Lebanon's Healthcare System Is at Breaking Point

Jacques Cofard

March 24, 2023

Paris, France — Forty years after the creation of TULIPE, a nongovernmental organization (NGO) that gathers funds from pharmaceutical companies to provide an emergency response during times of crisis, in 1982, NGO representatives and TULIPE partners have reviewed the healthcare situation in Lebanon, which is "sinking into the depths of a black hole," according to Alexandre Laridan, TULIPE's director of operations. "In 3 years, TULIPE has sent 25 tons of medicinal products to Lebanon," he added.

The Turning Point

Although numerous NGOs, such as the Order of Malta or the France-based humanitarian aid NGO Première Urgence Internationale, have long operated in this Middle Eastern country to support refugees, the situation changed drastically after the August 2020 Beirut port explosion.

"Over the last 2 years, the profile of those seeking help from us has changed. We are now seeing more and more middle-class people in our centers, people who turn to us in despair after the Beirut port explosion led to increased blurring of the lines between the lower and upper sectors of society. Since then, inflation has skyrocketed. To give you an idea of the scale of this situation, a medical appointment now costs 3 million Lebanese pounds, yet the minimum wage is 450,000 pounds," said Oumayma Farah, vice chairwoman of the Order of Malta in Lebanon.

Her organization has been working in Lebanon since the 1950s. During and after the Lebanese Civil War (1975-1990), the Order of Malta set up between 1000 and 1500 clinics, which were taken over by the state in 2008 as part of a primary healthcare program. Nowadays, the NGO manages 25 primary healthcare facilities, including 11 centers for medical and social care, as well as seven mobile units.

"Lebanese people often come to our centers because they're poor, but they're ashamed to be so. This generates a lot of aggression, and we train our professionals in handling these demographics. Lebanese people come to our community clinics because we are also able to offer them high-quality medication, obtained from donations from TULIPE," said Farah.

Corruption Impedes Access

Due to the financial crisis in Lebanon, it has become hard to find high-quality medicinal products, and a black market of prescription drugs has developed. "Unfortunately, many Lebanese people have been hospitalized by taking these contraband drugs, or by being deprived of good quality medicine. We are no strangers to the drug shortage and find ourselves having to reduce the dose for certain conditions, such as osteoporosis or benign prostatic hyperplasia," said Farah.

Corruption also plays a role in the country's medicine shortage. "The country has supplies of medicinal products, but wholesalers keep hold of them so they can resell them to the highest bidder at a later date."

According to Elie Haddad, MD, chairman of the EuroLebanese Medical Society, an association uniting healthcare professionals of the Lebanese diaspora to aid their fellow citizens who have remained in Lebanon, "Confessionalism and corruption are the two gaping wounds in Lebanese society."

Medical Brain Drain

It's not just medicines that are hard to come by: Doctors and healthcare professionals are also few and far between. "Over the last 2 years, around 3000 doctors have left the country. But what's astounding is that 60% of our doctors are junior doctors. When they leave, they go for good. So, there are some specialties that are on the verge of disappearing altogether, like pediatric surgery, for example," said Haddad.

"Despite everything, we have managed to retain a number of good doctors, but the problem still lies with the dollarization of the economy. The only people who can access these doctors are the ones who can pay them in dollars," said Farah.

Continued Refugee Care

Although primary care can be managed by the many community clinics still open in Lebanon, secondary care is a thornier issue. "Treating cancer and mental health conditions is a huge issue for us. We aren't allowed to hand out psychiatric or cancer drugs at our primary care centers, so we have opened a clinic that specializes in oncology, mental health, and neurodegenerative diseases," said Farah.

Although the Lebanese people were plunged into a healthcare crisis 2 years ago, refugee populations in their country (numbering approximately 1 million inhabitants) are still cared for by NGOs, said Olivier Routeau, director of operations at Première Urgence Internationale. "The crisis isn't over for Palestinians seeking refuge in Lebanon. And what's more, since 2010, the country has also had an influx of Syrian refugees. We have targeted Syrian refugees concentrated in urban areas of northern Lebanon. But we have also expanded access to the at-risk Lebanese population, which makes up 60% of people that we help."

Third-Party Payment

To cover healthcare costs, Première Urgence Internationale has set up a sort of third-party payment system for access to the care system and to diagnostic and specialist services. "We have also put a community approach in place to convince members of these communities to make use of healthcare facilities," Routeau added.

"In 3 years, we have treated between 300,000 and 700,000 patients in Lebanon. We have sent two tons of medicine to the emergency medical center. We have managed to find partners here on the ground to care for these patients. Our action in Lebanon is needed to allow this country to smoothly navigate the humanitarian and economic crisis it's currently experiencing," said Laridan.

This article was translated from Medscape's French edition.


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