Abstract
We present a systematic study of healthcare-domain cross-lingual transfer to address the scarcity of biomedical NMT resources for Arabic-script languages. We use Arabic and Persian as higher-resource pivots to improve translation for \textbf{four severely low-resource} targets: Dari (Afghan Persian, a standardised variety of Persian), Pashto, Sorani Kurdish (Central Kurdish, a major standardized variety of Kurdish), and Urdu (closely related to Hindi). Using LoRA fine-tuning on small decoder-only LLMs, we train \textit{domain-specific pivot adapters} and evaluate \textbf{three transfer strategies}: few-shot in-context learning, minimal supervised adaptation, and, to the best of our knowledge, for the first time in this setting, zero-data LoRA adapter merging. Supervised adaptation with just 500 sentences achieves near pivot-language quality for Dari (CHrF++ 41.01) and meaningful gains for Urdu (28.88), while adapter merging reaches within 3.5 CHrF++ of supervised adaptation for Dari at zero additional cost. Pashto and Sorani Kurdish remain insufficient for high-stakes clinical deployment exposing the limits of cross-lingual transfer when structural distance from the pivots is too great. LoRA adapter merging works surprisingly well for closely related languages, even without target-language biomedical data.