As Lebanon faces an unpredictable and potentially protracted conflict, the need for a robust and well-coordinated healthcare system has never been more urgent
As Lebanon faces the looming threat of full-scale conflict with Israel, the country is taking urgent steps to fortify its healthcare system. With memories of the devastating July 2006 war still fresh, Lebanon is stockpiling emergency medical supplies and preparing its hospitals for an influx of war injuries. The World Health Organization (WHO) has already delivered 32 tonnes of emergency medical supplies, with more expected to arrive soon. The situation in Lebanon is increasingly tense, with skirmishes between Hezbollah and Israel at the southern border intensifying, and fears of a wider regional conflict growing.
Lebanon’s healthcare sector is currently facing immense challenges, far worse than during the 2006 war with Israel. The economic crisis has severely impacted the private sector, which provides 85% of healthcare services. About 30% of doctors and nurses have left the country, leading to a significant shortage of specialists, particularly in brain and vascular surgeries. Private hospitals are also struggling with maintenance issues and the high cost of surgical supplies. The number of available hospital beds in private facilities has decreased to 8,000, and public hospitals are unprepared to handle severe cases due to logistical and personnel constraints.
The WHO’s Program Director in Lebanon, Dr. Alissar Rady, highlighted the contrast between the current situation and that of 2006, when hospitals were fully operational with a six-month supply of medications and a well-staffed medical workforce. Today, however, the healthcare system is in a dire state, exacerbated by ongoing economic difficulties and the potential for an expanded war.
War Flashbacks
In response to these challenges, Lebanon’s Health Ministry, in coordination with the Syndicate of Drug Importers, has initiated regular inventories of medications, revealing that current supplies may only last for five and a half months. However, the WHO has warned that the stockpile is sufficient for just two months, raising concerns about potential shortages if people begin hoarding essential supplies. The Health Ministry has also established an operations room connected to the Disaster Risk Management Center to coordinate the distribution of injured patients and medical supplies across the country.
In 2006, Lebanon’s healthcare infrastructure not only had sufficient supplies, but also benefited from international support that came swiftly after the war began. Humanitarian organizations were able to mobilize and coordinate relief efforts effectively, ensuring that medical supplies and personnel could reach even the most affected areas despite the blockades and damaged infrastructure. Additionally, the Lebanese diaspora played a crucial role, sending funds and medical supplies to support the overwhelmed healthcare system.
Today, however, the situation is more complex. The global economic downturn, combined with Lebanon’s own financial crisis, has limited the ability of international donors and the diaspora to provide the same level of support. Moreover, the healthcare system is now operating in an environment of prolonged economic instability, which has led to chronic underfunding, outdated equipment, and a brain drain of medical professionals. The ability to quickly scale up medical response efforts, as was done in 2006, is now severely compromised, making the current preparations for a potential conflict even more challenging.
Despite the strained resources, however, Lebanon is not unprepared. The WHO has trained 118 hospitals in disaster management and distributed medical supplies, particularly to field hospitals in vulnerable regions like the Beqaa Valley and the southern borders’’ areas. Additionally, plans are in place to identify accessible locations for distributing medications and supplies in the event of road blockages.
Challenges in Emergency Preparedness
Professor Amin Kazzi, President of the Lebanese Society of Emergency Medicine (LSEM) at the Lebanese Order of Physicians (LOP) and Founding Former Chair of the Department of Emergency Medicine at the American University of Beirut told NOW that the Health Ministry has been at the forefront of efforts to prepare the country’s healthcare system for potential mass casualty events. Since October 2023, Dr. Kazzi has been serving as the LSEM and LOP representative on the national Public Health Emergency Operation Center (PHEOC). PHEOC was established by the Lebanese Ministry of Public Health, as a collaborative national effort that includes representatives selected by the MOH, the Lebanese Orders of Physicians and of Nurses, the Lebanese Red Cross, the World Health Organization (WHO), and international organizations like the ICRC and MSF to train hospitals across Lebanon. “We’ve been working since October with the Ministry to prepare for mass casualty and war scenarios,” Dr. Kazzi noted, emphasizing the urgency and importance of these preparations and the prioritization given by the Minister of Health and PHEOC member organizations.
Despite the extensive training initiatives, which have involved seminars and hands-on courses, Dr. Kazzi acknowledges the significant challenges that remain. “It’s not enough to have them trained if there are hospitals that will have no physicians or specialists or nurses on duty or available to respond,” he stated, highlighting the critical shortage of medical professionals. For example, with only 30 emergency physician specialists currently available across the country, Dr. Kazzi expressed concern about the sustainability of these efforts, if war erupts and lasts for prolonged periods, especially given that “70 specialists graduated over the last decade, but they don’t stay in Lebanon” due to better opportunities abroad than intolerable practice conditions in the country.
Dr. Kazzi also pointed out the logistical and operational challenges faced by hospitals, particularly in terms of equipment and resources. “Imagine them [emergency staff] having a stock of 12 chest tubes; if you use them, who will provide replacements?” he questioned, illustrating the potential shortages of essential medical supplies during a prolonged conflict. Moreover, sustaining operations requires not just medical staff but also essential utilities like electricity and fuel. “Now it’s worse than 2006. Mazout, for example, is more expensive, and there are shortages,” Dr. Kazzi added, underscoring the financial and logistical difficulties of maintaining a functional healthcare system in times of war.
Acknowledging the exceptional efforts and results achieved by the Ministry of Health in Lebanon to provide supplies and contingency plans to address sustainability challenges, Dr. Kazzi’s insights paint a stark picture of the challenges Lebanon faces in ensuring its healthcare system is prepared for the worst if war and conflicts were sustained, and the heterogeneous hospital capacities across Lebanon to respond or sustain all services needed across Lebanon. “You can train people how to make an omelet, but you need eggs,” he remarked, metaphorically illustrating that training alone is insufficient without the necessary resources and infrastructure to support it. As Lebanon braces for possible conflict, the need for sustainable solutions and adequate funding becomes ever more critical.
The Fragile State of Lebanon’s Health Sector
Anis Germani, a medical doctor and health policy researcher, offers a critical assessment of Lebanon’s healthcare system as it grapples with the aftermath of multiple crises, including the economic collapse and the COVID-19 pandemic. “The health sector has taken a very substantial blow following these crises,” he noted, emphasizing that the system is still in a state of flux, struggling to adapt to the new economic realities.
One of the most pressing issues is the privatization of Lebanon’s healthcare system. With around 160 hospitals, the vast majority being private, Germani highlights a significant challenge: “The ability for the state to control these hospitals is very low, because these are all private businesses.” This privatization has led to a mismatch between the strategic needs of the country, especially during crises, and the profit-driven motives of private hospitals. This problem became particularly evident during the early months of the COVID-19 pandemic, when many private hospitals initially refused to participate in the national response.
Adding to these challenges is the severe shortage of healthcare professionals. “Half of the doctors emigrated from the country after the crisis,” Germani pointed out, and while some have returned, the nursing staff has been harder to retain, with many leaving for better-paying jobs abroad. This brain drain has left the healthcare system severely understaffed, further compromising its ability to respond to emergencies.
The sufficiency of medical equipment is another critical concern, especially in light of the ongoing conflict. “The sufficiency of medical equipment is equally dependent on the duration of the war and its severity,” Germani explained. He also highlighted the likelihood of Israel continuing to ignore international law, exacerbating the situation. The World Health Organization (WHO) has sent batches of strategic medicines and equipment, but whether these supplies will last depends on how the conflict unfolds. As Germani pointed out, “There’s no information on how long these supplies will last, and it all depends on the severity of the conflict.”
Germani also referred to a study from 2020 that evaluated the disaster preparedness of Lebanese hospitals. The findings were concerning: while about half of the hospitals surveyed had a plan to increase their surge capacity in the event of a crisis, most struggled to implement these plans effectively. This gap between planning and execution poses a significant risk in the event of a large-scale emergency, such as a war.
In terms of infrastructure, Lebanon’s healthcare system has always been fragile. “The health system was never robust; it was always very fragile,” he stressed, dispelling any notions that the system was once strong and only recently weakened. This inherent fragility, coupled with the current crises, leaves Lebanon’s healthcare system on the brink of collapse, particularly as it faces the dual threats of economic instability and armed conflict.
Electricity is another critical issue. The energy crisis in Lebanon has reached a dire point, with Electricité du Liban (EDL) issuing a statement that it will run out of fuel in ten days. This looming power outage will severely impact hospital operations, which rely heavily on electricity to run critical medical equipment and maintain essential services.
Germani underscores the importance of a coordinated response, but also highlights the limitations posed by the country’s fragmented and privatized healthcare system. As Lebanon faces an unpredictable and potentially protracted conflict, the need for a robust and well-coordinated healthcare system has never been more urgent. However, the current state of the sector, compounded by long-standing structural weaknesses, raises serious concerns about its ability to cope with the challenges ahead.
