www.jogh.org •doi:10.7189/jogh.11.03052 Anita Shallal Lebanon islosingitsfrontline JOGH ©2021ISGH © 2021THEAUTHOR(S) The onlineversionofthisarticlecontainssupplementarymaterial. Electronic material: supplementary 6 5 4 3 2 1 *Equal authorship. The HolySpiritUniversityofKaslik,SchoolMedicineandMedicalSciences,Jbeil,Lebanon Infectious Diseases,NotreDamedesSecoursUniversityHospital.Jbeil,Lebanon Wayne StateUniversitySchoolofMedicine,Detroit,Michigan,USA Infectious Diseases,HenryFordHealthSystem,Detroit, Michigan, USA American UniversityofBeirutMedicalCenter,Beirut,Lebanon Henry FordHospital,Detroit,Michigan,USA find abetterlifeelsewhere. saster asphysiciansareleavingto The countryisfacingcripplingdi need for any community response. Since then, Lebanon has seen a substantial spike in COVID-19 cases COVID-19 in cases spike asubstantial seen has Lebanon then, Since response. for community need any patients, increasing the fragility of the country and leading to an overwhelmed medical system ( system medical overwhelmed to an leading and country of the fragility the increasing patients, of number the in increase exponential to an of supplies ashortage from difficulties to face continued system care health the instability, political and economic this Amidst completely went bankrupt. systems banking 81% lost pound [ Lebanese value the of its as worsened crisis The financial measures. safety and lockdown the despite continued that to led protests pandemic the to handle ability its and government the in of trust A lack diagnosed. was country of COVID-19 the in case 2020 first the on 21Then, February highly contagious measles virus [ virus measles contagious highly the as such population, refugee the in more prevalent already are that illnesses of preventable vaccinations in delays including arrested, been have campaigns immunization addition, In virus. the from protection little provided tents in conditions crowded the as deteriorated, of refugees health the pandemic, the ing Dur providers. care health and system care health country’s on the world the [ in capita per of refugees number highest home to to the be thought is Thecountry refugees. Syrian one million of more than crisis ahumanitarian with state, ile afrag in was Lebanon bombing, Beirut the and pandemic to the Prior elsewhere. life abetter to find leaving are physicians events: of these aresult followed as has However, catastrophe another damage. eral collat as behind left people were Lebanese the and resigned, cabinet Lebanese the unrest, civil and outcry public Following government. their in people’s of trust lack Lebanese the reinforced event tragic This rut. Bei in port at the stored being nitrate ammonium of dangerous tons were there that years for several knew with over 150 with L 1 *, ChloeLahoud October Revolution, clashes with the government began, and by early 2020, violence was escalating. escalating. 2020, was early by and violence began, government the with Revolution, clashes October 2019. in complete of 2019, collapse its 1990, fall the in the until to as war In now referred civil atime of end its the since festering been had that recession economic an after reeling left been has ebanon
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0 reported cases and over 1200 deaths [ deaths over 1200 and cases 0 reported - 2 *, Marcus Zervos [ of over homes 300 the to destroying dition to help one another without regard for social distancing, given the desperate desperate the given distancing, for regard social without to help one another tating blast left 204 people dead and more than 6500 people injured, in ad in people injured, 6500 more than and people dead 204 left blast tating The devas Beirut. capital 2020 world the of in the on 4 August history the in explosions non-nuclear powerful followed most one by of later the was This 2 ]. That evening, civilians rushed to the nearest hospitals, centers and streets streets and centers hospitals, nearest to the rushed civilians ]. evening, That 4 ]. 3 ], placing a tremendous burden burden atremendous ], placing 1
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VIEWPOINTS VIEWPOINTS 2021 •Vol. 11 • 03052 produced withpermission). Photo: NationalAnthem(73 Matar (reproducedwithpermission). 1. Figure Beirut, theMartyredCity(97 country’s currency. It is estimated that the total loss in physicians’ income from the pandemic and de and pandemic the from income physicians’ in loss total the that estimated It is currency. country’s the in devaluation enormous to the owing changed, has Lebanon in for pay aphysician the above, the × 54cm), paintingbyLebaneseartistJoseph Matar(re
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who were already in short supply and high demand have have demand high supply short and in already who were nurses, addition, In life. a more secure family for their for US, to hoping to provide or leave Europe the planning are physicians Other family. his and for himself safety and of stability search in Emirates Arab United to the ing of 2020, summer mov the in (AUBMC). Lebanon left He Center Medical of Beirut University American at the ogy Oncol Surgical and Surgery of General Professor former of Lebanon”, Faek Jamali, Dr future says the in Ihad faith little shook any really carnage senseless the and explosion of the absurdity “The physicians. future taught and ticed prac both they where hospitals university established well leaving of them year, many this Lebanon left ready al have physicians of 400 upwards that estimated It is time. some for known not be will education able secondary to afford un being of population ayoung effect long-term stream, order decently. to live in The down dreams their sacrifice due to debt, or to needs basic of some their sacrifice and dreams their to pursue decision: acritical to make dents 160% by [ tuition their increased versities ([ non’s class middle Leba of people in number the impacting significantly 2019 28% in from to 55% increased rate 2020, in poverty Theheadcount famine. of impending fears and security, food in and health as well as on citizens, burden bigger to led a This increased. tremendously has services basic and money. their of food, medications, Thecost retrieve to unable are banks country’s the in savings with Those [ 80% more than is pound Lebanese of the valuation and equipment, including personal pro personal including equipment, and supplies essential to import aid mental non-govern local and foreign as well as (WHO), World Organization the Health on dependent completely left were tals hospi Some surged. pandemic the as es to help supply resourc much needed tals for hospi package a stimulus aside set to unable was on funds, short ernment, [ people alike newly impoverished the and protesters anti-government both to care health providing hours, after es church would at local volunteer cians physi some then, Even visit. the afford to unable were they to because needed they when care health to seek unable [ scarce were plies sup medical basic most the even demic, pan to the Prior lines. front on the cians for physi circumstances dire in resulting world the [ in countries indebted most one of the being Lebanon in resulted has mismanagement fiscal with Issues tective equipment (PPE). equipment to addition tective In 7 ]. After the pandemic struck, the gov the struck, pandemic ]. the After 9 ]). Lebanon’s top addition, uni In www.jogh.org • 6 ], and patients were were ], patients and doi: 10.7189/jogh.11.03052 10 ], leaving stu ], leaving 8 5 ], ], ]. ]. ------www.jogh.org • REFERENCES
10 4 3 2 1 9 8 7 6 5 doi: 10.7189/jogh.11.03052 BMC InfectDis.2020;20:244. El ZarifT, KassinMF, BizriN,KassirG,MusharrafiehU,AR.MeaslesandmumpsoutbreaksinLebanon:trendslinks. Health. 2020;13:1-7. Bizri AR,KhachfeHH,FaresMY,MusharrafiehU.COVID19Pandemic: AninsultoverinjuryforLebanon.JCommunity vid-19-infection-in-lebanon- Republic ofLebanon-MinistryPublicHealth.Available: com/452653-lebanese-pound-the-most-undervalued-currency-in-the-world currencyintheworld.ArabianBusiness.Available: Lebanese pound:themostundervalued lebanons-top-university-aub-hikes-tuition-160-percent-citing-crisis Lebanon’s topuniversityhikestuition 160percent,citingcrisis.AlJazeera.Available: tions/wealth-distribution-poverty-impact-covid-19-lebanon Wealth distributionandpovertyimpact ofCOVID-19inLebanon|UNESCWA.Available: forms/ https://www.arab-reform.net/publication/saving-the-suffering-lebanese-healthcare-sector-immediate-relief-while-planning-re Saving thesufferingLebanesehealthcaresector:Immediaterelief while planningreforms.ArabReformInitiative.Available: ary 2020. org Amid Lebanon’sEconomicCrisis,theCountry’s HealthCare SystemisAiling.NPR.Available: east-and-africa/2020/11/21/much-of-the Out ofpractice–MuchtheArabworldisshortdoctors.TheEconomist. Available: Lancet. 2020;396:1380-2. Abouzeid M, Habib RR, Jabbour S, Mokdad AH, Nuwayhid I. Lebanon’s humanitarian crisis escalates after the Beirut blast. /2020/02/09/800410394/amid-lebanons-economic-crisis-the-countrys-health-care-system the correspondingauthor),anddeclarenoconflictsofinterest. Competing interests: to thesubmissionasfirstauthors. Authorship Funding: com). Thepaintingsinthisarticlewereusedwithhispermission. Acknowledgements We are writing this article to call attention to this crisis within a crisis. The multiple economic strains on strains Themultiple economic acrisis. within crisis to this attention to call article this We writing are [ altogether of closing danger in are hospitals some –while services some closing and employees furloughing and off laying are hospitals continues, crisis economic the poor.the As for nor equity, particularly access care health not ensure does spending higher States, United the in seen (8.2%) countries [ Arab among expenditures health highest one of the had anon year, Leb same that In unknown. is number Two country. of later, the this collapse years economic to the [ requirement [ people1000 respectively [ worker density health munity com as known is this to describe term – the care health order safe to people 1000 deliver in per midwives) and nurses physicians, (which of 4.45includes personnel minimum skilled abare recommends The WHO [ for COVID-19 patients caring when safety and health own their including challenges, [ numbers high in country the to leave started also ucation. The full impact of these events on the state and people of Lebanon will affect generations to come. generations affect will people of Lebanon and state on the events of these impact The full ucation. ed medical promotion, and health practices, immunization prevention, disease care, of preventative flight the is ever. them With more than needed are physicians when at atime occurring is of physicians exodus This frontline. burned-out and struggling already to the burden aheavy in resulted has pandemic the ing dur public officials from of transparency alack coupled with crisis Theeconomic crisis. a humanitarian resolve can system just and afair only as government, acorrupt from result can that of damage berations rever the to emphasize seek we Additionally, protection. social and or food security of health form the in be aid whether of Lebanon, country to the aid and support global urgent for We continued call viders. pro care health without of patients followed be thousands by shortly will system care Lebanon’s health . Accessed:22February2020. None. contributions: 6 ] including Lebanon, which had under 40 medical staff per 10 per staff medical 40 under had which Lebanon, ] including
Medline:32661861 : Theauthorswishto acknowledge the Lebanese artist andpainterJosephMatar(www.lebanonart. The authors completed the ICMJE Unified Competing Interest form (available upon request from The authors completed the ICMJE Unified Competing Interest form (available upon request from
Medline:32919521 . Accessed:22February2020.
Medline:32216754 All authors have contributed to the submission, and AS and CL have contributed equally Allauthorshavecontributed to thesubmission,andASCLhavecontributedequally 13 ]. A number of countries in the Middle East have failed to meet this minimum minimum this to meet failed have East Middle the in ]. of countries Anumber 13 -arab-world-is-short-of-doctors ]. In Europe and the Americas, this number approaches 14 approaches number 9.6 and per this Americas, ]. the and Europe In
doi:10.1016/S0140-6736(20)31908-5
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. Accessed:22February2020. https://www.moph.gov.lb/en/Pages/127/39220/monitoring-of- 11 ]. The health care workers who stay face a number of anumber face workers who stay care ]. Thehealth . Accessed:22February 2020. . Accessed:22February2020. . Accessed:22February2020. https://www.aljazeera.com/news/2020/12/8/ 8 https://www ]. https://www.unescwa.org/publica 000 people in 2018 people in 000 –prior -is-ailing https://www.arabianbusiness. 14 2021 •Vol. 11 • 03052 ]. However, have we as .economist.com/middle- . Accessed:22Febru 12 ]. https://www.npr. co ------
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. Accessed:22February2020. [email protected] USA Detroit, Michigan48202 2799 WGrandBlvd Henry FordHospital Fellow Physician,InfectiousDiseases Anita ShallalMD Correspondence to: www.jogh.org •
. Accessed: 22 February . Accessed:22February https://www.thenation doi: 10.7189/jogh.11.03052 https://www.hrw.org/
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