Doctors fear ‘surge in deaths’ after Lebanon lifts drug subsidies

Beirut, Lebanon – Over the past six months, Beirut’s Rafik Hariri University Hospital has struggled with power cuts, medicine shortages and a tidal wave of medical staff emigrating for better job opportunities.

But now, with medicine subsidies also partially lifted, doctors at the government-run facility in the Lebanese capital fear the worst.

“We can expect a surge in deaths,” Dr Mahmoud Hassoun, the hospital’s chief operating officer, told Al Jazeera.

“How can you treat a patient, when there is expensive medicine that you cannot provide?”

Health Minister Firas Abiad earlier this month announced the partial lifting of subsidies, including on some drugs for chronic illnesses. The move led to prices for these medicines skyrocketing, exacerbating a medical crisis that has crippled Lebanon’s fragile healthcare system.

The price of one hypertension medication has increased ninefold. Other drugs, such as those prescribed for mental health conditions like depression and schizophrenia, are now costing three times as much, according to the Lebanese nonprofit Embrace.

Hassoun said the hospital will have to continue relying on NGOs’ support for supplies and prioritise some patients over others.

Legislator Bilal Abdullah, who is also a member of the parliament’s health committee, told Al Jazeera the Central Bank “used to provide about $120m on medical subsidies” monthly. “Now it can only allocate $35m.”

Lebanon is already going through a damning economic crisis that has slipped roughly three-quarters of the population into poverty. The Lebanese pound, in just over two years, has lost about 90 percent of its value against the United States dollar, while ongoing political paralysis has stalled any hopes of economic recovery in the near future.

The country’s healthcare sector has been particularly hit. Hospitals already struggling with shortages of medical supplies and staff – Rafik Hariri University Hospital, the epicentre of Lebanon’s COVID-19 response, has been functioning with only about half of its capacity – are also unable to secure enough fuel to keep lights on and machines running. Meanwhile, the authorities have failed to stop suppliers from hoarding stockpiles of medicine, as well as to curb their smuggling and trade on the black market at extraordinary rates.

“Our pharmacies are already empty without medicine,” pharmacist Joe Salloum told Al Jazeera. “Pharmacists don’t have the capital to buy medicines any more, and citizens have less access.”

In May, the Central Bank refused to dip into foreign currency reserves to cover medicine subsidies. Two months later, as the reserves dwindled, the crisis-hit country partially lifted subsidies on products such as vitamins and painkillers costing 12,000 Lebanese pounds or less, alongside expensive blanket subsidies on wheat and fuel.

In an interview on Thursday, Abiad, the health minister, described this month’s move affecting medicines for chronic illnesses as a “necessary step” and sought to alleviate fears that medicine subsidies will be fully lifted.

Abiad said people “have a right to express their pain” and said he wanted to boost local production for some 500 medicines for chronic diseases.

‘Bad policy but a lifeline’

Experts have said Lebanon’s entire subsidy programme, including for medicines, has been disproportionately benefitting the wealthy over the poor. Several studies show that because the scheme is not targeting the most vulnerable but is applied across the board, people with higher incomes benefit more because of their higher spending power. One study by the International Labour Organization shows that less than half of the people who benefit from subsidies are among the poorest 80 percent.

Leila Dagher, associate professor of economics at the American University of Beirut, said Lebanon has squandered billions of dollars to maintain the programme.

“It was a bad policy right from the start,” Dagher, who is also a senior fellow for The Lebanese Center for Policy Studies, told Al Jazeera. “However, we had warned over and over again that given the rapidly deteriorating economic situation, Lebanese households will be severely impacted by the lifting of the subsidies and hence should be compensated by a cash assistance programme.”

The government has long promised to implement a ration-card programme to provide assistance to some vulnerable 500,000 families and soften the blow from the lifting of subsidies. But it has not managed to secure funding from the international community amid the ongoing political turmoil and the Central Bank’s refusal to use its reserves to help fund the $556m programme.

“There is still no clear timeline as to when the long-awaited ‘ration card’ will be launched and I have not heard a single valid justification for that,” Dagher said.

“Togo, similarly to Lebanon, does not have a comprehensive social registry yet they were able to roll out an emergency cash assistance program to over half a million individuals in less than four weeks.”

Meanwhile, Olivier De Schutter, the United Nations special rapporteur on extreme poverty and human rights who recently met Lebanese officials and struggling families, said the authorities were aware of the negative consequences but told him that lifting subsidies was “inevitable”.

“You cannot lift subsidies – whether on bread or wheat or medicine – without strengthening the purchasing power of people in poverty by raising the minimum wage and improving social protection, which is extremely thin today,” De Schutter told Al Jazeera.

“I think we should be really attentive to the sequencing.”