Lebanon has been in a state of emergency since late-2019, pummelled by economic crisis, political instability, social tensions, and hit hard by the COVID-19 pandemic. On top of everything came the devastating explosion that rocked Beirut on 4 August 2020. One year later, people are in increasing need of humanitarian aid. Half of the people in Lebanon live in extreme poverty, with many barely able to afford food or medicine. Fawziyya Al-Sahili is one of them.

Fawziyya stands in her kitchen in north-eastern Lebanon stirring a vegetable stew. “My neighbours brought me this meal yesterday, otherwise we wouldn't have any fresh vegetables,” she says. “We haven't eaten meat for a year. With my son's salary we can only afford bread, beans and lentils. That's the way it is now.”

The 64-year-old woman has high blood pressure and diabetes, and needs to eat a healthy diet with lots of fruits and vegetables. But such food is often out of reach for her and her family. One of her sons works in a shop where he earns 10,000 Lebanese pounds each day – less than US$1 at today’s informal exchange rate. Her other son is unemployed. The three of them live together in an unfinished house that they can’t afford to complete. 

For the past two years Fawziyya has visited MSF’s clinic near her house in the north Lebanese town of Hermel, for regular check-ups and to collect the medication and insulin she needs for her treatment. 

After the explosion

Fawziyya and her family are part of half of the people in Lebanon now living in extreme poverty. Since 2019, this small country on the eastern coast of the Mediterranean has been hit hard by an economic crisis, rising inflation, political instability, and the COVID-19 pandemic.  And then came the explosion, which brought the Beirut to its knees, on 4 August 2020. 

The huge explosion in the port area had devastating effects: close to 200 people were killed, more than 6,000 were injured and tens of thousands lost their homes. It also destroyed a number of public facilities, including hospitals, and badly damaged the central warehouse of the health authority, disrupting access to medicine, especially for elderly people and patients with chronic diseases. 

In the wake of the explosion, our teams donated first-aid kits to the Lebanese Civil Defense, and medical supplies and masks to the Lebanese Red Cross. We treated more than 1,800 patients with wounds caused by the blast and 4,500 patients with chronic diseases who needed medical support in three locations – Karantina, Mar Mkhayel and Khandak.

Our teams also went door-to-door in affected areas to assess people’s needs. We installed water tanks, distributed water purification and hygiene kits, and also scaled up psychosocial support. 

In the weeks following the explosion, several public hospitals were almost at capacity due to high numbers of patients with COVID-19. People injured in the explosion rushed to reach hospitals without taking preventative measures, as coronavirus was the least of their worries. 

With numbers of COVID-19 patients rocketing, Lebanon was put under lockdown for several weeks. Even before the pandemic, the public health system faced regular bottlenecks in drugs and medical supplies as a result of the economic crisis. Post-pandemic, the situation deteriorated dramatically. 

Shortages of medicine 

One year after the Beirut explosion people’s need for medical and psychological support is still enormous. At the same time, a visit to the doctor has become a luxury for many people due to the cost of private healthcare. 
 

“The health system in Lebanon is highly privatised so more and more people cannot afford medication or to see a doctor,” says Hammoud al-Shall, MSF assistant project coordinator. “People have to decide whether to spend their money on food or medicine. The prices of both are up to five times what they used to be.”

Fawziyya needed pain medication but found it impossible to get hold of even the most basic medecine, like paracetamol. “I fell and then I had such a headache,” she says. “I wanted to buy paracetamol, but the pharmacist didn't have it. We tried three other pharmacies, but it was nowhere to be found. The drug is no longer available in Lebanon.” 

Such shortages of medication are challenging, even for organisations like MSF. It is difficult for local companies to import medicine into the country, so our teams now import the most essential ones. The escalating fuel crisis has increased transportation costs, affecting both stocks of medical supplies and patients trying to reach medical care.

An uncertain future 

Many people in Lebanon – both Lebanese and refugees – already struggle with stress and psychological trauma connected with war or displacement. Now, deteriorating living conditions are proving an additional burden, which impacts their mental health further. Numerous patients who seek psychological help from MSF suffer from depression, anxiety or despair.

Fawziyya worries about her family’s future. She’s particularly concerned about her son who is out of work. He also attends our clinic in Hermel, where he receives psychosocial support.

The meal now ready, Fawziyya sits on the carpet with plates of rice, white bread and vegetable stew in front of her. Her anxiety about the future is ever-present, but she has not lost all hope yet. There is solidarity amongst the Lebanese people and she feels supported by her community – not just the neighbours who bring her food, but the social workers and doctors in MSF’s clinic where her family receive free medical and psychosocial care.