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The paper examines the determinants of the government's performance in responding to the COVID-19 outbreak in the MENA region. An examination of public opinion polls demonstrates that government approval ratings improved over time, primarily because the portrayal of the pandemic as a common global challenge enhanced the state's response in handling the crisis. The statistical analysis of the surveys further indicates that vulnerable citizens, namely the underclass, are more likely to approve government handling of the pandemic. Yet, more educated people are less likely to support government performance. Additionally, educated citizens consider the provision of health care unjust. These results indicate that different segments of the society have a distinct understanding of state obligations in providing health care to citizens. These findings have important implications for understanding what constitutes social contracts in delivering health care and welfare and how external shocks influence state-society relations in authoritarian regimes.