More than a year after the Lebanese government removed subsidies on most medications, short-sighted policies and a lack of adequate social safety nets have left people unable to access or afford vital and life-saving medication, Amnesty International said today. The government has also failed to fulfil its commitments to support Primary Health Care Centres (PHCCs), which provide free and low-cost medication and have been facing high demand.

In a statement titled “Lebanon: Government must ensure medication is available and affordable”, the organization explains how the ongoing economic crisis in Lebanon, coupled with an underwhelming government response, has placed enormous strains on an already fragile health sector. With the Lebanese lira rapidly losing its value and the depletion of the Central Bank’s foreign currency reserves, the Ministry of Public Health (MoPH) announced on 9 November 2021 the lifting of foreign exchange subsidies on all medications except those treating cancer and some other chronic diseases with immediate effect. As a result of the lifting of subsidies, the prices of most medicines rose exponentially.

“People in Lebanon are facing unimaginable levels of suffering while trying to get their hands on life-saving medication. The Lebanese authorities, meanwhile, continue to shirk their responsibility to safeguard the right to health,” said Aya Majzoub, Amnesty International’s Deputy Director for the Middle East and North Africa.

“The Lebanese authorities must urgently address the medication crisis by increasing the budget for PHCCs, addressing shortages in subsidized and unsubsidized medications, strengthening social assistance programs, and implementing long overdue economic and financial reforms, necessary to safeguard human rights. The international community should increase funding to organizations providing affordable and accessible health services.”

Between 19 July and 12 August 2022, Amnesty International conducted research on the accessibility of medication across Lebanon. Researchers visited three PHCCs in Baalbek and Beirut and interviewed 23 individuals, including patients, pharmacists, health workers, health care officials, and NGO workers.

Exorbitant medicine prices amid an economic crisis

PHCCs, which are supervised by the Ministry of Public Health and managed by non-governmental organizations and local authorities, have become one of the few options available for residents seeking free or low-cost medication. However, despite a substantial increase in the number of people seeking their services, the centres did not receive an increase in funding, resulting in medication shortages.

The director of the medication program at an organization that supplies medication to PHCCs said: “The new prices of medications are out of most people’s reach. Sometimes prices [are] double the minimum wage”. A Ministry of Public Health official told Amnesty International that the number of patients accessing health services, including medication, at PHCCs had increased by 62% since 2020.

According to Caretaker Minister of Public Health Firas Abiad, the government reduced its total spending on the health sector by 40% between 2018 and 2022 without increasing the PHCC’s share to more than 3% of the health budget, meaning that funding for PHCCs has reduced in this period. In addition to the decrease in the amount of money allocated to the provision of affordable healthcare and medication, the currency devaluation meant that the money itself lost 95% of its value.

Severe shortages of life-saving medicine

Cancer medications are one of the few categories of medicine that remain subsidized by the government. But across Lebanon, there are severe shortages of cancer medicines. Since 2019, the Ministry of Public Health has partially blamed the shortages on traders and smugglers who purchase the medicine at low subsidized rates and hoard them before selling them at inflated prices. The government’s attempts to combat this issue and hold those responsible to account are inadequate.

Fadia, a breast cancer patient, had to skip a radiotherapy session due to lack of medication. “I hear the same promise every time I don’t receive my medication. It’s always ‘next week’. It has been three months. I live in constant fear of not being able to find my next session’s medicine,” she said.

There are also acute shortages of unsubsidized medication as importers are unable to bring in the necessary quantities of medicine due to the country’s ongoing financial crisis.

A staff member at a local pharmaceutical company told Amnesty International that the supply of unsubsidized medication has been inconstant due to mounting debts owed to the manufacturing companies abroad. Foreign pharmaceutical companies, she said, would not send new orders until old bills had been settled. In July 2022, the head of the Syndicate of Pharmaceutical Industries in Lebanon said that local importers owed international pharmaceutical companies US$400 million. As a result, Lebanon’s pharmaceutical imports plummeted from USD 1.184 billion in 2020 to USD 750 million in July 2022. 

Crises compounded in remote areas

Governorates located in remote areas or further away from Beirut are suffering disproportionately during the crisis, due to a lack of resources from the central government. Lebanon’s director of healthcare in Baalbek-Hermel governorate, which has one of the country’s highest poverty rates, told Amnesty International that most of the PHCCs in the governorate are inactive, even though they are expected to provide services to more than half a million residents and around 340,000 Syrian refugees living in the governorate.

He told Amnesty International: “Smaller healthcare centres in villages and towns are mostly closed due to the lack of personnel… People have to travel a long way and pay the increasingly insane cost of fuel to access better-equipped PHCCs located in the central areas. The painstaking heartbreak is when they travel all that way and don’t find their medications.”

An informal drug market

Amid sky-high costs and an unrelenting shortage of medicine, people explained to Amnesty International how an informal drug market has emerged. That means medications that are not accredited or authorized by the MoPH are imported from abroad through intermediaries, resulting in an uncontrolled supply of expired or counterfeit medication, with risks to people’s health.

Richard, a 35-year-old man with Crohn’s disease, a chronic autoimmune disease of the digestive system, was forced to buy his medication from abroad after it became unavailable in 2021. Because it was unapproved by the Ministry of Public Health, hospitals refused to administer it, and the delays in treatment caused him to experience serious health complications.

Cancer patients are also “importing” their own chemotherapy drugs so they can continue treatment in hospitals. Other patients are rationing or substituting medicine to save money, with serious adverse health impacts.

“The Lebanese authorities must prioritize the availability, accessibility and affordability of medication — even in the face of financial challenges. The right to health cannot and should not be sacrificed,” said Aya Majzoub.