How political dysfunction precipitated Lebanon’s healthcare collapse

The damaged Wardieh hospital is pictured in the aftermath of the Beirut blast that tore through Lebanon's capital in August, 2020. (AFP/File Photo)
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Updated 20 February 2022
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How political dysfunction precipitated Lebanon’s healthcare collapse

  • Study says sector is in decay thanks to the problems that led to the 2019 economic collapse
  • International aid community needs to be incentivized to pour resources into the health system

LONDON: Lebanon’s health system is in a precarious state following wave upon wave of political and economic crisis. As the country reels from medical supply shortages, COVID-19 case surges and an exodus of skilled medical professionals, the urgency of the sector’s need for outside help is no longer a matter of debate.

In most countries, it might seem reasonable to look to the government to implement reforms to rescue the health system from collapse. But in Lebanon, where it is arguably politics itself that is making the nation sick, the embattled state is unlikely to offer solutions.

A new study led by King’s College London and the American University of Beirut suggests Lebanon’s health system is in decline thanks in large part to the same disastrous political decisions and systemic problems that led to the country’s 2019 economic collapse.

The study, “How politics made a nation sick,” conducted by the Research for Health in Conflict–MENA project (R4HC-MENA), shows how a series of politically driven disasters has created a crisis state that is unprepared to deal with a deepening public-health emergency.

Dr. Adam Coutts, one of the R4HC-MENA project leads, describes the health situation in Lebanon as “a slow moving trainwreck, which sped up in the pre-pandemic period when the economy collapsed in 2019.”

Ever since the end of Lebanon’s civil war in 1990, sectarianism, clientelism and corruption have dominated political life and driven the country into successive bouts of unrest and instability.

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

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.




Protesting pharmacists (above) hold signs saying “no gasoline = no ambulance,” denouncing the critical condition facing the country’s hospitals while grappling with dire fuel shortages. (AFP)

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

“The social and economic situation in Lebanon right now is dire,” said Dr. Coutts. “We have been working on health, economic and social issues in Lebanon for ten years and have never seen it this bad.”

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

Furthermore, patients have been left 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 registered doctors and 16,800 registered nurses have emigrated since the onset of the crisis.

To make matters worse, Lebanon’s chronic 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 perennially in short supply.

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

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

The COVID-19 pandemic arrived at the worst possible moment for Lebanon, further exposing the health system’s weakness and placing additional strain on the country’s battered economy.




A combination of images showing shuttered doors of pharmacies in Lebanon during a nationwide strike to protest against a severe shortage of medicine during 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 top concern among people. It’s the street-level issue which affects everything in people’s day-to-day lives. Development needs to be about lives and livelihoods.”

While COVID-19 infections are currently falling in Lebanon, successive waves of the virus have exacted a devastating toll on Lebanon’s health system. In December 2020, for instance, about 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 overwhelmed hospital capacity and resources, exacerbating shortage of staff, to say nothing of equipment such as ventilators and pharmaceuticals.

“Many private hospitals were reluctant to undertake COVID-19 care for fear of ‘losing’ income from more lucrative services, losing their physician and nursing staff, and lack of trust that they would actually be reimbursed by the government,” Dr. Fouad M. Fouad, R4HC-MENA project lead in Beirut, told Arab News.

Just when it seemed things could not get any worse for Lebanon’s health sector, the Beirut port blast of Aug. 4, 2020 leveled a whole city district.




The damaged Saint George hospital (left) in Beirut more than a week after the port blast of Aug. 4, 2020. Some 43,000 Lebanese emigrated in the first 12 days after the explosion, including skilled workers such as medical staff. (AFP/File Photo)

More than 220 people were killed in the blast, about 7,000 injured, and some 300,000 left homeless. Within hours of the explosion, people began to pour into the city’s hospitals with all kinds of trauma, disfiguring burns and wounds caused by flying glass and masonry.

However, the blast also shattered the city’s health infrastructure. According to a WHO assessment, four hospitals were heavily affected and 20 primary care facilities, serving about 160,000 patients, were either damaged or destroyed.

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

“It also caused many patients to miss routine care for a variety of conditions, including critical care therapy such as cancer treatments, with many having to move to other hospitals, which led 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 impacts of the blast have only now started to become apparent, with survivors experiencing anxiety, depression and post-traumatic stress disorder.

Embrace, a mental health awareness NGO in Lebanon, surveyed about 1,000 people aged 18 to 65-plus in the first 10 days after the blast. It found that 83 percent of respondents reported feeling sad almost every day, while 78 percent reported feeling very anxious and worried every day.

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

R4HC-MENA outlined several recommendations to help Lebanon salvage its health system. “The first thing that needs to happen is that clear political commitments are given to securing the health and wellbeing of the Lebanese and refugees,” said Dr. Fouad.




Despite the severity of the health care emergency, the Lebanese government has been unable to respond, lacking both the financial means and the willpower amid a multitude of overlapping crises. (AFP/File Photo)

“A new social contract needs to be created. Just signing a WHO declaration on Universal Health Care is not enough.”

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

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

“If that is not state failure, then state failure needs redefining.”


‘What wrong did he do?’ Gaza family mourn three-year-old shot dead

Updated 4 sec ago
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‘What wrong did he do?’ Gaza family mourn three-year-old shot dead

  • “There’s no hope or peace.”

KHAN YUNIS, Palestinian Territories: Gazan mother Amal Abu Shalouf ran her hand over her son’s face and hair, a brief farewell before a man abruptly sealed the body bag carrying the three-year-old who was killed just hours earlier on Tuesday.
“Amir, my love, my dear!” cried his mother, struggling to cross the crowded courtyard of Nasser Hospital in Khan Yunis, southern Gaza’s main city, where several bodies lay in white plastic shrouds.
According to the civil defense agency, at least nine people were killed on Tuesday in the southern Gaza Strip as Israeli forces carried out military operations, more than 20 months into the war triggered by Hamas’s 2023 attack on Israel.
Contacted by AFP, the military did not respond to a request for comment about Amir Abu Shalouf’s death.
At the hospital, a man carried the boy’s body in his arms through a crowd of dozens of mourners.
“I swear, I can’t take it,” his teenage brother, Ahmad Abu Shalouf, said, his face covered in tears.
“What wrong did he do?” said another brother, Mohammad Abu Shalouf. “An innocent little boy, sitting inside his tent, and a bullet struck him in the back.”
Mohammad said he had “found him shot in the back” as he returned to the tent that has become the family’s home in Al-Mawasi, a coastal area near Khan Yunis that is now a massive encampment for displaced Palestinians.
The devastating war has created dire humanitarian conditions in Gaza, where the United Nations has warned that the entire population is at risk of famine.
The grieving mother, comforted by relatives, said her young son had been begging for food in recent days and dreaming of a piece of meat.
“There is no food, no water, no clothing,” said Amal, who has eight children to take care of.
Amal said she too was injured in the pre-dawn incident that killed her son.
“I heard something fall next to my foot while I was sitting and baking, and suddenly felt something hit me. I started screaming,” she said.
Outside the tent at the time, she said she tried crawling and reaching for other family members.
“Then I heard my daughter screaming from inside the tent...  found them holding my son, his abdomen and back covered in blood.”
A group of men formed lines to recite a prayer for the dead, their words almost drowned out by the noise of Israeli drones flying overhead.
In the second row, Ahmad Abu Shalouf held his hands over his stomach in prayer, unable to hold back a stream of tears.
Similar scenes played out at the hospital courtyard again and again over several hours, as the day’s dead were mourned.
At one point, an emaciated man collapsed in front of the shrouded bodies.
One mourner pressed his head against one of the bodies, carried on a stretcher at the start of a funeral procession, before being helped up by others.
At a distance, a group of women supported Umm Mohammad Shahwan, a grieving mother, with all of them in tears.
“We need the war to end,” said Amal Abu Shalouf.
In Gaza, she lamented, “there’s no hope or peace.”


Syria rescuers say two killed in drone strikes on northwest

Updated 15 min 53 sec ago
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Syria rescuers say two killed in drone strikes on northwest

  • During a meeting in Riyadh last month, US President Donald Trump called on his Syrian counterpart Ahmed Al-Sharaa to help Washington prevent a resurgence by Daesh

DAMASCUS: Two people were killed in separate drone strikes Tuesday on a car and a motorcycle in the northwestern bastion of the Islamist former rebels who now head the Syrian government, rescuers said.
There was no immediate claim of responsibility for the twin drone strikes in the Idlib region but a US-led coalition in Syria has carried out past strikes on terrorists in the area.
Earlier this year, the United States said it killed several commanders of Al-Qaeda’s Syria affiliate Hurras Al-Din in the area.
The group had recently announced it was breaking up on the orders of the interim government set up by the rebels after their overthrow of Bashar Assad in December.
US troops are deployed in Syria as part of a US-led coalition to fight the Daesh group.
When contacted by AFP, a US defense official said they were aware of the reports but had “nothing to provide” at the time.
During a meeting in Riyadh last month, US President Donald Trump called on his Syrian counterpart Ahmed Al-Sharaa to help Washington prevent a resurgence by Daesh.
 

 


Gaza-bound activist convoy enters Libya from Tunisia

Updated 47 min 29 sec ago
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Gaza-bound activist convoy enters Libya from Tunisia

  • Convoy members were heard chanting “Resistance, resistance” and “To Gaza we go by the millions” in a video posted on the organizing group’s official Facebook page

BEN GUERDANE, Tunisia: Hundreds of pro-Palestinian activists taking part in a convoy crossed the Tunisian border on Tuesday into Libya, aiming to keep heading eastwards until they break Israel’s blockade on the Palestinian territory, organizers said.
This comes after Israel intercepted an aid ship attempting to breach its blockade on Gaza, which was carrying 12 people, including campaigner Greta Thunberg and European parliament member Franco-Palestinian Rima Hassan.
The “Soumoud” convoy, meaning “steadfastness” in Arabic, set off from Tunis on Monday morning, spokesman Ghassen Henchiri told Tunisian radio station Mosaique FM.
He said it includes 14 buses and around 100 other vehicles, carrying hundreds of people.
Convoy members were heard chanting “Resistance, resistance” and “To Gaza we go by the millions” in a video posted on the organizing group’s official Facebook page.
Henchiri also told Jawhara FM radio channel the convoy plans to remain in Libya for “three or four days at most” before crossing into Egypt and continuing on to Rafah.
Organizers have said Egyptian authorities have not yet provided passage to enter the country, but Henchiri said the convoy received “reassuring” information.
Organizers said the convoy was not bringing aid into Gaza, but rather aimed at carrying out a “symbolic act” by breaking the blockade on the territory described by the United Nations as “the hungriest place on Earth.”
Algerian, Mauritanian, Moroccan and Libyan activists were also among the group, which is set to travel along the Libyan coast.
After 21 months of war, Israel is facing mounting international pressure to allow more aid into Gaza to alleviate widespread shortages of food and basic supplies.
The Madleen aid boat, which set sail for Gaza from Italy on June 1, was halted by Israeli forces on Monday and towed to the port of Ashdod.
The 12 people on board were then transferred to Ben Gurion Airport near Tel Aviv, the foreign ministry said, adding that Thunberg had been deported.
Five French activists were taken into custody after they refused to leave Israel voluntarily.
 

 


Algeria man’s self-immolation investigated as ‘terrorism’

A general view shows the Justice Ministry in the Algerian capital, Algiers. (AFP file photo)
Updated 53 min 45 sec ago
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Algeria man’s self-immolation investigated as ‘terrorism’

  • The charges include “endangering the lives and physical safety of others” and “publishing and promoting false and malicious news”

ALGIERS: Algerian authorities have launched a counterterrorism investigation after a man had set himself on fire, an act investigators suspect was part of coordinated plot with links abroad, prosecutors said Tuesday.
Faouzi Zegout was injured as a result of the self-immolation on June 1 outside the justice ministry to protest a case he was involved in.
A video of the incident in the capital Algiers circulated on social media, showing Zegout saying he had done it “because of a judge... who arbitrarily threatened me with a 10-year prison sentence.”
At an Algiers court on Tuesday, a prosecutor said that five people had been detained in the case, without specifying whether Zegout was one of them.
One of the five has been released under judicial supervision, and the case has been transferred to a counterterrorism division, the court heard.
According to the prosecutor, investigators had found that the act was orchestrated by an “organized criminal group” with suspected ties abroad.
The prosecutor said the group had allegedly plotted the act and assigned roles, including filming and publishing the self-immolation online, to “disturb public order and disrupt institutions.”
The charges include “endangering the lives and physical safety of others” and “publishing and promoting false and malicious news.”
The person who filmed the incident had “communicated with people abroad,” had “multiple bank accounts” and “received money transfers from people,” the prosecutor said, without specifying when the alleged transfers had occurred or who made them.
Zegout has said that he recently appeared in court for launching a fundraiser without official authorization to help cover medical costs for sick people.
A court in Frenda, his hometown about 340 kilometers (200 miles) west of Algiers, was scheduled to deliver its decision the same day he set himself on fire.
 


Israel cancels waiver allowing Israeli and Palestinian banks to work together

Updated 10 June 2025
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Israel cancels waiver allowing Israeli and Palestinian banks to work together

JERUSALEM: Israel canceled a waiver on Tuesday that had allowed Israeli banks to work with Palestinian ones, threatening to paralyze Palestinian financial institutions, Israel’s finance ministry said in a statement.
“Against the backdrop of the Palestinian Authority’s delegitimization campaign against the State of Israel internationally, Finance Minister Bezalel Smotrich has instructed Accountant General CPA Yahli Rotenberg to cancel the indemnity provided to correspondent banks dealing with banks operating in Palestinian Authority territories,” the ministry said.
Smotrich had threatened in May 2024 to cut the vital connection between Israel and Palestinian banks in the occupied West Bank in retaliation for the recognition of the State of Palestine by three European countries.
The Palestinian financial and banking system is dependent on the regular renewal of the Israeli waiver.
It protects Israeli banks from potential legal action relating to transactions with their Palestinian counterparts, for instance in relation to financing terror.
In July, G7 countries urged Israel to “take necessary action” to ensure the continuity of Palestinian financial systems.
It came after US Treasury Secretary Janet Yellen warned that “to cut Palestinian banks from Israeli counterparts would create a humanitarian crisis.”
The overwhelming majority of exchanges in the West Bank are in shekels, Israel’s national currency, because the Palestinian Authority does not have a central bank that would allow it to print its own currency.