Lebanon has been experiencing great political and financial difficulties for the past 10 months, and since the anti-government demonstrations in October 2019. On August 4, 2020, Beirut faced a blast, which caused severe damage and destruction to the city, and resulted in the government declaring a state of emergency. How has this state of emergency impacted the spread of COVID-19? And what is expected in relation to Lebanon’s ability to contain the pandemic?
A crisis within a crisis in Lebanon
At the start of October 2019, the Lebanese Pound (LBP) severely devalued against the US dollar (USD) due to shortages of foreign currency reserves. Mass demonstrations swept Lebanese roads after the government announced tax levies on petrol, tobacco and WhatsApp services on October 17, 2019. Tens of thousands of protestors called for political and economic reforms. ,  Even before the coronavirus pandemic, almost a third of the population was living below poverty line and the World Bank estimated that this would increase to 50% in 2020.  According to the Human Rights Watch, the imposed lockdown measures to slow the coronavirus spread has exacerbated the economic situation in Lebanon and compounded poverty rates. 
On August 4, 2020, a massive blast in the port of Beirut, caused by the detonation of 2,750 tons of ammonium nitrate due to unsafe storage facilities in the port devastated the city. Shortly thereafter, Lebanon’s parliament declared a “state of emergency”.  This explosion has fueled further protests against the government’s corruption and negligence, which led to the resignation of the Lebanese government.  The blast has resulted in thousands of injuries and the death of over 200 people, with over 110 people still missing.  It has damaged 70,000 houses, including schools, offices and healthcare facilities. 
COVID-19 Containment and Spread
The first COVID-19 case in Lebanon was confirmed on 21 February 2020, and by 1 March 2020 there were 10 confirmed cases. As of 3 September 2020, there has been 18,375 confirmed cases and 172 deaths. The total number of cases has tripled since 3 August 2020 (a day before the blast).  Daily testing remained stable after the blast , meaning that the increase in number of cases cannot be attributed to increased testing, but rather an actual surge of cases.
Health System’s Capacity
The health system’s situation in Lebanon was already critical before the explosion; hospitals were starting to become overwhelmed with increased COVID-19 cases (MSF, 2020).  As a result of the explosion, only half of primary health care facilities are operational and 40% suffered from moderate to serious damages.  Additionally, out of 16 hospitals in Beirut, three hospitals are now non-functional and three hospitals are partially functional according to the World Health Organization (WHO). 
Lebanon has the highest physician emigration rate in the Middle East and North Africa region with almost 40% of all medical graduates migrating to work in the United States.  According to Information International, the average number of people departing from Lebanon has increased by 36% after the blast.  It is likely that more physicians and health workers will migrate from Lebanon due to the emergency situation. All these factors will further strain an already overburdened health system.
After the blast, there has been significant shortages of Personal Protective Equipment (PPE), medications, health supplies, electricity and fuel, in addition to reduced numbers of available beds and Intensive Care Units (ICUs) in hospitals that are available for COVID-19 cases.  Furthermore, it is likely that daily COVID-19 tests will be reduced due to financial constraints on the health system. It is unclear if and how the ministry of health plans to facilitate the procurement and delivery of these shortages.
The explosion and destruction of houses have caused 300,000 people to be left homeless. Most of which are staying with friends and family.  With overcrowded houses, it is now more difficult for people to practice physical distancing as a crucial COVID-19 preventative measure. Hospitals and clinics are also overcrowded with patients and health professionals , causing an increased risk of COVID-19 infection. Eventhough the government introduced new partial lockdown measures on 21 August including a night curfew , the population will not be able to comply to such measures during an emergency situation; people have been supporting each other and cleaning the streets because the government is absent. 
Residents are facing difficulties in fixing their houses and buying glass due to their poor economic situation. In addition, the government is providing dollars to importers of essential building materials including glass and wood at double the exchange rate.  This means that prices for such materials will increase, making it more difficult for people to fix or reconstruct their houses. The high poverty rates are expected to increase during this emergency situation; due to loss of jobs, increased prices, and the destruction of the port which was a main entry point of aid.  The dire financial situation will also influence people’s ability to afford masks, disinfectants and access to water, further hindering their ability to practice preventative measures.
What’s next for Lebanon?
Lebanon is facing an unprecedented emergency situation that is hampering the ability to fight the pandemic. It is vital to support the local and international communities through urgent delivery of funds and essentials supplies. Health facilities must be prioritized in order to treat those injured while protecting health workers, patients and their families from being infected with COVID-19. Finally, Lebanon is in need of a new responsible and transparent government; the only way to fight the pandemic is through addressing the socio and political determinants of health.
Filters: COVID-19, Beirut Blast, Policy
 Independent global health specialist and researcher. UCL MSc Global Health and Development (2017), London.
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