New analysis from Phesi suggests 6.7% of globally recruiting clinical trials are impacted by disruption in the Middle East, with Phase III studies showing the highest exposure.

The dataset, covering 65,061 active clinical trials across 186 countries and more than 356,000 investigator sites, identified 4,361 studies with some level of impact. A total of 7,958 sites were located in affected countries, representing 2.2% of global trial site activity.

Phase III trials accounted for the largest share of impacted sites, with 2,732 locations affected, reflecting the scale and geographic distribution of late-stage development programmes.

Phesi said the highest concentration of affected sites was found in Turkey, Israel and Egypt. Oncology programmes accounted for a significant proportion of impacted trials, with non-small cell lung cancer and breast cancer among the most frequently affected indications. Additional exposure was also identified in heart failure, multiple myeloma and Crohn’s disease.

Phesi founder and chief executive Gen Li said clinical development is increasingly exposed to external disruption due to its global structure.

Li said: “Clinical development has become deeply interconnected. When disruption occurs the impact extends beyond individual sites, particularly in high-priority disease areas such as oncology.”

He added that Phase III trials are particularly sensitive due to their size and the level of patient commitment required.

Li said: “The impact on Phase III trials is particularly significant, as these later-stage studies involve larger, committed patient populations and represent years of investment.”

The analysis also notes that large pharmaceutical companies maintain substantial operational presence in the region, with all top 10 global pharma companies having investigator sites in affected countries.

According to Phesi, this level of exposure highlights the importance of monitoring geographic risk and ensuring continuity planning in global clinical development strategies, particularly in late-stage programmes.

The company’s analysis draws on its clinical trial dataset, which aggregates global study and patient-level information to support trial design and feasibility assessment across therapeutic areas.