By Mona Ali Hassan, MD, Deborah Mukherji, MBBS, and Ali Taher, MD, PhD, FRCP
Lebanon is a small country, fewer than 7 million people, bearing the scars of past conflict and hosting one of the largest populations of forced migrants globally relative to its size. Despite these adversities, a commitment to excellence in health care has seen Lebanon emerge as a major regional hub for cancer care and clinical research, with rapid adoption of novel therapeutics.
The COVID-19 pandemic put health care systems under immense pressure worldwide; in Lebanon, the pandemic coincided with a political and financial crisis that has seen the local currency lose over 90% of its value. In addition to managing COVID-19 and the devastating explosion at the Beirut Port in August 2020 in the face of economic collapse,1 an exodus of skilled health care workers and the rising costs of importing drugs and medical supplies have made it increasingly difficult to provide even the most basic health care for patients.
Lacking a reliable source of electricity from the government, private homes, businesses, and hospitals are relying on generators. Fuel is becoming increasingly costly and difficult to find, resulting in several hospitals closing their doors and large institutions such as the American University of Beirut Medical Center (AUBMC) putting out emergency appeals for fuel to sustain essential services.2
AUBMC has one of the biggest cancer centers in the region, treating over 4,000 patients annually, and is struggling to continue to provide systemic therapy due to acute drug shortages. Some patients have the ability to secure medications from outside Lebanon; however, for many patients previously receiving assistance from local third-party payers, this option is far beyond their financial capacity. Dr. Taher, director of the Naef K. Basil Cancer Institute at AUBMC, has secured medication donations from private companies and gratefully received assistance from the King Hussein Cancer Center in Jordan with the support of HRH Princess Ghida Talal, chair of the King Hussein Cancer Foundation. These donations will assist some of the most vulnerable patients in Lebanon as a short-term solution.
A typical day in the inpatient unit at AUBMC is spent trying to discharge patients who unfortunately cannot be discharged, either because they do not have electricity at home or because we cannot find the necessary outpatient medications including painkillers, antibiotics, and anticoagulants. In the outpatient infusion unit, oncologists review lists of patients and their treatment plans, looking for alternative available medications, adapting or stopping treatment plans according to the resources available.
What can the international oncology community do to help?
- Support calls for donations of medications/financial assistance to organizations and institutions able to distribute these donations to the most vulnerable patients.
- Assist Lebanese colleagues to produce rapid resource-sensitive guidance for common malignancies.
- Support training and development opportunities for trainees in Lebanon. [Editor's note: ASCO made valuable educational materials available to trainees in Lebanon through ASCO Education.]
Governance failures and a complex political climate mean that there will be no easy solutions for Lebanon or rapid resolution of the current economic catastrophe. As physicians previously operating in a relatively well-resourced health care system, the transition to crisis has been difficult on all levels. Collaboration with professional societies, academic institutions, and community representatives can assist with rapid priority setting and resource allocation. Focusing on the management of curable malignancies and high-value palliative treatments can help to manage the limited resources available.
- Saliba AN, Taher AT. A land in agony: COVID-19, economic collapse, political corruption, and a deadly blast. Am J Hematol. 2021;96:E1-E2. Epub 2020 Nov 4.
- Ahsan S. Lebanese health care racked by medicine shortages. Lancet. 2021;398:568.