War on Lebanon
Five weeks of hell
Some hospitals survive conflict … with some help

Although the Israeli attack on Lebanon lasted only five weeks before a ceasefire was declared on 14 August, in that short time thousands of civilians were killed or wounded, more than 900,000 people, nearly a quarter of the total population, were displaced and the damage to infrastructure was vast and widespread in southern Lebanon, with many healthcare facilities completely destroyed.

According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), entire villages in the south were reduced to rubble. A 24 August WHO report notes: Preliminary results of the health facility assessment show that between 50% and 70% of all Primary Health Care facilities in Bint Jbeil and Marjayoun have been completely destroyed. At present, there is no functioning hospital in this area. Serious shortages of fuel, drinking water, and medical supplies are still not resolved.

According to a 21 August WHO report, overall damage to the civil infrastructure (including water pipes system, sewage system, and power plants) was most severe in the regions of Tyre, Marjayoun, Nabatiyeh, Bint Jbeil, West Bekaa, Baalbek and Akkar.

Analysts have estimated that the damage done to Lebanon's overall infrastructure could cost anywhere between US$3 billion and $15 billion. At the time of going to press the government was reluctant to release any figures until a full assessment had been completed.

During the conflict, the devastation of infrastructure and the drastic fuel shortages, which in turn threatened the supply of electricity, put tremendous strain on medical facilities that were already struggling to cope with a massive influx of wounded civilians.

Some 4,060 civilians were wounded during the conflict and 1,187 civilians killed, according to the latest estimates received before going to press. Lebanon is renowned in the region for having several advanced and wellequipped hospitals and many, such as AUBMC (American University of Beirut Medical Centre), had to resort to only accepting emergency cases. This hospital was also forced to turn off the air conditioning system to save energy.

In media reports around 10 August (at the height of the conflict) AUBMC, like many other medical facilities in Lebanon, stated that were desperately worried that they would run out of energy supplies – electricity and fuel for their generators – within a week or two and would have to turn off incubators and other lifesupport equipment.

The situation was looking dire. The five main hospitals in Beirut, including AUBMC, were already making contingency plans to pool their resources where they would take on only life-threatening cases and reluctantly discharge all others even before they had finished their care.

Middle East Health spoke to Marc Chakal, Medecine Sans Frontieres (MSF) representative in Beirut about the medical situation on the ground during the conflict and immediately following the ceasefire. In the first week of hostilities, MSF and most other emergency relief organisations were denied access to Lebanon. “We managed to send in teams to Beirut from Damascus and Lanaka, Cyprus, on the 19th and 20th of July.

They had difficulty getting in by road and boat, having had to apply for permission from the IDF (Israeli Defence Force) beforehand. The teams were from Holland, Belgium, France and Switzerland … in total about 25 to 30 individuals,” said Chakal. “Once on the ground in Beirut, they split into four teams to assess the capabilities of medical facilities in various areas including Sidon, Tyre, Shouf, Beirut and the Bekaa Valley.

“Our main objectives during the conflict were to provide assistance to the displaced and to medical centres. This included the supply of logistic materials, non-food items, such as blankets and tents, and of course surgical materials and drugs, particularly those needed for chronic diseases such as diabetes and cardiac disease.

He said in three weeks MSF brought in some 300 tonnes of relief, which he described as a tremendous effort, although the teams faced many challenges, particularly with distribution. “Transport to the south was very difficult and dangerous.

We would have to notify the IDF before transporting the medical relief in clearly marked MSF trucks. We would then make a decision, independent of what the IDF said, whether to go or not. “In one instance, the bridge on the road to Tyre was bombed just before we got there. We had to carry the relief materials across the river by hand to another truck waiting on the other side,” Chakal said.

According to IRIN News reports, around 200,000. People fled to Syria and around 700,000 were internally displaced during the conflict. Chakal said around 200,000 to 300,000 had gathered in the Shouf region, a mountainous area east of Beirut. “This area was slightly easier to access and we were able to provide medical supplies and support to medical centres here and directly assist the many displaced people.”

Following the ceasefire there is, however, a new set of problems facing government and relief organisations, even though the supply of relief is not as urgent and, with new fuel supplies available, hospitals don’t have to worry about electricity supplies coming to a standstill.

“The displaced people have come back very quickly,” Chakal said. However, as clearing-up operations take place and with an estimated 15,000 houses and apartments completely destroyed and another 45,000 damaged, many people are being forced to stay in schools and public buildings. (At the time of going to press Lebanon’s Higher Relief Council (HRC), a government body set up to manage relief efforts during the crisis, said only 3,000 displaced remain in public shelters, mostly schools.)

However, many returnees are still without adequate sanitation, water and critical household supplies. “We have to adapt our operations a little bit to deal with this new crisis,” Chakal said. One of the big dangers now are the many pieces of unexploded ordinance (UXO) lying in the rubble.

Public awareness campaigns are under way to warn people and particularly children to stay away from any ammunition found lying about. Already, between 14 and 25 August 12 people, among them two children, have died due to UXO, and 51 injured, according to the WHO.

These figures rise daily. Reconnaissance teams of the United Nations Mines Action Co-ordination Center estimate it may take 12 months to clear UXOs from southern Lebanon.

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