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.”


“She’s not coming back” : Alawite women snatched from streets of Syria

Updated 51 min 20 sec ago
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“She’s not coming back” : Alawite women snatched from streets of Syria

  • Since March, social media has seen a steady stream of messages and video clips posted by families of missing Alawite women appealing for information about them, with new cases cropping up almost daily

DAMASCUS: “Don’t wait for her,” the WhatsApp caller told the family of Abeer Suleiman on May 21, hours after she vanished from the streets of the Syrian town of Safita. “She’s not coming back.”
Suleiman’s kidnapper and another man who identified himself as an intermediary said in subsequent calls and messages that the 29-year-old woman would be killed or trafficked into slavery unless her relatives paid them a ransom of $15,000.
“I am not in Syria,” Suleiman herself told her family in a call on May 29 from the same phone number used by her captor, which had an Iraqi country code. “All the accents around me are strange.”
Reuters reviewed the call, which the family recorded, along with about a dozen calls and messages sent by the abductor and intermediary, who had a Syrian phone number.
Suleiman is among at least 33 women and girls from Syria’s Alawite sect — aged between 16 and 39 — who have been abducted or gone missing this year in the turmoil following the fall of Bashar Assad, according to the families of all them.
The overthrow of the widely feared president in December after 14 years of civil war unleashed a furious backlash against the Muslim minority community to which he belongs, with armed factions affiliated to the current government turning on Alawite civilians in their coastal heartlands in March, killing hundreds of people.
Since March, social media has seen a steady stream of messages and video clips posted by families of missing Alawite women appealing for information about them, with new cases cropping up almost daily, according to a Reuters review which found no online accounts of women from other sects vanishing.
The UN Commission of Inquiry on Syria told Reuters it is investigating the disappearances and alleged abductions of Alawite women following a spike in reports this year. The commission, set up in 2011 to probe rights violations after the civil war broke out, will report to the UN Human Rights Council once the investigations are concluded, a spokesperson said.
Suleiman’s family borrowed from friends and neighbors to scrape together her $15,000 ransom, which they transferred to three money-transfer accounts in the Turkish city of Izmir on May 27 and 28 in 30 transfers ranging from $300 to $700, a close relative told Reuters, sharing the transaction receipts.
Once all money was delivered as instructed, the abductor and intermediary ceased all contact, with their phones turned off, the relative said. Suleiman’s family still have no idea what’s become of her.
Detailed interviews with the families of 16 of the missing women and girls found that seven of them are believed to have been kidnapped, with their relatives receiving demands for ransoms ranging from $1,500 to $100,000. Three of the abductees — including Suleiman — sent their families text or voice messages saying they’d been taken out of the country.
There has been no word on the fate of the other nine. Eight of the 16 missing Alawites are under the age of 18, their families said.
Reuters reviewed about 20 text messages, calls and videos from the abductees and their alleged captors, as well as receipts of some ransom transfers, though it was unable to verify all parts of the families’ accounts or determine who might have targeted the women or their motives.
All 33 women disappeared in the governorates of Tartous, Latakia and Hama, which have large Alawite populations. Nearly half have since returned home, though all of the women and their families declined to comment about the circumstances, with most citing security fears.
Most of the families interviewed by Reuters said they felt police didn’t take their cases seriously when they reported their loved ones missing or abducted, and that authorities failed to investigate thoroughly.
The Syrian government didn’t respond to a request for comment for this article.
Ahmed Mohammed Khair, a media officer for the governor of Tartous, dismissed any suggestion that Alawites were being targeted and said most cases of missing women were down to family disputes or personal reasons rather than abductions, without presenting evidence to support this.
“Women are either forced into marrying someone they won’t want to marry so they run away or sometimes they want to draw attention by disappearing,” he added and warned that “unverified allegations” could create panic and discord and destabilize security.
A media officer for Latakia governorate echoed Khair’s comments, saying that in many cases, women elope with their lovers and families fabricate abduction stories to avoid the social stigma.
The media officer of Hama governorate declined to comment.
A member of a fact-finding committee set up by new Syrian President Ahmed Al-Sharaa to investigate the mass killings of Alawites in coastal areas in March, declined to comment on the cases of missing women.
Al-Sharaa denounced the sectarian bloodshed as a threat to his mission to unite the ravaged nation and has promised to punish those responsible, including those affiliated to the government if necessary.

GRABBED ON HER WAY TO SCHOOL
Syrian rights advocate Yamen Hussein, who has been tracking the disappearances of women this year, said most had taken place in the wake of the March violence. As far as he knew, only Alawites had been targeted and the perpetrators’ identities and motives remain unknown, he said.
He described a widespread feeling of fear among Alawites, who adhere to an offshoot of Shiite Islam and account for about a tenth of Syria’s predominantly Sunni population.
Some women and girls in Tartous, Latakia and Hama are staying away from school or college because they fear being targeted, Hussein said.
“For sure, we have a real issue here where Alawite women are being targeted with abductions,” he added. “Targeting women of the defeated party is a humiliation tactic that was used in the past by the Assad regime.”
Thousands of Alawites have been forced from their homes in Damascus, while many have been dismissed from their jobs and faced harassment at checkpoints from Sunni fighters affiliated to the government.
The interviews with families of missing women showed that most of them vanished in broad daylight, while running errands or traveling on public transport.
Zeinab Ghadir is among the youngest.
The 17-year-old was abducted on her way to school in the Latakia town of Al-Hanadi on February 27, according to a family member who said her suspected kidnapper contacted them by text message to warn them not to post images of the girl online.
“I don’t want to see a single picture or, I swear to God, I will send you her blood,” the man said in a text message sent from the girl’s phone on the same day she disappeared.
The teenage girl made a brief phone call home, saying she didn’t know where she had been taken and that she had stomach pain, before the line cut out, her relative said. The family has no idea what has happened to her.
Khozama Nayef was snatched on March 18 in rural Hama by a group of five men who drugged her to knock her out for a few hours while they spirited her away, a close relative told Reuters, citing the mother-of-five’s own testimony when she was returned.
The 35-year-old spent 15 days in captivity while her abductors negotiated with the family who eventually paid $1,500 dollars to secure her release, according to the family member who said when she returned home she had a mental breakdown.
Days after Nayef was taken, 29-year-old Doaa Abbas was seized on her doorstep by a group of attackers who dragged her into a car waiting outside and sped off, according to a family member who witnessed the abduction in the Hama town of Salhab.
The relative, who didn’t see how many men took Abbas or whether they were armed, said he tried to follow on his motorbike but lost sight of the car.
Three Alawites reported missing by their families on social media this year, who are not included in the 33 cases identified by Reuters, have since resurfaced and publicly denied they were abducted.
One of them, a 16-year-old girl from Latakia, released a video online saying she ran away of her own accord to marry a Sunni man. Her family contradicted her story though, telling Reuters that she had been abducted and forced to marry the man, and that security authorities had ordered her to say she had gone willingly to protect her kidnappers.
Reuters was unable to verify either account. A Syrian government spokesperson and Latakian authorities didn’t respond to queries about it.
The two other Alawites who resurfaced, a 23-year-old woman and a girl of 12, told Arabic TV channels that they had traveled of their own volition to the cities of Aleppo and Damascus, respectively, though the former said she ended up being beaten up by a man in an apartment before escaping.

DARK MEMORIES OF ISLAMIC STATE
Syria’s Alawites dominated the country’s political and military elite for decades under the Assad dynasty. Bashar Assad’s sudden exit in December saw the ascendancy of a new government led by HTS, a Sunni group that emerged from an organization once affiliated to Al-Qaeda. The new government is striving to integrate dozens of former rebel factions, including some foreign fighters, into its security forces to fill a vacuum left after the collapse of Assad’s defense apparatus.
Several of the families of missing women said they and many others in their community dreaded a nightmare scenario where Alawites suffered similar fates to those inflicted on the Yazidi religious minority by Islamic State about a decade ago.
IS, a jihadist Sunni group, forced thousands of Yazidi women into sexual slavery during a reign of terror that saw its commanders claim a caliphate encompassing large parts of Iraq and Syria, according to the UN
A host of dire scenarios are torturing the minds of the family of Nagham Shadi, an Alawite woman who vanished this month, her father told Reuters.
The 23-year-old left their house in the village of al Bayadiyah in Hama on June 2 to buy milk and never came back, Shadi Aisha said, describing an agonizing wait for any word about the fate of his daughter.
Aisha said his family had been forced from their previous home in a nearby village on March 7 during the anti-Alawite violence.
“What do we do? We leave it to God.”


Guardian Council in Iran approves law to end cooperation with nuclear watchdog

Updated 27 June 2025
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Guardian Council in Iran approves law to end cooperation with nuclear watchdog

  • Mystery surrounds whereabouts of Tehran’s stockpile of enriched uranium

TEHRAN: Iran’s powerful Guardian Council on Thursday approved legislation that would suspend Tehran’s cooperation with the UN nuclear watchdog, the International Atomic Energy Agency.

The proposed suspension, which will now be submitted to President Masoud Pezeshkian for final ratification, would “ensure full respect for the national sovereignty and territorial integrity of the Islamic Republic of Iran ... especially with regard to uranium enrichment,” spokesman Hadi Tahan Nazif said.

The watchdog passed a resolution two weeks ago accusing Iran of non-compliance with its nuclear obligations. A suspension of cooperation with the agency would deny UN inspectors access to Iran’s uranium enrichment operations at Fordow, Isfan and Natanz, which were attacked in US bombing raids last Sunday.

Meanwhile confusion continued to surround the location of Iran’s stockpile of about 400 kg of highy enriched uranium. Satellite images from before Sunday’s attacks showed a long line of vehicles outside the Fordow plant. Some experts believe Iran used the convoy to move the uranium and other nuclear components, and is hiding them elsewhere.

However, US President Donald Trump and his Defense Secretary Peter Hegseth both insisted on Thursday that the stockpile at Fordow had been destroyed. “The cars and small trucks at the site were those of concrete workers trying to cover up the top of the shafts. Nothing was taken out,” Trump said. Hegseth said: “I’m not aware of any intelligence that I’ve reviewed that says things were not where they were supposed to be.”


Syrian architect uses drone footage to help rebuild hometown

Updated 26 June 2025
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Syrian architect uses drone footage to help rebuild hometown

TAL MARDIKH, Syria: Syrian architect Abdel Aziz Al-Mohammed could barely recognize his war-ravaged village when he returned after years away. Now, his meticulous documentation of the damage, taken using a drone, helps to facilitate its rebuilding.

“When I first came back, I was shocked by the extent of the destruction,” said Mohammed, 34.

Walking through his devastated village of Tal Mardikh, in Syria’s northwestern Idlib province, he said he could not recognize “anything, I couldn’t even find my parents’ home.”

Nearly half of Tal Mardikh’s 1,500 homes have been destroyed and the rest damaged, mainly due to bombardment by the former Syrian army.

Mohammed, who in 2019 fled the bombardment to near the Turkish border, first returned days after a militant offensive toppled longtime ruler Bashar Assad in December.

The architect, now based in Idlib city, had documented the details of Tal Mardikh’s houses and streets before fleeing and later used his drone to document the destruction.

When he returned, he spent two weeks surveying the area, visiting homes, and creating an interactive map that detailed the conditions of each house. “We entered homes in fear, not knowing what was inside, as the regime controlled the area for five years,” he said.

Under the blazing sun, Mohammed watched as workers restored a house in Tal Mardikh, which adjoins the archeological site of Ebla, the seat of one of the Syrian Arab Republic’s earliest kingdoms.

His documentation of the village helped gain support from Shafak, a nongovernmental organization which agreed to fund the reconstruction and rehabilitation of 434 out of 800 damaged homes in Tal Mardikh.

The work is expected to be completed in August and includes the restoration of two wells and sanitation networks, at a cost exceeding $1 million.


Instagram influencer Motaz Azaiza brings the Gaza story to US

Updated 26 June 2025
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Instagram influencer Motaz Azaiza brings the Gaza story to US

PHILADELPHIA: At a church in Philadelphia, Pennsylvania, hundreds of people gathered recently for a weeknight charity fundraiser hosted by a celebrity guest.

The venue was not announced in advance due to security concerns, and attendance cost at least $60 a pop — with some spending $1,000 to get a photo with the host.

Yet, the event was not a gala hosted by a movie star or famed politician, but by a photojournalist: Gaza native Motaz Azaiza, whose images of the Israeli assault following the Oct. 7, 2023, attack launched him to international recognition.

Wearing a black T-shirt, jeans, sneakers, and gold-framed glasses, the 26-year-old boasts nearly 17 million followers on Instagram for his images from the war in Gaza.

“I wish you had known me without the genocide,” Azaiza told the crowd, his voice faltering.

Before the war, Azaiza was a relatively unknown figure, posting photos from his daily life in Deir Al-Balah, in the central Gaza Strip, to his roughly 25,000 Instagram followers at the time.

But as soon as the first strikes from Israel hit Gaza, he became a war photographer by virtue of circumstance, and his wartime posts soon went viral.

“As a photojournalist, I can’t watch this like anyone else, I’m from there, this is my home,” Azaiza said.

After surviving 108 days of Israeli bombardment, Azaiza managed to escape Gaza via Egypt, and he has since become an ambassador of sorts for the Palestinian territory, sharing the story of his people as the conflict rages on.

“Every time you feel like you regret leaving, but then you lose a friend, you lose a family, you say, OK, I saved my life,” Azaiza said.

Before the war, Azaiza had been hired to manage the online content for the UN Relief and Works Agency for Palestine Refugees in the Near East, or UNRWA, the humanitarian agency accused by Israel of providing cover for militants.

This month, he is touring the US to raise money for UNRWA USA, a nonprofit that collects funding for the agency.

“I can’t handle this much of fame ... it’s a real big responsibility,” Azaiza said from the fundraiser in Philadelphia.

“This is not me ... I’m waiting for the genocide to stop. I want to go back to Gaza, continue my work capturing pictures,” he added.

At one point, he blended into the crowd, posing for a selfie before shaking hands with the donors.

At the fundraiser, a UNRWA USA official solicited donations.

“Is there someone who wants to give $20,000? I would like to have $20,000. Nobody? Is there someone who wants to give $10,000? I would like to have $10,000,” the official calls out.

Once the call lowered to $5,000, five hands raised, and even more went up when asked for donations of $2,000 and $1,000.

One of the donors, Nabeel Sarwar, said Azaiza’s photographs “humanize” the people in Gaza.

“When you see a picture, when you see a child, you relate to that child, you relate to the body language, you relate to the dust on their face, the hunger, the sadness on their face,” Sarwar said.

“I think it’s those pictures that really brought home the real tragedy of what’s going on in Gaza.”

Veronica Murgulescu, a 25-year-old medical student from Philadelphia, concurred.

“I think that people like Motaz and other Gaza journalists have really struck a chord with us, because you can sense the authenticity,” she said.

“The mainstream media that we have here in the US, at least, and in the West, lacks authenticity,” she added.

Sahar Khamis, a communications professor at the University of Maryland who specializes in Arab and Muslim media in the Middle East, said Gazan journalists like Azaiza who have become social media influencers “reshape public opinion, especially among youth, not just in the Arab world, not just in the Middle East, but globally and internationally, including in the US.”

“The visuals are very, very important and very powerful and very compelling ... as we know in journalism, that one picture equals a thousand words.

“And in the case of war and conflict, it can equal a million words, because you can tell through these short videos and short images and photos a lot of things that you cannot say in a whole essay.”


Musk calls Lebanese president as Starlink seeks license

Updated 26 June 2025
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Musk calls Lebanese president as Starlink seeks license

  • Musk called Aoun and “expressed his interest in Lebanon and its telecommunications and Internet sectors“
  • Aoun invited Musk to visit Lebanon

BEIRUT: Billionaire businessman Elon Musk and Lebanese President Joseph Aoun spoke by phone to discuss making elements of Musk’s sprawling business empire available in Lebanon, a statement from Aoun’s office said on Thursday.

The statement said Musk called Aoun and “expressed his interest in Lebanon and its telecommunications and Internet sectors.”

Aoun invited Musk to visit Lebanon and said he was open to having Musk’s companies present in the country, which ranks among the countries with the lowest Internet speeds.

The call came just weeks after Aoun and other top Lebanese officials met with Starlink’s Global Director of Licensing and Development, Sam Turner, in Beirut for talks on providing satellite Internet services in Lebanon. US ambassador Lisa Johnson was pictured attending those meetings.

The negotiations have prompted some pushback in Lebanon. Internet access in the country has so far been operated exclusively by state-owned companies and their affiliates, who are lobbying the government not to license Starlink.

Starlink recently received licenses to operate in India and Lesotho.