How political dysfunction precipitated the collapse of health care in Lebanon


LONDON: The Lebanese health system is in a precarious state following successive waves of political and economic crisis. As the country reels from shortages of medical supplies, increases in COVID-19 cases and an exodus of skilled medical professionals, the urgency of the sector’s need for external assistance is no longer a subject of debate.

In most countries, it may seem reasonable to look to the government to implement reforms to save the health system from collapse. But in Lebanon, where politics itself is arguably sickening the nation, the beleaguered state is unlikely to offer solutions.

A new study by King’s College London and the American University of Beirut suggests Lebanon’s healthcare system is in decline, largely due to the same disastrous policy decisions and systemic issues that led to the collapse country’s economy in 2019.

The study, “How Politics Made a Nation Sick,” conducted by the Research for Health in Conflict–MENA (R4HC-MENA) project, shows how a series of politically induced disasters created a state of crisis that n is unprepared to deal with a worsening public health emergency.

Dr. Adam Coutts, one of the R4HC-MENA project managers, describes the health situation in Lebanon as “a slow sinking, which accelerated during the pre-pandemic period when the economy collapsed in 2019” .

Since the end of the civil war in Lebanon in 1990, sectarianism, clientelism and corruption have dominated political life and plunged the country into successive episodes of unrest and instability.

Corruption, hyperinflation and the collapse of the banking sector in 2019 plunged Lebanon into the worst economic crisis in its modern history. The arrival of millions of refugees from neighboring Syria has only added to the strain on its creaking infrastructure.

Around 19.5% of Lebanon’s 7 million inhabitants are refugees from neighboring countries. Already living precariously in impoverished communities, few have the means or the connections to obtain life-saving medicines in times of scarcity.


Protesting pharmacists (above) hold up signs saying ‘no gas = no ambulance’, denouncing the critical state facing hospitals across the country while grappling with severe fuel shortages (AFP)

Meanwhile, the drastic currency devaluation has made health insurance unaffordable for many Lebanese.

“The social and economic situation in Lebanon at the moment is dire,” said Dr Coutts. “We have been working on health, economic and social issues in Lebanon for ten years and we have never seen it so badly.”

The steady depletion of foreign exchange reserves has made it difficult for Lebanese traders to import essential goods, including basic medicines, and has led banks to cut lines of credit – a disaster for a nation so heavily dependent imports.

Additionally, patients are struggling to access appointments and surgeries as medical staff flee the country in droves.

According to the R4HC-MENA study, about 400 doctors and 500 nurses out of the country’s 15,000 qualified doctors and 16,800 qualified nurses have emigrated since the start of the crisis.

To make matters worse, chronic power shortages in Lebanon have forced hospitals to rely on private generators to keep lights on and life support equipment running. But the generators run on fuel, which is also permanently in short supply.

Despite the severity of the health emergency, the Lebanese government has been unable to respond, lacking both financial means and will in the face of a multitude of overlapping crises.

“Health always seems to be seen as the poor relation of development and early recovery compared to economic stabilization, education and security,” said Dr Coutts. “The problem is that if we continue to neglect health and health systems, it will lead to even bigger problems in the future.”

The COVID-19 pandemic has come at the worst possible time for Lebanon, further exposing the weakness of the health system and putting additional pressure on the country’s struggling economy.


A combination of images showing the closed doors of pharmacies in Lebanon during a nationwide strike to protest a severe shortage of medicines in 2021. (AFP/File Photo)

“As the COVID-19 pandemic shows, if you neglect health systems, you cannot respond to health emergencies,” Dr Coutts said. “Health is a major concern among people. It is the street problem that affects everything in people’s daily lives. Development must be about lives and livelihoods.

While COVID-19 infections are currently on the decline in Lebanon, successive waves of the virus have wreaked havoc on Lebanon’s healthcare system. In December 2020, for example, around 200 doctors who lacked sufficient protective equipment to avoid infection were placed in quarantine.

The R4HC-MENA study found that successive peaks of the virus have overwhelmed hospital capacity and resources, exacerbating shortages of staff, not to mention equipment such as ventilators and pharmaceuticals.

“Many private hospitals were reluctant to undertake COVID-19 care for fear of ‘losing’ revenue from more lucrative services, losing their doctor and nursing staff, and not believing they would actually be reimbursed by the government,” Dr. Fouad M. Fouad, R4HC-MENA project manager in Beirut, told Arab News.

Just when it looked like things couldn’t get any worse for Lebanon’s healthcare sector, the August 4, 2020 Beirut port explosion flattened an entire neighborhood of the city.


The damaged Saint George Hospital (left) in Beirut more than a week after the August 4, 2020 port explosion. Some 43,000 Lebanese emigrated in the first 12 days after the explosion, including skilled workers such as medical personnel. (AFP/file photo)

More than 220 people were killed in the blast, around 7,000 injured and some 300,000 made homeless. Hours after the blast, people began pouring into city hospitals with all kinds of trauma, burns and disfiguring injuries from shards of glass and masonry.

However, the explosion also destroyed the city’s health infrastructure. According to a WHO assessment, four hospitals were seriously affected and 20 primary care facilities, serving around 160,000 patients, were damaged or destroyed.

“The explosion generated multiple health and rehabilitation needs among the survivors,” Rasha Kaloti, research associate of the R4HC-MENA project, told Arab News.

“It has also caused many patients to miss out on routine care for various conditions, including critical care therapies such as cancer treatments, and many have had to move to other hospitals, leading to delays. and a lack of continuity of care.”


Doctors have warned that Lebanon is losing its best and brightest medical staff amid the crisis. (AFP/file photo)

Meanwhile, the mental health effects of the blast are only beginning to be felt, with survivors suffering from anxiety, depression and post-traumatic stress disorder.

Embrace, a mental health awareness NGO in Lebanon, interviewed about 1,000 people aged 18 to 65 and older in the first 10 days after the explosion. It revealed that 83% of respondents said they felt sad almost every day, while 78% said they felt very anxious and worried every day.

The explosion also accelerated the brain drain of skilled workers, including health personnel. According to the R4HC-MENA study, 43,764 Lebanese emigrated in the first 12 days after the explosion.

R4HC-MENA has made several recommendations to help Lebanon save its health system. “The first thing that needs to happen is that clear political commitments are made to ensure the health and well-being of Lebanese and refugees,” Dr Fouad said.


Despite the severity of the health emergency, the Lebanese government has been unable to respond, lacking both financial means and will in the face of a multitude of overlapping crises. (AFP/file photo)

“A new social contract must be created. It is not enough to sign a WHO declaration on universal health care. »

Indeed, the causes of the collapse of health care in Lebanon are largely political. For Dr Coutts, a good first step could be to redefine the definition of “state failure” to incentivize the international aid community to inject resources into the health system.

“It is difficult to see how Lebanon is not a failed state when the health system is out of breath, half the population cannot afford to access the health system, three quarters of the population are on the World Bank poverty line and that a man-made explosion has occurred in the middle of the capital for which no one has been held responsible,” he said.

“If it’s not a state failure, then the state failure needs to be redefined.”

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