Patients suffer privatised, politicised healthcare

When Hamza Shahrour had a heart attack in June last year, the 24-year-old Shia might have hoped to survive it, given that he was just a few blocks away from the Rafik Hariri hospital, named after the former five-time Sunni prime minister.

But because Hamza’s family had no health insurance and could not afford to pay the thousands of dollars deposit demanded, the doctors refused to treat him.

Worse was to come. In Lebanon’s current political standoff between a Sunni-led government and the Shia-led opposition, Hamza was discriminated against by the doctors, according to his mother, because of his sect.

Hamza was transferred to the Rasool al-Azam (Mighty Prophet) hospital, owned and controlled by Shia group Hezbollah in Beirut’s southern suburbs, where his mother said the family receive free medical care, despite their lack of insurance. But Hamza died as the Lebanese Red Cross drove him across town.

“I wish my son had been a Sunni,” Hamza’s mother, Raheja Shahrour, told IRIN. “Maybe he would be sitting next to me now instead of dying, having been turned away from the Hariri hospital.”

Hamza’s case is far from unique, say doctors and analysts, in a healthcare system grounded in politics and sectarianism since the civil war (1975-1990), lacking funds, and privatised to the point at which most citizens are priced out of basic treatments.

[Read two more case studies]

Over the past 20 years the Ministry of Public Health has founded 27 state hospitals, but half of these have closed due to poor management and finance, according to Ismael Sukkareye, a member of a parliamentary committee which worked with the World Health Organization (WHO) on the “Right to Healthcare” report on Lebanon’s healthcare system, released in Arabic in December 2007.

Of a total of over 1,500 beds in state hospitals, just 300 are functioning, according to the research.

''I wish my son had been a Sunni. Maybe he would be sitting next to me now instead of dying, having been turned away from the Hariri hospital.''


By comparison, Lebanon has 175 private hospitals with around 14,500 functioning beds. They are generally considered to have more modern facilities and provide a higher standard of healthcare. In 2006, total government health spending was just US$400 million, while total costs in the healthcare sector amounted to $686 million, according to the WHO report.

“The Ministry of Health is encouraging the privatisation of healthcare by transferring more and more patients from state hospitals to private hospitals,” said Sukkareye. “In 1971, 14 private hospitals had contracts with the ministry to treat patients under public healthcare. In 2000, the figure had risen to 134.”

When a patient is treated at a private hospital under such a “transfer” arrangement, the Health Ministry is supposed to pay 90 percent of their bill.

However, the government has become increasingly unable to pay its bills, said Sukkareye, leaving private hospitals massively out of pocket and meaning that since 2006 no private hospitals have accepted such public to private transfers.

Lack of insurance

The failure of government to pay for public healthcare bills means Lebanese are required to hold expensive private healthcare insurance. Only 27 percent of residents are able to do so, according to December’s report. Poor migrant workers or asylum-seekers are particularly vulnerable to Lebanon’s expensive healthcare system.

Figures from the WHO December report reveal the extent of the healthcare problem. Out of 2,700 patients needing treatment for kidney disease, 1,200 were state employees with government health insurance, 100 had their bills paid by the army, 400 had private health insurance, while 1,000 had to pay their bills without support.

Photo: Rami Aysha/IRIN
Only one in three Lebanese have health insurance, and with the government unable to pay for most citizens’ treatments, families can often spend thousands of dollars on days spent in hospital

Civil war

Some doctors blame Lebanon’s ruinous 15-year civil war for stunting the development of its healthcare system and fragmenting it between numerous religious and ethnic sects.

“Before the civil war began in 1975, Lebanon had the best hospitals and doctors in the region,” said Dr Ibrahim al-Haber, who also contributed to last December’s report.

“But while Lebanon went through bad times, countries in the region improved their health systems. After the civil war, Lebanon’s healthcare system was built on sectarian standards. Each sect now has its own hospitals and clinics which provide their own people with free treatment.”

Sectarian favouritism

In interviews with IRIN, doctors from the Hariri Clinic, run and controlled by the Sunni Future party, and the Shia Hezbollah-controlled Rasool al-Azem hospital both stressed their services were open to anybody in need.

However, said Dr Ali Shahrour of Rasool al-Azem, while the hospital “provides healthcare to everyone, with no exceptions” Hezbollah militants and their families are given “top priority” as part of the hospital’s strategy.

Photo: Rami Aysha/IRIN
Despite starting life as a public healthcare facility, the Rafik Hariri hospital in Beirut now requires patients to have private insurance or pay a large deposit before receiving treatment

“While serving your country you expect someone to look after the health of your family,” said Shahrour. “We consider the resistance fighters and anyone who lives in Daheye [Hezbollah-controlled southern suburbs] as our people.”

Likewise, Dr Khaled Bsat of the Hariri Clinic in the Sunni-majority neighbourhood of Tarik al-Jdeide said his staff “give free medicine to everyone, not according to sect but because healthcare is for everyone.”

However, were a patient to be a member of the Sunni Future party, their treatment at the Hariri Clinic would certainly be a priority.

“Lebanon is a sectarian country, but even if we open clinics in Sunni areas we also give medicine to everyone,” said Bsat. “But as Sunnis we must take care of Sunnis before any other sect.”

Member of Parliament Sukkareye believes reform of the health system requires both public and private hospitals to be put under independent management to root out corruption and waste.

“There is no clear health policy and no one has oversight on the financial figures,” said Sukkareye. “We need independent committees to take over the management of hospitals. We must end the business of making profits through healthcare.”