Under the knife: Lebanon's lifting of essential medical subsidies threatens millions

As Lebanon faces one of the "Most Severe Global Crises Episodes" according to the World Bank, the lifting of government subsidies on medicines with no real alternative has left many people unable to afford proper health care. As a result, more and more people are dependent on international aid or civil society initiatives. 

In its latest report Surviving Without The Basics, UNICEF highlighted that more than nine out of 10 families surveyed have experienced an increase in the price of medicines. 

"Nobody wants to take responsibility for this crisis, it's a vicious circle. In the end, without their medicines, it's the people who suffer. Many people are now relying on NGOs, but the question remains: do NGOs have enough capacity to take care of everyone?” This was the observation of Marina el Khawand, a 20-year-old student who started the aid group Medonations to help contribute towards the medical needs of Lebanese citizens. 

"After the explosion, I was shocked by the number of people in need of medicines, and by how few NGOs were taking care of these people. So I started the initiative by securing medicines for the families around me as if it were my duty. We started by securing medicines for 510 families, then we managed to secure all the requests. We did this on a weekly basis until we reached 500 families in Beirut,” Marina reveals.

"The economic and financial crisis has had a direct impact on the availability of medicines in large quantities," says Dona Moughayar, a 27-year-old pharmacist and one of the co-founders of Pill Donors, a group of pharmacists aiming to provide medication to underprivileged families by collecting unused medicines from households and pharmacies. 

“In the beginning, there was a lot of medicine. But with the crisis, people began to panic and purchase huge amounts they were not used to buying before. Meanwhile, the central bank could not use its money to buy more medicine nor could it meet the new demand, which had tripled in a short period of time,” Dona explains. 

As the demand increased dramatically in the face of the shortage of supply, pharmaceutical companies paid late by the central bank were unable to supply the country's various pharmacies with medicine.

Today, despite the end of government aid, several pharmacists like Dona are frustrated by the high prices of medicines and the crippling shortages. "When they said they were going to remove the subsidies, we thought it would be like gas, that it would be available for everyone. And now, even with the removal of subsidies, we still don't get all the medicines we need. Some, like for blood pressure, are available in large quantities but are very expensive and unfordable for most of our clients.”

"Some families prefer to live outside their homes, sleep on the street, or stop eating so that they can still afford their medicine. Every day we lose lives. We lose children who can't find their milk, we lose adults who can't afford their antibiotics, we lose elderly people who can't access their medication for chronic illnesses"

Although it is still difficult to know the exact reasons for the shortage of medicines, it is likely that it is at least in part due to the stock depletion strategies of pharmaceutical companies. While some companies sell their available stock, others take advantage of the situation, keep their stocks, wait until the subsidies are completely withdrawn, and sell the medicines at black market prices.

When companies cannot keep their stock for long, they sell it to the pharmacist with very short expiry dates. This is what Dona noticed when she received medicine with very short expiry dates that were supposedly not available. 

“When we asked the companies if they kept the medicines, they said no. But what we see in the pharmacies is that sometimes we get medicines with short expiry dates that were out of stock a few months ago. It doesn't make sense that they are now distributing a drug with a very short expiry date,” she explained. 

At the same time, it seems that neither party seems to take responsibility for the lack of medication. Dona notes that the pharmaceutical companies blame the central bank, while the government blames the pharmaceutical companies, who in turn blame the pharmacists. 

The ability of NGOs to supply a whole population with medicines in the long term is also a question that Marina asked herself. Many external donors that initially invested after the August 4 explosion are now starting to run out of resources. At the same time, external donors to Lebanon have little confidence in the Lebanese institutions, which are unable to reform the system despite international pressure.

“I don't know where we are going, we live from day to day," Marina says. "We are doing the work of the government, we are doing the work of the institution, we are doing the work of the UN, we are doing the work of everyone. We don't see any positive action from the government or the ministers. They don't care about anyone in Lebanon.”

Many commentators now openly state that the Lebanese state is failing its people, including Olivier De Schutter, the UN special rapporteur on extreme poverty and human rights, who visited Lebanon in November and was “very struck by the fact that this is a state that, if it is not failed yet, is failing and that the needs of the population are still not addressed... They are in a fantasy land.”

Despite a concrete and sensible response from the government, many people including Marina describe a situation that is indescribable beyond words.

"No words can express how low the situation is in the country,” she stated. "Some families prefer to live outside their homes, sleep on the street, or stop eating so that they can afford their medicine. Every day we lose lives. We lose children who can't find their milk, we lose adults who can't afford their antibiotics, we lose elderly people who can't access their medication for chronic illnesses,” she agonisingly added. 

Clément Gibon is a freelance journalist based in Lebanon. 

Follow him on Instagram: @clm_gbn