The explosion that ripped through Beirut on August 4 killed at least 200 people. Injured 6,000. Caused suffering on an untold scale.
It also killed doctors, nurses, and patients in their hospitals. Destroyed vital medicines, vaccines, and personal protective equipment. Damaged primary health care centers. And placed tremendous strain on a health system already in crisis.
At a moment when first responders are still treating the wounded and finding shelter for the displaced, the long-term future of the country may not be top of mind.
But when it comes to Lebanon’s health care system and the health of the people who live there, the impacts will be profound and long-lasting.
“It’s impacted everything on a grand scale of unfathomable proportion,” said Dr. Josyann Abisaab, a New York City emergency room doctor originally from the country, and a co-founder of the NGO Lebanon Needs. “We are watching the total collapse of the health care system in Lebanon.”
“People were Literally Hungry”
Lebanon was already “a country where we have a predominance of the private sector in health,” explained Fadi El-Jardali, chair of Health Policy and Management at the American University of Beirut. “We have a poor public structure.”
Even without a strong public health presence, however, Lebanon still had a strong, well-educated medical workforce and state-of-the-art medical centers, El-Jardali said.
The country’s primary health centers, many of them privately run with aid from NGOs, provided everything from chronic disease treatment to antenatal care.
Then, Lebanon’s economic system collapsed, causing staggering inflation. “We lost about 80% of our income over the past few months because of the devaluation of the Lebanese pound,” El-Jardali said.
“There’s a huge concern that the country was already facing famine because of the economic collapse,” Dr. Abisaab said. “People were literally hungry. We’ve seen pictures of empty fridges, and people begging on the streets, which we had never seen in Lebanon before.”
Malnutrition is dangerous enough on its own. But in addition, said Dr. Jennifer Leaning, a professor of Global Health and Population at Harvard’s T.H. Chan School of Public Health, “over the months of economic decline, people have been too hungry and economically stressed even to pay the minimum fees…to go to the health center.”
Primary health care centers are seeing fewer people seek treatment for chronic disease or antenatal care, which means that worse outcomes will likely become more common, Dr. Leaning said. Even childhood vaccinations have declined, increasing the threat of infectious disease.
And the economic collapse compromised the quality of medical care in Lebanon. According to Dr. Leaning, electricity was sometimes only available for three or four hours a day. Minimal water was available at times.
Primary health centers “were already overstretched,” said Dima Zayat, deputy country director in Lebanon for the Middle East-based NGO Anera. “Increasing their capacity even more is impossible. They have reached their limit.”
Hospitals laid off hundreds of medical workers. Medicines and supplies like PPE were harder to come by. “Many doctors actually protested in front of hospitals, warning about the lack of lifesaving medicines and supplies,” Dr. Abisaab said.
“Already on Their Knees”
Covid-19, which first appeared in the country in February, has only made things worse.
At first, Dr. Abisaab recalled, there was “a fairly organized lockdown, and initially, there were only a few cases per day.”
But the country opened its borders in July, she said, and case levels shot up. As of August 10, there were 5,951 reported cases in the country, according to Dr. Leaning. Beirut was one of the hotspots.
Protective equipment was already in short supply for medical workers, Dr. Abisaab explained. “Then you had the pandemic…they were working on double time, many of them were on quarantine.”
At some primary health care centers, medical workers were going unpaid. “Many of the people who work in these public health centers have not been paid for a year and a half,” Dr. Leaning said. “They’re tightening their belt, they’re not eating as much, but they really care about the public health mission.”
The situation at hospitals wasn’t much better, according to Dr. Abisaab. “The hospitals were already on their knees even before Covid. Then Covid made it worse, and this explosion…was the final blow, the coup de grâce,” she said.
“The Seeds for This”
The explosion, piled on top of the existing tensions, “is a slow but severe disaster now culminating in an acute and horrible disaster,” Dr. Leaning said.
The blast damaged three hospitals so badly that they had to transport patients to other hospitals at precisely the moment when thousands of wounded people needed immediate care.
Medicine and PPE, already in short supply, quickly became even more scarce.
For one thing, “a lot of these resources were consumed in a quick time” as wounded people sought medical care, Zayat said.
In addition, Dr. Leaning said, several major warehouses where vaccines, medicines, and supplies were stored were heavily damaged – and the materials lost – during the explosion.
Beirut, El-Jardali said, was Lebanon’s main port, where much of its medical supply entered the country. Its loss places more pressure on the country’s remaining port, in Tripoli, and on air freight.
In addition, Dr. Abisaab expressed concern that the explosion would increase the spread of Covid, as medical workers treated the wounded with limited PPE: “I think more people will contract Covid, and more health care workers will be exposed, and they’ll be out, so you’ll have even less staff in the hospital who can treat the injured and the wounded and those who have acute medical problems.”
The estimated 300,000 people displaced by the explosion, crowding into shelters or with relatives, are also at higher risk, she said.
The explosion also further compromised the food supply. A major grain silo was damaged, and the port was an important entry point for imported food.
Zayat said that Anera had found at least 12 damaged primary health care centers, which the organization will focus on rehabilitating. “We don’t have complete destruction of any of the centers [in Beirut], but they are all damaged,” further compromising access to vital primary care, she said.
Chahine Hamze, an information and communications technologies manager for the Lebanese Red Cross, said that while the organization was still focused on emergency and ambulance services, along with shelter for the displaced, there was also a tremendous need for psychological support. “We need it so much, badly, in Lebanon,” he said.
In the midst of the devastation, El-Jardali said he took comfort from seeing a widespread response from NGOs and community groups. He described laid-off health care workers volunteering to treat the wounded. “That’s something we celebrate,” he said.
And El-Jardali described Lebanon as a resilient country that has dealt with its fair share of challenges. “It’s a success story in Lebanon for many years,” he said. “I’m not saying we don’t need support, we don’t need help. But we have the seeds for this to work.”
Direct Relief has made a $50,000 grant to Anera, and is donating an initial $500,000 to response efforts.
The organization is also planning a large-scale medical delivery based on information gathered about needs on the ground.
Direct Relief will continue to coordinate with local and U.S. partners to assess needs and deliver aid.