A bitter pill to swallow: Lebanon's medical sector buckles under continuous crises

As Lebanon struggles to overcome a crippling financial crisis, the country’s medical sector has been stretched almost to breaking point. Already drained of resources by the global COVID-19 pandemic, the devaluation of the Lebanese lira has caused the cost of hospital treatments to skyrocket, forcing people to choose between healthcare or other essential amenities like food or fuel.

At the same time, doctors and nurses – many of whom work in the private sector on a case-by-case basis – have seen their own salaries reduced to almost nothing, leaving them with few options.

“After five or ten years of work, seeing your business going down to ten percent of what you used to do [is] very frustrating,” Dr Zaki Sleiman, with the LAU Medical Center-Rizk Hospital, told The New Arab. “That’s why most of the Lebanese doctors are leaving now. I moved my own family to Switzerland.”

"Because Lebanon imports most of its medical equipment and supplies from other countries, buying in US dollars, the lack of fresh foreign currency has led to severe shortages of even basic medicines such as paracetamol, anti-inflammatories or anti-coagulants"

“I was lucky,” he continued. “I have worked in other countries, like Kuwait, Iraq and Syria. What I’m doing now is I’m spending 50 percent of my time in Beirut and 50 percent of my time abroad. It’s a lot of travelling and moving around, but I don’t want to quit my job in my country.”

Because Lebanon imports most of its medical equipment and supplies from other countries, buying in US dollars, the lack of fresh foreign currency has led to severe shortages of even basic medicines such as paracetamol, anti-inflammatories or anti-coagulants.

For patients with chronic illnesses like cancer or cardiovascular disease, the situation is even more serious as the life-saving treatments they require are becoming increasingly hard to come by. Where they are still available, they are often prohibitively expensive for a country where more than 70 percent of the population now live in poverty.

“For [the] 70 percent of people who have public coverage, when they pay the government to have this coverage [through taxes], they’re paying on the rate of 1500 [Lebanese lira against the US dollar],” said Sleiman. “The hospitals still have to buy products and offer services at the rate of 20,000.”Many who have lost their jobs due to the crisis have also lost their medical insurance. In the past, Lebanon’s social security policies provided something of a safety net, but rampant hyperinflation has radically diminished their effectiveness.

“We’re going to arrive at the point where a patient has to pay in cash for the hospital’s services, and then he or she has to go to their insurance or the social security and try to refund whatever they can,” he lamented. “[At the same time, the] private sector will become strictly exclusive to the rich, offering services that the public sector can no longer afford to.”

This is then complicated further by the lack of electricity. State-run power stations were already inadequate to meet Lebanon’s needs before the beginning of the financial crisis, with the gaps in the national energy supply being filled by privately-owned generators. Without access to a reliable source of affordable fuel, neither can function, leaving many institutions – including hospitals – stuck in the dark.

“We have a shortage of electricity but we also have a shortage of team members in the hospital, because people are unable to get fuel,” said Sleiman. “[You cannot expect] an employee to come to the hospital when they have no fuel.”

“We’ve had to work in crisis mode,” he explained. “We’re not able to do any more elective surgery. We’re only allowed to operate in emergency cases. Instead of operating eight operating theatres in my hospital, we’ve reduced to just three.”

"We’re going to arrive at the point where a patient has to pay in cash for the hospital’s services, and then he or she has to go to their insurance or the social security and try to refund whatever they can"

Queues for fuel are still a common sight in Lebanon, with desperate citizens lining up in the hundreds just to fill up their cars. Fights over limited supplies are also not uncommon, making looking for fuel a daunting prospect for many.

Last month, during the height of the fuel crisis, Sleiman found himself at the centre of attention after a photograph of him dressed in his cycling clothes with a newly delivered baby went viral on social media. For those struggling through Lebanon’s crisis, the image of a doctor having to cycle to reach his hospital struck at the heart of the country’s many problems, but Sleiman insists that what he did was nothing exceptional.

“I’m a cyclist,” he explained. “People ask me: How can you cycle 12 kilometres from your place to the hospital? I can do 180 to 200 kilometres, so [it] was not really an issue for me. During the [October] Revolution, I used to take my bike to the hospital because the roads were [often] closed or there was too much traffic. I was not planning to be a hero.”

“I [used to] take some pictures with the new-borns but, after the Revolution, I stopped because I was [depressed, but] – when I was putting my cycling outfit back on – I thought: Maybe I have to take a picture today, of all days,” recalled Sleiman. “Maybe, in the future, his parents will show him this picture and tell him the story about his delivery and say: Look, your doctor came to your delivery on a bike, because we [had a] shortage of fuel.”

Despite Lebanon now having formed a new rescue government under Prime Minister Najib Mikati, the state of crisis looks set to continue. Political infighting remains a serious obstacle to vital reforms, fuelled by disagreements over sectarian power-sharing and constant attempts to frustrate and obstruct the ongoing investigation into last August’s explosion at the Port of Beirut.

To many Lebanese citizens, this is just more of the same ineffective and self-serving governance that they have come to expect from an increasingly out-of-touch and unpopular political elite.

“I don’t think that the government will be able to do anything,” said Sleiman. “Maybe they changed the names and the faces, but it’s still the same thinking, the same consequences and the same results.”

Robert McKelvey is a British freelance journalist and cultural writer based in Lebanon.

Follow him on Twitter: @RCMcKelvey