The Lebanese-Italian Hospital in Sour, Oct. 18, 2023. (Credit: Lucille Wasserman/L'Orient-Le Jour)
At Mount Lebanon Hospital, the plan for a potential war centers on a system of color-coded protocols. The private hospital is located just a few meters away from the southern suburbs of Beirut, which came under Israeli heavy shelling in 2006.
"Like other hospitals, we've implemented a 'white code,' which involves a comprehensive plan for evacuating patients in case of bombardment," said Gracia Dona, director of the nursing department at the hospital. "Additionally, we've reconfigured our emergency department to categorize patients as red, yellow or green, depending on the severity of their injuries."
The harrowing 33-day episode of violence in 2006 left a lasting impact on healthcare professionals, shaping their current emergency strategy for potential future incidents.
"In 2006, we sheltered patients in our basement to shield them from the bombings," Dona recalled as she guided L’Orient-Le Jour through the underground corridors.
"We've now readied our three basement levels to house 27 intensive care beds, with every detail meticulously planned, even down to the window coverings designed to withstand an explosion," she added.
The Lebanese-Italian Hospital in Sour, Oct. 18, 2023. (Credit: Lucille Wasserman/L'Orient-Le Jour)
Amidst the war between Israel and Hamas, the Lebanese Order of Physicians (LOP) is taking proactive measures should the conflict spill further into Lebanon.
On Oct. 25, the LOP organized a workshop at its headquarters in Beirut, bringing together representatives of the Health Ministry, humanitarian partners and doctors.
"What's happening in Gaza indicates that Israel is willing to take extreme actions," said MP Bilal Abdallah (Chouf/Progressive Socialist Party) and chairman of the parliamentary health committee.
"It is important to acknowledge that Lebanon's hospitals are already facing significant challenges, including power shortages and a significant emigration of doctors to other countries due to the country's multifaceted crisis," he added.
Meanwhile, Amin Azzi, head of the Emergency Medicine Order, warned that out of the 90 emergency physicians, a crucial asset in times of war, registered in the country, "only 30 are currently practicing."
The rest have left Lebanon, primarily enticed by better salaries abroad.
"We are facing a severe shortage of both nurses and doctors due to the ongoing crisis," President of the Syndicate of Hospitals Sleiman Haroun told L’Orient-Le Jour. "We’ll have to deal with this in the event of a conflict."
LOP President Youssef Bakhache said that doctors who remain on the front lines in the event of a war "breaking out" will receive training in treating war-related injuries.
During the LOP workshop, Nadeen Hilal, advisor to caretaker Health Minister Firas Abiad, gave a PowerPoint presentation on the ministry’s emergency plan to support hospitals.
"As early as Oct. 9, we activated the Public Health Emergency Operations Center," Hilal said.
What is the primary objective of this unit? "To save the lives of the wounded and take care of the health of displaced people," Hilal said, adding that this could be achieved by collecting data from each hospital and then reallocating resources and patients according to their respective capacities.
"An emergency plan? What are we talking about? The war began two weeks ago in the South, and only now are we assessing hospital resources?" retorted Doctor Elias Jarade, an MP affiliated with the protest movement (South III), during the workshop.
‘With the means at hand’
In Sour, nearly 7,000 residents have already fled the Israeli bombardment to take refuge, as reported by Mortada Mhanna, the head of the disaster management unit at the federation of municipalities in the district.
"We are preparing, but we're doing so with the meager resources at our disposal," said Youssef Jaafar, the director of the privately-owned Lebanese-Italian Hospital. "Today, we're struggling to secure medicines and even basic medical equipment."
The 2019 financial crisis has caused a shortage of medicines, and access has become even more challenging following the end of subsidies by Banque du Liban on the vast majority of medicines in 2021.
For his part, Hassan Wazni, director of the Nabatieh Public Hospital, close to the border, said: "In normal times, public health resources are already stretched thin."
"However, in the event of a conflict, we must ensure we have an adequate stock of equipment, medicines and fuel for our generators, given the potential for road closures," he explained, adding that he is working "with the means at hand to have a month’s supply."
According to Wazni, the Health Ministry’s emergency plan "remains largely theoretical at the moment, due to a lack of funding for its implementation."
Abiad told L’Orient-Le Jour that in addition to equipment donations from the World Health Organization (WHO) and the International Committee of the Red Cross (ICRC), "the government granted the Health Ministry the equivalent of almost $11 million Lebanese lira."
"The ministry also allowed the disbursement of$1 million, earmarked for the fight against COVID-19, to support public hospitals," Abiad added.
Abiad explained that the ministry’s aid has helped cover the costs of injured displaced persons in Sour.
"Negotiations are underway with the World Bank so that part of the loans allocated to Lebanon can be paid to hospitals in the event of injured people needing care," Abiad explained.
Accustomed to war
In the meantime, hospital directors say they are compensating for the lack of resources by drawing on their experience of previous conflicts.
"We're used to war," Jaafar said.
"We'll probably do what we did in the old days when, as soon as there was a truce, we sent sick and wounded people to calmer areas, like Saida or Beirut," Wazni said, recalling the July 2006 war.
Brahim al-Raai, the director of Saida's private Al-Raai Hospital, said he launched an emergency plan three weeks ago, with "reserves to last two months, emergency doctors on standby, ready to intervene at any moment, and training for employees in emergency care."
Raai also recalled the more recent clashes in the Palestinian camp of Ain al-Hilweh, when the hospital "received many wounded, with the material support of the ICRC, not the Health Ministry."
In Beirut, several private hospitals have prior experience in treating patients transferred from other areas.
"We received 220 wounded individuals by helicopter during the Nahr al-Bared clashes [between the army and the Fatah al-Islam in 2007]," explained Georges Ghanem, head of cardiology at Beirut’s Rizk Hospital.
Responsible for the hospital's strategic development, Ghanem said, "All major hospitals have emergency preparedness plans."
"We have enhanced ours based on the lessons learned from the explosion at the port on Aug. 4, 2020," he added. "The most important thing is ensuring that everyone is aware of their specific roles."
Ghanem said his hospital is planning a full-scale drill exercise on Nov. 4.
"Despite many crises, from the pandemic to the financial crisis, we remain prepared," Ghanem said.
This article was originally published in French in L'Orient-Le Jour. Translation by Sahar Ghoussoub.