Lebanon: The State Fails the Healthcare System

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Statistics confirm that 50 percent of Lebanese do not have any form of health coverage. (Photo: Haitham Moussawi)

By: Rajana Hamyeh

Published Friday, February 7, 2014

On February 3, 2014, Hussein Qataya died outside the hospital because there was no available bed in the intensive care unit. He was not the first, and he certainly won’t be the last. In January, a man named Mustafa died at the same door, for the same reason.

Similarly, Mumin al-Mohammed died outside a hospital in the North Lebanon district of Akkar because his family did not have sufficient funds to admit him. Then there was Mohammed Taha, who died outside the hospital while his family scrambled to find money for his treatment.

These are but some of the countless people who have died outside hospitals in Lebanon; they were killed by Lebanon’s failed state and its “clientelist” healthcare system. The system is designed to leave more than half of the Lebanese people without any health coverage, forcing them to sell their loyalty in return for their health.

Indeed, what else can explain the failure of Lebanon’s overbearing political elite to pass a draft law on universal health coverage, which could have otherwise protected us from dying in humiliation at the doors of their hospitals?

Meanwhile, what procedures does the Ministry of Health follow when people die because they are refused treatment? Does the ministry investigate the pretexts that hospitals cite to refuse patients? Has a single case like this ever been referred to court, or has anyone been held accountable before the law?

The answer to these questions is no. Those responsible are protected. Furthermore, there can be no legal action or accountability because there is no official admission that a crime has been committed. People thus die, mainly because their lives are worthless in the eyes of the offenders.

Commenting on Qataya’s death, Health Minister Ali Hassan Khalil rejected the characterization that Hussein had died at the door of a hospital. He said, “Qataya died because there was no ICU room available, and not for any other reason. We have opened an inquiry into the incident, and it is in the process of being followed up.”

What about the essence of the issue? The minister said that the deaths are not related to “funding problems or admission at the expense of the ministry.” Instead, he claimed, “The problem lies in the overwhelming pressure on hospitals, especially in the peripheries, and also in each hospital’s capabilities, compounded by the influx of Syrian refugees. There are 228,000 cases of hospitalization followed up by the ministry, in addition to 232,000 applications being examined at the inspectorate.”

Is this enough to justify what is happening? MP Atef Majdalani, chairperson of the Public Health Committee in parliament, spoke of the responsibility of the healthcare system in general. He said, “Despite all the offerings of the Ministry of Health, oversight in public institutions is virtually nonexistent.”

This issue, according to Majdalani, goes beyond the Ministry of Health. He said, “The crisis is about the lack of inspectors who can be on call around the clock. We actually almost need inspectors to monitor inspectors.” Majdalani then wondered, “What is it to say that there really was no bed available at the ICU?”

This, Majdalani said, is not a question that necessarily assumes bad intention on the part of hospitals, but it is nonetheless legitimate. Majdalani then raised the issue of mending the entire healthcare system, and said, “There is a project put forward by the Future Movement bloc in this regard. The project involves a comprehensive healthcare card, which would rid us of the problem of a financial ceiling for hospitals, and safeguard the dignity of the citizens. The project merges the offerings of the Ministry of Health and small annual contributions from the citizens, like with an insurance company.”

In other words, those running the country have only two logics: They complain about – and cave in to – the lack of capabilities; or they want to replace the healthcare system with insurance companies! Between these two worldviews, there is no room for healthcare as a human right that must never be subject to such horse trading.

Recall that a project for universal coverage for all Lebanese was submitted to the cabinet previously, with suggestions about how to finance the scheme from taxes on real-estate and financial profits. In effect, while Hussein, Mustafa, Mumin, Mohammed, and many others we may not know about are dying, there are others who are accumulating wealth without paying any taxes.

Statistics confirm that 50 percent of Lebanese do not have any form of health coverage. Meanwhile, all those enrolled with the National Social Security Fund (NSSF) lose their benefits upon retirement or loss of job, or in other words, when they need them the most.

According to the same figures, a significant proportion of people who are not covered by the NSSF scheme cannot afford to pay annual premiums or even pay their medical bills, which are already overpriced. So, will anyone take interest in these facts to stop justifying the dismal reality of healthcare in the country, show interest in people’s rights, and keep the issue of their health separate from the political bazaar?

This article is an edited translation from the Arabic Edition.

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