Struck by an endless economic crisis, Lebanon is facing the collapse of its health system. Since 2019, more than 3,000 doctors and nurses have left the country. In the private sector, however, the dollarization of care has allowed the hospital sector to catch its breath. On the other hand, the Lebanese who do not have the means turn to a medico-social structure. Reportage.
The Levant French Hospital (HFDL) is one of the jewels of private medicine in Beirut. His reputation for excellence has crossed the borders of Lebanon and since 2018, he has acquired a fourth generation surgical robot. The establishment also has a robotics training center, unique in the Middle East, which trains Lebanese, Arab and North African surgeons in minimally invasive techniques.
“I had to go into debt to buy it, a few months before the start of the financial crisis in the fall of 2019”, explains, on November 14, Doctor Maalouf, majority shareholder of the HFDL located in Sin el -Fil, in East Beirut. “Fortunately I invested part of my money in this project, otherwise my assets would currently be blocked in the bank”.
Like all Lebanese, this doctor and entrepreneur has to face the worst economic and financial crisis since the middle of the 19th century.e century (according to the World Bank) and the devaluation of the Lebanese pound (LL) which has lost more than 95% of its value against the greenback in three years. Result: the banks drastically limit the access of depositors and public and private institutions to their accounts.
“We are forced to pay out of pocket to finance our projects and the hospital’s activities. We pay our suppliers’ invoices in ‘fresh’ dollars (dollars on which no bank restrictions apply), and without payment delay, otherwise they refuse to deliver our orders. It’s a disaster! We are a hospital and not a supermarket which could close in times of crisis and reopen when the situation improves. In addition, the explosion of The price of energy is unsustainable. It represents 40% of our budget”, adds Doctor Maalouf.
The economic collapse and the deterioration of living conditions in Lebanon have pushed more than 3,000 doctors, nurses and caregivers to emigrate, mainly to the Gulf countries, where the hospital sector is booming. To plug the flight of Lebanese health professionals, which in 2021 caused the temporary closure of certain care units, Doctor Maalouf had to increase salaries and pay bonuses to specialist doctors.
“More than half of our staff left Lebanon between 2020 and 2022. In recent months, I have had to significantly increase the salaries of employees. I absolutely wanted no care unit to be closed. definitely,” he says with a sigh. And to continue: “The reputation of our establishment is at stake. In 2015, in Dubai, we obtained the prize for ‘Best Hospital for Medical Tourism’. I make every effort to maintain the high standing of our institution. and to allow the HFDL to operate as quickly as possible at full capacity”.
The dollarization of the hospital sector
Also in the private medical sector, hospitals adapt their operations to the volatility of the Lebanese pound against the US dollar on the black market.
“The situation is improving with the dollarization of the hospital sector. Importers of medicines and medical equipment have resumed their activities, despite the enormous financial losses they are suffering due to the fluctuation of the exchange rate”, explains Dr. Henry Fakhoury, anesthesiologist-resuscitator at the Beirut Eye and ENT Specialist Hospital (BESH), located in the National Museum district, in Beirut. “The revival of imports and the opening of the market to generics has loosened the grip on hospitals,” he specifies.
The shortages of many essential medicines recorded as of June 2020 were on an unprecedented scale and had serious repercussions on patients for several months. Faced with the prolonged negligence of the Lebanese State, certain establishments, including the government hospital of Tripoli and the Rafic-Hariri university hospital, operate thanks to donations of money and medicines.
The dollarization of care has reinforced social inequalities in health, as many Lebanese cannot afford to pay their hospital bills or buy private medical coverage.
“The national social security fund and public bodies pay our bills by calculating the dollar at the official rate of 1,500 Lebanese pounds. To cover our costs, we are obliged to bill our services at the parallel market rate (39,000 LL) “, says Dr. Fakhoury. And to add: “The patient or the sick who does not have medical coverage in dollars will have to pay the difference. We are mindful of our social responsibilities, and this is the reason why our hospital rates have been revised to the decline”.
Physicians’ incomes suffered from this price readjustment. Some have seen their income melt by more than half. “It was inevitable! But with the dollarization of several related sectors, particularly private insurance, I am considering a revaluation of wages, with an increase in the percentage of pay in ‘fresh’ dollars. Banking restrictions force us to pay our employees in cash,” says Michael Cherfan, CEO of BESH.
In public hospitals and other health establishments in Lebanon, remuneration is always made in a currency called “lollars”, a contraction of pounds and dollars, quoted at 8,000 pounds for one dollar, or even at the official rate of 1,500. LL
“I decided to stay in Lebanon and fight. The country has gone through several crises over the past four decades, and it has recovered. I keep hope for the future! Working conditions are improving, slowly but surely!”, exclaims Doctor Fakhoury in a playful tone.
“At 60, it is difficult to rebuild your life abroad. If I was 40, and if I was less concerned with public affairs, I might have left. But there, it’s impossible . The country needs us.”
Primary health care centers, an affordable alternative
Faced with the collapse of the entire hospital sector, public and private, and the dizzying increase in the cost of care and medication, many Lebanese are turning to primary health care centers (CSSP). These medico-social establishments, accredited by the Ministry of Public Health, have the mission of providing quality services, ranging from prevention to treatment, free of charge or at affordable prices.
Jamale Daou is a nurse at the CSSP in the village of Baabda, located in the southeast of Beirut. For 26 years, she has cared for the elderly and the most disadvantaged. In this locality, nearly 200 people have recourse to this structure which works mainly thanks to donations from individuals and the help of local NGOs. Financial contributions from the State have been almost non-existent since the outbreak of the financial crisis, almost 4 years ago.
“Before the crisis, about twenty people with chronic illnesses came to the center every month to collect their medication. Today, more than 140 are on our lists, not counting the sick who come from outside the village. We let’s not turn away those who ask for our help” assures Jamale Daou, whose voice betrays his emotions.
“The abolition of government subsidies on drugs by the Banque du Liban is an act of profound recklessness. In Lebanon, nothing guarantees patients access to essential drugs.”
It has been three weeks since Pierre, 85, has been going to the CSSP in Baabda in the hope of obtaining the medicine needed to treat his prostate adenoma. This old man, with the build of an athlete, finds it difficult to hide his despair.
“I can’t take it anymore! Every month, it’s the same scenario. I have to go around the CSSPs and charities ten times. Nothing! No one is able to help me. The medicine cannot be found. What do you want me to do? I’m at my wit’s end!” he says, suppressing sobs. “They (Lebanese officials) want us to die. They don’t care about the suffering of the population. If they are sick, they have access to the biggest hospitals in the country. If they need medicine, they can obtain it without difficulty in pharmacies, or order it abroad”.
“The sharp deterioration in the situation of the most modest people is very worrying, especially since the national social security fund is facing a major crisis. We are short of medicines because donors no longer have the means to support to our needs as in the past. May she come to our aid”, says Jamale Daou, looking at the statue of the Blessed Virgin Mary which sits at the entrance to the center.