 For more videos on people's struggles, please subscribe to our YouTube channel. Hi everyone and welcome to another issue of the People's Health Dispatch. In today's episode, we are talking to two public health professionals from Beirut, Lebanon, with Aline Germani and with Samer Jabur, who are both public health experts. And today we are going to talk a bit about what is happening in Lebanon, so the new changes that the country faces. Could you give us a brief overview of the situation for the past year? So as we all know, we have been going through actually the past two years, an economic crisis that has escalated and brought to its final year, I think stages in the past maybe six to seven months. If we want to focus on the water crisis in particular, you know that the crisis that has been, that we have been experiencing for the past four months, which is related to the fuel crisis. What we need to put in context before that is that Lebanon, for decades even, has been suffering from water issues. It's a country that has plenty of water resources and sources, but we already have a lack of water supply from water establishment, from governmental and public water establishment. The same for electricity. So electricity generation by the government is very, very poor. We have always had for the past like 10 to 15 years almost no publicly generated electricity. We have almost six to seven hours max of electricity per day. So the country is run by on generators and this brings the two issues together. Sometimes we do rely on water tanks to distribute clean water and this is water that we pay for privately, for those who can afford it of course, and for portable water almost every household in Lebanon again for the past at least 10 years count or buy either in bottles or in gallons that are distributed in homes again for those who can afford it. Now with the fuel crisis that has hit Lebanon in the past four months electricity is not being generated of course and all generators cannot run and cannot operate. And this is why water establishment cannot pump nor treat nor supply water the same for these private distributors who pump water and distribute water to homes. It has escalated almost to the dire situation that is threatening livelihoods for the past one month now. It probably is the country as Ali said is the country that has the most water resources among the countries that have the most water resources in the region and the least amount of water insecurity. Now this is also a country however that's at war with itself and with its identity. It's gone through a civil war, a 15-year civil war from 1975 to 1990 and it has had a dysfunctional post civil war governance characterized by sectarian governance. The centers of power are distributed between the the heads of different sects and therefore has produced compromises that have unfortunately come at the expense of the public interest. Now whether previously or now the resulting policies have remained the same is that there's no fiscal responsibility. There's no commitment to investment in public services when there's no commitment to the public goods to the common public goods and when there are vested interests in private profit off the water off the electricity all of that you'll find that we moved month to month almost on purchasing fuel to generate electricity as opposed to investing in infrastructure hydropower or other means to generate electricity on a sustainable basis. The same goes for all the other sectors. In 2015 you will recall that we had a major crisis which was the the garbage crisis and unfortunately this did not lead to any significant political change. However in the further deterioration of the situation as well as the other political developments led to the uprising in October of 2019 that led to the resignation of Prime Minister then Saad al-Hariri which took a long time to get a replacement, a compromise government that was also not seen to be highly effective by Hassan Diyya which also resigned then soon afterwards and the aftermath of the Beirut explosion. The explosion exacerbated the all of the other crises that had proceeded and we are right now a year now aligned with the government that was formed a few days ago and we are hopeful that there will be some change forthcoming but we are not ignoring the fact that the crises of Lebanon are so deep entangled with regional crises that they could actually not be solvable merely with the formation of a compromised government. Thank you for such a good introduction and also for mentioning the explosion and of course you both being health experts and present in the field. I was wondering if you could tell us a bit more about how in this context the COVID-19 pandemic hit and how did Lebanon and its health system cope with what has happened over the past year or so. We have been living for quite two decades now in a weak state that has little public service. From the beginning there is a lack of social protection in Lebanon. We are in a hybrid healthcare system where funding is private and public and the public funding is pretty much fragmented which leads to a situation of lack of social protection not lack of healthcare but lack of social protection. The pandemic of course did not affect us as much as the economic crisis and this is what affected mostly the health not the health system but the health and the protection of the residents and the population. When the economic crisis hit and when the banks took the money of the people hostage because this is what happened I consider it the biggest money heist of the century. This led to a real threat to people being able to afford healthcare. The elderly in Lebanon who are above 64 who are in retirement age who spared and money and saved money all their life to be able to afford at least healthcare and pay for food and survival and whatever cannot touch this money anymore. The Beirut explosion has exacerbated of course to a peak to a high peak the cases of corona in Lebanon accompanied by the economic crisis there is an incapacity of people of the government to rebuild hospitals that were totally destroyed. Add to this of course the issue of the currency as we said a money heist which is it's not only the people who suffered from this but also big institutions like hospitals or primary healthcare centers or non-governmental organizations and thus the shortage in medication add to that the highest migration of healthcare professionals ever ever in Lebanon ever and here we're not talking about fresh graduates which used to be the case after the civil war. Today in Lebanon physicians who are very well established in hospitals in their private clinics in the public sectors public sector also senior physicians have left the country in numbers. So just like any country we've gone through waves of infections and we've tried multiple approaches to containment and so the fact that Lebanon houses the second highest perhaps percentage of displaced people to the population in the world one out of six perhaps people who live in Lebanon is a displaced person so the country really provides a global good by supporting refugees mostly Syrian refugees as well as older Palestine refugees that has produced about a million refugees in Lebanon. So this is a country that has about four and a half five million so you can imagine what a million refugees mean those refugees just like other parts of the population have been affected by the COVID pandemic they've been among the most impoverished by the COVID pandemic the COVID response in this country or so is that it has been affected by the same constraints on public performance as other sectors as well. One of the problems that everyone is aware of is that the decisions that were made last December for example to open up the country to expatriates so that there's an influx of fresh cash and with the fresh visitors to the country led to a major outbreak that took weeks to control with a lot of lost lives from January to March and April of this year. So these issues again as Ali said converge with the other crisis to produce the situation where we are today. There is one one more point that we wanted to go through today and that is related to something that you mentioned before Summer and it's related to the new government. So if I'm if I'm not wrong it was on Friday that it was announced that there was a new government form so I would be interested to hear a bit more if you have any expectations about that. Weird enough in Lebanon government or no government we have learned through the years that it's the same so for the past 13 months as you said we have been without the government and it doesn't affect much any of the any of our operations we are a country and the people that are able to govern themselves without without a government so to say the least that it's a government that is being that was brought by the same parties that were ruling the country for the past many years and with the same conditions of the previous of the of the previous several governments that have been created and and resigned in the past two already in the past two years and and before that. So we cannot expect much because these are the same parties that have for the past 30 years and even more structurally and systemically leading us to a point of crisis they could have during the past two years even if there was no government in the past 13 months and since the revolution and October 2019 they could have started thinking about a strategy to salvage the country if they wanted to I think they have the brain to do so but they have no will to do so and this is why I'm not sure Samar had some hope I have no hope at all this government was born out of a regional compromise you know so so the reason that we have not had a government over this past year is because the conditions for a political regional compromise were not there regional slash international I mean we're talking here about an agreement between the Biden administration with Hezbollah, Syria and others to pass essentially gas through through Syria to to to Lebanon it's quite clear that that this government and the the conditions for its birth explain why Lebanon will will be in in a difficult situation for years to come because it's always at the at the table of compromise between regional and international powers now I'm still hopeful that this current government will produce a bit of relief to the people the electricity and the gas and water situation is unbearable right now and I'm hopeful that there will be some reforms made and that aid will start flowing but I share Ali's assessment that that radical reform to say the least justice for the for the for the victims and the families affected by the Beirut explosion for example I'm with Ali that we are not yet seeing the light at the end of the tunnel thank you both for sharing your thoughts with us today thank you so much for joining us