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The Impacts of Corruption on Lebanon's Public Health Gjertsson 3/2021 The Impacts of Corruption on Lebanon’s Public Health — Sofia Gjertsson PUBLISHED BY THE SWEDISH INSTITUTE OF INTERNATIONAL AFFAIRS | UI.SE Sofia Gjertsson © 2021 The Swedish Institute of International Affairs Language editing: Andrew Mash Cover photo: TT NYHETSBYRÅN Introduction Public health and medical inequalities have dysfunctional public provision. However, the been an area of focus for states throughout healthcare system is still being criticised for the world for many decades. Adaptation to its lack of quality and accessibility, at least to international legal frameworks, and the poorer socio-economic classes.2 3 4 5 6 investments in health and social services, This brief addresses the question of who has access to clean water and sanitation, and the right or is able to access good public education have led to improvements in healthcare. Accessibility in this case is a global health indicators, notably increases in matter of both financial capacity and life expectancy and decreases in child geographical distance. mortality. However, such improvements have been uneven both between and within Public health research suggests that bad states, and some countries and socio- governance and corruption have negative economic classes have fared better than impacts on healthcare systems by diverting others.1 Much depends on a state’s ability to crucial resources.7 Hence, this brief analyses cope with inadequate financial resources, how corruption in Lebanon affects public health inequalities and disparities. Lebanon health and the healthcare system. The time is one state that seems to have performed frame is the 1990 to 2019, as many political quite well at times. However, its weak state, and societal changes were made during this financial situation and levels of corruption time, in particular to the healthcare system. mean that a large proportion of its The brief uses the 1948 World Health population struggles to access or afford Organisation (WHO) definition of public healthcare services. health, which is still widely used today: “Health is a state of complete physical, Lebanon has struggled financially and mental and social well-being and not merely politically since its 1975–90 civil war. The the absence of disease or infirmity”.8 9 While privatisation of much of its system of there are other definitions of public health, healthcare was intended to improve the this definition is chosen because it explains 1 Skolnik, R. (2016). Global health 101. Third Edn. 6 El-Jardali, F., Jaafar, M., Dimassi, H., Jamal, D., & Jones & Bartlett Publishers. Hamdan, R. (2010). The current state of patient safety 2 Méon, P.G. and L. Weill (2010), Is corruption an culture in Lebanese hospitals: a study at baseline. efficient grease? World Development, 38(3), 244-259. International Journal for Quality in Health Care, 22(5), 3 El-Jardali, F., Hemadeh, R., Jaafar, M., Sagherian, L., 386-395. El-Skaff, R., Mdeihly, R., Ataya, N. (2014). The impact 7 Alnahdi, S. (2020). The impact of corruption on of accreditation of primary healthcare centers: healthcare services: Empirical evidence from the successes, challenges and policy implications as MENA region. International Journal of Economics and perceived by healthcare providers and directors in Financial Issues, 10(5), 8-15. Lebanon. BMC Health Services Research, 14(1), 86. 8 Skolnik, R. (2016). Global health 101. Third Edition. 4 Tawil, S., et al. (2020). Patients’ perceptions Jones & Bartlett Publishers. regarding pharmacists’ healthcare services: the case 9 Leenders, R. (2012). Spoils of truce: Corruption and of Lebanon. Journal of Pharmacy Practice and state-building in postwar Lebanon. Cornell University Research, 50(2), 137-143. Press. 5 Deets, S. (2015). Networks and communal autonomy as practice: Health, education, and social welfare in Lebanon. Ethnopolitics, 14(4), 329-353. © 2021 The Swedish Institute of International Affairs 3 simply and briefly how a state of well-being high rates of cancer and cardio-vascular is different from an absence of illness. It also disease in particular, compared to takes the definition one step further in neighbouring countries. committing to complete well-being, which everyone deserves. Deserving good health, however, does not The Case of Lebanon guarantee equal access for all, as is explained Lebanon’s uneven development, and its throughout this brief. Public health in financial and political struggles have led to a Lebanon has become a class issue where large public sector debt and an unstable only those who can afford to pay the industrial base and economy. The main necessary bribes or hidden expenditures, reason for this is political instability, as and who live in urban areas, are able to illustrated by events such as the access quality healthcare. There has been a assassination of Prime Minister Rafiq Hariri lack of focus in previous studies on in 2005 and regular violent conflict and corruption and its links to public health, political turmoil, as well as the spillover from which means that the consequences for the the Syrian Civil War and the related refugee field are yet to be explored and pinpointing crisis, high levels of corruption and more the exact causes is difficult.10 11 The analysis recently the effects of the COVID-19 12 13 finds that Lebanon has good quality pandemic. All this has led to increasing healthcare services, but these are not levels of poverty in recent years and high accessible to everyone. People in lower levels of inequality. Its Gini Index of 51 in socio-economic classes, those living in 2017 ranked Lebanon 129th of 141 states on 14 poverty and stateless persons, such as inequality. Lebanon is also host to the Palestinian and Syrian refugees, struggle to highest number of refugees per capita in the access healthcare services. In recent world, but it has not signed the 1951 Refugee decades, corruption in this area has not been Convention. This means that an estimated tackled strongly enough by the state, and 1.7 million people living in Lebanon have no this is affecting the quality and accessibility legal right to access public services such as of healthcare. There are both an urban-rural healthcare. Syrian refugees must pay out of bias and issues over the high cost and low their own pockets or receive cover from the quality of healthcare. The result has been an United Nations High Commissioner for increase in non-communicable diseases, and Refugees (UNHCR), while Palestinian 10 Alnahdi, S. (2020). The impact of corruption on 13 ESCWA, ESCWA warns: more than half of healthcare services: Empirical evidence from the Lebanon’s population trapped in poverty, MENA region. International Journal of Economics and https://www.unescwa.org/news/Lebanon-poverty- Financial Issues, 10(5), 8-15. 2020. 11 Leenders, R. (2012). Spoils of truce: Corruption and 14 Saliba, E., Sayegh, W. and Salman, T. F. (2017). state-building in postwar Lebanon. Cornell University Assessing Labor Income Inequality in Lebanon's Private Press. Sector: Findings, Comparative Analysis of 12 Vohra, A.,(2020) Foreign Policy.The Death of Determinants, and Recommendations. UNDP Fiscal Lebanon’s Middle Class. Policy Advisory and Reform Project at the Lebanese https://foreignpolicy.com/2020/05/21/lebanon- Ministry of Finance Report. coronavirus-middle-class-poverty/. © 2021 The Swedish Institute of International Affairs 4 refugees are supposedly covered by the resources and small domestic industry leave United Nations Relief and Works Agency for it heavily dependent on imports. The Palestine Refugees (UNRWA) healthcare economy is mainly made up of the services system. This creates an environment in sector, banking and finance, tourism and which millions of people cannot get the construction. As mentioned above, tourism healthcare they need and are not allowed to has been a fragile industry since the end of work in the same way as citizens can.15 the civil war, with fluctuations depending on the political and security situation in the However, many citizens also struggle country. Events such as the assassination of financially with the cost of healthcare, even Hariri, the July War of 2005–2006, the though they have full legal rights. The ongoing Syrian Civil War and refugee crisis turmoil in Lebanon has led to rising since 2011, and the “October Revolution” of unemployment and there is a large informal 2019 have all called the stability of the sector where people look for alternative job country into question and led to contractions opportunities to make ends meet. Lebanon in sectors such as tourism. The Lebanese has tried to adopt a laissez-faire economic government has taken on several loans to policy focused on the services sector. make up the deficit created by imports Tourism in particular has undergone great exceeding exports. This has contributed to fluctuations due to the political instability Lebanon’s state-debt, which is estimated at and political violence. The economy has 150% of GDP, being one of the highest in the collapsed several times in recent decades, world, and it is expected to increase fuelling the vicious circle of rising inequality further.20 21 The government has made and poverty.16 17 18 19 several attempts to stimulate economic growth and reduce poverty, and these had Political and Economic Developments in relatively positive results in the post-war era Lebanon of the 1990s until the assassination of Lebanon’s civil war (1975–1990) affected the Hariri.22 23 This type of cycle has been economy, its industry, and its politics and common for Lebanon, which seems to be policymaking. Lebanon’s scarce natural stuck in a vicious circle of economic growth 15 Janmyr, M. (2016) Precarity in exile: The legal status 20 Vohra, A.,(2020) Foreign Policy.The Death of of Syrian refugees in Lebanon. Refugee Survey Lebanon’s Middle Class. Quarterly, 35(4), 58-78. https://foreignpolicy.com/2020/05/21/lebanon- 16 Chen, M.A.
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