WASHINGTON (Reuters) – U.S. President Donald Trump awarded the U.S. Legion of Merit, Degree Chief Commander, to Kuwaiti Emir Sheikh Sabah al-Ahmad al-Sabah, the White House said in a statement on Friday, adding that it was the first time the honor has been given since 1991.

The 91-year-old emir arrived in the United States in July to complete medical treatment, the Kuwaiti state news agency said at the time, adding that he was in stable condition after having undergone successful surgery in July.

The emir’s eldest son, Sheikh Nasser Sabah al-Ahmad al-Jaber al-Sabah, accepted the award on behalf of his father at a private ceremony with Trump on Friday.

The White House praised the emir as an “unwavering friend and partner to the United States” who gave “indispensable support to the United States throughout Operation Iraqi Freedom, Operation Enduring Freedom, and the Defeat-ISIS campaign.”

Operation Iraqi Freedom refers to the 2003 U.S. invasion of Iraq to oust former Iraqi dictator Saddam Hussein; Operation Enduring Freedom to the 2001 U.S.-led military operation that drove the Taliban from power in Afghanistan; and the Defeat-ISIS campaign to the coalition effort to end the Islamic State militant group’s control of territory in Syria and Iraq.

The White House described the award given to the Kuwaiti emir on Friday as a rare, prestigious decoration that can only be bestowed by the president, typically to foreign heads of state or government.

On Monday, Kuwait’s prime minister told the Kuwaiti cabinet of the improvement of the emir’s health.

In July, Kuwait’s cabinet tweeted that the emir arrived at Rochester airport in the United States, without specifying which U.S. city of that name. The main campus of the Mayo Clinic, among the top U.S. medical centers, is in Rochester, Minnesota.

Speaking on condition of anonymity, two sources familiar with the matter said the emir is being treated at the Mayo Clinic. The clinic referred queries to the Kuwaiti government, which issued a statement largely echoing the White House’s comments about the emir receiving the award.

(Reporting by Makini Brice, Tim Ahmann, Arshad Mohammed and Steve Holland; Editing by Chris Reese and Paul Simao)

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