Lebanon: a conflict particularly destructive to health care

وفيات أكبر نسبيًا للعاملين الصحيين والمرضى في لبنان مقارنة بأوكرانيا وغزة

22 November 2024, Beirut, Lebanon - Since 7 October 2023, 47% of attacks on health care - 65 out of 137 - have proven fatal to at least one health worker or patient in Lebanon, as of 21 November 2024.

This is a higher percentage than in any active conflict today across the globe - with nearly half of all attacks on health causing the death of a health worker.

In comparison, the global average is 13.3%, based on the SSA's figures from 13 countries or territories that reported attacks in the same period, 7 October 2023 - 18 November 2024 - among them Ukraine, Sudan and the occupied Palestinian territory (oPt). In the case of oPt, 9.6% of the total number of incidents has resulted in the death of at least one medical professional or patient.

According to SSA, 226 health workers and patients were killed in Lebanon and 199 injured between 7 October 2023 and 18 November 2024.

In the same period, the SSA registered a combined total of 1401 attacks on health in oPt, Lebanon and Israel - 1196 in oPt, 137 in Lebanon and 68 in Israel.

Civilian health care has special protection

"These figures reveal yet again an extremely worrying pattern. It's unequivocal - depriving civilians of access to lifesaving care and targeting health providers is a breach of international humanitarian law. The law prohibits the use of health facilities for military purposes - and even if that is the case, stringent conditions to taking action against them apply, including a duty to warn and to wait after warning," said WHO Representative in Lebanon Dr Abdinasir Abubakar.

International humanitarian law states that health workers and facilities should always be protected in armed conflicts and never attacked. Health facilities must not be used for military purposes, and there should be accountability for the misuse of health facilities.

"There need to be consequences for not abiding by international law, and the principles of precaution, distinction and proportionality should always be adhered to. It's been said before, indiscriminate attacks on health care are a violation of human rights and international law that cannot become the new normal, not in Gaza, not in Lebanon, nowhere," said WHO Regional Director for the Eastern Mediterranean Dr Hanan Balkhy.

The majority of incidents in Lebanon impact health workers

The majority (68%) of incidents in Lebanon registered by the SSA impacted health personnel, a pattern seen repeatedly in the last few years, including in Gaza in the past year. In Lebanon, roughly 63% affected health transport and 26% affected health facilities.

Attacks on health care hit twice. First, when health workers lose their lives or when a health centre is obliterated, and again in the following weeks and months when the injured can't be treated, those who are dependent on regular care don't receive it and when children can't be immunized.

"Casualty numbers among health workers of this scope would debilitate any country, not just Lebanon. But what the numbers alone cannot convey is the long-term impact, the treatments for health conditions missed, women and girls prevented from accessing maternal, sexual and reproductive health services, undiagnosed treatable diseases and, ultimately, the lives lost because of the absence of health care. That is the impact that's hard to quantify," said Dr Abubakar.

1 in 10 hospitals in Lebanon directly impacted

The greater the blow to the health workforce, the weaker the longer-term ability of a country to recover from a crisis and deliver health care in a post-conflict setting.

Lebanon is a lower middle-income country with a fairly advanced health system that's been hit hard by multiple crises in recent years. After hostilities in Lebanon escalated in September 2024, the growing number of attacks on health have caused further strain on an already over-burdened system.

Today, the country's health system is under extreme duress, with 15 out of 153 hospitals having ceased to operate, or only partially functioning. Nabatieh, as an example, one of Lebanon's 8 governorates, has lost 40% of its hospital bed capacity.

"Attacks on health care of this scale cripple a health system when those whose lives depend on it need it the most. Beyond the loss of life, the death of health workers is a loss of years of investment and a crucial resource to a fragile country going forward," Dr Balkhy concluded.

So far this year, between 1 January 2024 and 18 November 2024, a total of 1246 attacks on health care were registered globally, in 13 countries or territories, killing 730 health workers and patients and injuring 1255.

The Surveillance System for Attacks on Health Care (SSA), established in 2017 by the World Health Organization, is an independent global monitoring mechanism whose goal is to collect reliable data on attacks on health care and to then identify patterns of violence that inform risk reduction and resilience measures so that health care is protected. The SSA also provides an evidence base for advocacy against attacks on health care.

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