In Lebanon, deterioration of health system endangers cancer patients' lives

BEIRUT — As Lebanon experiences the most extensive economic and financial crises in its history, cancer patients find themselves in an unbearable situation where lifesaving medicine is becoming too expensive or is not available on the market. This is the case for Rima, a 51-year-old nurse diagnosed with stage 4 advanced breast cancer who is in constant search of the necessary medication for her treatment.

“With the shortage of medicine, I have already missed many doses, which have forced me to postpone several of my chemotherapy sessions,” she told Al-Monitor.

“Having to find my medication every two weeks adds even more stress to what I am going through. If I can't find more boxes, I simply won't be able to continue my treatment and I will have to suffer the consequences of it. The future is scary, and I am afraid of what will happen next,” she said.

While Lebanon imports more than 95% of the pharmaceuticals available in the local market due to its low pharmaceutical production, the country's financial crisis — which resulted in a dollar shortage — has significantly reduced its capacity to import medicines.

At the same time, the scarcity of public funds is threatening the end of government subsidies for an ever-increasing number of medicines. In November, Health Minister Firas Abiad announced a reduction from $120 million per month to about $35 million in medical subsidies.

The situation worries doctors like Ali Taher, associate vice president for Medical Advancement and Communications at the American University of Beirut Medical Center and director of the Naef K. Basile Cancer Institute, a leading center that receives and offers treatment to around 40% of the cancer population in Lebanon. He fears a reduction of government subsidies on all drugs, including those for treating chronic diseases and cancers.

“Looking at our financial situation, we believe that all subsidies will end very soon, and this in the absence of enough funds to cover health bills, which will be catastrophic in terms of access to appropriate care,” Taher told Al-Monitor.

To illustrate the possible unaffordability of cancer drugs in the country, Taher took as a reference the most common drug for cancer treatment in Lebanon: tamoxifen, used for breast cancer treatment, as well as for endometrium cancer and malignant melanoma.

“In 2020, a total of 17,029 units were used in the market. Each unit is publicly priced at 11,000 Lebanese pounds [$7.30 at the official exchange rate]. In the event of medication subsidization being removed by the central bank, the unit price in national currency would be 139,000 Lebanese pounds, using the August 2021 Lebanese pound to US dollar rate at the black market [19,000 Lebanese pounds]. This alone represents 21% of the minimum wage in Lebanon [675,000 Lebanese pounds],” Taher noted.

Faced with a shortage of medicines and the danger of the end of government aid, patients like Rima must find alternative solutions to continue their treatment. Rima has used her personal network to obtain medicines in Turkey for between $3,000 and $5,000. These solutions, while providing some short-term relief, can in some cases be very harmful. While taking medication from Turkey, Rima explained how she ended up with severe allergies and asthmatic reactions that worsened her condition.

“The medications I took may not have been stored properly, or they may have been fake. That's why I had such a bad reaction to these drugs. If I wanted to buy the same medication in Europe, it could potentially be safer, but the price would be twice as high, around $8,000,” she told Al-Monitor.

In addition to facing a problem related to access to medicines, it is also the cost of hospitalization that has become inaccessible for a large part of the population, according to Taher. The National Social Security Fund has faced a 95% devaluation of its savings, covering only 5% of hospital bills, and many private health insurance providers have shifted to second- or third-class coverage.

While Rima finds herself supported by her family to pay for her 700,000-pound hospital bills, others find themselves dependent on funding provided by nongovernmental organizations (NGOs). With this in mind, the Cancer Support Fund (CSF), a charitable initiative launched in 2018 to support underprivileged patients, has funded the treatment of at least 2,500 patients since its start.

However, with the worsening of the crisis, Hala Dahdah Abou Jaber, CSF president and founder, noted a surge in the demand for funding. Lebanon diagnoses more than 20,000 new cases of cancer each year, and the center cannot take care of everyone.

“When we started, there was still a semblance of a state that provided the minimum of its obligations to the citizen. The patient came to the hospital with a minimum of care, and we only had to provide the difference that he could not pay, which was an acceptable amount. In the last two years, the state has crumbled and cancer patients have found themselves in a situation where they are alone,” Abou Jaber told Al-Monitor.

The CSF now finds itself having to assume 90% of the patient's hospital bill. These are significant costs, according to Abou Jaber, who points out that cancer treatments are often heavy, lasting for months or even years, and cost between $1,000 and $80,000, depending on the type of cancer.

This situation has pushed many NGOs and international organizations to denounce the responsibility of the state in this “man-made disaster.” Olivier De Schutter, UN special rapporteur on extreme poverty and human rights, had declared in November 2021 that the Lebanese government officials have no sense of urgency and are not taking responsibility for an economic crisis that has "brutally impoverished" the population.

Abou Jaber denounced a violation of basic rights such as access to health care, which she says no longer exists in the country.

“Cancer is a life and death struggle. Every minute counts and the longer the treatment is delayed, the lower the response to the treatment and the higher the chances of dying from the disease. The dignity of people suffering from cancer has been violated. With patients' lives at risk, we are witnessing a real collective death here,” she concluded.