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Commentary

Malek Nassar, ¹ Wael Abdallah,¹ Bernard Najib,¹ Khalil Khalil ¹ and David Atallah¹

¹Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon. (Correspondence to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Citation: Nassar M; Abdallah W; Najib B; Khalil K; Atallah D. Weakening of the Lebanese health sector. East Mediterr Health J. 2023;29(3):168–169. https://doi.org/10.26719/emhj.23.022 Received: 10/04/22; accepted: 21/11/22

Copyright © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence  (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

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Since fall of 2019, Lebanon has been experiencing multisectoral crises. Allegations of corruption, the October 17 revolution, economic crisis, COVID-19 pandemic, Beirut port blast, the fuel tank explosion, and many other challenges put the country in a chronicle of tragedies (1). With an annual inflation of 84.9% in 2020 and a 90% loss of the Lebanese pound value, the World Bank identified the Lebanese economic crisis as one of the 3 most severe in the world since the mid-19th Century (2). Today, Lebanon can be described as a near-collapse State, with shortage of water, electricity, fuel, food, medication, and other essential life-saving services.

The Bloomberg Healthcare Efficiency Index ranked Lebanon 23rd in the world healthcare efficiency in February 2019 (3), but the healthcare system has now been weakened. The minimum wage decreased from US$ 585 to US$ 43 in 2021 and there has been massive emigration of healthcare workers, negatively impacting the healthcare system. The decrease in fee value, workers’ trapped savings in banks, the difficulty in getting to the workplace due to fuel and electricity shortages, and the lack of basic medications have forced healthcare service providers to search for better opportunities abroad. The average nurse’s salary became US$ 75 while they still work for 40 hours per week. Many of these nurses have been forced to accept unfair salary cuts or unpaid salaries, while the highly educated and experienced ones are migrating abroad for more attractive job offers.

As hundreds of doctors leave the country, many units like the pediatric cardiac critical care, fetal medicine, and brachytherapy now lack the capacity to provide services and this has serious implications for patient care and on-the-job training for the next generation of healthcare workers. More than half of young doctors or residents in the country now prefer to undertake their residency abroad, where better research and training opportunities are available. United States, Canada, France, Belgium, Germany, and other Arab countries are the most common destinations.

On the other hand, the highly privatized healthcare system in Lebanon provides inequitable medical services only to patients who can afford them. Lebanon, which was once known for its developed screening programmes and preventive medicine, now suffers a shortage of laboratory kits, vaccine, and screening kits. A non-invasive prenatal test can cost almost 10 times the minimum wage, making patients to avoid screening tests such as human papilloma virus (HPV) co-testing and mammogram because they cannot afford them. The fuel shortage constitutes a barrier to patients who require annual medical visits and the COVID-19 pandemic has played a crucial role in the decision to postpone screening tests and medical visits. All these factors have contributed to the surge of advanced diseases and undiagnosed abnormalities, with potential more serious impact in the coming years.

Moreover, hospitals are experiencing shortages of drugs, medications and medical supplies, as well as electricity cuts, which may force them to shut down. For example, on 14 August 2021, the American University of Beirut Medical Center was obliged to shut down due to fuel shortage and this may have caused the death of 40 adult and 15 child patients who were on ventilators (4). Similarly, Makased University Hospital was forced to close its doors due to electricity cuts. The fuel tank explosion on 15 August 2021 exposed the severity of the medical shortages, as some hospitals could not provide intravenous acetaminophen and antibiotics for the basic care of victims. The Lebanese healthcare system could not treat all the victims of the explosion and was forced to transfer some of them to Türkiye, Jordan, and Kuwait.

The Venezuelan experience is similar to that of Lebanon (5); the economic crisis and the shortage of foreign currency left the country with a lack of equipment, food, and medicines.

As young providers and experienced medical doctors, we are witnesses of this crisis in the health sector. We are therefore making an urgent appeal to help save and protect our healthcare system. Lebanon is facing an existential threat and needs urgent help to stop this free fall of the healthcare system. We advocate the supply of solar-powered electricity, drugs and medical equipment, and staffing support, to hospitals and health centres to help restore the standards of quality care in the country.

References

1. Abdallah W, Khalil K, Najib B, Kassis N, Atallah D. Beirut blast: creating our expectations through heartbreak. Future Sci OA. 2020;7(2):FSO653. DOI: https://doi.org/10.2144/fsoa-2020-0171.
2. Massoud A Derhally, Deena Kamel. Lebanon’s crisis among the worst since mid-19th century, World Bank says [Internet]. The National News, 1 June 2021. https://www.thenationalnews.com/business/economy/lebanon-s-crisis-among-the-worst-since-mid-19th-century-world-bank-says-1.1233228.
3. Ministry of Public Health. Latest developments. http://www.moph.gov.lb.
4. The Daily Star. AUBMC warns it’ll close down Monday if no fuel. Lebanon News. https://www.dailystar.com.lb/News/Lebanon-News/2021/Aug-14/52260 8-aubmc-warns-itll-close-down-monday-if-no-fuel.ashx.
5. The Lancet. The collapse of the Venezuelan health system. The Lancet. 2018;391(10128):1331. DOI: https://doi.org/10.1016/S0140-6736(16)00277-4.