There are a few things that Roula Itani, the head A&E nurse at Beirut’s Rafiq Hariri hospital, depends on to do her job: fuel so she can drive to work, electricity for the hospital to run and medicines for her patients.
But currently in Lebanon, these goods and services, along with many others, are in short supply. It’s a result of what the World Bank has called one of the worst economic collapses ever recorded, and nowhere are its effects felt more than in Beirut’s only functioning public hospital.
“We have an overload of patients and that’s why the nurses are overloaded,” Itani told VICE World News. “We have many Lebanese patients that can’t afford now to pay for the insurance or to pay privately in the other hospital because of the economic crisis.”
The breadth of the crisis, which has been years in the making, can be hard to wrap your head around. But speaking to patients in A&E it’s clear just how devastating it has become for people in Lebanon.
Nouri Daher shouldn’t be here. The 52-year-old’s hypertension is manageable, but he can’t find the medicine he needs to manage it. So for the second time this month, he’s had to come to the ER to receive urgent care.
“You go to a private doctor and they prescribe you medicine, but you go to the pharmacy to buy it and it's not there,” Daher told VICE World News, adding that he’s been to dozens of pharmacies to no avail.
“So you end up coming to the hospital to receive treatment.”
Nearby, Itani explains to Hanayna Maroune, an 89-year-old in urgent need of a replacement pacemaker, that she’s being kept in A&E since there are no places in the hospital’s cardiac unit. Maroune’s son, Emile, has stepped into the hallway to continue phoning relatives abroad to see if they can help locate a pacemaker for his mother.
“My mother is dying in front of my eyes,” Emile Maroune said, wiping back tears. “I’ve been looking for a pacemaker for two or three days, but couldn’t find one. There are no pacemakers available.”
During a week in A&E, we met dozens of patients like Daher and Maroune who are being hospitalised because they are unable to obtain medicines or equipment needed for diabetes, cancer, epilepsy, blood pressure, and other chronic illnesses.
When the hospital’s power switches from state to private, as it does multiple times per day, the lights might go off for a minute before flickering back on to the sounds of beeping machines in every direction. Hospital staff run from patient to patient resetting the life-saving equipment and checking that nothing has been disrupted; for them it’s become routine.
Lebanon’s state-run power company is only able to provide electricity for at most a few hours per day, meaning that hospitals like this rely on their private generators. But finding fuel for them can also be challenging, and in August Rafiq Hariri’s director warned they were close to shutting its doors before they received an emergency donation of diesel. But they’re not sure how long it will last.
The collapse of the Lebanese economy predates the explosion at Beirut’s port last year and affects every aspect of society — but how did it get here?
Lebanon is a country not unfamiliar with turmoil. It was the arena for a bloody 15-year civil war. When the fighting ended in 1990 and the country sought to rebuild, the government went into massive debt and relied primarily on foreign currency coming from millions of Lebanese in the diaspora.
For a while, Lebanon was at relative peace and reclaimed titles in international media, like the “Switzerland of the Middle East”. But locals would scoff at such nicknames because of the country’s poor infrastructure and corrupt political class.
When uprisings and unrest spread throughout the Middle East and North Africa in 2011, much of the foreign money coming into the country slowed. To encourage investment banks introduced interest rates as high as 15 percent. The political elite, many with close ties to the banks, got richer while the country ran out of money.
In 2019 when the government needed cash it tried to generate revenue through a tax on WhatsApp calls. In response, Lebanese across the country protested in a rare display of cross-sectarian unity.
The government resigned, the banks shut as Lebanese tried withdrawing their crash, and the crisis worsened.
Today, the Lebanese lira has lost more than 90 percent of its value on the US dollar. What this means in practice is that Lebanese have far less purchasing power than they did only a few years ago, and the price of imports has skyrocketed, creating shortages of wheat, medicines, fuel and almost everything else.
Remittances from millions of Lebanese around the world, which usually count for around one quarter of Lebanon’s GDP, might still be the only thing keeping many households afloat. But Lebanese know this is a temporary fix to more systemic issues, and therefore are no longer looking for solutions inside the country.
Back in A&E, 20-something residents and interns are paying close attention to the doctors whose jobs they hope to do one day, but not in Lebanon.
“We want to [work in Lebanon], but how feasible is it for us to actually stay here under all this pressure … we're not sure yet,” said Janna Farhat. “So if we do get the opportunity to actually practice somewhere else, I think it would be better for us financially and economically.”
Farhat and the other interns organised a one-day strike among all residents and interns in the country, demanding that the government offer them more support. But photos and videos of students rushing to get their exam results so they can apply for positions abroad, and passports so they can travel, have been shared widely on social media in Lebanon as examples of the ongoing “brain drain” the country is facing.
“I think that the next crisis [after] the economic one, will be the medical one because many doctors are leaving now, we’ll stay with no doctors and no hospital supplies,” said intern Aliyah Masry.
Back in her office, nurse Itani has locked the door. She’s already stayed more than an hour past her finishing time. In addition to checking on patients, she needs to schedule her thinning staff, and update her inventory to know. She also needs to plan with her husband how they will plan to get work tomorrow.
The lines from the mask she’s been wearing all day, this is still in the midst of a pandemic lest we forget, visible on her face. She’s tired and frustrated, and like nearly everyone else in the A&E, has applied for nursing jobs in Kuwait and Canada, and is searching for other options.
“On one hand, I keep telling myself not to leave or give up, but on the other, I really can't take it anymore,” Itani said, the lines from the mask she was wearing all day still visible, on top of everything Lebanon is facing it’s still in the middle of battling the pandemic.
Like nearly all of her colleagues, Itani has applied for work in Kuwait and Canada, and is searching for other options.
“We can’t handle the amount of stress we’re under. It's too much.”