Lebanon is undergoing a surge in mental health disorders – and a shortage of the medications needed to treat them.
“We had Covid, we had the economic situation, we had one thing on top of the other,” said psychiatrist Dr. Jocelyne Azar. “Mental health is a major issue now.”
Azar is a physician at Lebanon’s Deir-el-Salib Hospital (known in English as the Psychiatric Hospital of the Cross) and a professor at the Lebanese American University’s Gilbert and Rose-Marie Chagoury School of Medicine. She also treats patients in her private practice.
Lebanon has experienced more than its share of crises. Political instability and economic collapse have led to a host of problems – including medication shortages. As BBC News reported, the economic crisis has made it difficult to pay medication suppliers, leading to a lack of availability of everything from chronic disease medications to treatments for mental health.
Azar said that the pandemic deaths and the resulting lockdown were also devastating for many of her patients. And the Beirut port explosion in August of 2020, which killed more than 200 people and wounded approximately 6,000, was a highly traumatic event.
In the months since the blast, Azar has seen a rise in less severe mental health issues, such as anxiety and depression. But she’s also seen more severe issues, such as schizophrenia, increase. “I think the situation is just a trigger – for any psychiatric disorder,” she said.
Wasseem Kabbara of the American Task Force for Lebanon said that phone calls to a Lebanese suicide hotline have “shot up to the sky.” Complicating matters is the fact that “all throughout the Middle East, we have stigma against any psychological or psychiatric illness,” he said. At Deir-el-Salib Hospital, he said, “the majority of these patients have been marginalized by their families.”
According to Kabbara, the medication shortages in Lebanon have been exacerbated by hoarding – people buying up supplies of psychotropic or other medications and selling them at high rates to whoever can afford them.
Not long ago, Lebanon’s sophisticated health system was the envy of the Middle East. “People would come from all around the Middle East and the Gulf states, whether for acute medical interventions or cosmetic surgeries,” Kabbara said. Many highly qualified physicians and nurses have left the country. “A lot of these hospitals have been suffering not just from the lack of medications and funding, but from the loss of their person power.”
Deir-el-Salib Hospital, where Azar works, is the largest mental health hospital in Lebanon, with over 1,000 beds. The focus is on treating mental health disorders around the clock on both an inpatient and outpatient basis. Azar and her fellow doctors primarily deal with more severe mental health disorders, including schizophrenia and paranoia.
Azar explained that the shortage of medications in Lebanon has made treating patients significantly more difficult.
“It’s a major problem. Unfortunately, we’ve had many relapses because of the lack of medication, and sometimes we were perplexed,” she said. “How can we help these people?”
Often, she said, doctors will make do with what they have – “In that case, we have to find the medicines,” Azar said – but that sometimes makes for a less-than-ideal match for a patient’s individual health concerns. Sometimes, she said, a patient will arrive at the hospital and it will take days before doctors can source a medication for them – prolonging their need for treatment.
In a country where the U.N. reports that 74% of the population now lives below the poverty line, money is an additional problem. The families of Azar’s patients frequently tell her that they can’t find or afford the medications for a child, husband, or wife.
“All psychiatrists are confronted with these stories, and we do what we can,” she said.
To support Deir-el-Salib Hospital in its essential work, Direct Relief delivered a shipment of medications to Kabbara’s organization, to be consigned to the hospital. The shipment contained more than $180,000 worth of medications – about 300 pounds total. Contained in the delivery were medications created to treat a variety of mental health concerns, including depression, anxiety, schizophrenia, post-traumatic stress disorder, and bipolar disorder.
“It can be of great help,” Azar said of the shipment of medications. “It can help us to maintain our care of these people.”
Since January of 2020, Direct Relief has provided 26 shipments of medical aid to over 65 recipients in Lebanon, valued at more than $43.3 million. Recently, a new shipment containing medications for schizophrenia departed for the country as well.