The devaluation of Lebanon’s currency has led to a 95% loss in the value of funds allocated to health care. 1 Since 2019, the health care sector has been struggling due to the combined effects of COVID-19, the financial crisis, and the destructive Beirut blast in August 2020.Reference Bou Sanayeh and El Chamieh 2 The recent 2024 war, primarily affecting southern Lebanon, Beqaa governorate, and parts of Beirut, has worsened an already struggling health care system, creating a crisis within a crisis. This urgent situation calls for immediate humanitarian assistance to address short-term needs, as well as long-term strategies to rebuild and strengthen Lebanon’s health care infrastructure. This report from the field highlights the challenges facing the health care sector in Lebanon and provides some potential solutions.
Narrative: Challenges Facing the Lebanese Health Care Sector
The Lebanese health care system is facing a major crisis due to a severe shortage of medical staff and essential supplies. The recent surge in war casualties has overwhelmed hospitals, putting even more pressure on resources in a country already struggling with economic problems and infrastructure challenges.
Pagers Explosions
The 2024 pagers explosions, which occurred on September 17, severely impacted Lebanon’s health care system, particularly in Beirut. Hospitals in Beirut were inundated with patients suffering from complex and life-threatening injuries. Many victims experienced devastating eye injuries and hand amputations resulting from holding the pagers when they detonated. Emergency medical services have struggled with the safe transport of wounded individuals, as ongoing hostilities and infrastructure damage have rendered certain routes impassable. Over 1800 individuals were admitted to hospitals, with hundreds requiring urgent surgeries on their eyes, faces, and limbs. Intensive care units reached full capacity, treating critical cases involving facial swelling, brain hemorrhages, and shrapnel injuries. This surge in medical emergencies placed significant pressure on Lebanon’s already weakened health care infrastructure, which was struggling amid the country’s ongoing economic crisis. 3 In total, around 200 individuals remained in critical condition, further straining health care resources.Reference Horvath 4
War Casualties
The situation has escalated significantly lately. As of October 11, 2024, the ongoing conflict in Lebanon has resulted in significant casualties, with the Lebanese Health Ministry reporting a death toll of 2169 and over 10 212 injured since October 8, 2024. The escalating violence and high casualty rates highlight the urgent need for humanitarian assistance, as Lebanon’s health care infrastructure continues to face unprecedented strain from the ongoing war.Reference Sio 5 Additionally, the pre-hospital transport of victims was severely disrupted due to damaged roads, overwhelmed emergency response teams, and a shortage of ambulances. Many patients faced delays in reaching hospitals, exacerbating their conditions and increasing mortality rates.Reference Golden 6 The large number of fatalities has posed significant challenges in human remains identification. 7
Hospital Closures and Staff Fears
Many hospitals in southern Lebanon and Beirut are facing closure due to direct bombings or critical shortages of supplies. Since September 23, over 50 health care workers have lost their lives, and the number of injured paramedics continues to rise sharply, highlighting the severe risks faced by medical personnel during this ongoing conflict.
As medical staffs are displaced, particularly in southern Lebanon, the health care system is struggling to cope with the increasing number of individuals requiring urgent medical attention, often exceeding 100 casualties daily. Rafik Hariri University Hospital, the largest public hospital in the country, reported disruptions caused by nearby bombings that have forced some staff to relocate. In response, the hospital has set up dormitory accommodations for essential personnel and is seeking safe housing options for others. However, anxiety among hospital staff regarding their safety remains palpable.Reference Christou 8 , Reference Gunter 9
Exodus of Health Care Professionals
A recent study revealed a significant shortage of Lebanese physicians and nurses, with marked regional disparities between urban and rural areas.Reference Hemadeh, Kdouh and Hammoud 10 This shortage can be explained by the exodus of health care professionals since 2019, which was triggered by the economic crisis and has been exacerbated recently by the ongoing war.Reference Nemr, Moussallem and Nemr 11 The shortage of health care professionals can negatively affect the country’s ability to respond effectively to the ongoing war and the large number of casualties, often requiring complicated surgeries that overwhelm the already strained medical system.
Shortage of Drugs and Lack of Stewardship Programs
The ongoing economic crisis in Lebanon has led to significant shortages of essential medications, compelling many Lebanese citizens to individually import missing drugs from nearby countries at inflated prices. Some residents also resort to using brand-name medications from low-income countries that may not always be fully tested or safe as alternative treatments.Reference Ahsan 12 This situation is further exacerbated by the inconsistent availability of crucial new antibiotics for multidrug-resistant organisms, such as cefiderocol, ceftazidime-avibactam, and ceftolozane-tazobactam, which are not uniformly accessible across hospitals. This lack of availability complicates the management of war casualties, particularly as infections are common in war-related injuries. Additionally, the absence of antimicrobial stewardship in Lebanon has contributed to an unprecedented increase in antimicrobial resistance, further hindering effective treatment options for patients.Reference Sayegh, Hallit and Hallit 13
Shortage of Medical Supplies
Since October 2019, Lebanon has experienced a severe shortage of medical supplies, a crisis exacerbated by the country’s financial turmoil. The devaluation of the Lebanese currency, soaring inflation, and ongoing economic instability have hindered the procurement of essential medical products, leaving health care facilities struggling to meet the needs of patients. Many hospitals face limited access to crucial supplies, including surgical instruments, implants, prosthetics, casting materials, and personal protective equipment, leading to compromises in patient care.Reference Bou Sanayeh and El Chamieh 2 This shortage poses significant challenges in treating injuries during the ongoing war in 2024, as health care providers are ill-equipped to manage the influx of casualties effectively. As a result, patients face higher post-operative infection rates due to the unavailability of sterile equipment, prolonged hospital stays caused by delays in surgical interventions, and increased mortality rates among critically injured individuals who cannot receive timely and adequate treatment.
Cholera Resurgence Concerns
Lebanon’s Ministry of Public Health confirmed a cholera case on October 16 in Akkar governorate, the first since the 2022-2023 outbreak, heightening concerns over deteriorating water and sanitation conditions amid ongoing conflict. In response, WHO and health authorities have launched a cholera preparedness and response plan, strengthening surveillance, laboratory testing, and water sanitation efforts while evaluating the necessity of oral cholera vaccines to curb the outbreak. 14
Discussion
Suggested Solutions
Lebanon’s health care system faces overwhelming strain from war casualties, hospital closures, critical staff shortages, and supply deficiencies. Addressing these challenges requires a comprehensive and coordinated approach.
In the short term, international humanitarian assistance is crucial; this includes mobilizing resources from global health organizations and countries willing to provide medical supplies, financial support, and technical expertise. Setting up temporary medical facilities or field hospitals could help alleviate the burden on overwhelmed hospitals, ensuring that care is accessible to the influx of patients needing urgent medical attention.
Furthermore, the Lebanese government, in collaboration with international bodies, should urgently recruit and retain health care professionals in public hospitals by offering competitive salaries, safety assurances, and mental health support to address their fears and trauma during the ongoing conflict. Short-term incentives for expatriate health care workers to return, combined with training programs, can help mitigate the brain drain that has severely impacted the sector.
A critical need is the rehabilitation of war casualties, particularly those who have suffered amputations. Providing prosthetics, physical therapy, and psychological support for amputees is essential for restoring their independence and quality of life. Specialized rehabilitation centers should be established or expanded to address the long-term needs of these individuals, ensuring they receive comprehensive care.
In addition, addressing the Emergency Medical Technicians (EMTs) shortages and lack of ambulances is crucial. The Lebanese government, along with international agencies, could deploy additional EMTs and offer training for local volunteers. Temporary increases in ambulance numbers could be arranged through partnerships with international humanitarian organizations or neighboring countries. Mobile clinics and temporary transport units could also be utilized to overcome road closures or infrastructure damage in some regions.
For long-term stability, implementing a robust and sustainable supply chain management system is essential to address shortages of essential medications; this includes fostering partnerships with pharmaceutical companies to ensure the availability of necessary drugs and vaccines. Expanding local pharmaceutical production can also reduce reliance on imports, making essential medications more accessible and affordable. Additionally, investing in public health infrastructure and antimicrobial resistance programs can combat the rising rates of antimicrobial resistance, enhancing the overall quality of care.
Finally, long-term investments in preventive care and health education are essential for reducing the demand for emergency services and strengthening the resilience of Lebanon’s health care system. Programs such as vaccination campaigns, health screenings, and nutrition workshops can improve public awareness and promote disease prevention. Additionally, creating sustainable support networks, like peer groups for mental health, can help individuals navigate health care services more effectively. By empowering communities with knowledge and resources, these initiatives can alleviate pressure on the exhausted health care system.
A combined approach of immediate intervention and long-term planning will be key to alleviating pressure on the exhausted health care system.
Limitations
This report relies on grey literature due to the scarcity of newly published articles focusing on the recent health care conditions in Lebanon. While grey literature offers valuable insights, it may lack the rigorous peer-review process of scholarly publications, affecting reliability. Additionally, the rapidly changing situation in Lebanon means that available information can quickly become outdated. Despite these limitations, the findings aim to highlight the urgent needs and ongoing issues within the Lebanese health care system during this critical period.
Conclusion
In conclusion, Lebanon has shown resilience, with health care professionals and organizations working tirelessly to maintain care despite the crisis. However, the current challenges facing Lebanon’s health care system require urgent and multifaceted solutions. By securing international humanitarian assistance, enhancing the recruitment and retention of health care professionals, improving drug supply chain management, investing in public health initiatives, and empowering communities through education and preventive care, Lebanon can build a more resilient health care infrastructure. With coordinated efforts, there is hope for revitalizing the Lebanese health care sector.
Author contribution
AA conceived the idea for the manuscript. AA and NEA wrote the manuscript. EH, NC, JC, and GS critically revised it and contributed to the writing process. All authors read and approved the final version of the manuscript.
Funding statement
There were no funding sources.
Competing interests
The authors declare that they have no competing interests.
