‘This will get ugly’: Lebanon’s health system trapped between economic catastrophe and coronavirus

Lebanon’s surging Covid-19 cases will overwhelm its crisis-stricken health system by mid-month unless urgent action is taken, according to hospital managers and health officials.

As the country battled its highest daily number of coronavirus infections on Wednesday, Rafik Hariri University Hospital (RHUH), the main coronavirus facility, also battled an 18-hour electricity cut that threatened to overwhelm their ageing generators.

The country’s hospitals – trapped in the middle of economic catastrophe and a surging pandemic – are in crisis.

The dollar shortage that is driving Lebanon’s financial meltdown has triggered a scarcity of medical supplies across the country, restricting the ability to pay staff or even send enough electricity to the hospitals.

Chronically underfunded public hospitals such as RHUH, which have been leading the charge against coronavirus, are a matter of days away from being overwhelmed. But private hospitals, which account for 85 per cent of the country’s healthcare system and have long buttressed the weak public health care system, warn they are also on the brink of collapse.

“It’s getting more and more difficult to admit patients and give them the necessary treatments,”said Suleiman Haroun, President of the Syndicate of Private Hospitals.

“How long can this last before hospitals begin to fully close, I don’t know. It’s like a dying person, you know that he’s dying but you don’t know when it’ll be over with. We are in the same situation, it’s agonising.”

Warning that the crisis could be about to force more private hospitals to shut their doors, Mr Haroun said that most of the hospitals have already closed departments, minimised their activities and postponed all non-urgent procedures and admissions.

Open heart surgery on a patient with Covid-19 in RHUH’s ER

Credit: Abbie Cheeseman

When the pandemic first arrived in the country in February, it was left to RHUH, long a last-resort hospital for the underprivileged and refugees, to lead the response. Over 70 per cent of the Covid-19 patients have been treated in the neglected, underfunded public hospital.

Dr Firass Abiad, the director of RHUH, has become the figurehead of the coronavirus response in Lebanon: a rare voice of transparency in a country considered one of the most corrupt in the world.

“Clearly, we are heading into the eye of the storm. A rise in hospitalisations will surely follow,” Dr Abiad tweeted on Thursday morning after Lebanon recorded 182 new infections, it’s highest daily toll, on Wednesday evening.

While Lebanon’s numbers remain low, the quickly rising cases are already pushing the country’s healthcare capacity to its limits. According to an estimate by Prime Minister Hassan Diab’s advisor, Petra Khoury, Lebanon’s ICUs will be overwhelmed by mid-August.

“We need to be worried,” Dr Abiad said. “This is going to look ugly.”

All of the healthcare workers who spoke to The Telegraph reported a serious shortage of PPE.

Before the airport reopened and all lockdown restrictions were lifted at the beginning of July, the peak for the Covid Intensive Care Unit at RHUH was eight patients.

“Once we reach 23 patients I cannot do anything,” said Dr Mahmoud Hassan, the head of the coronavirus ICU, which is currently treating 18 patients.

“We could reach this stage in maybe days, maybe hours – you never know. Last Monday I received eight patients on the same day, within hours. When we do reach full capacity we will start to close ER because you cannot accept patients if you cannot take care of them.”

A baby with Covid-19 in pre-op before open heart surgery in RHUH’s ER

Credit: Abbie Cheeseman

According to a nurse supervisor in the coronavirus Emergency Room at RHUH, last week at least three ICU patients who had tested positive had to be kept in the ER, where patients who were only suspected coronavirus cases were also being treated, because there were no beds in the ICU.

Dr Hassan said the medical team is already overwhelmed. “We only have seven or eight doctors for the corona ICU, so we have to do 24-hour shifts,” he said.

The nurses, he added, are working 12-hour shifts on a four day on, two day off schedule. With the risk of being infected outside the hospital too high, the hospital now has a policy where the nurses have to sleep in the hospital dorms for the four days that they are on.

While the struggling public hospitals are hoping that the private hospitals, where the majority of ICU beds are, will shoulder more of the coronavirus burden, the economic crisis has unbearable pressure on them, Mr Haroun explains.

According to his calculations, Lebanon’s private hospitals are owed almost $1.5 billion from the severely indebted government. Health officials say that 99 per cent of medical supplies in Lebanon are imported.

This has further restricted their ability to buy medical supplies in the midst of the rapid depreciation of the Lebanese Lira – which is trading at around a 70 per cent loss of its official value – and its ensuing hyperinflation.

Simultaneously, as confidence in Lebanon’s economy hits new lows, sending international bank transfers to suppliers and factories abroad for medical supplies has become more complicated with none willing to send supplies on credit anymore, Mr Haroun said.

Shortages of medicine are being reported in pharmacies and hospitals across the country. Some hospitals are closing their more expensive wards first, such as chemotherapy, as they cannot afford to buy the drugs for the patients and wait to be reimbursed. The first private hospital shut its doors in April, telling local media they “would not be the last”.

Many private hospitals are refusing to admit patients who do not have insurance with very specific coverages, in a country where half of the population has descended into poverty.

For almost a month the country has been facing severe power cuts. Lebanon hasn’t had 24-hour electricity since the end of the 1975-1990 civil war, but now the generators that usually plug the gaps in the service are overwhelmed, frequently plunging the country into darkness. The hospitals are not immune.

Where they used to only face an hour or two of power cuts a day, they are now stretching between 10 and 18.

The increased power cuts are putting too much pressure on many generators and overloading them. In RHUH, Mr Chehimi, the head of maintenance, complains that the hospital’s infrastructure is old and expensive to service.

“Two out of my six generators are out of order – I don’t know what we can do.”

For the second time in less than a month, RHUH is relying on donations of 30,000 litres of fuel to keep the hospital running throughout the electricity shortages.

According to Mr Chehimi, the hospital is struggling to buy spare parts to fix the ageing hospital systems.

RHUH has cut the air conditioning to parts of the hospital due to the fuel shortages. The generators, which used to load three coolers, now only load one for the entire hospital – which Mr Chehimi says is resulting in a shortage of cooling to the operating rooms.

More than half of the 4,334 coronavirus infections have been reported since July 1.

On Monday MP Assem Araji, head of the parliament’s health committee warned that Lebanon has entered the fourth stage of the first wave, in which control has been lost, adding that 20 per cent of recent cases were untraceable.

The health versus economy war in Lebanon, that saw what critics call a hasty reopening of the airport from a successful lockdown, is far from over.

Lebanon re-entered partial lockdown on Thursday in an attempt to reverse the alarming trend of rising cases since the lockdown was lifted. Health officials, however, are concerned that only another full-lockdown, which debilitated Lebanon’s economy last time, will create any significant progress.

Myrna Doumit, President of the Order of Nurses in Lebanon, has called for a nursing strike on August 5 to highlight the conditions the country’s nurses are working under, with many working without being paid, taking salary cuts or being asked to take unpaid vacations.

Between 35 and 40 per cent of nurses in Lebanon have been laid off since November, according to Ms Doumit.

The patient to nurse ratio has increased past 20:1 in recent months, putting both nurses who are lacking PPE and patients at greater risk, she said.

“We cannot even think about continuing as it is – we’ve reached the edge. The health care sector cannot continue without finding a source of money to finance hospitals. If this continues we won’t have hospitals,” she said.

  • Additional reporting: Christina Cavalcanti

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