Lebanon is facing the imminent threat of economic default and ongoing anti-government protests which have failed to abate. These factors have allowed problems within the healthcare system to slip from the government's grasp, leaving it to rot. Now, just when a strong healthcare sector is most needed, it is becoming clear that Lebanese hospitals will simply not be able to cope with a surge in coronavirus infections.
The World Health Organisation (WHO) representative for Lebanon, Dr Iman Shankiti, told the Daily Star that dealing with an outbreak "with current supplies and capacities… will be difficult." As it stands, the Rafic Hariri University Hospital in Beirut is the only healthcare facility in the country capable of treating coronavirus patients. The hospital, according to the newspaper, has seven intensive care and four isolation units, with the capacity to accommodate approximately 128 mild and 11 severe cases. With rapid rates of infection, and 14-day periods of self-isolation necessary to identify carriers, the capacity to treat only 139 people nationwide is not enough.
"All patients with symptoms, regardless of the hospital they go to, are being transferred to Rafic Hariri, and will be put in isolation… with negative pressure in the room, following WHO recommendations," an infectious disease specialist from the Rafic Hariri Hospital in Beirut, Dr Oussayma El-Dbouni, told me.
The Ministry of Health had called on all hospitals across the country to prepare themselves for a potential outbreak. In an interview with Al-Arabiya English, Future Movement MP Assem Araji said that, "In every governorate there should be a hospital prepared with isolation rooms as Rafic Hariri Hospital is." This has not materialised, though. Instead, Lebanon has requested assistance from the WHO to bolster its defences, in a clear indication that the country's health service cannot cope.
The health sector in Lebanon suffers from a crippling shortage of medical supplies, which has been exacerbated by the national currency crisis. Hospitals pay importers in US dollars, at an unofficial exchange rate, which has reached as high as 2,500 Lira to the dollar in recent months. Compared to the official exchange rate of $1 to 1,507.5 Lira, the cost of importing medical supplies is increased substantially.
Yet, despite the chronic shortage of supplies, including face masks, gowns and gloves, all of which are now in high demand since the coronavirus reached the country, Lebanese companies have been selling such protective equipment internationally. According to local news outlet The 961, more than 4.5 tonnes of newly-imported medical masks, purchased from abroad and intended to supply the Lebanese market, were instead resold to the UAE, Congo and even China.
In response, Minister of Trade and the Economy Raoul Nehme issued a moratorium on the export of protective medical gear, including rubber gloves, face masks and shoe covers. The former banker said these measures were put in place to avoid "any negative impact that might affect the health of the citizens due to the lack of the necessary medical personal protective equipment." Though the efficacy of medical masks in preventing the spread of disease is arguable, Lebanon's supplies are already the subject of profitable international trade deals, leaving hospitals and pharmacies unable to meet domestic demand.
The government in Beirut has floundered in its response to an explosion of cases in the region, taking five days after the first confirmed case in Lebanon was reported on 21 February to convene an emergency meeting on the subject, and then implementing only rudimentary travel bans. In comparison, other infected countries in the region have quickly, and harshly, shut borders with neighbouring states, issued travel bans and closed schools and religious sites.
Iran, the site of the largest outbreak in the region, and the deadliest outside China, has suspended parliamentary sessions and closed universities and other public spaces indefinitely. While five of Iran's seven neighbours have closed their shared borders, Saudi Arabia, Kuwait, Jordan, the UAE, Oman and Georgia have all imposed travel and immigration restrictions. Meanwhile, the approach at Beirut's Rafic Hariri International Airport has reportedly been lackadaisical, with continuing traffic from heavily infected states, including Italy and Iran.
According to El-Dbouni, "Measures at the airport are the main form of prevention." Despite this, several videos show passengers from Italy disembarking at Beirut airport and walking freely out of the terminal buildings. Claims have been made that only passengers on Iranian planes are being checked for symptoms, despite Italy reporting hundreds of confirmed cases. However, the Lebanese authorities have called upon travellers to self-quarantine for 14 days to reduce the risk of infecting more people. Nevertheless, WHO representative Shankiti told the Daily Star that no plan to ensure that proper self-quarantine procedures are followed has been put in place, "but we're working on it."
Preoccupied by lengthy discussions with the International Monetary Fund over the repayment, or default, of the Eurobond, which is set to mature on 9 March, the government in Beirut has failed to take adequate steps to prepare Lebanon for a potential coronavirus epidemic. The time for "working on it" has passed. Lebanon is fundamentally unprepared and must now get ready to deal with the consequences.
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