Lebanon’s health system on life support as economic woes worsen

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Updated 17 August 2021
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Lebanon’s health system on life support as economic woes worsen

  • Explosion’s adverse impact continues to be felt by nation’s medical professionals and patients alike
  • Health system creaks under the weight of medical supply shortages, COVID-19 and brain drain

DUBAI: Last August, millions around the world watched in horror as footage of the devastating Beirut port blast looped on TV channels and social-media feeds for days. For residents of the Lebanese capital, that month was like no other in recent memory.

Within hours of the explosion on Aug. 4, people began to pour into the city’s hospitals with all kinds of trauma, disfiguring burns and wounds caused by flying glass and masonry. But then, Beirut’s public-health infrastructure itself was one of the biggest casualties.

According to a World Health Organization assessment, four hospitals were heavily affected and 20 primary care facilities, serving approximately 160,000 patients, were either damaged or destroyed.

A year on, as Lebanon reels from the combined impact of economic chaos, medicine shortages, power cuts and repeated COVID-19 waves, the nation’s health system is on life support.

Furthermore, medical professionals report that they are not receiving sufficient protection while on duty as their workplaces lack the medical gear and the protocols necessary for dealing with the highly transmissible delta variant of COVID-19.

“The health situation in Lebanon is really dire,” Rabih Torbay, president and CEO of US-based humanitarian aid agency Project HOPE, told Arab News.




Lebanon reels from the combined impact of economic chaos, medicine shortages, power cuts and repeated COVID-19 waves. (AFP)

“It is a combination of the lack of electricity in hospitals, a lack of fuel for generators in hospitals and beyond, a lack of medicine for hospitals and clinics, the currency losing 90 percent of its value, doctors and nurses leaving and a rise in the number of COVID-19 infections.”

Lebanon took another jolt last week when the Central Bank announced that fuel subsidies had been halted. Already, according to CNN, many factories, including one that supplies the majority of Lebanon's intravenous lines to hospitals, have closed because of long power outages.

Nivine Bou Chakra, whose grandmother takes Nebilet for hypertension, said they have had to ration the stock of drugs they were able to buy last year. “You can’t find it now. And if you do, it’s expensive,” she told Arab News.

Bou Chakra’s father has run his own dental practice for more than 20 years. Many of his patients only visit if they have an emergency, “such as inflammation from an infected tooth,” she said.

“Since they can’t find antibiotics, they come to the dentist to take the tooth out. They do that because they can’t afford the alternative: Proper treatment.”

According to Ingrid Antonios, who is doing her residency at the anesthesiology and critical care department of the Hotel-Dieu de France hospital in Beirut, doctors and nurses are having to resort to cheaper, locally produced alternatives to imported drugs.

“A lot of products were, and still are, not available in the country for various reasons. From very basic stuff, such as painkillers and proton-pump inhibitors, to more specific medications for cancer, hypertension, diabetes and antibiotics,” she said.

Tony Noujaim, a master’s student, said it has become increasingly difficult to find diabetes and cholesterol medications for his father and aunt.

“We haven’t had the need to get them from across the border, at least not yet. But getting them involves a pharmacy treasure hunt in the north. Basically, we go from pharmacy to pharmacy until we eventually find what is a pretty basic and standard medicine,” Noujaim told Arab News.

And it is not just the people of Beirut who are struggling. About 19.5 percent of Lebanon’s population of 7 million are refugees from neighboring countries. Already living precariously in impoverished communities, few of them have the means or the connections to obtain vital medications at a time of scarcity.

It is hard to believe now that Lebanon’s health sector was in much better shape not so long ago, attracting patients from across the Middle East. But conditions began to deteriorate with the onset of the financial crisis in late 2019.

At the time, the New York-based Human Rights Watch warned that health professionals were struggling to meet the needs of their patients owing to the “government’s failure to reimburse private and public hospitals, including funds owed by the National Social Security Fund and military health funds, making it difficult to pay staff and purchase medical supplies.”

The steady depletion of foreign-currency reserves has made it difficult for Lebanese traders to import essential goods and “led banks to curtail credit lines” — a disaster for a nation that depends so heavily on imports.

“Lebanon imports 80 percent of its products — most of the country’s oil, medicine, meat, grain and other supplies come from abroad,” according to a report by Christian aid agency ACT Alliance.

“The pharmaceutical crisis has deepened in Lebanon as the central bank is unable to meet the cost of subsidized medicines.”




According to a World Health Organization assessment, four hospitals were heavily affected and 20 primary care facilities, serving approximately 160,000 patients, were either damaged or destroyed during the port explosion. (AFP)

The drastic devaluation of the currency has also made health insurance unaffordable for many Lebanese. “A challenge I faced at work was when a lady in her forties suffering from advanced cancer came to the emergency department in a critical condition following a severe infection,” Antonios, of the Hotel-Dieu de France hospital, told Arab News.

“She required admission to an intensive care unit, but she and her husband couldn’t afford to pay for admission. She had to be transferred to another hospital in a very unstable condition, which could have been life threatening.”

Amid Lebanon’s overlapping crises, electricity shortages have forced hospitals to rely on private generators to keep the lights on and their life-sustaining equipment functioning. But generators run on fuel, which is also now in short supply.

The American University of Beirut (AUB) Medical Center gave warning last week that its patients were in imminent danger owing to the fuel shortage.

“This means ventilators and other lifesaving medical devices will cease to operate. Forty adult patients and 15 children living on respirators will die immediately,” the AUB said in a statement.

Water has also become a finite commodity because of prolonged mismanagement, infrastructure decay and the unmet energy needs of pumping stations and treatment plants.




“The pharmaceutical crisis has deepened in Lebanon as the central bank is unable to meet the cost of subsidized medicines,” according to a report by Christian aid agency ACT Alliance. (AFP)

“A lot of the pumps are no longer in a position to supply water to homes, yet people can’t afford to buy bottled water,” said Torbay.

“It’s not just the lack of water. With lack of water comes infection outbreaks, diarrheal diseases and hygiene-related issues.”

Watching the health system beset by a lengthening list of problems, many medical professionals have made the difficult decision to leave the country. The trend started with the onset of the economic crisis and has only accelerated since the Beirut blast.

Amani Mereby, a Ph.D. candidate, said her physician now spends more time working in France, despite being in high demand in Lebanon.

“Because of the economic crisis, my physician, who was very successful in Lebanon, is having to divide his time between here and France,” she said. “The only reason he visits Lebanon once every two months is because he wants to help his patients.”




“A lot of products were, and still are, not available in the country for various reasons,” said Ingrid Antonios, who is doing her residency at the Hotel-Dieu de France hospital in Beirut. (AFP)

Among those who have been heading for the exits are colleagues of Antonios at the Hotel-Dieu de France hospital. “A large number of medical staff are leaving the country, from medical doctors to nurses, but also students,” he said. “It’s not just young people at the beginning of their careers. A lot of people in their thirties, forties and fifties are finding a way out where possible.”

For many, the reasons for departure are a mix of financial and emotional. “They can’t survive on the salaries they get paid,” said Torbay. “It’s also extremely difficult for a doctor or a nurse to take on a patient and not be able to heal them or give them the medicine they need.”

To many among the millions currently scraping by on their meager incomes, the remedy for Lebanon’s health system maladies lies either at the ballot box or the streets. They hold the same political elites blamed for the country’s deepening governance crisis, responsible for the unfolding health disaster.

“My friends call me delusional, but I have some hope,” Noujaim told Arab News. “After the Oct. 17, 2019, revolution, there was a huge political awakening in the country. My hope is confined to the next election.”


Gaza rescuers say 4 dead, 30 missing under rubble after Israeli strike

Updated 11 sec ago
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Gaza rescuers say 4 dead, 30 missing under rubble after Israeli strike

GAZA: Gaza’s civil defense agency said an Israeli strike on Gaza City on Saturday killed four people and left “more than 30” feared buried under the rubble of a house.
“Our crews were able to recover four martyrs and five wounded following the attack,” said civil defense spokesman Mahmud Bassal, adding that “more than 30” people are presumed missing under the rubble and “our crews cannot reach them because of the lack of the necessary machinery.”

Missile launched from Yemen into Israel intercepted, Israeli army says

Updated 26 April 2025
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Missile launched from Yemen into Israel intercepted, Israeli army says

CAIRO: The Israeli army said in the early hours of Saturday that a missile that was launched from Yemen was intercepted before crossing into Israeli territory.
Sirens sounded in a number of areas in Israel following the launch, the Israeli army added in a statement.
There was no immediate comment from Yemen’s Iran-aligned Houthis, who have been launching attacks against Israel as well as ships they perceive as affiliated to Israel, in what they say is to support the Palestinians in Gaza against the Israeli offensive on the enclave.


Former Lebanese PM Diab questioned over Beirut port blast

Updated 25 April 2025
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Former Lebanese PM Diab questioned over Beirut port blast

  • Investigation gains momentum as French official files transferred to Judge Tarek Bitar
  • Lebanese President Aoun reiterates importance of judiciary in securing broader reform

BEIRUT: Former Lebanese Prime Minister Hassan Diab appeared before Judge Tarek Bitar on Friday for questioning related to the devastating Beirut port explosion of Aug. 4, 2020. 

Diab was interrogated for two and a half hours before being remanded for further questions. The session came a week after Bitar questioned former Interior Minister Nohad Machnouk.

In recent weeks, former General Security Chief Maj. Gen. Abbas Ibrahim and former Head of State Security Maj. Gen. Tony Saliba also appeared before the judge.

The explosion devastated the capital’s waterfront, resulted in thousands of casualties, and has been compared in scale to a nuclear bomb.

It prompted widespread outrage both at home and abroad due to the long-term neglect in safely storing large quantities of ammonium nitrate at the port.

Diab, who was prime minister at the time of the explosion, had previously failed to attend hearings into the disaster for various reasons, notably claiming that “the investigative judge lacked jurisdiction to question” him, or stating that he was abroad.

For more than 18 months, several individuals contested their summons, arguing that Bitar was not the appropriate authority to investigate them.

They also initiated lawsuits against Bitar, whose work was suspended for a significant period due to political pressures and legal challenges.

During their unexpected appearances before the investigative judge, these individuals all expressed their intention to cooperate.

In Lebanon, political and judicial powers are intertwined, contrary to the constitution’s separation of powers principle.

The judiciary is mostly subject to political pressure, starting with judicial appointments, as with other institutions and administrations, which hinders reform efforts and the full independence of the judiciary.

A ministerial source told Arab News that President Joseph Aoun had always stressed two key pillars essential for the state’s recovery are security and the judiciary.

“The security appointments have been finalized, and measures are in place to restore security.

“The minister of justice and the High Judicial Council are actively working on judicial appointments to restore processes free from political interference and corruption.

“These procedures have started to affect the justice system, and everyone has begun to understand that the authority of the judiciary is not negotiable; the previously accepted method is no longer valid.”

The source emphasized that gaining political support for the judiciary is essential to shield it from interference.

This should be prioritized, particularly in light of the president’s commitment to maintaining judicial independence.

Additionally, Prime Minister Nawaf Salam is dedicated to implementing the ministerial statement that received unanimous support through the vote of confidence in his government, said the source.

Political authorities are still debating the law on judicial independence, but it remains unapproved and is currently stalled in joint parliamentary committees.

Aoun has previously stressed his belief in the judiciary as a cornerstone of reform.

In a recent meeting with the Bar Association, he noted that the challenge is not the coubtry’s laws themselves, but their implementation and accountability for violations.

“Too often, laws are interpreted for personal gain and interests. By working together, individuals committed to justice and accountability can address imbalances, fight corruption, and promote responsibility,” he said.

“Only the judiciary has the authority to deter offenders and corruption,” the president added.

Currently, the High Judicial Council is investigating bribery cases involving several judges and has issued a preliminary arrest warrant for one of them, who was arrested and transferred to the prison run by the General Directorate of Internal Security Forces.

The council recently set up three bodies to investigate cases against judges.

Lawyer Ghida Frangieh — who represents victims of the Beirut port explosion — told Arab News that the “renewed cooperation between the Public Prosecution and investigative Judge Bitar is a crucial development.

“It will help revive the port explosion case and allow the investigation to continue until an indictment is issued and, ultimately, a trial takes place,” Frangieh said.

“The election of the republic’s president, setting up a functional government instead of a caretaker government, and the political will for reform would collectively help reactivate Lebanon’s judicial system.

“This should have been the scenario in the port investigations three years ago, and all pending judicial cases should now be addressed and resolved in due order,” Frangieh added.

A French delegation is set to arrive in Beirut next Monday, following the transfer of judicial summons from the Public Prosecution at the Court of Cassation in Lebanon to France.

Bitar has requested access to French investigations regarding the port explosion, and the French judiciary has expressed willingness to support the judge by providing all necessary files and documents for his investigation.

Several French nationals were among those killed and injured in the Beirut port explosion.


US says blast near UNESCO world heritage site caused by Houthi missile

A picture shows a view of UNESCO-listed buildings in the old city of the Yemeni capital Sanaa on July 12, 2023. (AFP file photo)
Updated 26 April 2025
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US says blast near UNESCO world heritage site caused by Houthi missile

  • A Houthi official was quoted by the New York Times as saying the American denial was an attempt to smear the Houthis

WASHINGTON: The US military said a blast on Sunday near a UNESCO world heritage site in Yemen’s capital city of Sanaa was caused by a Houthi missile and not an American airstrike.
The Houthi-run Health Ministry said a dozen people were killed in the US strike in a neighborhood of Sanaa. The Old City of Sanaa is a recognized UNESCO World Heritage Site.
The US ordered the intensification of strikes on Yemen last month, with officials saying they will continue assaulting Houthis until they stop attacking Red Sea shipping.
A US Central Command spokesperson said the damage and casualties described by Houthi officials “likely did occur,” but a US attack did not cause them.
The spokesperson said the closest US strike was more than 5 km away that night.
The US military assessed that the damage was caused by a “Houthi air defense missile” based on a review of “local reporting, including videos documenting Arabic writing on the missile’s fragments at the market,” the spokesperson said, adding the Houthis subsequently arrested Yemenis.
A Houthi official was quoted by the New York Times as saying the American denial was an attempt to smear the Houthis.
Recent US strikes have killed dozens, including 74 at an oil terminal on Thursday in what was the deadliest strike in Yemen under Trump so far, according to the local Health Ministry.
The US military says the strikes aim to cut off the Houthi militant group’s military and economic capabilities.
Rights advocates have raised concerns about civilian killings, and three Democratic senators, including Sen. Chris Van Hollen, wrote to Pentagon chief Pete Hegseth on Thursday, demanding an accounting for the loss of civilian lives.
The Houthis have taken control of swaths of Yemen over the past decade.
Since November 2023, they have launched drone and missile attacks on vessels in the Red Sea, saying they were targeting ships linked to Israel.

 


Flow of Sudan war refugees puts Chad camp under strain

Sudanese refugees fill jerry cans with water at the Touloum refugee camp in the Wadi Fira province, Chad, on April 8, 2025. (AFP
Updated 25 April 2025
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Flow of Sudan war refugees puts Chad camp under strain

  • Chad has taken in more than 770,000 of them, according to the UN refugee agency — with many more likely on their way

IRIBA, Chad: Nadjala Mourraou held her haggard two-year-old son in her henna-tattooed hands for the medics to examine. Then came the painful diagnosis: little Ahma, like many of his fellow Sudanese refugees, was severely malnourished.
The pair were toward the front of a long line snaking out of the doctors’ tent at an already overcrowded refugee camp in east Chad, creaking under the strain as more and more people fleeing the civil war across the nearby border with Sudan turn up.
“We’re suffering from a lack of food,” complained the mother, who fled the fighting in Nyala, in Sudan’s South Darfur region, with Ahma more than a year ago.
Since their arrival at the Touloum camp, Mourraou added that all she and Ahma had to eat each day was a bowl of assida, a porridge made from sorghum.
Yet, as with other conditions at the camp, this meagre ration could deteriorate further as the war between the Sudanese army and the paramilitary Rapid Support Forces drags on.
Besides killing tens of thousands, the two-year conflict has uprooted 13 million people, more than three million of whom have fled the country as refugees.
Chad has taken in more than 770,000 of them, according to the UN refugee agency — with many more likely on their way.
Between 25,000 and 30,000 Sudanese refugees already live in the makeshift sheet metal and white canvas tents, packed together across the arid Touloum camp, according to sources.
Recently, more and more of them have become malnourished, said Dessamba Adam Ngarhoudal, a nurse with medical charity Doctors Without Borders, or MSF.
“Out of 100 to 150 daily consultations, nearly half of them deal with cases of malnutrition,” said the 25-year-old medic.
The worst cases are sent to the Iriba district hospital, around half an hour’s drive away.
But the hospital was powerless to stop the first Sudanese infant dying of malnutrition under its care.
“Since the beginning of the month, we have already exceeded the capacity of the malnutrition ward at the hospital,” said MSF nurse Hassan Patayamou recently.
“And we expect admissions to continue to rise as the hot season progresses and temperatures rise above 40 degrees Celsius (104 degrees Fahrenheit).”
With the fighting set to grind on, Chad’s government fears the number of Sudanese refugees in the country could soon reach nearly a million.
That burden would be too heavy for impoverished Chad to bear alone, argues the UN High Commissioner for Refugees.
The refugee agency was seeking $409 million in aid to help the Sahel country — only 14 percent of which it had received by the end of February.
“The Chadian people have a tradition of welcoming their Sudanese brothers in distress,” said Djimbaye Kam-Ndoh, governor of Wadi Fira province where the Touloum camp is located.
“But the province’s population has practically doubled, and we’re asking for major support.”
Humanitarian groups are worried about the impact of US President Donald Trump’s move to freeze America’s foreign aid budget, while other donors, notably in Europe, have also made cuts to their financing.
“Hundreds of thousands of lives are at stake,” Alexandre Le Cuziat, the UN’s World Food Programme deputy director in Chad, said in a phone call.
Nearly 25 million people are suffering from acute food insecurity in Sudan itself, according to the WFP.
And with the rainy season just under two months away, medics fear outbreaks of diseases.
“We’re preparing for an explosion of cases of malnutrition and malaria,” said Samuel Sileshi, emergencies services coordinator for MSF in Central Darfur state.
“This year, we are also facing measles epidemics in Darfur,” he said.
That unhealthy cocktail of diseases, he warned, “could have devastating consequences,” not least for children.