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Lebanon: what happened to healthcare?

Portrait of woman, young man, and older man in front of flowers and greenery.

L-R: Nadia, her son Jad, and husband Ali.
 All photos: Kate Crosby/CARE

L-R: Nadia, her son Jad, and husband Ali.
 All photos: Kate Crosby/CARE

Nadia Mhanna was the head of nursing at Sayde Hospital in Zahlé, Lebanon for years. It’s where she met her husband, Ali, who was a radiology nurse.

Both were and are dedicated to the nursing profession, taking great pride and joy from what Nadia describes as “humanitarian” work. They knew they wanted a family, but it took time for Nadia to get pregnant. But they had two healthy sons in the following years, and life was good. Nadia took time off to raise her family. She intended to return to the hospital when her children were grown, but that hope was dashed.

We are sitting in the sunroom of Nadia’s house in Baalbek. The comfortable setting belies an underlying truth: Nadia and her family struggle daily with finances because of the “crisis” in Lebanon. That is what it is commonly called, but it is well beyond a crisis. It is the devastating, years-long result of a catastrophic meltdown of the Lebanese economy.

It started in the fall of 2019 with the devaluation of the Lebanese pound (LBP). Currency shortages prompted banks to limit withdrawals, trapping millions of people’s savings. Foreign exchange inflows dried up.

Then in February 2020, the government defaulted on its foreign debt. The currency collapsed.

The budget deficit skyrocketed, and the balance of payments sank deeper and deeper into the red. Because of this, three-quarters of Lebanon’s 6 million people have fallen into poverty since the financial crisis began. To put this into perspective, before the devaluation one U.S. dollar bought 1,500 Lebanese pounds; today, the practical street exchange rate is one-to-100,000.

A man waving from behind the wheel of a small motorized vehicle
Ali waves from behind the wheel of his tuk-tuk.

Losing a “vocation of love”

After that, Nadia and Ali struggled to feed their family. Both had to leave their jobs because the cost to commute, a 45-minute drive, was greater than their incomes. It was and remains an upsetting decision because according to Ali’s son Elie, nursing is “a vocation of love, of dealing with people, of serving people.” They stopped working on the house they built themselves, room by room. They cut household expenses to keep their kids in good schools. This is particularly important because their sons are eager and gifted students.

Ali bought a tuk-tuk, a three-wheeled, motorized, covered vehicle he uses to make deliveries. “What he gains after a workday isn’t enough. If I want to buy some groceries, food, or something else for example. I mean that our income is less than our expenses,” Nadia explains. Ali puts its differently.

“We were living a decent life, and now it’s below zero. Not zero, but below zero,” he emphasizes.

Their eldest, 22-year-old Elie, studied biochemistry at the Lebanese University before switching to computer science. The fees combined with the commute prevented him from continuing his studies. He then enrolled in nursing school but was again forced to drop out because of costs. An avid reader, Elie became interested in pharmaceuticals. Today, he works in a pharmacy and absorbs all he can, with the dream of one day becoming a pharmacist. Like his parents, he proudly states that nursing is a critical profession, one deserving of respect and admiration. “It’s very sad to see people in the medical field not given their worth, not just financially, but to feel with them and take care of them,” he says.

18-year-old Jad is a high school senior. “I am working on getting a scholarship or going on to a university I deserve because, honestly, I’m at the top of my class and I have a strong potential.” He wants to study Artificial Intelligence because he feels the “impact of AI will be positive in the future, for technology is here to serve the interests of society. Humans are the ones in control of its positive and negative aspects.”

Jad talks a lot about how AI could help in a place like Lebanon because “this country needs new ideas.” Jad and his teachers are confident that he will win a scholarship and be able to attend university. The challenge is that AI is not a formal major anywhere in Lebanon. It’s filed under computer science. Perhaps Jad will be the one to change that. Until then, he learns a new skill every week, determined to broaden his knowledge any way he can.

Portrait of a woman with serious expression
Nadia Mhanna.

When you can’t afford to work

In a very short period, what has happened in Lebanon hasn’t just happened to its people, it has happened to its critical professions, and healthcare at the top of the list. In January 2020, the first case of COVID-19 was diagnosed, which exposed a shortage of supplies, resulted in an exponential increase in the number of patients, increased the fragility of the country, and overwhelmed its medical system.

The August 2020 Beirut port blast left 220 dead and 7,000 injured. People were rushed to hospitals with little regard for distancing, causing a spike in COVID infections. Lebanon is also home to some one million Syrian refugees, placing further burden on health systems.

Prior to the pandemic, Lebanon was short on medical supplies. The crises that followed required hospitals to become reliant on funding from the World Health Organization (WHO), and other foreign and non-governmental aid. Pay for healthcare workers has dropped roughly 80 percent, along with the value of the Lebanese Pound. Hundreds of doctors have left the country, unable to afford to work.

All of this has had dire consequences for the healthcare system in Lebanon. In the example of Nadia and Ali’s family, the community has lost two, potentially three frontline healthcare workers. In a place that has lost its economic value, the trust in its government, and the hope of a future, it is also losing the people who care for the health of their communities.

 

 

It’s not just Lebanon

 

Vintage portrait of a man and woman embracing
1994: Nadia and Ali in happier times.

Worldwide, there is a severe shortage in the number of health workers. Frontline health workers are the lynchpins of strong health systems. Most of these workers are women, and many are unpaid, underpaid, and under-supported.

This includes nurses, doctors, midwives, community health workers, pharmacists, and others who provide health services in patient-facing roles, either within or outside of health facilities.

Even before COVID-19, investments in health systems – and especially in female health workers – were too low. In 2019, there were about 18 million fewer health workers than needed around the world. After two years and 15 million deaths over the course of the COVID-19 pandemic, this gap has likely increased dramatically to at least 26 million fewer health workers than we need.

CARE is urging the U.S. Congress to pass the Global Frontline Health Worker Resolution and fund and strengthen the global health workforce. This includes acknowledging and supporting the role of frontline healthcare workers to be fairly paid, respected, protected, and trained, and ensuring that U.S. global health programs include funding to support them.

Man and woman looking at each other, smiling
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