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An employee organizes pharmacy supplies at Beirut's Rafik Hariri University Hospital, where Lebanon's overlapping economic and social crises have made medicines hard to come by.
Photography by Rafael Yaghobzadeh/The Globe and Mail
Bonus podcast ？ Mark MacKinnon speaks from Lebanon on The Decibel
Tears well up in Raida Bitar’s eyes as she opens one nearly barren cupboard after another in the pharmacy of Beirut’s biggest public hospital.
“It’s a disaster,” Ms. Bitar says as she lists off medicines that have become impossible to buy as Lebanon’s multiplying crises – which have left the country desperately short of money, medicine and fuel amid a resurgent pandemic – collide at the hopelessly overstretched Rafik Hariri University Hospital.
There’s no magnesium to give to new mothers suffering from eclampsia. There’s a shortage of sedatives for COVID-19 patients who need to be intubated. Antibiotics have disappeared from the shelves of not just the hospital pharmacy but pharmacies across Lebanon. Medications that help control chronic conditions such as diabetes or high blood pressure have also become scarce.
“You can go to 20 or 30 pharmacies and you cannot find baby Aspirin,” says Ms. Bitar, the hospital’s head pharmacist.
“It’s killing people. I have a family member who passed away because he couldn’t find hypertension medication anywhere and he had a stroke.”
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'It's a disaster,' head pharmacist Raida Bitar says of the drug shortages at the hospital.
Upstairs in the hospital’s clinical pathology department, there’s a shortage of reagents needed to run diagnostic tests on emergency room patients.
And as what looks to be a third wave of the pandemic hits Lebanon – propelled in part by the decision to keep the country’s airport open to allow a trickle of foreign travellers carrying U.S. dollars – the economic crisis is creating additional patients.
Growing poverty – the country’s economy has shrunk 40 per cent in just two years – has prompted concern about nutrition, as well as a surge in reports of domestic violence.
“It’s so difficult because we have to choose which patients we will test. This is not normal,” says Zeina Mohsen, the head of clinical pathology. She says the hospital is now testing about one in five new arrivals, leaving it up to doctors to assess, as best they can, what is wrong with the other 80 per cent of patients.
“I can’t predict how long we can continue like this. It’s day by day.”
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An ambulance parks outside the hospital, which bears a large portrait of its namesake, former Lebanese prime minister Rafik Hariri. His assassination in 2005 would create 16 years of political instability in Lebanon leading up to its current troubles.
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Shelves of drugs lie empty at the hospital, which is also short on resources to test all incoming patients for COVID-19: They can only manage to test about one in five people admitted.
The World Bank recently warned Lebanon’s financial collapse – which has been exacerbated by the massive explosion last year that killed almost 200 people and destroyed large parts of Beirut – could be one of the three worst the world has seen since the mid-1800s in terms of its effect on living standards.
The Lebanese pound has lost 90 per cent of its value against the U.S. dollar over the past two years and continues to tumble on a near-daily basis.
A country of six million people that imported almost everything, including medicines, can no longer afford to do so.
Unicef reported this week that about 77 per cent of Lebanese families do not have enough food or money to buy it. The figure was 99 per cent among the 1.5 million Syrian refugees in the country.
“The problem is we are overburdened,” says Rula Itani, the supervising nurse in the hospital’s emergency room, who showed The Globe and Mail a long list of patients waiting for beds or rooms to become available.
“We are receiving many people in the emergency room because they stopped taking their regular medication because they couldn’t find it in the pharmacies. Every day there is a fight because patients can’t understand how they came to the hospital and there are no medicines here either.”
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A patient rests in bed in the hospital's emergency services area. Some of the people who come to the emergency room aren't able to get their usual medications from their local pharmacies either.
The country’s acting prime minister, Hassan Diab – who resigned in the wake of last year’s port disaster but has remained in the post because the country’s quarrelling political factions have failed to agree on the shape of a new government – said this week that the country was “a few days away from social explosion.”
In the absence of a fully empowered government, efforts to negotiate a rescue package from the International Monetary Fund have collapsed.
The scarcity of medicines is a direct result of the financial crisis. For decades, Lebanon’s central bank has pegged the country’s currency to the U.S. dollar at the artificial rate of 1,500 pounds to US$1. That created an import-reliant economy and incentivized heavy government borrowing and spending, all the while feeding endemic corruption.
The scale of the problems with the country’s balance sheet became clear two years ago when investors began pulling their money out of Lebanon amid anti-government protests. Soon it was obvious that banks, including the central bank, did not have the money necessary to cover deposits. Many financial institutions locked their doors rather than deal with angry clients demanding to withdraw money that wasn’t there.
As the currency collapsed – it now costs more than 18,000 Lebanese pounds to buy one U.S. dollar – hyperinflation arrived. The cost of children’s Aspirin has climbed 1,200 per cent since 2019.
On July 4, the country’s association of pharmaceutical importers said in a statement that its members could not acquire more medicines unless the banks unlocked the funds needed to pay suppliers abroad. “The situation will be catastrophic by the end of July,” the statement reads, adding that members were collectively more than US$600-million in arrears to their suppliers.
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In this empty corridor of the hospital, the lights are off. Lebanese hospitals are used to power outages, but fuel to power generators is getting scarce and expensive.
The same factors are driving an energy crisis that has seen the government cut electricity to just a few hours a day. The country’s hospitals are accustomed to blackouts – all of them have backup generators – but fuel shortages mean hospitals worry the day may come when they’ll no longer be able to keep the lights on in operating rooms or be able to power life-saving medical equipment. Doctors and nurses are already used to working without air conditioning in temperatures that hover near 30 C.
Hours-long lineups for gasoline, which is subsidized but still rapidly becoming unaffordable for many Lebanese – the government raised prices 35 per cent last month – are now a common sight across Lebanon, and hospital staff looking to refill their generators have to wait in line along with everyone else. Much of the fuel brought into the country is smuggled across the border into neighbouring Syria, which is facing a fuel crisis of its own, because traders can fetch a higher price there.
“Even if hospitals have generators, they might not have fuel, and without electricity hospitals simply cannot run,” says Firass Abiad, the chief executive officer of Rafik Hariri University Hospital, who adds the hospital now goes through what used to be a month’s supply of generator fuel in just three or four days.
“All of these crises are happening at the same time, and nobody has a clear idea of until when the system can hold.”
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Firass Abiad is chief executive officer of Rafik Hariri University Hospital.
Another growing shortage at the hospital – and across Lebanon – is skilled workers. The hospital has lost 40 nurses in the past month as the country’s educated middle class continues to decamp for places such as Canada, France and the United Arab Emirates – an exodus that has accelerated since the port disaster.
The base salary for nurses, once equivalent to US$1,000 a month, is now less than US$90. Several staff members at Rafik Hariri University Hospital told The Globe they’ve remained at their posts this long out of a sense of duty, but it’s getting harder by the day to justify staying in Lebanon as worries about the country’s future grow.
“I’ll go anywhere. This is hell,” says Ms. Itani, the emergency room nurse. “I have 16 years of experience, and this is the first time I want to leave Lebanon.”
Ms. Bitar says she was in the process of applying for a move to Canada. “This is not the way to live. We studied. We went to university. We worked very hard. We deserve a better life. We are not part of what is happening here, but we are paying the price for it.”
The Decibel: A view from Lebanon On this episode of The Globe and Mail’s daily news podcast, Tamara Khandaker asks senior international correspondent Mark MacKinnon to explain the Lebanese financial crisis. Subscribe here for more episodes.