Understanding
The Lebanese Healthcare Crisis
Our Mission
To illuminate the challenges faced by the Lebanese healthcare system and to galvanize support for actionable solutions
Overview of the Healthcare Crisis in Lebanon
Lebanon is currently facing an unprecedented healthcare crisis, exacerbated by economic turmoil, political instability, and the devastating impact of the COVID-19 pandemic. Hospitals and clinics are struggling to maintain operations due to severe shortages of medical supplies, medications, and healthcare professionals. Many Lebanese citizens are unable to access basic medical care, and those with chronic conditions or urgent needs find themselves in dire situations. The collapse of the local currency has further limited the ability of individuals to afford healthcare services, leading to widespread suffering and preventable deaths.
A brief
Timeline of Major Events
October 2019
Economic Crisis Worsens
Widespread government corruption and overspending combined with a stagnating economy led to spiraling inflation, default on debts, and a liquidity crisis. The resulting halt in foreign investment further amplified these issues and led to a rapid collapse of the national currency and GDP.
August 2020
Beirut Port Explosion
With confiscated explosives let to sit for 6 years, a small nearby fire detonated one of the biggest non-nuclear explosions in history. Resulting in 218 deaths, over 7,000 injured, and 300k+ newly homeless from an avoidable tragedy.
2024
Continuing Impacts
The resulting and rapidly escalating economic crisis has grown to deeply affect every sector of the economy, especially the salaries of workers and operations of businesses. A brain drain of professionals deeply afflicted the healthcare system and quality of care.
Through a Statistical Lens
The Brain Drain
The poor economic conditions in Lebanon have precipitated a significant exodus of physicians from the country. Accurate quantification of the current number of physicians is challenging, as the Lebanese Order of Physicians (LOP) is the primary body that regularly reports these figures. As of December 2023, the LOP registers a total of 15,059 physicians, inclusive of those who have emigrated or are employed abroad, resulting in a ratio of 254 physicians per 100,000 population. However, LOP estimates indicate that approximately 3,500 physicians have left Lebanon since 2019. Adjusting for this outmigration, the actual ratio is approximately 195 physicians per 100,000 population, which falls below the recommended ratio of 200.7 physicians per 100,000 population. This trend of brain drain shows no signs of abating, given the persistent economic challenges.
The shortage of primary healthcare doctors is even more pronounced. Pre-2019 estimates indicated a ratio of 4.17 primary healthcare physicians per 100,000 population, well below the recommended ratio of 29.54 physicians per 100,000 population. Considering a similar rate of emigration among primary care physicians since 2019, the current ratio is estimated to have declined to 3.20 physicians per 100,000 population. To meet the recommended ratio, a substantial increase of 923% in the number of primary care physicians is required. This is an enormous health crisis, as this means there is a nearly 10-fold mismatch between primary care physicians working in the country and the level recommended for people to receive adequate care.1
Medication Costs
The affordability of essential medications in Lebanon presents a severe challenge. A program initiated by the Ministry of Public Health in November 2019 subsidized 85% of the cost of essential drugs. However, the termination of this program in November 2021 resulted in a substantial increase in drug prices for the Lebanese population.
Given that the minimum monthly income is approximately 25% of the median, an individual requiring diabetes medication would need to allocate over 84% of their income solely to afford their diabetes treatment2. In stark contrast, the average American spends only 1.68% of their monthly income on all medications. This disparity highlights the severe impact on the lower socioeconomic classes, who are rendered unable to afford even the least expensive medications, let alone multiple medications from more costly categories. Even those earning a median income in Lebanon find these drugs consuming a significant portion of their earnings. This pervasive lack of access to essential medications results in numerous avoidable medical visits due to the acute effects of untreated conditions.
An October 2021 survey of cancer patients in Lebanon further underscored the medication accessibility crisis. Among those who could afford it, 71.3% reported difficulties obtaining non-chemotherapy medications, and 49.6% experienced challenges accessing chemotherapy treatments3. At the time of the survey, the exchange rate was approximately 20,000 Lebanese Lira to 1 USD. Since then, the exchange rate has further devalued to approximately 90,000 Lira to 1 USD, representing a 78% devaluation from the time of the survey. The further currency devaluation not accounted for in the cancer drug survey has exacerbated the already critical issue of medication affordability and accessibility in Lebanon.
Personal Stories
Dr. Aya Farès
Hematologist & Oncologist
Aya works at Rizk hospital in Beirut is an outspoken advocate for the medical crisis.
Dr. Farès details her experience with struggles in treating patients. She writes that “Emergency room admissions in Lebanon in recent days: acute decompensated heart failure due to lack of diuretics… convulsions after stopping antiepileptic drugs… stroke because it was impossible to find anticoagulants … diabetic ketoacidosis after insulin rationing… septic shock because antibiotics cannot be found.” These cases of complications that she lists, she now encounters on a daily basis in the hospital, because “each patient cannot find at least one of the medications he needs”. “I would say that at least 30% of daily admissions to emergency rooms are due to drug shortages,”
“Some heart patients arrive in the emergency room with very low oxygen saturation levels due to lack of treatment. Other patients stay hospitalized longer because the treatment is not available in pharmacies, she reveals. Moreover, most people arrive at the emergency room in critical condition. They don’t make a doctor’s appointment for fear of having to pay a lot of money. They let themselves go, telling themselves that they can still take it upon themselves and, in the end, they reach the point of no return,” she laments.
Dr Farès, who follows many cancer patients, warns of the harmful effects of interrupting treatments in the long term. “In oncology, the effect is not visible immediately, but the cancer can return slowly if the treatment is not administered continuously,” she explains.
“The situation is going from bad to worse, as the crisis worsens. A difficult experience for many doctors who prefer to emigrate. We need long-term solutions, otherwise we will be powerless to save our patients,” warns the specialist.4
Mohammed Qassem
Lebanese Citizen & Father
Mohammed Qassem explained his experience with struggling to receive medical care at Beirut’s Rafiki Hariri University Hospital. His wife, who was 5 months pregnant at the time began to experience major bleeding. He rushed her to the hospital but once they arrived they demanded payment. As he hadn’t thought to bring any, they refused to admit his wife until one of his relatives brought cash. Luckily his wife was ok and made a full recovery but he was infuriated that they risked her life simply to ensure payment.
“If I don’t have money, what do I do? I let my wife die?” he said, speaking outside the hospital this week. With a poverty rate of 80% in the country and half the population experiencing food insecurity, very few can afford the unexpected cost of a visit to the emergency room. Withholding care based on ability to pay means many lives are put at risk, even if they make it to the hospital.
The Ministry of Public Health has seen demand for help to cover medical bills grow from 50% to 70% of the population. However, their budget has been affected by the currency devaluation too, shrinking from US $300 million then to only $20 million now. In addition, the Ministry only reimburses costs, they do not pay upfront. So patients who are relying on the Ministry’s reimbursement and are unable to make the upfront payment will simply not be able to receive care.
This shows the growing problem of healthcare inaccessibility in the country. “If this crisis goes on for long without solutions we will of course come closer to a great collapse,” Health Minister Firass Abiad told Reuters.5
Solutions for The Future
The Brain Drain
Addressing the issue of brain drain simply requires substantial reform of the economy to increase stability and stop the spiraling inflation. Within the healthcare system specifically, remuneration for medical professionals must be stabilized. Providing competitive salaries in more stable currencies, such as the US Dollar, can mitigate the risks associated with the volatile Lebanese currency. By offering financial stability and security, Lebanon can better retain its healthcare workforce and attract international talent.
Medication Costs
To mitigate the catastrophic drug shortage currently afflicting Lebanon, the implementation of subsidized drug programs is essential. Given that many essential medications now consume a double-digit percentage of the median monthly income, subsidies are critical to making these drugs accessible to the broader population. Previous subsidy programs failed largely due to issues such as smuggling for profit, stockpiling, and processing delays. For a new program to succeed, it must incorporate robust funding, potentially sourced from international aid, to ensure adequate enforcement, auditing, and the imposition of criminal penalties. Enhanced regulatory measures would help address the problems that undermined the earlier efforts by the Ministry of Public Health, ensuring the efficient distribution and accessibility of essential medications.2
Foundational Longer-Term Solutions
Addressing Lebanon’s healthcare crisis necessitates tackling the underlying economic issues rooted in corruption and government instability. The current faith-based system of governance exacerbates corruption, as individuals who are seen as religiously significant often evade accountability. These leaders prioritize religious ideals over public service, undermining governance and economic stability.
A shift towards a system of government that emphasizes accountability and stability is imperative. By replacing the faith-based governance structure with a secular system that upholds transparency and accountability, Lebanon can foster an environment conducive to economic recovery. This systemic change would prevent future economic collapses and create a more organized economy that encourages participation from all sectors, including healthcare.
Such a transformation would not only stabilize the economy but also create an attractive environment for healthcare professionals, both local and international, to serve in Lebanon. This comprehensive approach addresses both immediate and long-term challenges, ensuring a sustainable improvement in healthcare access and quality for vulnerable communities in Lebanon.
Advocacy Initiatives
To accomplish these initiatives, advocacy to improve healthcare access in Lebanon must focus on several key areas:
International Collaboration and Funding: Engage international organizations and donor countries for financial aid and technical support. Secure funds for subsidized medication programs and healthcare infrastructure in the country.
Public Awareness Campaigns: Launch targeted campaigns to raise awareness about Lebanon’s healthcare crisis, highlighting drug shortages, brain drain, and the need for systemic reforms. This will support the election of a government that is incentivized to focus on and address these issues instead of others.
Policy Advocacy: Work with policymakers to push for governance changes, anti-corruption measures, and policies ensuring fair healthcare resource distribution. Legislation can be the catalyst that quickly improves the quality and accessibility of the healthcare system in the country.
Community Engagement: Educate disadvantaged citizens on healthcare resources that may be able to provide support. Train leaders to advocate for their needs and ensure vulnerable populations know about available healthcare services.
Lessons for Our Healthcare System
Understanding the struggles faced by Lebanese citizens can enhance our awareness of their perspectives and concerns in receiving care. This awareness allows us to be more empathetic and responsive to their needs. In addition to the typical practices for providing culturally competent care: Culturally Adapted Health Materials, Culturally Sensitive Communication, and Respect for Cultural Practices. We may implement more specific strategies for Lebanese patients that make care more effective and equitable.
Specific Strategies Include:
Longer Duration Prescriptions
Accommodate requests for longer duration prescriptions, particularly for patients traveling back to Lebanon. This reduces the burden of accessing medications abroad.
Access to Specialists
Address concerns about the ability to see specialists by providing necessary treatments without requiring referrals when appropriate.
Primary Care Referrals
Recognize the challenges in accessing primary care doctors by providing all necessary referrals at once, streamlining the process for patients.
Detailed Breakdown of Medication Coverage
Offer a comprehensive explanation of drug uses and insurance coverage to alleviate anxiety related to financial burdens.
Prescribing Generics
Opt for generic medications over brand names or specialties when possible, to reduce costs and increase accessibility.
Addressing Anxiety and Concerns
Be attentive to manifestations of anxiety related to healthcare access and costs. Provide clear explanations of wait times, costs, scheduling processes, and system stability to reassure patients.
By integrating these multicultural considerations into healthcare delivery, we can provide culturally competent care that optimizes patient outcomes and fosters a more inclusive and effective healthcare system.
Get Involved!
Everyone can contribute directly to furthering this cause – both healthcare professionals and regular people alike can personally improve healthcare access in Lebanon by volunteering in the field with international aid organizations that provide care.
Specific Organizations Include:
Doctors Without Borders
Lebanese Red Cross
International Medical Corps
AmeriCares Global Emergency Response
MedGlobal
Project Lifeline
We can make a difference.
About the Author
Richard Maroun
Pre-Med Student
I was inspired to make this website in order to advocate for my own community. As a Lebanese American citizen, I have been privileged to not suffer under the missteps of the Lebanese government, but with extensive family in the country I feel it’s my duty to advocate for them. People are suffering and regardless of where they live in they have a right to high-quality, equitable healthcare. As a pre-med student, I plan to advocate for this underserved communities at every step of my career, helping those that need it the most. Doing what I can to serve people and improve their lives is what I dedicate my medical career and personal life to.