommendations represent a prospected successful strategy to ensure a sound approach to foreign policy analysis of the current Middle East crisis. Here are five fundamental recommendations for a strategic foreign policy analysis of the current Middle East crisis:

1) Incorporate historical context: A thorough understanding of the Middle East’s history of colonialism, decolonization, state formation, and regional rivalries is crucial. This historical lens reveals the roots of current tensions, mistrust, and the institutionalization of conflict, providing a foundation for analyzing contemporary events. Hence, as an actionable measurement, foreign policy analysts should prioritize historical understanding. This necessitates developing comprehensive case studies on colonialism, decolonization, state formation, and regional rivalries to identify enduring patterns of mistrust and conflict. For instance, understanding the Sykes-Picot Agreement’s impact on artificially drawn borders can inform strategies for addressing territorial disputes. Insights from colonial exploitation of resources can guide equitable regional economic collaborations.

2) Employ a multi-level analysis: Examine the crisis through individual, state, regional, and systemic levels, analyzing the motivations of key actors (both state and non-state), the internal dynamics of states involved, regional power balances and alliances, and the influence of the broader international system. Hence, it is crucial to develop analytical frameworks that separately evaluate individual leadership traits, domestic political structures, regional alliances, and systemic influences on crises. Utilizing simulations and scenario planning allows for exploring potential outcomes at each level of analysis. Furthermore, incorporating data-driven tools such as social network analysis can provide valuable insights into the intricate interconnections among state and non-state actors, contributing to a more comprehensive understanding of the complex dynamics shaping foreign policy decisions and their consequences. For instance, during the Syrian conflict, a multi-level analysis would involve examining Bashar al-Assad’s leadership style (individual level), the role of internal factions (state level), regional power struggles involving Iran, Saudi Arabia, and Türkiye (regional level), and the actions of global powers like the US and Russia (systemic level) (Syrian Civil War: Limitations and Preconditions for Effective Multilateralism in an ever more Conflictual Multipolar World, 2017) [20].

3) Utilize theoretical Frameworks, but with nuance: Structural realism, which emphasizes anarchy, self-help, and power distribution, offers valuable insights. However, it should not be the sole lens. Consider other theoretical perspectives, such as liberalism and constructivism, to capture the situation’s complexities, including the role of international institutions, norms, and identity. Hence, analysts should apply multiple theoretical lenses when assessing crises, combining structural realism, liberalism, and constructivism to gain a holistic understanding. This multi-theoretical approach should be complemented by integrating quantitative and qualitative tools to rigorously test the applicability of different theories in specific cases. This multifaceted approach allows for a more nuanced and comprehensive understanding of the complex factors driving foreign policy decisions and their consequences. For instance, a multifaceted approach is crucial when analyzing the Israeli-Palestinian conflict. Structural realism can explain the power struggles between Israel and its neighbors, emphasizing the anarchical nature of the international system. Liberalism highlights the role of international institutions like the United Nations in promoting cooperation and conflict resolution. Constructivism explores the impact of identity, narratives, and historical grievances on Israelis’ and Palestinians’ actions and perceptions.

4) Analyze foreign policy decision-making and implementation: Scrutinize the decision-making processes of relevant actors, considering the available information, contextual factors, and available instruments of power (military, economic, diplomatic, and cultural). Pay close attention to the implementation phase, recognizing the interplay between domestic and international considerations and the potential for unintended consequences. Hence, conducting in-depth studies of decision-making processes within Middle Eastern states is vital, focusing on how leaders gather and process information and the influence of advisors and institutions. This understanding can inform the development of training programs for policymakers to enhance their skills in scenario planning and risk assessment for policy implementation. Furthermore, collaborating with think tanks to simulate the implementation phase of policies can help predict unintended consequences and identify potential gaps, ultimately leading to more effective and robust foreign policy outcomes. For instance, when assessing Iran’s nuclear negotiations, it’s crucial to understand how information from internal factions and international actors shaped decision-making. Internal factions, like hardliners and moderates, likely held differing views on the nuclear program’s goals and acceptable compromises. This internal debate influenced the negotiating stance and the types of agreements considered.

5) Focus on the dynamic interplay of power and context: The Middle East is characterized by a fluid interplay of power, with shifting alliances and constant action-reaction cycles. Analyze how power distribution influences state behavior and how contextual factors, such as regional rivalries and external interventions, shape the implementation and outcomes of foreign policy decisions by continuously adapting and pragmatizing the approach to considering hard and soft power instruments. Hence, it is essential to establish robust monitoring systems to track shifts in regional alliances and power dynamics to enable the creation of adaptive policy frameworks that effectively integrate hard (military, economic) and soft (diplomatic, cultural) power tools, allowing for adjustments based on the evolving geopolitical landscape. For example, The Yemen conflict is a complex web of regional and international dynamics. The Saudi-Iranian rivalry is a key driver, with both countries backing opposing factions. Saudi Arabia supports the internationally recognized government, while Iran is alleged to support the Houthi rebels. This proxy war has exacerbated tensions in the region.

Conflicts of Interest

The author declares no conflicts of interest.

Conflicts of Interest

The author declares no conflicts of interest.

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