Intended for healthcare professionals

Analysis And Comment

Can Lebanon conjure a public health phoenix from the ashes?

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:848
  1. Abla-Mehio Sibai (, associate professor1,
  2. Kasturi Sen, director of research2
  1. 1 Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, Lebanon
  2. 2International NGO Training and Research Centre, Oxford OX2 6RZ
  1. Correspondence to: A-M Sibai

    The recent bombing of Lebanon has destroyed much of the health infrastructure. The challenge now is to establish a focus on primary care and public health services

    Lebanon is currently struggling with the aftermath of the most devastating conflict in its history. Israel's bombardment over the 34 day war that started on 12 July has crushed the economic, social, and health infrastructure of Lebanon, a small country with less than 4 million population. The south, where the population was already disadvantaged, was worst affected. Two government hospitals were completely destroyed along with many health and social centres. Over one million people, about a quarter of the population, were displaced. The Higher Relief Council put the overall death toll at 1183, nearly all of them civilians; over 5000 were wounded, mostly women and children. Acute crises, such as loss of clean water and electricity, destruction of road networks, and overcrowding with thousands of homeless families living in tents are exacerbated by an underlying chronic fundamental lack of resources.

    Before the war Lebanon had one of the highest gross domestic products in the region ($4045 (£2150; €3195) per head), with 12% spent on health (table).1 However, because of a system dominated by private providers with little interest in the needs of people who are poor or have long term disabilities or chronic illnesses, health provision in the south was already inadequate. We describe how healthcare provision developed and argue that the postwar climate ought to compel the government to reconsider the prevailing market led structure.

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    Lebanon's healthcare statistics1

    Development of health services

    After independence in 1943, Lebanon briefly built up some public …

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