Lebanon’s readiness for acute emergencies tested

26 September 2024, Beirut, Lebanon – How does a country reeling from socioeconomic and internal and external political shocks prepare for an acute health emergency? Lebanon may provide an answer.

On 17 September 2024, at 15:30 local time, message-receiving devices (pagers) began to explode across the country, causing a huge number of casualties. Thousands were rushed to hospitals with almost identical atypical war injuries – amputated fingers, severe facial injuries, especially to the eyes, and less frequently, femoral and hip injuries.

On 18 September, another wave of device explosions occurred adding to the thousands of injuries and casualties and the violence continues.

The readiness of Lebanon’s fragile health system was sorely tested.

The response

Initial reports following the explosions on the 17th suggested close to 2,750 casualties in need of wide-ranging medical procedures were being rushed to more than 100 health facilities across the country. Immediately, the Ministry of Public Health (MoPH) and hospital administrations called on medical professionals to report to nearby hospitals and provide any assistance needed.

Within an hour of the first explosions, the Public Health Emergency Operations Centre (PHEOC) at the MoPH was activated, and representatives from the main 4 emergency transport systems joined the PHEOC team to organize the dispatch of casualties.

Other than patient referrals between hospitals, the availability of surgical and blood supplies, hospital staff capacities, hospital bed occupancy, and coordination with partners on the ground were monitored and closely coordinated by the PHEOC team.

Health staff on duty used the experience they had gained through recent surgical and mass casualty management trainings and simulation drills delivered by WHO and MoPH. Surgical supplies procured and prepositioned by WHO were dispatched to hospitals within hours and a total of 400 blood units were provided by the Lebanese Red Cross in coordination with the PHEOC team to support the treatment of severe cases.

Within 6–7 hours, what had threatened to be a completely overwhelming situation had been successfully managed. Coordination of the response to the second wave of explosions on the next day was even faster as hospitals across the country were already on high alert and all health partners had already initiated their support.

Preparedness

Despite persistence of hostilities that continue to put pressure on Lebanon’s health system, the success by which the initial events on 17 and 18 September were managed was in large part due to years of health system preparedness efforts led by MoPH and supported by WHO and partners.

Several years of instability, followed by the advent of the COVID-19 pandemic in February 2020, through the devastating Beirut port explosion in August of the same year and the economic collapse that followed, Lebanon has faced multiple crises. Like the rest of the country, the health sector has had to deal with the rising challenges by adopting measures that maximize gains and minimize losses.

With support from WHO, MoPH worked to enhance health system preparedness through a holistic approach, addressing gaps at the strategic, operational and technical levels.

Strategically, WHO and MoPH worked together to establish and operationalize the PHEOC to improve public health emergency preparedness, response and recovery activities. First put to the test during the cholera outbreak in 2022, The PHEOC once again proved its value on 17 and 18 September.

On the operational front, no effort was spared in ensuring efficient, predictive and cost-effective logistics operations. WHO supported multiple assessments that identified priority needs and immediately began procuring and prepositioning essential medical supplies.

Since 8 October 2023, WHO has provided over 60 metric tonnes of essential health supplies, including surgical supplies, essential medicines, medical consumables, laboratory and blood transfusion supplies and personal protection equipment for health staff. These supplies were effectively managed and dispatched thanks to the fully automated Logistics Management System, developed and supported by WHO at the Central Drugs warehouse since 2021.

Technical support to enhance the knowledge and skills among frontline health workers was provided through a wide range of intensive trainings and upskilling activities. Considering the volatility of the situation, not least rising tensions after the events in Gaza on 7 October, WHO worked with MoPH to deliver mass casualty management trainings for more than 5500 surgical and nursing staff at 118 out of the 145 hospitals across the country, followed by simulation drills for 110 hospitals. Other trainings focused on integrating mental health services into hospital and primary health care and strengthening early warning surveillance and disease outbreak response.

The test continues

The events on 17-18 October were followed with an intensification of the crisis. Hospitals continue to work around the clock to manage the hundreds of cases arriving daily with various injuries as a series of other explosions and airstrikes overcome the country in this escalation of violence.

Despite the escalating violence, coupled with financial and health workforce challenges, Lebanon's MoPH continues to dedicate efforts to improving preparedness and health system readiness.

Under the leadership of the Ministry of Public Health, WHO and partners are working closely to put in motion a carefully crafted preparedness plan focusing around 4 main pillars: coordination, continuity of essential health services including mental health and psychosocial support at primary health care level, disease surveillance and vaccination; and of course, mass casualty management.

The plan aims to support the health system in managing mass casualty incidents with minimal impact on the continuity of essential services required by thousands of other patients. The explosions that brought life across Lebanon to a standstill for a few hours also showed that the health system is moving forward while simultaneously revealing areas for further investment.