Lebanese cancer patients protest medical shortages at the highway leading to the presidential palace in Baabda, east of Beirut, Lebanon, on May 20. Photo by Wael Hamzeh/EPA-EFE
BEIRUT, Lebanon, June 14 (UPI) -- Cancer patients are bearing the brunt of Lebanon's financial crisis, their survival threatened by drug shortages, skyrocketing hospital costs and an exodus of medical workers.
The cash-strapped country can no longer provide healthcare for them or the rest of its traumatized population as they sink deeper into poverty, with rising unemployment and a currency that has lost 90% of its value.
Before the economic crisis broke out in October 2019, Lebanon was known as the region's medical hub for its high standards of medical education, quality of care and abundant personnel and hospital facilities.
"We never faced such a crisis related to medications and hospitals. This was never an issue," Anne Franjieh, president of the "Faire Face" Cancer Association, which has provided support for cancer patients since 1995, told UPI.
But for the past three years, the group has been doing nothing but helping patients with hospital bills and securing medications, often with travelers carrying them from Iraq, Turkey or Egypt.
"The situation is getting worse. Many of those knocking on our doors are from the ex-middle class, now under poverty line, and not just the poor," Franjieh said.
Running out of resources because of dwindling foreign currency reserves and shortage of U.S. dollars, the government in November started gradually lifting subsidies on medicines, including some for chronic illnesses. The amount allocated per month dropped from $115 million to $35 million for drugs and medical supplies.
Later, subsidies on certain cancer medications were also removed, despite heartbreaking appeals from desperate cancer patients and their families who have been protesting on the streets for months.
Elizabeth, a 43-year-old mother of two children who would only be identified by her first name, was "so weak" that she could not join the last protest. Three years ago, she was diagnosed with breast cancer, had surgery and chemotherapy and was cured.
Last year, she learned her breast cancer had returned and spread to her liver. With no medical insurance, having lost her job at a supermarket, she started to borrow money to cover her new treatment. Her husband's monthly salary of 4.5 million LL ($145 at Monday's market rate of 27,000 LL per USD) barely covers the family's essential needs.
Last week, she had to skip her chemotherapy session after she was told that it was no longer covered by the National Social Security Fund. She has been skimping on food for her kids to be able to cover her treatment that costs 12 million LL ($437) per month.
Another breast cancer patient, a midwife who asked not to be identified, said she found out she had cancer in August and was told she "should start treatment quickly." The crisis had then started: no medications, no hospitals admitting patients, unaffordable treatments.
After her insurance company and NSSF refused to cover many of her tests, she had to turn to her aunt and cancer associations for help.
"But it was all about begging and feeling deprived of any dignity to the extent I prefer to have cancer and not knocking on the doors to ask for money," the 38-year-old woman told UPI. With a monthly salary of 2.5 million LL ($91), she resorted to borrowing to cover her treatment -- 100 million LL ($3,636) since August.
As desperate as she was, she rejected an offer by an unnamed political party to completely cover her treatment on the condition that she vote for its candidates in the May 15 parliamentary elections.
"I prefer to die and not do that. I was among those who went to the streets on Oct. 17  and was very active until I was diagnosed and had to keep away," she said, choking back tears. "Without social disobedience, nothing would change because politicians are playing with our lives and no one is reacting."
Two years of COVID-19 lockdown measures had also an impact on people's health, with many skipping annual checkups.
"The problem is that those coming to us to start the treatment are in stage 2 and 4," Franjieh said.
For the Children's Cancer Center of Lebanon, it is a daily struggle to secure the needed treatment so they don't "say no" to any child.
"We are currently in a very uncertain period. We are trying our best not to decrease the number of patients we annually admit, but it's very hard," Manal Azhari Bashi, operations and HR manager, told UPI, noting that the center supported 3,633 Lebanese and non-Lebanese children with cancer from 2010 till the end of 2021.
With some 371 patients currently receiving treatment, Bashi said the center needs support from the international community "or else we will reach a point that we might fail to admit new patients as much as we used to."
"We are battling to survive and maintain the quality of care we have vowed to our children," she added, citing shortage of the most needed oncology medications, increased cost of treatment, inflation and bank restrictions on cash withdrawals.
Doctors are also struggling to provide treatment.
"We were at the top and we were forced to go down," said Dr. Nagi E. El Saghir, head of hematology oncology and director of the Breast Center of Excellence at the American University of Beirut Medical Center. "We used to treat patients with cancer with the latest advanced technology like they are treated in the U.S., Europe and even better... and patients were used to high-standard treatment."
The best treatment was available even to patients who did not have an income, El Saghir told UPI.
With today's high cost of tests and surgery, coupled with medication shortages, doctors are asking for minimal tests, changing medications to the least expensive or managing with what's available in the market, even with expired dates.
"There are people delaying their tests and consultations with the doctors... What we are seeing is advanced gastric and lung cancers," El Saghir said. "If people with fast-spreading cancer are not treated, they could die quickly."
When a patient who has no money to cover his treatment says "I am going back home," it means "he is going home to die," Franjieh said.