Lebanon's doctors refusing to abandon patients by moving abroad amid economic crisis

Frustrated by traffic caused by a fuel shortage protest on a motorway north of Beirut last week, Dr Julien Lahoud flagged down a passing scooter. The obstetrician gynaecologist was in a hurry. His patient was at risk of uterine rupture during labour. He made it just on time to deliver the baby, but the incident shook him. “Both Mom and baby are fine. However Lebanon is NOT fine,” he said in a post on Twitter. His post received hundreds of likes as other Lebanese identified with the myriad issues caused by Lebanon’s financial meltdown and the knock-on effects of acute fuel and medicine shortages. “We are relying on luck and hope,” said Dr Lahoud. Dr Lahoud, 41, is one of several doctors who told The National that they have decided to stay out of moral duty towards their patients despite salary cuts, medicine and fuel shortages and a chaotic environment that is taking a toll on their mental health. Thousands of other medical professionals have left Lebanon since the financial crisis started in 2019. “I ask myself maybe a hundred times a day: why are we here?” said Ghina Ghazeeri, 50, an obstetrician gynaecologist at the American University of Beirut Medical Centre. “I believe we are staying in Lebanon not because of our job just because of our moral duty. I cannot turn my back on my patients right now.” Lebanon is experiencing its third mass exodus, the American University of Beirut’s crisis observatory said on Monday. The first occurred between 1865 and 1916, when war and famine pushed an estimated 330,000 people to flee Mount Lebanon, or about 45 per cent of the region's total population, the observatory's director Nasser Yassin said. Over half a century later, roughly 30 per cent of Lebanon's total population (990,000 people) left because of the 1975-1990 civil war. The third wave of migration, triggered by the country’s financial meltdown in 2019, is seeing a particular exodus from health and education professionals, said Mr Yassin. “These sectors are sought after in many countries. That's why they're the first to leave,” he told The National . Because the Lebanese pound has lost more than 90 per cent of its value, salaries across the country, including for doctors and teachers, have been hit. For example, a doctor earning 3.5 million Lebanese pounds a month used to make the equivalent of about $2,300. Now, that amount is only worth $184. But rising insecurity and a lack of basic services, including electricity, are also important considerations when considering emigration, said Fadi Abou Jaoudeh, a cardiologist at St Georges Hospital. “It’s a question of quality of life. We don’t know what will happen,” said Dr Abou Jaoudeh, who works half of his time in France and plans to settle there permanently by next year. Doctors who choose to stay say the feeling of responsibility outweighs struggles both at work and in their households — including electricity and water supply. Two weeks ago, Dr Ghazeeri returned home at 11pm dripping with sweat after delivering a baby by Caesarean section. But electricity did not return for the next 12 hours, meaning the water pump — and shower — would not work. “I work on myself psychologically to not reach a burnout,” she said. “I convince myself that these patients don’t have anybody left to help them. That’s the Hippocratic oath: we swear that we’ll take care of our patients to the best of our knowledge and we’re not going to leave them at a time of crisis.” Finding a job elsewhere is relatively easy for Lebanese medical professionals. Lebanon used to be one of the region’s main hubs for medical tourism and local doctors have a reputation for being highly skilled. “Head hunters contact us,” said Dr Lahoud. “We receive regular emails and text messages from recruiters in the Gulf area.” But only the threat of physical harm would convince Dr Lahoud and his family to leave. “We’re fine taking a shower with no water pump or having no heating at school, as long as there’s no violence or acts of war,” he said. The psychological toll of staying in Lebanon is heavy, said Peter Noun, head of the paediatric haematology oncology unit at Saint George Hospital, which is slowly recovering from the devastation caused by the explosion at Beirut’s port in August 2020 that killed at least 18 of the hospital’s staff. In addition to delivering medical care, doctors are scrambling to help their patients buy medicine abroad and administer it in the most efficient manner. Dr Noun groups children with similar medical treatments together and saves what is left in every vial for reuse instead of throwing it away. None of the children he treats has yet skipped a treatment. “I come to the hospital and I see all these kids and I think: I cannot leave,” said Dr Noun, 53. But anxiety levels are running at a record high. “I’m not saying I’m happy. I’m not,” said Dr Noun, who cofounded an NGO in 2005 that supports children with cancer. “I hope this nightmare will finish soon because I'm really at the bottom of myself. I don’t want to leave my country. I don’t want to have to start something new and leave behind everything that I’ve done.” Hospitals regularly ring alarm bells in local media about the life-threatening effects of medical shortages, while the government, importers and the cash-strapped central bank all blame each other. Last Thursday, cancer patients took to the streets in protest in Beirut. Two days later, the former head of Lebanon’s pharmacists syndicate was arrested on suspicion of stockpiling large quantities of drugs. “Those who are hiding essential drugs from people who will die if they will not receive their treatment need to go to jail,” said Dr Noun. “Everyone says it’s the fault of the other. And who is paying? The patient.” Watching colleagues leave may be disheartening, but knowing that it is in the best interest of one’s own children to go is even worse, said Dr Noun. His three daughters are preparing to study in France and have no plans to return. “I know it’ll be a loss for Lebanon. But do we have another option? At least I’m not leaving for now but I’m thinking about my daughters. I don’t want them to live what I’m living. It’s so sad,” he said. Similarly, one of Dr Ghazeeri’s daughters is already studying in the US. The two who remain in Beirut hope to leave. Their lack of hope in their own country is painful to her. “These are young people who lost trust in Lebanon and these are the people who we want to build the new Lebanon,” she said. “The problem is that I have nothing to promise them. That’s why I cannot blame them.”

Lebanon's doctors refusing to abandon patients by moving abroad amid economic crisis

Thousands of medical staff have left since the start of the economic crisis in 2019