Contrary to what is happening on the ground, where cholera bacteria have entered a phase of rapid spread with the cumulative number of infections reaching 1,889 cases at the beginning of this month, including 186 new cases, there is no general mobilization in the government and field hospitals treating the infected so far. The percentage of occupied beds is still within the manageable range. Currently, 89 confirmed and suspected cholera cases are being treated in hospitals. These numbers are still classified as "manageable" in hospitals; 89 occupied beds are much easier to handle compared to the situation during the Coronavirus outbreak. There is no room for comparison between the two "pandemics" - at least for now - for two main reasons: first, cholera in Lebanon has not yet completed its first month, and second, "we have learned a lot from COVID-19 regarding how to deal with the new pandemic," says Hicham Fawaz, head of the hospitals and health centers department at the Ministry of Public Health.
Despite this beginning, the healthcare sector is managing. There is no general mobilization like during the COVID-19 fight, as today the engagement of hospitals is limited to six government hospitals announced by Minister of Public Health, Firas Abiad, three of which are in the northern region (Halba-Akkar, Tripoli Government Hospital, and Miniyeh Government Hospital), two in Beirut (Rafik Hariri University Hospital and Baabda Government Hospital), and one in Bekaa (Hermel Government Hospital).
**Available Beds**
These choices were not random, as the selection criteria are currently limited to areas of spread, such as Akkar Governorate, where the town of Bbeinen is classified as an outbreak area, and certain areas in Beirut have been prepared to ensure readiness, especially if it becomes necessary to transfer some critical cases there. Based on this specificity and the map of outbreak areas, the beds for cholera patients are distributed, with the north receiving the largest share, totaling 236 beds distributed among 114 beds in Halba Hospital (40 of which were opened the day before yesterday), 84 beds in Tripoli Government Hospital (35 of which were opened the day before yesterday), and 18 beds in Miniyeh Hospital. Additionally, another 10 beds are expected to be added at the field hospital in Bbeinen. The remaining beds are distributed among 12 beds in Baabda Government Hospital, 10 beds in Hermel Government Hospital, and 12 beds in Rafik Hariri Government Hospital. Moreover, Médecins Sans Frontières has started operating 20 beds in Bar Elias Hospital, and this number is expected to increase to around 70 beds later, according to Fawaz.
Parallel to this, there is work to introduce other hospitals according to the need. However, according to Fawaz, the current situation does not warrant sounding the alarm, stating that "as long as there is no necessity, there is no need to convert beds in new hospitals for cholera."
**Field Hospitals Preparedness**
Nonetheless, this does not mean that there is no need to adhere to these limits of participation, as Fawaz points out that work is currently being carried out according to "planned strategies" regarding operations in the healthcare sector. In addition to the government hospitals that are currently receiving cases, work has begun on field hospitals, with the first hospital starting operation in Bbeinen, Akkar, which saw the first outbreak, while work is ongoing to prepare three other field hospitals in the Arsal region of Bekaa, in Sireh in the proximity of Sireh Government Hospital, and in Miniyeh. Additionally, efforts are being made to re-equip rooms that were previously used for COVID-19 cases in terms of partitioning and increasing the number of bathrooms, "which requires new work and partitioning," says Fawaz.
**Private Hospitals**
On the opposite side, and in anticipation of the panic that may arise with the rapid spread of cholera, the Ministry of Public Health recently sent a letter to the Hospitals Syndicate in Lebanon inquiring whether there are private hospitals willing to receive cholera patients if needed. While a response has not yet come from the syndicate, the head of the private hospitals syndicate in Lebanon, Suleiman Haroun, indicated in a statement to "Al-Akhbar" that "if we are requested to do so, we are ready," noting that "there is nothing preventing this, as medications and serums for treating patients are still available," which Fawaz also mentioned regarding "the ministry's provision of medications, serums, and supplies necessary for treating cholera patients."
However, these facilities do not prevent Haroun from feeling concerned about a potential increase in cases, particularly "regarding the shortage of human resources, including doctors and nurses. The problem exists and could worsen with the need for them in the event of cholera spreading." Therefore, the standard now for Haroun is that "as long as the cases are in the hundreds, we can cope, but if they reach thousands, I expect the situation will become more difficult." This concern has also been echoed by the World Health Organization, which fears a shortage in the number of healthcare workers and medical supplies in the face of rapid spread. Consequently, they have sent teams of nurses and doctors to meet sudden needs in hospitals in the most affected areas, according to a statement from the organization two days ago.
