The World Health Organization [WHO] designated 2020 as the International Year of the Nurse, and Lebanese nurses were put to the utmost adversity. Amidst the global pandemic that crippled our already weakened healthcare system, the country was hit by the third-largest non-nuclear blast that disfigured the city, took the lives of more than 200 people, displaced more than 300,000 people, and shattered Lebanese psyche.
Lebanon, named as the pearl of the Middle East, is a small country strategically positioned on the eastern coast of the Mediterranean Sea in Southwest Asia, bounded by the Syrian Arab Republic and the occupied Palestinian territory. These areas of unrest have had their tolls on Lebanon. For the past three decades the government has had to concentrate its efforts and resources on improving the healthcare system to unravel the effects of the civil war that decimated the country in the 1970s and 1980s. The post-war healthcare system was characterised by unregulated, poorly planned, hasty growth of the private for-profit high technology health sector and a weakened public sector. Although momentous progress was made towards improving healthcare, this was nonetheless halted by the unstable political and security situation. In 2020, Lebanon was hit by a global pandemic that brought its own challenges to the struggles facing the country.
The first documented case of COVID-19 in Lebanon was identified on 21 February 2020. This was four months into Lebanon’s civil uprising where Lebanese youth rose to change the political leadership in the country following a major political and economic mayhem and a banking crisis that shook the whole country. Lebanon was unstable on all levels, and the healthcare system was no different.
Lebanon has had to face many unique challenges that affected its aptitude to fight the pandemic. With a total area of 10,452 square kilometers, Lebanon is the home of around seven million people with a population growth rate of 9.37% [as compared to a 0.77% in the United States]. This is attributed to the political turmoil in the Middle East and the subsequent migration of Palestinian, Syrian, and Iraqi refugees to Lebanon [the net migration rate is as high as 84% placing Lebanon as the country with the highest migration rate in the world].
This overly dense population has overtaxed Lebanon's water, sanitation, housing, and healthcare systems which further complicated the country’s response to COVID-19. To further confound this, many Lebanese families are under poverty line and reside in underserved, overcrowded camps, or households with no access to healthcare. More so, Lebanon has sociocultural challenges that added a layer of complexity to the COVID-19 national response. One of many is the close-knit extended families and multigenerational households that increased the risk of COVID-19 on our elderly population.
The Lebanese government’s approach was centered around early aggressive containment to allow for building capacity to respond to COVID-19 cases as most of the Lebanese hospitals were not ready. Lebanon went into full lockdown of non-essential services by mid-March 2020. During this time, healthcare providers raised public awareness, and hospitals trained their healthcare providers, ensured availability of supplies and ventilators, and increased their capacities and beds and therefore readiness to fight COVID-19. This effort was multidisciplinary, and all disciplines - nursing, medical, and public health - shared equal responsibility. Yet, throughout the pandemic these efforts were challenged by the grave economic situation and the inability of the government to support the most vulnerable population and this aggressive approach was not sustained.
The lockdown threatened the lives of poor families and affected the vulnerable, and the country had to be gradually reopened. Despite pleas from the overstretched healthcare sector, the country opened again, and lockdown was lifted as the government needed to balance between reviving the economy and protecting the most vulnerable population.
Two months later, one of the largest explosions in the world hit Lebanon’s capital and left the country shattered. Lebanon lost more than 200 lives including five nurses, and the rest of the country was left shocked. This and the dire economic state of the country have led to the immigration of more than 1,600 nurses in less than a year weakening the healthcare sector even more. Within this shortage of nurses and physicians, our fight against COVID-19 is more complex.
The lack of public awareness and the many challenges listed above have weakened the healthcare sector, which was left alone to face the global pandemic, especially that Lebanon has no local manufacturing capability to produce essential COVID-19 supplies, including N95 masks and ventilators. Reports of nurses [and their family members] dying from COVID-19 gripped our profession. Nurses and doctors were living in fear of transmitting the virus to their families and major efforts were done to improve nurses’ morale [especially when they see the public carelessness]. Subsequently, Lebanon saw a rise in cases with the greatest rise in the early months of 2021.
As the biggest tertiary medical center in Lebanon, the American University of Beirut Medical Center was involved in twinning projects with the WHO to support the governmental sector. The Order of Nurses in Lebanon also hosted many competency-based seminars to help in critical care capacity building of the less privileged healthcare systems. Nurses among other healthcare providers were active on social media and media outlets raising awareness.
As of February 2021, a year after the first COVID-19 case was identified, Lebanon’s vaccination campaign started. As of September 2021, 2.54 million vaccine doses were given, 1.13 million residing in Lebanon have received at least one dose of the vaccine which accounts for 16.5% of the Lebanese population. There remain major efforts to address vaccine-resistant people, and nurses have a huge role in this.
This pandemic taught us many lessons, one of which is the importance of combined efforts between the public, governments, and the healthcare sector. Building resilience and capacity is a must and these need to be planned efforts prior to disasters. One grave lesson we learned in Lebanon is that not everyone is treated equally especially in a pandemic. Health disparities exist and need to be addressed when this is all over.
Additionally, mental health and taking care of our most vulnerable should be a national priority in developing and struggling countries like Lebanon.