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.”


Palestinian teenager with US citizenship shot dead by Israeli settler, Palestinian officials say

Updated 16 sec ago
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Palestinian teenager with US citizenship shot dead by Israeli settler, Palestinian officials say

  • Settler violence in the West Bank, including incursions into occupied territory and raids on Bedouin villages and encampments, has intensified since the Gaza war began in October 2023

RAMALLAH: A Palestinian teenager with US citizenship was killed after being shot by an Israeli settler in the West Bank town of Turmus Ayya, Palestinian officials said on Sunday, as tensions continue to escalate amid a surge in settler violence and near-daily confrontations between Israeli settlers and Palestinians across the occupied territory.
Omar Mohammad Rabea, 14, was shot along with two other teenagers by an Israeli settler at the entrance to Turmus Ayya, the town’s mayor, Adeeb Lafi, told Reuters.
“Two of them were transported by ambulance to a nearby medical center and then to the hospital. The army arrived at the scene and detained the third injured boy, who is 14 years old and holds US citizenship,” Lafi said.
The army later pronounced Rabea dead and is still holding his body, Lafi added. The Palestinian health ministry confirmed his death, saying he was killed by “occupation forces.”
There was no immediate comment from the Israeli army.
Settler violence in the West Bank, including incursions into occupied territory and raids on Bedouin villages and encampments, has intensified since the Gaza war began in October 2023.
European countries and the previous US administration under President Joe Biden imposed sanctions on violent Israeli settlers, though the White House under President Donald Trump removed these sanctions.

 


Syria’s president to visit Turkiye and UAE next week

Updated 12 min 6 sec ago
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Syria’s president to visit Turkiye and UAE next week

  • Sharaa and other members of the new Syrian leadership have been working to strengthen ties with both Arab and Western leaders following the fall of Bashar Assad in a lightning offensive in December, led by Sharaa’s group, Hayat Tahrir Al-Sham

BEIRUT: Syria’s President Ahmed Al-Sharaa will make his first visit to the United Arab Emirates and is also scheduled to visit Turkiye next week, the Syrian foreign ministry said in a statement on Sunday, as he continues to garner support for the new administration.
Sharaa, who previously visited Turkiye in February, will make the UAE his second Gulf destination after traveling to
Saudi Arabia that same month on his first foreign trip since assuming the presidency in January.
He and other members of the new Syrian leadership have been working to strengthen ties with both Arab and Western leaders following the fall of Bashar Assad in a lightning offensive in December, led by Sharaa’s Sunni Islamist group, Hayat Tahrir Al-Sham.
Sharaa and his officials have also called for a full lifting of sanctions on Syria.
Syria is in desperate need of sanctions relief to kick start an economy collapsed by nearly 14 years of war, during which the United States, the UK and Europe placed tough sanctions on people, businesses and whole sectors of Syria’s economy in a bid to squeeze now-ousted leader Assad.

 


Moroccans protest Israel’s offensive in Gaza and take aim at Trump

Updated 22 min 11 sec ago
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Moroccans protest Israel’s offensive in Gaza and take aim at Trump

  • Moroccan authorities tolerate most protests, but have arrested some activists who have rallied in front of businesses or foreign embassies or implicated the monarchy in their complaints
  • More than 50,000 Palestinians have been killed as part of Israel’s offensive, according to Gaza’s Health Ministry, which doesn’t say whether those killed are civilians or combatants

RABAT, Morocco: Tens of thousands of Moroccans on Sunday protested Israel’s latest offensive in Gaza, putting fury toward US President Donald Trump near the center of their grievances.
In the largest protest Morocco has seen in months, demonstrators denounced Israel, the United States and their own government. Some stepped on Israeli flags, held banners showing slain Hamas leaders and waved posters juxtaposing Trump alongside displaced Palestinians fleeing their homes.
Organizers condemned Israel’s ongoing military operation in Gaza. Hundreds of Palestinians have been killed since Israel renewed air and ground strikes last month, aimed at pressuring Hamas to release remaining hostages.

Women lift a banner during a national march in support of Palestinians and against Morocco's normalisation of ties with Israel, in the capital Rabat on April 6, 2025. (AFP)

Such protests have erupted across the Middle East and North Africa, where leaders typically worry about demonstrations undermining domestic stability. Pro-Palestinian rallies were also staged this weekend in the capitals of Tunisia and Yemen as well as in Morocco’s most populous city Casablanca.
In countries that have historically aligned with the US, anti-Trump backlash has emerged as a theme. Demonstrators in Rabat on Sunday condemned his proposal to displace millions of Palestinians to make way for the redevelopment of Gaza. as well as the US efforts to pursue pro-Palestinian activists.
Still, many Moroccans said they saw Trump’s policies as mostly consistent with his predecessor, Joe Biden’s.
“(Trump) has made the war worse,” said Mohammed Toussi, who traveled from Casablanca with his family to protest.
“Biden hid some things but Trump has shown it all,” he added, likening their positions but not their messaging.
Protesters, Toussi said, remain angry about Morocco’s 2020 decision to normalize ties with Israel.
Abdelhak El Arabi, an adviser to Morocco’s former Islamist prime minister, said the reasons Moroccans were protesting had grown throughout the war. He predicted popular anger would continue until the war ends.
“It’s not a war, Gaza is getting erased from the earth,” the 62-year-old Tamesna resident said.
Demonstrations have included a range of groups, including the Islamist association al Adl Wal Ihsan. Moroccan authorities tolerate most protests, but have arrested some activists who have rallied in front of businesses or foreign embassies or implicated the monarchy in their complaints.
The war began when Hamas-led militants attacked southern Israel on Oct. 7, 2023, killing around 1,200 people, mostly civilians, and taking 251 hostages. Most have since been released in ceasefire agreements and other deals. More than 50,000 Palestinians have been killed as part of Israel’s offensive, according to Gaza’s Health Ministry, which doesn’t say whether those killed are civilians or combatants. The war has left most of Gaza in ruins, and at its height displaced around 90 percent of the population.

 


Sudan activists sound alarm on ‘catastrophic’ situation in besieged Darfur city

Updated 06 April 2025
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Sudan activists sound alarm on ‘catastrophic’ situation in besieged Darfur city

  • According to UN estimates, around two million people face extreme food insecurity in North Darfur state, with 320,000 already suffering famine conditions

KHARTOUM: Civilians trapped in Sudan’s El-Fasher city are facing “catastrophic” conditions, activists warned on Sunday, with their situation rapidly deteriorating amid a months-long paramilitary siege.
The paramilitary Rapid Support Forces have taken most of the vast Darfur region in their war against the regular army since April 2023, but El-Fasher in North Darfur remains the only regional state capital the RSF has not conquered.
A local advocacy group, the Darfur General Coordination of Camps for the Displaced and Refugees, said in a statement that residents “bear the brunt of artillery shelling” and live “with the sounds of aircraft and their terrifying and deadly missiles, in addition to the daily suffering of hunger, disease and drought.”
Life in El-Fasher and other areas of Darfur “has come to a complete standstill,” the group said, with no food at markets and a “complete halt” in humanitarian aid.
There was a sharp rise in prices of basic commodities and “a severe shortage in cash,” it added, warning of an “unprecedented and catastrophic deterioration” in already dire conditions in and around El-Fasher.
The RSF-aligned armed group Sudan Liberation Army called on Saturday for civilians in El-Fasher and the nearby displacement camps of Abu Shouk and Zamzan to leave, warning of an “escalation of military operations.”
Another RSF ally, the Gathering of Sudan Liberation Forces, said it was ready to “provide safe corridors” for residents to leave and head to “liberated areas” under paramilitary control.
In late March, the RSF announced its fighters had seized Al-Malha, which lies at the foot of a mountainous region 200 kilometers (124 miles) northeast of El-Fasher.
Al-Malha is one of the northernmost towns in the vast desert region between Sudan and Libya, where the RSF’s critical resupply lines have come under increasing attack in recent months by army-allied groups.
The war has created what the United Nations describes as the world’s worst hunger and displacement crises. More than 12 million people have been uprooted, tens of thousands killed and a UN-backed assessment declared famine in parts of the country.
According to UN estimates, around two million people face extreme food insecurity in North Darfur state, with 320,000 already suffering famine conditions.
Zamzam is one of three displacement camps around El-Fasher hit by famine, which a UN-backed assessment says is expected to spread to five more areas including the state capital itself by May.


Israeli strikes on Gaza kill 32, mostly women and children

Updated 06 April 2025
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Israeli strikes on Gaza kill 32, mostly women and children

  • The latest Israeli strikes overnight into Sunday hit a tent and a house in the southern city of Khan Younis, killing five men, five women and five children, according to Nasser Hospital, which received the bodies

DEIR AL-BALAH, Gaza Strip: Israeli strikes on the Gaza Strip killed at least 32 people, including over a dozen women and children, local health officials said Sunday, as Israeli Prime Minister Benjamin Netanyahu headed to the United States to meet with President Donald Trump about the war.
Israel last month ended its ceasefire with Hamas and renewed its air and ground offensive, carrying out waves of strikes and seizing territory to pressure the militant group to accept a new deal for a truce and release of remaining hostages. It has also blocked the import of food, fuel and humanitarian aid for over a month to the coastal territory heavily reliant on outside assistance.
“Stocks are getting low and the situation is becoming desperate,” the United Nations agency for Palestinian refugees said on social media.
The latest Israeli strikes overnight into Sunday hit a tent and a house in the southern city of Khan Younis, killing five men, five women and five children, according to Nasser Hospital, which received the bodies.
A female journalist was among those killed. “My daughter is innocent. She had no involvement, she loved journalism and adored it,” said her mother, Amal Kaskeen.
The body of one child, under 2 years old, took up just one end of an emergency stretcher.
“Trump wants to end the Gaza issue. He is in a hurry, and that is clear from this morning,” said Mohammad Abdel-Hadi, cousin of a woman killed.
Israeli shelling killed at least four people in the Jabaliya refugee camp in northern Gaza, according to Gaza’s Health Ministry. The bodies of seven people, including a child and three women, arrived at Al-Aqsa Martyrs Hospital in Deir Al-Balah in central Gaza, according to an Associated Press journalist there.
And a strike in Gaza City hit people waiting outside a bakery and killed at least six, including three children, according to the civil defense, which operates under the Hamas-run government.
Israel’s military said about 10 projectiles were fired from Gaza and most were intercepted, in the largest barrage from the territory since Israel resumed the war. Hamas’ military arm claimed responsibility. Israeli police said some fragments fell in Ashkelon city. There were no reports of injuries.
Netanyahu visits Trump amid anti-war protests
Dozens of Palestinians took to the streets in Jabaliya for a new round of anti-war protests. Footage circulating on social media showed people marching and chanting against Hamas. Such protests, while rare, have occurred in recent weeks.
There is also anger inside Israel over the war’s resumption and its effects on remaining hostages in Gaza. Families of hostages along with some of those recently freed from Gaza and their supporters on Saturday urged Trump to help ensure the fighting ends.
Netanyahu on Monday will meet with Trump for the second time since Trump began his latest term in January. The prime minister said they would discuss the war and the new 17 percent tariff imposed on Israel, part of a sweeping global decision by the new US administration.
“There is a very large queue of leaders who want to do this with respect to their economies. I think it reflects the special personal connection and the special connection between the United States and Israel, which is so vital at this time,” Netanyahu said while wrapping up a visit to Hungary.
The US, a mediator in ceasefire efforts along with Egypt and Qatar, expressed support for Israel’s resumption of the war last month.
The toll of war
Hundreds of Palestinians since then have been killed, among them 15 medics whose bodies were recovered only a week later. Israel’s military this weekend backtracked on its account of what happened in the incident, captured in part on video, that caused anger by Red Cross and Red Crescent and UN officials.
The war began when Hamas-led militants attacked Israel on Oct. 7, 2023, killing some 1,200 people and taking 251 hostage. Fifty-nine hostages are still held in Gaza — 24 believed to be alive — after most of the rest were released in ceasefires or other deals.
Israel’s offensive has killed at least 50,695 Palestinians, according to Gaza’s Health Ministry, which does not say how many were civilians or combatants but says more than half were women and children. It says another 115,338 people have been wounded. Israel says it has killed around 20,000 militants, without providing evidence.