There are no patients being treated on the damaged seventh floor of the Saint George Hospital in Beirut, where doors have splintered and wires dangle from the ceiling. The city’s destroyed port, now a wasteland, can be seen through the cracked and broken upper-floor windows.
Yet just three floors down, nurses in scrubs and face masks bustle around a partly restored ward, as two babies sleep in plastic cots oblivious to the sounds of hammering and drilling below them.
“I don’t let myself have the time to grieve or to be down because I have to be positive,” said Iskander Nehme, medical director of the hospital, which lost four of its nurses in the massive explosion at the port on August 4.
One month on, Beirut is still traumatised by the catastrophic blast that laid waste to the port and surrounding neighbourhoods, killing 190 people and injuring thousands. Yet in the face of a financial meltdown and political instability, Lebanon’s capital is doggedly rebuilding.
It is a grim undertaking, led by volunteers and private individuals in the absence of support from the bankrupt and discredited Lebanese state.
The country’s leaders have largely failed: whether it be in directing the reconstruction or pursuing a desperately needed bailout from the IMF. It took an intervention by French President Emmanuel Macron to pressure them into choosing a new prime minister who now has the task of forming a government.
Even before the blast, Lebanon’s worst economic crisis in 30 years had pushed more than half the population into poverty. The collapse has been exacerbated by civil unrest, with mass protests that broke out in October, toppling the government.
Following the explosion, caused by explosive materials inadequately stored at the port for years and widely blamed on official negligence, furious demonstrations felled a second administration.
Taking the brunt of the crisis is Lebanon’s fragmented healthcare system, which was already grappling with a surge in coronavirus infections that have risen quickly from single digits just weeks ago to hundreds per day since the port blast.
Seventeen Beirut hospitals were damaged in the explosion, with Saint George alone sustaining an estimated $35m worth of damage. Some 500 additional beds are needed to make up for those lost across the devastated facilities. Many hospitals have been forced to launch their own fundraising campaigns.
Saint George Hospital, which was built following the end in 1990 of Lebanon’s 15-year civil conflict, was designed to withstand a war — its operating rooms and critical facilities were constructed underground to protect them should fighting return.
Nonetheless the port blast blew out all of the hospital’s upper floors. But the fourth floor ward was partially salvaged and after a clean-up, surgeries are running again, albeit at limited capacity. “To live in Lebanon you have to accept that there will never be stability,” said Mr Nehme.
Like many others, medics working in Lebanon face an anxious future. The Lebanese pound has lost 80 per cent of its value on the black market compared with the official exchange rate, causing inflation to spiral.
“The whole economic situation, Covid-19 and then the blast — it was the perfect storm,” said Ghina Ghazeeri, associate professor of obstetrics and gynaecology at the American University of Beirut Medical Center.
Called to attend an expectant mother who had gone into labour on the day of the explosion, Dr Ghazeeri was walking to her hospital when the blast struck just after 6pm, showering her with glass. Still she pressed on, and 40 minutes later she delivered a baby girl using the light from a mobile phone torch.
However, the psychological toll on health workers had been immense, she said, explaining that she relived the details of the blast with practically every patient consultation. “This is more than resilience . . . This is more than a human can tolerate.”
Before Lebanon’s economy began its steep deterioration in October 2019, the country had one of the region’s more robust healthcare sectors, with 21 doctors per 10,000 people, according to World Health Organization data, a higher rate than Turkey.
Yet the world-class private hospitals, which once attracted medical tourists from across the region, are not matched in the smaller public sector, where underfunded institutions have struggled. Lebanon’s Palestinian and Syrian refugees — estimated at around 1.5m of the country’s roughly 7.5m population — depend on health services provided by NGOs.
For those without insurance or state protection, including hundreds of thousands of migrant workers, the system can be treacherous. To force patients or their relatives to pay their bills, some private hospitals refuse to release newborn babies or dead bodies until medical bills are settled, according to aid workers.
Rayah Touma Sawaya, 23, was among the trainee doctors who leapt to administer emergency help on August 4 when the explosion struck. But she is grappling with the tough choice faced by many of Lebanon’s talented young people — to stay or to go.
She is keen to remain in Lebanon, where her family is and where she feels settled. But, she said, “given the circumstances right now, I’m not sure we have a choice”.