“I was looking at my daughter's face and thinking I was saying goodbye,” he told The National from a hospital in the city of Baalbek.

After emergency surgery, Mr Houjeiri's prognosis is good. His treatment was paid for by MSF, which normally deals with primary health care situations but is increasingly having to support emergencies for Lebanese citizens such as Mr Houjeiri.

Lebanon’s economic crisis, which became apparent in 2019, has pushed much of the population into poverty. People like Mr Houjeiri are now unable to afford hospital treatment as inflation soars and salaries fail to match the rise in the cost of living amid the US dollar shortage, or access state support for healthcare.

Making the situation for people living in the Baalbek-Hermel governorate worse is the distance they must travel to find the treatment they need.

Arsal is 40 kilometres away in the mountains. The latter part of the journey to the town is marked by a winding road towards the Syrian border and the surging price of fuel is making matters more difficult.

“Definitely, 10 years ago I would have been able to afford to go to the hospital. I was living, not quite luxurious, but a comfortable life before the crisis,” Mr Houjeiri said.

“My heart condition has been exacerbated because of the stress I have been living in.”

And there is also the shame of being unable to afford treatment. Mr Houjeiri talks about the “humiliation” from not having the money to pay.

Before becoming aware that his care could be funded, “it was a conscious decision, wanting to stay at home and die rather than being put in that position”.

“I was so afraid to be put in a position where I go to a hospital and I cannot afford (it) … and feel like I’m helpless and I cannot do anything about my health. I was really worried about that. I was trying to say no to go to the hospital.”

Before the economic crisis Lebanese patients were paying about 15 per cent of their medical bills, with the rest covered by guarantors such as the Ministry of Public Health or Lebanon’s social security fund, said Maytham Al Jari, a referral nurse with MSF.

But now, Lebanese patients — already poor — have to pay about 85 to 90 per cent of the costs. Guarantors pay back at the official rate of the Lebanese pound — which is significantly lower than the parallel market figure that represents the true value to the US dollar of the local currency.

Then there is the effect of the economic crisis on hospitals. Qualified medical workers have left the country as their salaries buy less and living conditions deteriorate, while healthcare facilities face a shortage of electricity, surging fuel prices and a lack of medications.

“Let me give you an example. Before if I have pain in my abdomen, I used to go and seek medical advice,” said Mr Al Jari.

Now, fearing the financial cost, many patients delay treatment until the problem has worsened.

“They are preferring that, instead of going and taking medication or solving a problem which may require a simple medicine … they can’t afford this,” he said.

“They postpone, postpone, postpone. The problem gets worse.”

Abu Ali, 43, is a municipal policeman from Arsal who has five children. He earns $70 a month.

He has diabetes and heart problems. About a month ago, liquid began accumulating in his abdomen and he went to a hospital in Beirut, believing it to be the best place for specialised care despite the expense and distance from Arsal.

Taking a few thousand dollars with him, he was seen by a cardiologist. But he had developed a diabetic sore on his foot, and was told more money was needed to pay for his complex treatment.

Having run up bills of about $10,000, Abu Ali signed himself out of hospital against medical advice because he did not want any more debt.

“If you have money, you’re able to go to hospital. If you don’t have money, you cannot access hospital care,” said Abu Ali from hospital in Baalbek.

After presenting himself to the MSF clinic in Arsal, he was referred to the hospital in Baalbek and received further treatment. He now faces at least two months of recovery.

Even amid Lebanon’s economic crisis, residents on the Baalbek-Hermel governorate have more onerous challenges in accessing vital healthcare.

Distances are comparatively long and medical facilities limited. Abu Ali said he went all the way to Beirut, after raising money from family and friends, because he thought it was “safer”.

“I know that specialised care is more prominent there than this area.

“It was very, very expensive to make it to Beirut. We went in a public van, but it was still expensive.”

Mr Al Jari said that while there are some healthcare facilities in areas near Arsal, they are not equipped to tackle many specialised cases.

“The challenge to access hospital care is the distance and how the hospitals are from many locations in Baalbek-Hermel governorate, especially for Arsal,” said Mr Houjeiri.

“A lot of pregnant women delivered on the road before even reaching the hospital. With the transport costs, it’s even more difficult to afford.”