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Lebanon: Government recklessness in medication subsidy reform violates right to health and life

The Lebanese authorities are failing to safeguard the rights to health and life for the country’s population amid an ongoing crisis that has left patients unable to afford or access essential medication, Amnesty International said today.

Since the November lifting of subsidies, medication prices in Lebanon shot up four times as compared to 2019 when the economic crisis first started, and medication remains in severe shortage. Despite knowing for the past year at least that lifting subsidies might become necessary, the government failed to put in place a social protection plan to ensure continued access to essential medication. Amnesty International spoke to 13 pharmacists, doctors, hospital directors and patients with chronic or other diseases who consistently said that even when they do manage to obtain the funds, they regularly struggle to obtain essential medication.

“Since 2019, the people of Lebanon have been hit by round after round of crisis and today they have been left to muddle through a health crisis created by the government. Lifting subsidies on medication without ensuring that there is a social protection framework in place to guarantee their access to essential medication is an act of deep recklessness,” said Lynn Maalouf, Amnesty International’s Deputy Regional Director for the Middle East and North Africa.

“Government inaction on the medication crisis is inexcusable. The government has not met since mid-October at a time when they should be rushing to put in place urgent measures to address the medication crisis and its impact on people. These could include reintroducing targeted subsidies on essential medications and working with pharmaceutical companies and international donors to guarantee a reliable supply of essential medication.”

Lifting subsidies on medication without ensuring that there is a social protection framework in place to guarantee their access to essential medication is an act of deep recklessness.

Lynn Maalouf, Amnesty International

On 9 November, following months of statements by the Central Bank (BDL) announcing its inability to provide the US Dollars needed to sustain the subsidy scheme which covers up to 95% of drug consumption in Lebanon, the government announced it was lifting pricing subsidies on most medicines. This led to a further spike in the price of essential medication, even as the shortages continued. While this move was entirely foreseeable since the BDL had been warning of it for months, the government failed to accompany the subsidy removal with a social protection plan that would enable people’s access to essential drugs. A government cash card programme, for which registration was launched on 1 December, is not expected to issue payments until March 2022 and it remains unclear how the government plans to fund the scheme.  

Residents saw their medication bills shoot up exponentially after the November decision, according to pharmacists and patients interviewed by Amnesty International. As a result, at least 70% of the population is today unable to afford the medication that is still available, according to Assem Araji, chair of the Parliamentary Health Committee.

Pharmacies began reporting shortage of many essential drugs from June 2020 onwards. Several hospitals, including Rafic Hariri University Hospital (RHUH), Tripoli Governmental Hospital and Al-Makassed General Hospital, told Amnesty International that they were only able to function thanks to limited foreign donations.

BDL, drug importers and the Ministry of Public Health (MoPH) blamed the shortage on the smuggling of subsidized products, the stockpiling and hoarding of chronic medicines, and delays in processing import requests. Yet the government has taken little action to address these obstacles. In June, BDL largely stopped supplying dollars to banks to extend lines of credit to importers of infant baby formula and medicine, saying it could no longer afford the drain on its reserves and in November, MoPH announced the lift of subsidies on pharmaceuticals for chronic diseases, while subsidies on drugs used in cancer treatment, dialysis and the management of mental health illnesses would remain in force. However, even while maintaining subsidies on these categories of drugs, patients and hospitals have been struggling to find them on the market.

Unavailable or unaffordable medication

According to hospital workers in Beirut, Tripoli and Nabatiyeh Amnesty International spoke to, the lack of available medication is having a severe, life-threatening, impact on patients. The head of the pharmacy at RHUH told Amnesty International for example, that the impact is clear in emergency rooms (ERs): “A patient came with a failing heartbeat because he couldn’t find the med that organizes his heartbeats. And another patient had a seizure because he couldn’t find the med for blood pressure… […] Even my husband’s brother, he couldn’t find his blood pressure medication for two days, he was rushed here to the ER, but he passed away.”

Amnesty International spoke to patients suffering from cancer, diabetes and mental health issues who said that they could not find their prescribed medications, despite some looking in up to 12 different pharmacies across Lebanon. They were also rarely able to find suitable alternatives. A patient with bipolar disorder who couldn’t find her medication in Lebanon explained: “I asked friends to get me a drug called Manicarb from abroad. It is a very delicate drug. Something was different in its composition, so I suffered a severe manic episode. My doctor then checked the composition and ordered me to stop it.”

Meanwhile, hospitals are running low on supplies including donations they have received from international organizations. Doctors and patients told Amnesty International that they can barely source enough medication to cover their treatments for the rest of December. These shortages are particularly afflicting those suffering from conditions such as cancer, heart disease or mental health as they are likely to experience extremely serious health consequences if they are unable to access medication.

Government inaction on the medication crisis is inexcusable.

Lynn Maalouf, Amnesty International

Dr. Issam Chehade, Head of Hematology-Oncology Department at RHUH, said several of his patients had been deprived of medication and chemotherapy treatments for a period of three or four months, with a potential serious impact on their health and chances of recovery. “The psychological state of our patients is very bad, especially [those] who are diagnosed early with curable cancers and some types of blood cancers. Then suddenly you tell them that their meds are not available,” he said.

“Mahmoud”, a 60-year-old man with underlying heart, blood pressure and central nervous system issues, says he can barely find any medication and the ones he can find, he cannot afford. “How much worse can things get? And still, they [the state] are not even planning any kind of rescue,” he said.

To support patients, staff in Al Makassed Hospital launched a fund. “We cannot see our patients unable to buy their life-saving drugs and do nothing. But we are aware that the situation is too bad for our initiative to have an impact,” said Dr. Mohammed Badr, the director of Al Makassed. 

Although some doctors say the pressure has eased somewhat over the last weeks after some companies resumed importing medications, limited and costly supplies mean only a small number of patients are able to access the drugs.  

Dr. Rania Sultan, who runs the pharmacy at Tripoli Governmental Hospital, says they do not have the essentials a hospital needs to function. “I don’t have the shots required to resuscitate a patient rushed in with a heart attack… And I only have 10 adrenaline shots, while one patient in the intensive care unit needs up to 30 shots! I can’t speak about sustainable planning when I don’t even have the essentials needed to save lives today.” And as fears mount over another outbreak of Covid-19, Dr, Raida Bitar, director of RHUH pharmacy, told Amnesty International that “we do not have the necessary medication to treat the disease’s symptoms”.  

Background 

According to the International Trade Organisation, Lebanon imports approximately 95% of its pharmaceutical products, spending more than $1 billion annually. 

In November 2019, BDL reduced its subsidizing of the import of medicines to 85% of the foreign currency needed for pharmaceutical products at the official peg of LBP1,507.50. This meant that importers were forced to buy the remaining 15% of foreign currency on the black market at the unofficial exchange rate, thereby driving up medication prices. However, with the Lebanese pound losing over 95% of its value and the depletion of foreign-currency reserves, the BDL warned it had to remove subsidies from most medicines. MP Araji explained on 22 November that medical subsidies were reduced from $120 million per month to about $35 million.