On August 4, 2020, an explosion in the Port of Beirut killed 218 people, wounded seven thousand, and displaced more than three hundred thousand. The Beirut Blast, as it came to be known, was the result of tons of improperly stored ammonium nitrate detonating. It coincided with a time of growing sectarianism in the wake of the Lebanese Civil War, the COVID-19 pandemic, and accruing discontent with a corrupt government.
Between 1975 and 1990, Lebanon experienced a civil war that saw the formation of militias composed of Lebanon’s various ethnic and religious groups in response to increased political polarization. The main militias were recruited from the Shi’a, Sunni, and Maronite ethnoreligious groups, as well as the Palestine Liberation Organization (PLO), which represented the large Palestinian refugee population in Lebanon. Nearly 150,000 lives were lost during the civil war and the conflict remains deeply rooted in Lebanon’s political history.
Now, Lebanon is facing years of corruption, as government officials hailing from Lebanon’s elite families exploit various aspects of the state. Those officials fill positions in government ministries and other public institutions with their loyalists. They are also the same officials who were aware of the materials stored in the port but never took action to remove them. The blast, as a result, revealed the harmful impact that years of misgovernance has had on Lebanon’s health sector.
Regular check-ups, which cost anywhere from $40 to $100, have become too expensive for the average Lebanese person
According to Luma Makari, the cofounder and director of Elggo—a Dubai-based health and ed-tech platform for mental health and social-emotional learning in Arabic and English—medical equipment was in short supply after the blast and people who needed immediate operations could not receive them because anesthesia was also scarce. The countrywide shortage of medical equipment and medications stems from the devaluation of the Lebanese currency (lira), which has made it more costly for hospitals to purchase these items. The country’s inadequate energy supplies, including fuel and electricity, further exacerbated problems of distribution and proper storage. As Makari recalled, “priority was given to high-risk patients and a person with a wasta or someone who is potentially more well off can pay the cost of anesthesia, which is another obvious indicator of the classism of the health-care system in Lebanon.” Makari also emphasized the “gap between the different financial classes where some people cannot afford life-saving surgery and other people have acclimated to the dollar situation.”
Crumbling Economy
In the year following the blast, the average salary in Lebanon plummeted 84 percent, reaching $72 per month. It did so simultaneously with the devaluation of the lira, which is currently valued at 100,000 to the dollar. As a result, regular check-ups, which cost anywhere from $40 to $100, have become too expensive for the average Lebanese person, who now goes to a doctor’s office only if necessary.
One former American University of Beirut (AUB) student pointed out that some doctors—aware of the shortage of some medications—will direct their patients to multiple pharmacies for medication pick-up. They explain to patients that if their medicines are not available at one pharmacy, they will be at another. Across Lebanon, severe shortages in cancer drugs and insulin have increased. The student also remarked that some medical doctors and pharmacists tell their patients to request the medication from relatives living abroad. Some Lebanese patients have turned to alternative medicine because many can no longer afford to pay for medications that can range from less than $4 to more than $100. The lack of necessary medications is daunting to many facing life-threatening illnesses.
Another woman—who lives between Beirut and Doha—noted that a simple check-up at a doctor’s office is difficult, commenting that “the office might be crowded and it’s stressful…. there are some visits that require you to cancel all your plans just to be there because you never know when you get in.” Others expressed similar frustrations about receiving health care. The AUB student observed that health insurance is not accessible to everyone and even if a person does have it, coverage depends on whether payment is made in Lebanese lira or U.S. dollars. As Makarai noted, the Lebanese lira is rarely accepted anywhere, referring to this phenomenon as the “dollarization of Lebanon.”
The Lebanese lira is rarely accepted anywhere, in a phenomenon known as the “dollarization of Lebanon”
Corruption and Exodus
Furthermore, Makari noted that now more than ever, government-funded hospitals and a small handful of leading hospitals are divided. In Lebanon, the prominent hospitals belong to the largest universities, namely, the American University of Beirut and the Lebanese American University, which were able to survive the economic crisis with little harm. Directly after the blast, the AUB Medical Center (AUBMC) raised tens of millions of dollars after it faced electricity cuts, medication shortages, mass layoffs, and a projected 60 percent reduction in revenue for its hospital. The layoffs, Makari recalled, occurred when electricity outages threatened the well-being of patients on life support. The severity of the situation was publicized by AUBMC to garner donations from their global alumni network.
The impact of the financial crisis on the health sector also highlights the existing classism not only in Lebanon, but also in health care globally. All three interviewees noted that most health-care staff—medical doctors and specialists in particular—have gone abroad to the United States, Canada, or Arab states in the Gulf. Makari explained:
Nobody is in Lebanon anymore. If you can leave, you will. If you have dual citizenship, you will leave. People who can afford to be treated abroad, go abroad. The top doctors have left the country and migrated. Residents are opting to complete their residency abroad. Also, hospital fees are in dollars, so if you can’t pay in dollars, you usually don’t receive treatment. There isn’t necessarily greed among health-care professionals, but everyone is in survival mode and must look out for themselves.
According to a report published by the Lebanese Order of Physicians, between one thousand and fifteen thousand registered doctors have emigrated after securing “financially lucrative offers where political and economic conditions are stable.” The report also states that 40 percent of emergency personnel at AUBMC have left for opportunities abroad.
In addition, the rampant corruption of the Lebanese government and its inability to provide the average citizen with enough money to purchase necessities such as food and medications points to obvious governmental misgovernance. Currently without a president, Lebanon faces a massive economic crisis and the growing influence of militant groups such as Hezbollah. In effect, Hezbollah has supported low-income households in Lebanon by providing both grocery stores and microloans. Increasingly, such loans have become an attractive option for Lebanese families who are struggling to survive.
The wealth gap also leaves us with a massive socioeconomic disparity. As the AUB student put it, “there are two categories in Lebanon: people who are rich and have access to health care and who can pay it, and people who aren’t and can’t.” Conditions before the Beirut Blast were already severe, but after it, access to necessary medications and proper health-care provisions has become impossible for much of the Lebanese population.
What the future holds for Lebanon’s economic crisis is unknown, but what is clear is the dire need to address the health-care crisis before the “dollarization” of the economy becomes irreversible.
