Campbell MacDiarmid and Simon Townsley/The Telegraph: ‘If we stop the generators, our babies die’: Lebanon on life support/تقرير مهم باللغة الإنكليزية من جريدة التلغرام يلقي الأضواء على الوضع الصحي المأزوم والخطير في لبنان جراء أزمة المحروقات
تقرير مهم باللغة الإنكليزية من جريدة التلغرام يلقي الأضواء على الوضع الصحي المأزوم والخطير في لبنان جراء أزمة المحروقات
‘If we stop the generators, our babies die’: Lebanon on life support Campbell MacDiarmid and Simon Townsley/The Telegraph/October/October 10/2021 Its collapsing healthcare system was once the envy of the Middle East – now, it is a microcosm of a country in free fall
Endless fuel queues, runaway inflation, supply chain chaos and a shortage of skilled labour are only some of the issues making Karen Saqr angry.
The elegant Lebanese director of Karantina public hospital in Beirut, Mrs Saqr has spent the morning in her office making increasingly desperate phone calls to ministries, NGOs and private suppliers, trying to buy the fuel needed to run the facility’s generators in the absence of state electricity. “If we stop our generators our babies die,” she says. In the neonatal intensive care unit down the hall, eight tiny babies are kept alive with softly flowing oxygen and regularly beeping machines.
The situation is perilous. Amid a severe fuel and electricity shortage, the hospital – like most in Lebanon – has only a few days of diesel in reserve. The state electricity company is running out of fuel itself and says the country could be in total blackout by the end of the week, leaving private generator owners desperately scouring the black market for diesel. “Today we didn’t get fuel yet, and the supplier wants money in fresh dollars, he doesn’t want lira,” Mrs Saqr says between phone calls. The local currency has lost over 90 per cent of its value since 2019 and though a governmental hospital is not legally allowed to pay in dollars,
Mrs Saqr has no choice. With no funds coming from the bankrupt government, she turns for help from UNICEF, one of the international organisations now propping up Lebanon’s healthcare system. Mrs Saqr asks herself how long she, her hospital, and Lebanon can last. Her staff are leaving in droves and her own daughter is moving to Abu Dhabi on Friday. “Every day I think about leaving,” she says. “But leaving without anyone here to replace me is hard to contemplate.”
‘Worse than the civil war’
The decline has been swift and precipitous. Until just a few years ago, Lebanon’s healthcare system was the envy of the Middle East. Wealthy Arabs would fly into Beirut for nose jobs or routine surgeries. Diaspora Lebanese would visit their physician during annual trips home. Lebanese doctors were in high demand in the Gulf. But now that system is on life support, its collapse a microcosm of Lebanon’s broader downfall.
With only philanthropists and international NGOs staving off a total shutdown, doctors are terrified that donor fatigue may eventually pull the plug. To explain the current crisis, Robert Sacy refers back to the dark days of Lebanon’s civil war. Today the snowy haired septuagenarian is the head of pediatrics at Karantina, but back then he was a young doctor working for the Red Cross after completing his studies in France. “It’s worse now than the civil war,” says the suspenders-wearing Dr Sacy. “Then you’d have five days [of fighting] then one month of living normally. Now for one year we’re not living normally at all.”
Back then, Lebanese had faith that the war would eventually end, Dr Sacy explains. “In a tunnel you have a light at the end, now we don’t have a light.”In 1989, the light at the end of the tunnel was the peace deal signed in Taif, Saudi Arabia. After 15 years of war, Lebanon was a shattered shell of a country. State institutions were largely replaced by fiefdoms run by warlords, some of whom kidnapped foreigners like Terry Waite with impunity. Others extorted the population while offering a modicum of security and services to their own constituencies. At least 30 per cent of the pre-war population had emigrated. Many of those remaining believed that peace was only possible if government funds and positions were divided between the country’s 18 recognised religious sects. Thus the Taif agreement entrenched sectarian-based power-sharing. Warlords turned politicians and treated the state as the spoils of victory. Institutions were divided among them and used as vehicles for patronage and rent-seeking. This consensus-based system became known as muhasassa, an Arabic phrase meaning the ‘distribution of shares’.
The greatest Ponzi scheme in history’
During the 1990s and early 2000s Lebanon emerged from the rubble and many Lebanese returned home to rebuild their lives.Beirut was resurrected with a glitzy downtown designed to attract wealthy Gulf Arabs eager to spend their money in Lebanon’s more permissive environment. The government privatised much post-war rebuilding, funded by massive public borrowing with little public oversight. By never addressing corruption or mismanagement, the true cost of reconstruction would take longer to manifest. Former economy minister Nasser Saidi has said that “Lebanon is that rare combination of an experienced Kleptocracy and a Kakistocracy” – ruled by an elite that is both corrupt and incompetent – that pulled off the “greatest Ponzi scheme in history”.
A tiny Mediterranean nation that produces little, since the war Lebanon has attracted much of its foreign capital by offering high interest rates, with ever increasing public borrowing used to pay creditors – essentially a regulated Ponzi scheme. Expatriate Lebanese in particular parked their money in local banks, many enjoying the high returns while planning for eventual retirement in Lebanon. Rather than channelling money into productive investments like fixing the electricity grid, Lebanon’s government used foreign capital to fix the lira at an artificially high rate. This provided greater purchasing power to Lebanese in a country where nearly everything is imported but the ever-mounting public debt virtually guaranteed an eventual collapse. Even as growth slowed, public debt piled up, reaching 178 per cent of GDP in 2019, making it the third most indebted country worldwide after Japan and Greece. Interest payments were consuming nearly half of revenues, with much of the rest going towards a bloated public sector stacked with political appointees.
Anger at Lebanon’s corruption and mismanagement had been growing for years but a clumsy attempt to raise funds by proposing a tax on the popular messaging platform WhatsApp finally provoked massive anti-government protests in October 2019. The demonstrators demanded the resignation of the political elite that had ruled Lebanon since the war – chanting “all of them means all of them” – and called for an overhaul of the post-war system of governance. After two weeks of massive protests that brought the country to a standstill, then-prime minister Saad Hariri resigned. But a new cabinet formed three months later failed to appease protesters or arrest Lebanon’s economic slide and the state defaulted on its debt for the first time in March 2020. The arrival of the coronavirus pandemic only accelerated the economic downturn, while a shortage of foreign currency led to a rapid devaluation of the lira on the blackmarket. Financial institutions introduced informal capital controls to prevent bank runs. Then came the devastating Beirut blast last summer, a explosion of 2,750 tonnes of ammonium nitrate improperly stored at Beirut port under shady circumstances. Over 210 people were killed, while several districts of the capital were severely damaged. Worst hit was the portside neighbourhood of Karantina, whose destroyed hospital required extensive rebuilding funded by international donors.
Again the government resigned in the wake of the blast, leaving a caretaker cabinet unable to enact reforms at a critical time. With foreign reserves dangerously depleted, unsustainable subsidies have been gradually lifted in a piecemeal fashion from fuel, food and medicine, turbocharging hyperinflation. The lira, which for years had been fixed at 1,500 to the greenback, was being sold on the blackmarket for much less – 7,000 to the dollar, 10,000, over 20,000 (it is currently trading around 18,000). The International Monetary Fund and international donors stand ready to help but have said they will not give carte blanche to Lebanon’s government.
A 2018 donors conference hosted by France pledged $11 billion in aid to Lebanon in exchange for reforms to increase accountability and reduce corruption. That money remains unclaimed by the government, which has delayed key reforms such as an audit of the central bank. The World Bank has accused the Lebanese government of failing to act to help itself, citing a “political consensus in defence of a bankrupt economic system, which benefited a few for so long”. Instead, Lebanon’s leaders spent 13 months horsetrading until a new government was finally formed in September. During his incoming speech last month, Prime Minister Najib Mikati promised to enact reforms and resume bailout talks with the International Monetary Fund. “Our government emerged to light a candle in this deep darkness,” he told parliament. But many view the billionaire businessman – who has served twice previously as prime minister – as part of the political class that led Lebanon into this crisis and few expect him to take many tough decisions before elections scheduled for next spring.
Meanwhile ever more Lebanese are sliding deeper into poverty. In the southern city of Sidon, Najwa Hashem Ibrahim understands little of the economic collapse beyond the impact on her family. “What I’ve noticed is that the bags of rice I’m able to buy keep getting smaller,” says the grandmother, sitting in the damp cellar in the old city that she lives in with her daughter, son-in-law and two young grandchildren. “Hopefully we won’t reach starvation but we don’t know if we will hold it off.” With no phone or television, and little social contact, the future is unknown. “I hear it will get worse,” she says.
The family’s sole income is the one million lira son-in-law Ahmed makes a month as a security guard. Before they could get by on that – just. Now it’s not enough. At current exchange rates it is worth scarcely £40.
Drinking water, delivered in 22 litre bottles, costs 84,000 per month. The bottle of cooking gas they get through every month costs 150,000. Inflation surpassed 137 per cent in August, according to Lebanon Central Administration of Statistics, a rate exceeding that of Zimbabwe and Venezuela.
But their biggest expense is healthcare for their two-year-old son Mahdi, who has a rare blood disease. The ministry of health is no longer able to provide his medicine, which now costs 900,000 on the black market, and they are forced to ration. They sold their fridge, their cooking stove, even the cushions from their couches. They have not paid their rent in three months. “Most households around here are in this situation,” she says, adding that they avoid the neighbours to avoid burdening each other with reciprocal obligations. Across the country, poverty rates have risen from an estimated 50 per cent at the start of the year to encompass nearly three quarters of the population, the UN says. An estimated 82 per cent of people in Lebanon are now unable to afford at least one essential service like healthcare or public utilities, a rate that has doubled since 2019. The UN calls this multidimensional poverty.
Even families that were once comfortably middle class now struggle to make ends meet. From her home in the Bekaa Valley, Malak Mazloum explains that economies like cutting meat from her family’s diet only goes so far. Nexium, a medication to treat her six-year-old daughter Mira’s intestinal disease, now costs 400,000 a month. When it cost 35,000 the cost was borne by the healthcare plan provided by her husband’s job as a sergeant in the army. Now they must buy it from his salary of about 1.8 million lira a month. Visiting the family doctor’s private practise has tripled in price, so she now takes her two children to a clinic run by Medair, an international NGO. “Lebanese prefer private clinics,” she explained. “Primary healthcare clinics have a huge workload, the consultations are very brief, you feel like a number.”
Public hospitals have become inundated by patients unavailable to afford private care. At Rafik Hariri public hospital in Beirut, patients are charged 10 per cent of the cost of their care but many are unable to afford even this. “We never say no to any case though,” says Dr Imad Chokr. But with the government unable to pay running costs, the hospital is dangerously overstretched. The air conditioning has been turned off on many wards, some elevators don’t work, and the administrative staff are on strike, calling for wages sufficient to cover their basic needs. The hospital is now reliant on donations, Dr Chokr says, pointing out the respirators, incubators and even rubbish bins. “I worry every 10 minutes about donor fatigue,” he says. “Where’s the next packet of gloves going to come from? I’m really scared.”