Under the title "Diesel and Other Disasters: Lebanese Hospitals Await Their Inevitable Fate," the Al-Hurra website reported that the explosion of a fuel tank in the town of Tleil in Akkar was not the only shock Lebanese people experienced last Sunday. The sight of the health sector, particularly hospitals, largely unable to treat the injured and waiting for medical assistance from abroad, in addition to sending wounded individuals for treatment outside the country, represented the largest shock for citizens who faced a reality that had long been warned against reaching.
The catastrophe was exacerbated by the announcement from several Lebanese hospitals on Saturday and Sunday that they were close to shutting down completely, including the American University of Beirut Medical Center, one of the largest and most equipped hospitals in the country, due to its depleting supply of diesel necessary for electricity generation, following the state's near-total inability to provide the country's electricity needs. The hospital warned that "ventilators and other life-saving medical devices will cease to work," declaring that "40 adult patients and 15 children reliant on ventilators could die immediately." It further warned that "180 people suffering from kidney failure will die from poisoning without dialysis in a few days. Hundreds of cancer patients, both adults and children, will die in the following weeks and months without proper treatment."
On the same day, Al-Maqasid Hospital, one of the oldest charitable hospitals in Beirut, announced that its diesel supply would last for only 48 hours and stated that it had stopped admitting more patients due to its inability to provide necessary services to them.
Public Concern Over State Inability
This reality has served as a wake-up call for many Lebanese, who are now experiencing significant anxiety regarding the health situation in the country, especially those with special health conditions requiring regular hospital visits. Maria Akiki, 26, recounted how she had to resort to mediation to get her brother admitted for emergency surgery, stating, "Even though we are beneficiaries of an 'A' class insurance, we struggled immensely to get my brother into the hospital due to a lack of equipment, beds, and facilities. This was before the Akkar explosion; I then began to comprehend the reality we live in, where having money or a good insurance category no longer matters. Everyone suffers equally, and when hospitals close, they will close their doors to everyone without exception."
"After the explosion, all my fears were confirmed," Maria added in her conversation with Al-Hurra. "To see the state's failure and its health system unable to manage victims in such a disaster, and the announcement of hospitals closing their doors, was a terrifying scenario for me. I now rethink every step; I fear any emergency, like a car accident, a disease, or even an accidental injury—all of these have become daily anxieties I try to avoid knowing that there won't be a hospital to receive me next time."
Suleiman Haroun, head of the private hospitals association, shares Maria's fears, seeing them as a stark reality in Lebanon. He warns of worse scenarios the country may face in the coming period if officials do not find a solution to the crisis. He noted that hospitals are running out of many medications, supplies, and equipment, stating, "We still practice 'makeshift solutions' in the health sector, replacing this with that and easing matters. However, in some areas, we have been unable to do so, as is the case with cancer patients and chronic illnesses that cannot be managed with temporary or substitute solutions. If the situation continues to decline, we will end up in a much worse place than we are now."
Delaying Total Collapse
While many hospitals in Lebanon experienced their last hours in recent days, where complete closure seemed imminent, some fuel companies and specific stations, along with individual initiatives, aided in providing diesel reserves to several hospitals, which spared the country a health catastrophe, but did not eliminate it. The secured reserves are sufficient for only a few days before conditions revert to square one.
Firas Abyad, director of Rafik Hariri Government Hospital, expressed that "the health sector in Lebanon is going through a very difficult time due to the diesel issue. If diesel had not been secured and support provided to some major hospitals, we would certainly have reached a stage of collapse in the health sector. Yet the provision of a certain amount of diesel to these hospitals, including Rafik Hariri Government Hospital, has given us a little extra time—about 5 days to a week."
On the other hand, Mohammed Bader, director of Al-Maqasid Hospital, pointed out that "the fuel crisis has indeed brought the hospital to the complete collapse we announced in our statement. Nevertheless, there has been no communication from any official body to work on solving our proclaimed crisis. Instead, a group of community activists initiated their support for Al-Maqasid Hospital, assisting us in securing a small diesel supply sufficient for about 10 days only. The state has neither inquired nor acted on its responsibilities; it has completely abandoned its duties and its people, turning into a group of thieves and criminals."
Living Day by Day
"We operate on a day-by-day basis," emphasized the head of the hospitals association. He added, "I am worried about next week and beyond; the situation might worsen. I have learned from fuel distributors that they are distributing all they have in stock to avoid being responsible for any storage, so the reserves will run out in two or three days, and no credits have been allocated to import new fuel tankers, placing us in a situation worse than today." Haroun continued, "Today, the best-off hospitals have enough diesel for just a few days, and the narrative of these 'few days' is being presented as an achievement, while hospitals need at least a month’s supply. Hospitals schedule their surgeries and treatments, like dialysis and cancer treatments, based on at least a month in advance, as they cannot give appointments to patients and then retract them due to power or diesel shortages."
Haroun urged not to underestimate daily distress signals emitted by hospitals, adding, "When hospitals announce that they are stopping air conditioning in their wards, this represents a significant health risk. Air conditioning in hospitals is not a luxury; it is a medical necessity to maintain room temperatures at around 21 degrees Celsius. Otherwise, patients face risks of additional infections and transmission of viruses."
Another important point that is overlooked, according to Haroun, is that "when a hospital announces it will stop receiving patients or cease its services entirely and close its doors, we face the necessity of evacuating patients from this hospital to others. Patients within the hospital will need to be redirected to other facilities, exacerbating the burden that the remaining hospitals, already under pressure, will struggle to bear under these circumstances."
The Akkar Explosion: A Test
The primary problem faced by hospitals after the Akkar explosion is not their capacity to treat patients, according to Dr. Firas Abyad: "The question is how hospitals will secure the medications, supplies, and continuity required for those suffering from severe burns—they will need care and follow-up that could last two to three months, not just a few days. Meanwhile, all hospitals in Lebanon suffer from shortages of such equipment, and the diesel supply crisis threatens them with sudden shutdowns as soon as their fuel reserves run out."
Haroun explains what he calls the chronic crisis Lebanon faces, which the Akkar explosion highlighted clearly. The country is short on adequate burn injury beds, as there are only two hospitals in Lebanon equipped to treat burn patients: Al-Salam Hospital (30 beds) and Al-Jaaitawi Hospital (10 beds). "On Sunday, Al-Salam Hospital had 14 burn victims before the explosion, limiting its capacity to 16. Al-Jaaitawi Hospital had to transfer patients who were not in critical condition from the burns center to the Corona center, which has adequate ventilation for burn patients, thus managing to admit 11 victims from the Akkar explosion. This applies to burn cases, while other injured individuals were able to be accommodated in hospitals that accepted them."
Fuel is Not the Biggest Crisis
The medical sector in Lebanon faces significant challenges at various levels, not solely derived from the ongoing fuel crisis, which officials see as one of the easier crises to resolve, provided the required substance is secured. More dangerous are the potential repercussions of other crises that will impact the health sector in the coming days. The shortage of medications and medical equipment today poses a larger problem than the fuel and electricity crisis, as securing these essentials for hospitals is not simple and cannot tap into multiple sources as is the case with fuel. In this context, the head of the hospitals association warns of worse times approaching, due to several factors.
The first, according to Haroun, is that "importers of medication are unable to bring in more supplies because factories abroad are demanding their payments and debts owed by the Lebanese Central Bank, which have not been settled to this day. As a result, factories are no longer accepting new orders from Lebanon, which creates a crisis in the medication supply. The same applies to medical equipment, where the indiscriminate support policy from the Central Bank has left importers unable to know what is subsidized and what is not, leading them to currently sell all equipment to hospitals at non-subsidized prices, which hospitals cannot afford at costs multiplied nearly tenfold, placing them in a position to either cover these expenses from patients or forgo purchasing supplies entirely."
The impending crisis, which is unavoidable, is the effect of removing fuel subsidies on hospital bills on one hand and its impact on the readiness of medical staff on the other. Haroun says, "Many hospitals have contacted me, complaining about the absence of staff and crews, especially those living in areas relatively far from the hospital, as reaching them now costs them 30,000 to 40,000 Lebanese lira, amounting to almost a million lira monthly, while their salaries do not exceed one and a half million or two million lira. Consequently, hospitals will have to either raise medical bills to cover wage increases or lose their medical staff, about 55% of whom have already left Lebanon entirely."
In this context, Al-Maqasid Hospital also reports a shortage of staff due to the fuel crisis, according to its director: "Many do not show up for work their salaries do not allow for such rising costs, particularly commuting, and the hospital cannot increase salaries. In addition, the state does not pay the hospital the dues owed by the Ministry of Health. We are only required to respond to the Health Minister's calls to treat the wounded and patients at the ministry’s expense, but who pays the hospitals? No one."
Haroun questions, "How can we reflect all these high costs incurred by hospitals onto a citizen who is currently suffering? Which patient can afford these costs? Meanwhile, the government continues to reimburse hospitals based on the exchange rate of 1,500 Lebanese lira per dollar, while the current exchange rate exceeds 20,000 lira, assuming that the Health Ministry is paying hospitals what it owes, and the same applies to private insurance companies and guarantor bodies."
Bleeding Medical Staff
The director of Rafik Hariri Government Hospital considers "the biggest problem facing hospitals is the medical and nursing staff leaving Lebanon. It is not easy to train and teach new staff at this stage, and it is impossible to tell someone who has emigrated abroad, settled there, and found fair pay and a normal life, to return to a life of hardship in Lebanon."
In this regard, Dr. Bader emphasizes that "the collapse of the health sector has become a reality, and it began with the departure of medical personnel. The actual crisis in the health sector lies in the absence of capacities and staff. He questions who will treat patients tomorrow when supplies, medications, and fuel become available?"
Haroun reveals an incident in Lebanon that illustrates the extent of the depletion the health sector is undergoing, where a French company recently announced its arrival in Lebanon to hire around 600 nurses for France. "I was forced to write to the French embassy and the company, stating that we rely on France to support the health sector, not to exploit the crisis to drain medical staff. Following this, the company refrained from coming to Lebanon; otherwise, we would have witnessed street movements to stop this disaster."
COVID-19 Increases Pressure
The COVID-19 virus is also a part of the dramatic picture the health sector is experiencing in Lebanon, as numbers that had previously dropped significantly in recent months surged again sharply, reaching thousands of infections daily, with the death toll rising and increasing pressure on hospitals. In this context, Dr. Firas Abyad explains that the pressure of living conditions on citizens distances them from prioritizing COVID-19 against the backdrop of needs for essentials. "Those who cannot find bread, water, electricity, or fuel certainly will not worry about COVID-19. Therefore, I do not expect people to suddenly comply with preventive measures."
He adds, "Today, it is impossible for the state to enforce a general lockdown no matter how high the figures rise, as you cannot tell a person who is deprived of electricity, internet, fuel, bread, and water to stay home for COVID-19. This is sheer folly—no one can implement such a measure. There is no doubt that the trend is upward, and we will see in the coming days how the indicators of infections and numbers will be, which will also impact the condition of hospitals."
No Place for Minor Solutions
It is clear that a comprehensive crisis is affecting the health sector, Haroun states, "No matter where we turn, we are confronted with disaster, all accumulating together. In short, we cannot keep the health sector on its feet with current resources without external support, which will not reach Lebanon without forming a government. We have heard this from all international actors—they are ready to help provided a government is formed and the country begins to rise again. Otherwise, any efforts will be futile, and a catastrophe will be inevitable, if not today, then tomorrow."
For his part, Abyad sees that "when there is a series of tangled knots piled on one another, they are usually untangled one by one, and the same goes for the health sector in Lebanon today. We cannot say we are unable and close the doors of hospitals and go home; that is not an option. Unfortunately, the health sector in Lebanon has fallen into a deep hole, and it is not easy to climb out of it. It requires a lengthy process and significant effort. Most importantly, we must embark on this path and start the journey back. This is the greatest tragedy: everyone is in the hole, watching instead of starting to climb out."
Thus, we cannot separate the health sector from the general situation in the country; the health sector cannot stand alone isolated from the national reality, according to Abyad, who concludes, "As long as all sectors are in crisis, the health sector will follow suit. If the ship is sinking, it will sink with everything in it regardless of all efforts. Therefore, the first step to restore balance in the health sector is to restore balance in Lebanon as a whole. Without this, the health sector in Lebanon will mirror the health sectors of all failed states that rely on humanitarian aid and donations."
