Kuwait’s deputy ruler and his half brother, Meshal Al Ahmad Al Jaber, 83, is believed to be the world’s oldest crown prince. He is in line to take over as Kuwait’s ruler and represents one of the Gulf Arab countries’ last octogenarian leaders.

In late November, the emir was rushed to a hospital for an unspecified illness. In the time since, Kuwait had been waiting for news about his health. State-run news previously reported that he traveled to the United States for unspecified medical checks in March 2021.

The health of Kuwait’s leaders remains a sensitive matter in the Middle Eastern nation also bordering Iraq and Saudi Arabia, which has seen internal power struggles behind palace doors.

Those from Sheikh Nawaf’s lifetime, born before oil fully transformed Kuwait from a trading hub into a petrostate, have been fading away with age. That, as well as other Gulf Arab nations putting younger and more assertive rulers in power, has increasingly put more pressure on the ruling family to pass power onto the next generation.

In neighboring Saudi Arabia, King Salman, 87, is widely believed to have placed day-to-day rule of his nation in the hands of his 38-year-old son, Crown Prince Mohammed bin Salman.

Sheikh Nawaf was sworn in as emir in 2020 amid the coronavirus pandemic, following the death of his predecessor, the late Sheikh Sabah Al Ahmad Al Sabah. The breadth and depth of emotion over the loss of Sheikh Sabah, known for his diplomacy and peacemaking, was felt across the region.

Sheikh Nawaf previously served as Kuwait’s interior and defense minister. His political fortunes were never certain despite being part of the ruling Al Sabah family. As defense minister, Sheikh Nawaf oversaw the rapid collapse of his forces during Iraqi dictator Saddam Hussein’s invasion of his country in August 1990. He faced widespread criticism for his decisions during the war.

A letter reportedly sent to the country’s ruler at the time alleged Sheikh Nawaf ordered tank crews not to fire on the approaching Iraqi forces. The reasoning behind the alleged order remains unclear. Iraq’s battle-hardened forces, after years at war with Iran, easily overwhelmed the country.

A U.S.-led, multinational force later expelled the Iraqis from Kuwait in 1991. Kuwait’s leaders never published the findings of its investigations into the government’s actions around the invasion.

“Our main target is the liberation. After we return, we will repair our own house,” Sheikh Nawaf said in 1991. “You have to reform yourself and correct any previous mistakes.”

He faced a demotion and then didn’t hold a Cabinet-level position for about a decade afterward, serving as a deputy chief of the country’s National Guard. Even on his return, analysts viewed him as not particularly active in government, though his low-key approach later appealed to some Kuwaitis who ultimately moved on from his wartime performance.

Sheikh Nawaf was largely an uncontroversial choice for emir, though his advancing age led analysts to suggest his tenure would be short. It was — he had the third-shortest tenure of any emir since the beginning of Al Sabah control in 1752.

During his term, he had been focused on domestic issues as the nation struggled through political disputes — including the overhaul of Kuwait’s welfare system — which prevented the country from taking on debt. That’s left it with little in its coffers to pay bloated public sector salaries, despite generating immense wealth from its oil reserves.

In 2021, Sheikh Nawaf issued a long-awaited amnesty decree, pardoning and reducing the sentences of nearly three dozen Kuwaiti dissidents in a move aimed at defusing a major government standoff. He issued another just before his illness, aiming to resolve that political impasse that also saw Kuwait hold three separate parliamentary elections under his rule.

“He earned his title — he has a nickname here, they call him ‘the emir of pardons,’” said Bader al-Saif, an assistant professor of history at Kuwait University. “No one in modern Kuwaiti history has gone this far to reach out to the other side, to open up.”

Kuwait is perceived as having the Gulf’s freest parliament that comparatively allows for dissent.

Meanwhile, the Gulf Cooperation Council states, including Qatar, Saudi Arabia and the United Arab Emirates, restored ties after years of a boycott of Qatar, easing regional tensions and allowing Sheikh Nawaf to focus on issues at home.

Kuwait has the world’s sixth-largest known oil reserves. It has been a staunch U.S. ally since the 1991 Gulf War. Kuwait hosts some 13,500 American troops in the country, as well as the forward headquarters of the U.S. Army in the Middle East.