This summer is bringing an additional challenge to the public health front in Lebanon, along with higher-than-normal temperatures.

An uptick in food- and water-borne communicable diseases, mainly viral hepatitis A, has been registered in the country, according to recent statistics released by the Lebanese Ministry of Public Health from numbers collected in hospitals, health centers and laboratories.

The hepatitis A virus (HAV) causes hepatitis A, according to the World Health Organization (WHO), which causes inflammation of the liver. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the feces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene and oral-anal sex.

An unrelenting, thorny economic crisis has been ravaging the country for years and is considered the main culprit for the deterioration of basic facilities, community installations and public services.

Dr. Abdulrahman Bizri, member of the Lebanese parliament and the parliamentary committee on public health, professor of medicine and infectious diseases at the American University of Beirut (AUB) and chairperson of the national COVID vaccine committee and response, blames the collapse of Lebanese currency, the negligence, the intractable economic, political and livelihood crises, the mismanagement and the prevailing misconduct for the complications of preventing and containing diseases, including communicable types.

“All these factors led to failure in sustaining health infrastructure, such as sewage, and providing clean water to households for direct or indirect human use through produce and/or livestock, which resulted in the spread of many diseases, namely the infectious ones transmitted through contaminated water, such as cholera, hepatitis A, acute diarrhea, dysentery, salmonella and other diseases.”

Staff Shortages and Budget Cuts

Government dysfunction, scarcity of maintenance and investment and corruption slowed down the development of services and responses to health outbreaks.

Dr. Hussein Hassan, professor and researcher in food safety and food production at Lebanese American University (LAU), points out two additional elements that have deeply affected the public health situation: the reduced funding and the exodus of medical doctors.

“In hospitals, for example, we have staff shortages due to the brain drain while we are suffering from inefficiency and ghost workers. Unfortunately, we also have bribery and budget cuts that delay much-needed projects.”

Can the Ministry of Health (MoH), with its current shape in light of government spending, decrease its ability to manage and protect against communicable diseases?

Bizri says that “MoH is facing an uphill battle due to its limited and low capacities. It relies heavily on the support of the international community, for example, WHO, UNICEF, and UNHCR, among others, to control these diseases.”

Bridging the gap requires a comprehensive and holistic approach to dealing with the situation based on short-term and long-term steps to be taken on many official and public levels. Hassan believes that “we need to strengthen the surveillance of outbreaks, execute mass vaccination campaigns, provide affected individuals with required supplies, and improve the water and sanitation in crowded areas by installing purification systems and even distributing bottled water.”

Large Presence of Syrian Refugees

Poverty, poor public awareness, inadequate education, a social environment with minimal knowledge and disregarding good hygiene practices contribute to communicable disease transmission.

Bizri refers to the sizable presence of Syrian refugees who live in difficult and bad conditions, congregated in unorganized camps with insufficient reliable health structures or safe drinking water. He applauded the three-way partnership between the Lebanese Ministry of Health, international organizations like WHO and UNHCR, and the considerable Lebanese medical private sector in fighting diseases threatening the country.

“Lebanon succeeded in containing many epidemics that had the potential to prevail. The Lebanese medical body, including civil society, massively volunteered to control the spread of these diseases. The health sector spearheaded the efforts to address the COVID-19 pandemic and is still at the forefront of fighting communicable diseases.”

However, he has reservations regarding the “skeptical role of UNHCR in its fight against many of the epidemics menacing Lebanon as an outcome of the concentrated existence of Syrian refugees, since it does not deal transparently with the Lebanese government and its official institutions.”

To ensure continuity of public health preventative and controlling programs, Hassan mapped out some long-term measures to be put in place, including “economic and political stability, strengthening the healthcare system, investing in improving water supply and sewage systems, and developing and implementing maintenance programs related to water safety, particularly among refugees.”

He acknowledges the crucial role played by international collaboration and financial and technical support delivered by non-governmental organizations (NGOs).

Mistrust has dented the relationship between the healthcare system and the citizens.

“I believe that Lebanese citizens lost faith in the health sector long ago,” said Bizri. “Yet they keep depending on this sector, which offers affordable health and medical services compared to the private healthcare costs in Lebanon. The country boasts advanced medical services and treatments, but its public health is still enduring a significant deficit.”