DUBAI, United Arab Emirates (AP) — Kuwait’s 91-year-old ruling emir left Thursday morning for the United States with the help of the U.S. government to seek further medical care after recently undergoing surgery.

Kuwait has yet to elaborate on what required Sheikh Sabah Al Ahmad Al Sabah to seek a previously unannounced medical treatment beginning Saturday and a surgery Sunday. However, Sheikh Sabah’s sudden surgery could inspire a renewed power struggle within Kuwait’s ruling family.

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The state-run KUNA news agency quoted a statement from the country’s royal court saying Sheikh Sabah left “based on advice from the medical team treating His Highness to complete his treatment after a successful surgical procedure.”

Kuwait Emir Sheikh Sabah Al Ahmad Al Sabah

(credit: FETHI BELAID/AFP via Getty Images)

“We ask the Almighty to aid his recovery and sustain His Highness, who is healthy and well taken care of, and to protect him from all harm,” the statement said.

A statement attributed to Sheikh Ali Jarrah Al Sabah, the country’s royal court minister, did not elaborate or say where in the U.S. Sheikh Sabah will receive treatment.

However, a Kuwaiti government Airbus A340 that left Kuwait City landed Thursday in Rochester, Minnesota. That same Airbus had flown to Rochester and New York City before returning to Kuwait just days before Sheikh Sabah’s surgery.

Rochester is home to the flagship campus of the Mayo Clinic, one of America’s best hospitals, and has treated Sheikh Sabah in the past. The Mayo Clinic did not respond to a request for comment early Thursday.

Meanwhile, video shared widely on social media in Kuwait appeared to show an ambulance escorted by heavy security pull up to a U.S. military Boeing C-17A Globemaster III on Thursday morning at Kuwait International Airport.

Though The Associated Press could not immediately verify the video, flight radar data shows a U.S. Air Force C-17 flew out of Kuwait on Thursday morning to Ramstein Air Base in Germany, where it later took off heading west toward America. The U.S. military uses some C-17s as airborne hospitals for medical evacuations.

U.S. Air Force Central Command referred questions to the U.S. military’s Transportation Command, which declined to comment. A U.S. State Department official said America “provided assistance to help with the emir’s treatment,” without elaborating. The official spoke to the AP on condition of anonymity as the information had not been made public.

Kuwait earlier announced that 83-year-old Crown Prince Nawaf Al Ahmad Al Sabah had assumed some of Sheikh Sabah’s powers temporarily, without explaining why that was necessary.

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A copy of the ministerial decree posted by Kuwait’s official gazette, Kuwait Al-Youm, and seen by the AP on Sunday, said the crown prince would be empowered for “the duration of a surgical procedure until the health event is over.”

The decree did not elaborate. Kuwait’s Information Ministry has not responded to requests for comment.

Sheikh Sabah, a widely beloved ruler in this OPEC-member nation, took power in 2006 just nine days into the rule of the ailing Sheikh Saad Al Abdullah Al Sabah. Concerns mounted during Sheikh Saad’s brief reign as he was seen in public only in a wheelchair and did not speak.

However, Sheikh Sabah’s ascension upset an informal power-sharing arrangement between branches of Kuwait’s ruling family. While Kuwait has since remained politically stable with the most empowered parliament of any Gulf Arab nation, there have been internal power struggles behind the scenes of his rule.

Kuwait, a nation home to 4.1 million people that’s slightly smaller than the U.S. state of New Jersey, has the world’s sixth-largest known oil reserves.

It has been a staunch U.S. ally since the 1991 Gulf War expelled the occupying Iraqi forces of Saddam Hussein. Today, Kuwait hosts some 13,500 American troops, many at Camp Arifjan south of Kuwait City, which is also home to the forward command of U.S. Army Central.

Sheikh Sabah, a longtime foreign minister for Kuwait, has drawn praise during his rule for hosting donation drives for both war-torn Iraq and Syria. He also has been the lead negotiator in trying to resolve a yearslong boycott of Qatar by four Arab nations over a political dispute.

He previously cancelled a White House visit last November while in the U.S. and visited a hospital there for medical checks.

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