A land in agony: COVID‐19, economic collapse, political corruption, and a deadly blast
Authors: Antoine N. Saliba, Ali T. Taher
Journal: American Journal of Hematology (2020)

August 4, 2020. 6:08 pm (GMT +3). The American University of Beirut Medical Center. Gray smoke in the horizon. A surreally loud sound. A terrifying shock wave. Glass on the floor. Screams of panic in the corridors. Alarms sounding. About 150 attendees from 25 countries at the international thalassemia webinar one of us was hosting witnessed this in real-time video and audio. A stampede toward the emergency shelter. A few minutes later, hundreds of victims are being wheeled into the emergency department in the building across the street. What is happening? An apocalypse? Are we going to survive? Same day. 10:18 am (GMT −5). Ten minutes after the explosion. Rochester, Minnesota. One of us had stepped out of a patient room in the hematology clinic to find tens of text messages asking about the safety of family and friends in Lebanon. Phone calls, video calls, and audio messages. Did my sister and my friends go to work today? Is my grandmother in Beirut today? Was my father driving past the Beirut port area at that time? Why is he not answering his phone? The news was devastating and the pictures horrifying. Being away from home, one of us was incessantly talking to relatives and friends asking them to send pictures to prove they were safe. Being at the heart of the event, one of us was wrestling with the reality of what had just happened and how much had been destroyed in a few seconds. The massive explosion in the port of Beirut has challenged the initial success Lebanon achieved in controlling the spread of COVID-19.1-3 Even prior to the COVID-19 pandemic and the explosion, Lebanon had been grappling with pervasive political corruption, a growing national debt, and an escalating financial crisis for decades.2, 4 The COVID-19 pandemic was preceded by a period of political unrest and a wave of protests starting in October 2019 and gaining momentum again after the blast, which left over 200 people dead, about 6000 people injured, and tens of thousands homeless. The explosion was caused by the unsafe storage of more than 2000 tons of ammonium nitrate for seven years at the port - a disaster that could have been prevented. Falling foreign currency reserves and increasing national debt to recently unprecedented figures had made Lebanon's economy particularly vulnerable. Since the last quarter of 2019, many Lebanese healthcare workers have been facing pay cuts, shortages of medical equipment, and threats of unemployment.5 Those challenges have been augmented by a steep decline in purchasing power resulting from a rapid devaluation of the Lebanese lira. Healthcare systems have seen prolonged interruptions of payments from the Ministry of Health and the National Social Security Fund. Therefore, private hospitals, the channels of healthcare delivery to the majority of the Lebanese people, have been confronted by declining abilities to pay the salaries of their employees and maintain their inventory of medications and equipment. The American University of Beirut Medical Center, the country's leading medical institution, laid off 850 employees, amidst the institution's most challenging financial struggle since its founding. The tragedy the Lebanese healthcare system has been facing was compounded by the sheer destruction several hospitals in Beirut witnessed, with the explosion and the resulting shock wave.6 Some nurses at Saint George University Hospital had to experience the death of their colleagues, while they resourcefully scrambled to treat injured patients on the sidewalk and the parking lot outside the hospital. A nurse from the same hospital had to carry three newborns out of the hospital and to another medical facility to save their lives. Interns and residents, who were bleeding themselves, sutured wounds using the lights of their cellphones. First responders, unaware of the presence of highly explosive material in the port, died on the scene while attempting to put out the fire that preceded the blast. While COVID-19 and the explosion at the port posed immediate threats of death and destruction, Lebanon and its healthcare sector have been slowly hemorrhaging for years. The Lebanese people and healthcare system are simultaneously facing the COVID-19 pandemic, the worst financial crisis in thirty years, and a blast that crippled the capital.7 But, how long can the people of Lebanon persevere under these onerous conditions? For how long do we expect people in Lebanon to continue to fight under this overwhelming combination of mental, physical, and financial stress? For how long do we foresee the free clinics and dispensaries, which were started by personal or local non-governmental efforts, will continue to deliver primary care effectively and safely? How many futures in a country at the brink of bankruptcy are we willing to sacrifice before we act? How many more lives should we have to lose? When will we really proactively act and not just react, for only a few months, after a preventable explosion kills hundreds and renders thousands homeless? And, when we decide to act, will it be too late? What do we tell the nurse who is taking care of patients with COVID-19 at the hospital and returning home knowing he will be barely able to procure the simplest needs of his family with rising prices on basic goods? He knows that he is being applauded by the public, but that, alone, does not put bread on the table. How do we appease the anxiety of a teenager who is silently worried about her college education? She knows that her parents lost the value of most of their savings for her education; in fact, they currently live in a demolished apartment with broken windows. How do we comfort the mother who is tucking her five-year-old son with leukemia in bed? She is terrified by the impending shortage of chemotherapy; even the cancer center he receives treatment at has been severely damaged by the blast. What do we tell the mother who has been laid off? She knows that, with losing her job, the entire family lost their healthcare coverage. What do we tell the hundreds of parents who lost their children and the hundreds of children who lost their parents as a result of incompetence, bureaucracy, and political corruption? When will we be angry enough with them and for them, with ourselves and for ourselves? One of the rivers that run north of Beirut is believed to have carried the blood of the Phoenician god Adonis to the Mediterranean Sea. Legend has it that Adonis was killed by a wild boar in the forest. Like Adonis, Lebanon has been bleeding; COVID-19 and the Beirut explosion have certainly hastened the hemorrhage. But, isn't the wild boar, in this situation, our inaction for years in the face of social injustice, political corruption, and shortsighted sectarianism? Have we failed to see the humanity in our neighbors until our very basic needs of food, shelter, medicine, physical safety, and education were at stake - just like them? When will we place our basic rights and wellbeing ahead of our sectarian and political affiliations? When will our health, mental and physical, become more important than perpetuating political and financial practices that have failed to deliver for decades? Some of us, Lebanese people, are a sea, an ocean, and a thousand lakes away, waiting for our loved ones to pick up the phone and tell us they are safe. Some of us are living this reality firsthand every day in the heart of Beirut, opening our eyes every day to destruction and calamity that were avoidable, unjustified, and unnecessary. Will we emerge from this crisis with more debt accumulated, more lives lost, but no lessons learned? Will inequality be made only more extreme as the socioeconomically underprivileged lose their assets and as healthcare out-of-pocket payments increase? Or, will we grasp this opportunity to reform our political structure and our public healthcare system? We worry that we will be satisfied with a partially refurbished version of the current status quo. We nonetheless hope that we, the people of Lebanon living in the country and abroad, will find in the midst of this turmoil an opportunity for true and fundamental rebirth - just like Adonis. Data sharing is not applicable to this article as no new data were created or analyzed in this study.