How political dysfunction precipitated Lebanon’s healthcare collapse

Special 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)
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

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)
  • 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.”


Arab foreign ministers pledge support for Lebanon’s IMF negotiations and reform process

Arab foreign ministers pledge support for Lebanon’s IMF negotiations and reform process
Updated 02 July 2022

Arab foreign ministers pledge support for Lebanon’s IMF negotiations and reform process

Arab foreign ministers pledge support for Lebanon’s IMF negotiations and reform process
  • Arab League representatives also discussed the Ukrainian war, food and energy
  • The meeting will prepare for the Arab summit to be held in Algeria in October

BEIRUT: Arab foreign ministers on Saturday pledged their support for Lebanon’s IMF negotiations and reform process, following an Arab League meeting held in Beirut.

They said their presence in Lebanon amid its “significantly difficult” economic and political circumstances signaled that Arab countries supported stability and stood by the country’s negotiations with the IMF and the reform process.

Arab League secretary-general Ahmed Aboul Gheit said: “We came to say that there’s a problem and you must seek to resolve it.”

He told a press conference that the meeting had discussed the preparations, timing, and attendees of the upcoming Arab League summit.

“We just held some discussions and exchanged views to be decided upon in the appropriate place. We also went over the Ukrainian war, food, energy, and the topic of Somalia, where millions of Somalis might be at risk of starvation.

“We also discussed the Palestinian cause amid the American-Israeli moves and how we react to these events. We did not agree on anything because they are mere discussions that we will not reveal.

“Everyone supports ending the pressure of Syrian refugees. The Lebanese state provides them with care but, when decisions similar to agreeing on their return to their country are taken, some specific circumstances should be present.”

He said there was a civil war going on in Syria and “huge” destruction.

“At least $500 million is needed to rehabilitate the Syrian infrastructure,” he added. “These are very complex issues that cannot be resolved with a simple decision. But the international community has the will to end the Syrian war and is still exerting pressure when it comes to the matter of refugees in Lebanon, Jordan, and other countries.”

Lebanon, which was represented by caretaker Foreign Affairs Minister Abdallah Bou Habib, chaired the ministerial meeting.

Algeria will host the Arab League summit in early November after it was postponed in 2020 and 2021 due to COVID-19 lockdowns.

Saturday’s meeting was attended by the foreign ministers of Kuwait, Yemen, Jordan, Qatar, Tunisia, Algeria, the Comoro Islands, Sudan, Somalia, Palestine, the deputy foreign minister of Egypt, and the league’s permanent representatives from Saudi Arabia, the UAE, Djibouti, Iraq, Morocco, Oman, Libya, a representative from Mauritania, and the Bahraini ambassador to Syria.

The Arab ministerial delegation met Lebanese President Michel Aoun, who expressed the importance of regional relations in the “critical circumstances the Arab world is going through, the challenges it is facing, and that requires the utmost consultation and cooperation.”

He talked about the crises facing Lebanon and the burden of Syrian refugees in the country which, he said, was “no longer capable of handling this reality.”

“We seek to reach an agreement with the IMF. There’s an American mediation to demarcate the southern maritime borders of Lebanon,” he said, adding that Lebanon retained its water, oil, and gas resources.

Responding to media questions about revoking the suspension of Syria’s Arab League membership, Algerian Foreign Minister Ramtane Lamamra said: “We didn’t support its membership suspension because Syria is a founding member of the league. The Syrian foreign minister will visit Algeria and we will go over this point with a high sense of responsibility.”

The Arab ministerial delegation also met Lebanese Parliament Speaker Nabih Berri, who said Lebanon was now requesting that its “Arab brothers come and get to the core of its suffering.”

He told his guests that the indirect negotiations between Lebanon and Israel, with US mediation, to demarcate the maritime borders in preparation for gas extraction were advancing.

Prime Minister-designate Najib Mikati met the delegations on Friday night.

He reiterated Lebanon’s commitment to implementing all the resolutions from the UN Security Council and the Arab League in a way that reinforced the dissociation policy toward any Arab dispute, extending the state’s sovereignty over all its territory, and preventing offense to any Arab state and threats to its security.

Aboul Gheit received a political letter from the Sovereign Front for Lebanon opposing Hezbollah and Iran’s role in Lebanon.

The letter demanded “the activation of Lebanon’s right to be free from the Iranian dominance that uses Lebanon and its territories as a platform to conduct hostilities, putting the country in danger and exposing it to attacks from all sides.”   

It highlighted “the persistence of illegal weaponry represented by Hezbollah’s organized armed militia, which receives support, orders, and funding from Iran.”


Houthis criticized over refusal to open main roads in Yemeni city of Taiz

Houthis criticized over refusal to open main roads in Yemeni city of Taiz
Updated 02 July 2022

Houthis criticized over refusal to open main roads in Yemeni city of Taiz

Houthis criticized over refusal to open main roads in Yemeni city of Taiz
  • Last month on June 6, UN Yemen envoy Hans Grundberg proposed opening a main road linking Taiz with other provinces
  • The government previously insisted on a complete lifting of the siege

AL-MUKALLA: Yemen will not begin discussing other issues with the Houthis under a UN-brokered truce until the militia accepts a proposal to open roads in Taiz, a government official has told Arab News.
Last month on June 6, UN Yemen envoy Hans Grundberg proposed opening a main road linking Taiz with other provinces that would partially ease the Houthi siege on the city, with the aim of resolving stalled negotiations between the two sides.
The government previously insisted on a complete lifting of the siege but accepted the proposal as long as other roads opened during subsequent rounds of talks.
But the Houthis rejected Grundberg’s proposal, dealing a blow to the talks and the truce that has by and large been holding since April 2.
“We will not accept discussing other issues or offer more concessions before they agree to the UN envoy’s proposal,” the Yemeni government official said anonymously because he was not authorized to brief reporters. “We have not received any invitation (from the UN envoy) to take part in a new round of discussion on the Taiz file.”
The Houthis alternatively proposed opening an old, rough road connecting Taiz with the countryside.
Taiz residents and local government officials told Arab News that the proposed road was narrow, unpaved, and had been abandoned for over six decades.
The head of the Houthi delegation to the talks, Yahiya Abdullah Al-Razami, said on Friday that the movement would unilaterally open the old road, claiming it had not pledged to open main roads in Taiz when it signed the truce.
“This is not true. The Houthis signed the elements of the truce that include Sanaa airport, Hodeidah port, and opening roads in Taiz,” the government official said.
The Yemeni army has accused the Houthis of breaking the truce more than 100 times last week in Hodeidah, Taiz, Hajjah, Saada, Jouf, and Marib, and killing a soldier and wounding four more.
In Taiz, the army on Saturday said it had shot down a small explosives-rigged drone sent by the Houthis to government-controlled areas north of the city.
The Houthis have been laying siege to Taiz for the past seven years, having failed to take control of it due to resistance from government troops.
Yemeni and Western diplomats have criticized the Houthis for refusing to lift their siege and called on the movement to respond positively to peace efforts.
“The UN calls for access around Yemen’s third-largest city, Taiz. The Houthis must find a way to compromise on the UN proposal so we can move forward to broader issues important to Yemenis,” US Yemen envoy Tim Lenderking told France 24 Arabic TV on Friday.
Yemeni Foreign Minister Ahmed Awadh bin Mubarak warned that the Houthis’ unwillingness and delays in opening roads in Taiz would jeopardize the truce.
He said his government had accepted the UN proposal on Taiz as it was a test of the militia’s motivations for making peace and ending the war.
“Lifting the siege is one of the main elements of the truce. We affirm our keenness to respect the truce and treat it as a space of hope and a window for peace. But the continued intransigence of the Houthi militia threatens the truce very seriously,” he told Lebanon’s Annahar Al-Arabi news website.


UN condemns protesters’ storming of Libya’s parliament

UN condemns protesters’ storming of Libya’s parliament
Updated 02 July 2022

UN condemns protesters’ storming of Libya’s parliament

UN condemns protesters’ storming of Libya’s parliament
  • The UN’s top Libya envoy Stephanie Williams says ‘riots and acts of vandalism’ were ‘totally unacceptable’
  • Libyan protesters say they will keep demonstrating until all the ruling elites quit power

CAIRO/TRIPOLI: A senior UN official for Libya on Saturday condemned the storming of the parliament’s headquarters by angry demonstrators as part of protests in several cities against the political class and deteriorating economic conditions.
Hundreds of protesters marched in the streets of the capital, Tripoli, and other Libyan cities on Friday, with many attacking and setting fire to government buildings, including the House of Representatives in the eastern city of Tobruk.
“The people’s right to peacefully protest should be respected and protected but riots and acts of vandalism such as the storming of the House of Representatives headquarters late yesterday in Tobruk are totally unacceptable,” said Stephanie Williams, the UN special adviser on Libya, on Twitter.
Libyans, many impoverished after a decade of turmoil and sweltering in the soaring summer heat, have been enduring power cuts of up to 18 hours a day, fuel shortages, and crumbling services and infrastructure, even as their country sits atop Africa’s largest proven oil reserves.
In both the main eastern city of Benghazi — the cradle of the 2011 uprising — and the capital Tripoli, thousands took to the streets to chants of “We want the lights to work.”
Friday’s protests came a day after the leaders of the parliament and another legislative chamber based in Tripoli failed to reach an agreement on elections during UN-mediated talks in Geneva. The dispute now centers on the eligibility requirements for candidates, according to the UN.
Libya failed to hold elections in December, following challenges such as legal disputes, controversial presidential hopefuls and the presence of rogue militias and foreign fighters in the country.
The failure to hold the vote was a major below to international efforts to bring peace to the Mediterranean nation. It has opened a new chapter in its long-running political impasse, with two rival governments now claiming power after tentative steps toward unity in the past year.
The protesters, frustrated from years of chaos and division, have called for the removal of the current political class and elections to be held. They also rallied against dire economic conditions in the oil-rich nation, where prices have risen for fuel and bread and power outages are a regular occurrence.
There were fears that militias across the country could quash the protests as they did in 2020 demonstrations when they opened fire on people protesting dire economic conditions.
Sabadell Jose, the European Union envoy in Libya, called on protesters to “avoid any type of violence.” He said Friday’s demonstrations demonstrated that people want “change through elections and their voices should be heard.”
Libya has been wrecked by conflict since a NATO-backed uprising toppled and killed longtime dictator Muammar Qaddafi in 2011. The country was then for years split between rival administrations in the east and west, each supported by different militias and foreign governments.
Libya’s energy sector, which during the Qaddafi era financed a generous welfare state, has also fallen victim to political divisions, with a wave of forced closures of oil facilities since April.
Supporters of the eastern-based administration have shut off the oil taps as leverage in their efforts to secure a transfer of power to Bashagha, whose attempt to take up office in Tripoli in May ended in a swift withdrawal.
Libya’s National Oil Corporation has announced losses of more than $3.5 billion from the closures and a drop in gas output, which has a knock-on effect on the power grid.
(With AP and AFP)


Palestinians to hand bullet that killed journalist to US for examination

Palestinians to hand bullet that killed journalist to US for examination
Updated 02 July 2022

Palestinians to hand bullet that killed journalist to US for examination

Palestinians to hand bullet that killed journalist to US for examination

RAMALLAH: The Palestinian Authority will hand the bullet that killed prominent Palestinian-American Al Jazeera journalist Shireen Abu Akleh to US authorities for forensic examination, a Palestinian official said on Saturday.
Abu Akleh was killed on May 11 while was covering an Israeli military raid in the Palestinian city of Jenin in the occupied West Bank.
After an investigation, the Palestinian Authority said she had been shot by an Israeli soldier in a “deliberate murder.”
Israel has denied the accusation and says it is continuing its own investigation. But it says it cannot determine whether she was shot accidentally by an Israeli soldier or by a Palestinian militant during an exchange of fire without examining the bullet to see if it matches an Israeli military gun.
“We agreed to transfer the bullet to the Americans for examination,” Akram Al-Khatib, General Prosecutor for the Palestinian Authority, told Reuters without providing further details.


UAE sends three planes of medical aid to Afghanistan

UAE sends three planes of medical aid to Afghanistan
Updated 02 July 2022

UAE sends three planes of medical aid to Afghanistan

UAE sends three planes of medical aid to Afghanistan
  • The dispatched field hospital includes 75 beds and two operating rooms

The UAE has sent three planes of medical supplies, including a 1,000 square-meter-field hospital, to aid the injured of Afghanistan's earthquake that killed over 1,000 people and wounded scores more, Emirates new agency (WAM) reported on Saturday.
The dispatched hospital includes 75 beds and two operating rooms equipped with medical supplies and devices, the WAM statement read.
The planes also carried 16 metric tonnes of equipment and a medical team to operate the hospital and provide urgent medical services.
The UAE earlier established an air bridge to transport aid in the wake of the disaster.
The relief efforts come as Afghan authorities reported a shortage of food, shelter and medical supplies for the victims of the country’s deadliest earthquake in decades.

Last week, the country dispatched a plane carrying 30 tons of urgent food supplies to Afghanistan as aid continued to pour in from different parts of the world.