I recall a discussion of this in some article. It apparently defines “clans”. People look out for and protect fellow extended clan/family members with whom they have a deeper blood connection. First-cousin marriages might be part of it, but it also includes a lot of second and tird cousin marriages, people who share the same “family group”. Like the royal families of Europe, one could trace convoluted connections to another through several ancestors on both sides of their family. Of course, when the rich and influential also have multiple wives and dozens of children, that adds the convolution.
This was a protective thing -in a turbulent region, you needed someone to rely on, and blood relatives were the most reliable (supposedly) compared to idealists and strangers. Many cultures place emphasis on extended family connections.
(As an example, consider the caste system in India preventing excessive intermixing between parallel geographic groups - a person’s marriage choices in a particular area would be more limited to a smaller group, many of whom may share ancestors.)
There was even a suggestion that some middle east disputes, such as Hamas and the PA, were as much or more about clans and their vendettas than politics.
Birth defects are typically about recessive genes. A person has a defective gene because someone, somewhere in their ancestry, had a mutation in the replication of their genes. (There’s a suggestion that many cases of miscarriage are due to problems with defective genes- nature’s way of culling the errors) Most defectives don’t matter, because everyone gets two (except XY) so typically the complete one will be dominant and compensate. However, if you tend to pair up with others who share several recent common ancestors rather than someone from a different area of the country who has no family connection - the statistical odds that one of these defective genes will pair up is pretty high. It’s not so much they marry cousins, as they marry closely connected family.
Not sure if the problem is also that when a small group migrate to a new country and expect to carry on the intra-clan marriage lifestyle, the pool of potential mates gets even smaller and the risk greater.
(Then there’s the issue mentioned in one of Malcolm Gladwell’s books - that Michigan, with its high Muslim population, experienced a higher rate of neonatal issues in certain times of the year - specifically, when children conceived just before Ramadan were born. Fasting during Ramadan is not necessary for women who are pregnant, but fasting for up to 16 hours in a summer month for women who don’t necessarily realize yet they are pregnant is not good for the baby.)