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Syrian Refugees Crisis Impact on Lebanese Public Hospitals- Financial Impact Analysis: APIS Report


The impact of the Syrian crisis on Lebanon has been profound particularly in the healthcare sector. The influx of Syrian refugees has strained the public hospitals and their ability to respond to the crisis, resulting in:
  • An increased demand for healthcare services;
  • An increase in unpaid health services to refugees;
  • A sharp rise in communicable diseases and emergence of new diseases in Lebanon;
  • Increased risks of epidemics such as water-borne diseases, measles, and tuberculosis 1.
Neither United Nations High Commissioner of Refugees (UNHCR) nor other Non-Governmental Organizations (NGO) was able to meet the required level of funding to provide refugees with an acceptable level of secondary and tertiary healthcare services. They, therefore, decided to change their model of response in terms of healthcare support to Syrian refugees. As of 2014, UNHCR started covering 75% instead 85% of the hospitalization cost, leaving the patient with the remaining share of 25% to be paid out of pocket or by a third party. The healthcare referrals covered by UNHCR are limited to deliveries and life-threatening emergencies 2.

Hospitals are overburdened with Syrian patients who are unable to pay their part of the bill (increased to 25% of their total hospital fees) as well as patients whose hospitalizations are not subsidized at all. Some hospitals have put in place strategies to recover as much of the 25% as possible (deposits, retaining IDs/corpses, inflating bills). Referral of uncovered Syrian patients with complicated morbidities to public hospitals has become a common practice by private hospitals.

Overwhelmed by the high demand of healthcare by Syrian refugees, public hospitals end up treating patients without any specific reimbursement scheme thus creating a huge financial burden. This burden adds up to the existing difficult financial situation of public hospitals, putting the whole healthcare sector under stress. Public hospitals are restrained from completing their mission and incapable of providing healthcare services neither to Syrians refugees nor to Lebanese citizens...
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ATC Name B/G Ingredients Dosage Form Price
N02AA01 MST CONTINUS B Morphine sulfate - 10mg 10mg Tablet, film coated, prolonged release 972,942 L.L
N06AA21 MEFIDIOMIL B Maprotiline - 75mg 75mg Tablet, sugar coated 958,608 L.L
R01AB06 TRIOFAN B Xylometazoline HCl - 1mg/ml, Carbocysteine - 10mg/ml Spray, solution 646,388 L.L
R06AE09 XYZAL B Levocetirizine dihydrochloride - 5mg 5mg Tablet, film coated 572,477 L.L
A07FA02 ULTRA LEVURE B Saccharomyces boulardii - 200mg 200mg Capsule 513,348 L.L
A11AA PANTOGAR B P-aminobenzoic acid - 20mg, Keratine - 20mg, Medical yeast - 100mg, Thiamine mononitrate - 60mg, L-Cystine - 20mg, Calcium D-pantothenate - 60mg Capsule 2,005,013 L.L
C05A ANTROLIN B Nifedipine - 0.3%, Lidocaine - 1.5% Cream 1,333,092 L.L
C09CA04 APROVEL B Irbesartan - 300mg 300mg Tablet, film coated 651,764 L.L
J01CR05 TAZOCIN B Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable lyophilised powder for solution 1,306,215 L.L
J07AL02 SYNFLORIX B Polysaccharide from each of 10 capsular types of pneumococcus (conjugated to carrier proteins) adsorbed onto aluminium phosphate - 1mcg/0.5ml, Polysaccharide of serotypes 41,2, 18C1,3 and 19F1,4 - 3mcg/0.5ml, 1 adsorbed onto aluminium phosphate - 0.5mg Al3+, 2 conjugated to protein D (derived from NTHi) carrier protein - ~ 13mcg, 3 conjugated to tetanos toxoid carrier protein - ~ 8mcg, 4 conjugated to diphteria toxoid carrier protein - ~ 5mcg Injectable suspension 4,675,228 L.L
L01ED05 LORBRENA B Lorlatinib - 25mg 25mg Tablet 134,559,469 L.L
N02AA01 MST CONTINUS B Morphine sulfate - 30mg 30mg Tablet, film coated, prolonged release 2,289,908 L.L
L01EX05 STIVARGA B Regorafenib - 40mg 40mg Tablet, film coated L.L
A07FA02 ULTRA LEVURE B Saccharomyces boulardii - 100mg 100mg Powder for suspension 536,193 L.L
B02BX01 DICYNONE B Etamsylate - 250mg/2ml 250mg Injectable solution 482,439 L.L
C09CA04 APROVEL B Irbesartan - 300mg 300mg Tablet, film coated 651,764 L.L
C10AA07 CRESTOR B Rosuvastatin (calcium) - 10mg 10mg Tablet, film coated 804,962 L.L
L01ED05 LORBRENA B Lorlatinib - 100mg 100mg Tablet 403,677,371 L.L
M01AE01 SPIDIFEN B Ibuprofen alginate - 400mg 400mg Tablet, film coated 330,585 L.L
N02AA01 MST CONTINUS B Morphine sulfate - 60mg 60mg Tablet, film coated, prolonged release 3,839,358 L.L
R01AB06 OTRIVIN DUAL RELIEF B Xylometazoline HCl - 0.5mg/ml, Ipratropium bromide - 0.6mg/ml Solution 563,070 L.L
A07FA51 INFLORAN B Bifidobacterium infantis - 1milliard, Lactobacillus acidophilus - 1milliard Capsule 647,732 L.L
B02BX01 DICYNONE B Etamsylate - 500mg 500mg Capsule 1,311,590 L.L
G04BE08 CIALIS B Tadalafil - 5mg 5mg Tablet, film coated 6,512,261 L.L
J07AL02 PREVENAR 20 B Pneumococcal polysaccharide for serotypes 1, 3, 4, 5 , 6A, 7F,8, 9V,10A, 11A, 12F, 14, 15B, 18C, 19A, 19F,22F, 23F, 33F (2.2mcg) Pneumococcal polysaccharide for serotypes 6B (4.4mcg)Conjugated to CRM197 carrier protein (approximately 51mcg) adsorbed on aluminium phosphate (0.125mg aluminium) - Injectable suspension 7,415,107 L.L
M01AE01 ADVIL B Ibuprofen - 200mg 200mg Tablet 321,178 L.L
R01AB08 RINOFLUIMUCIL B Acetylcysteine - 1%, Tuaminoheptane sulfate - 0.5%, Benzalkonium chloride - 0.0125% Solution 419,279 L.L
A07XA04 HIDRASEC INFANTS B Racecadotril - 10mg 10mg Granules for suspension 858,715 L.L
A11AB CYPRO-VITA B Vitamin C - 20mg, Vitamin B3 - 5mg, Vitamin B12 - 2.5mg, Vitamin B6 - 0.6mg, Vitamin B2 - 0.75mg, Vitamin B1 - 0.6mg, Vitamin D3 - 167IU, Vitamin A - 1670IU, Cyproheptadine HCl - 4mg Tablet, film coated 409,552 L.L
J07AL02 VAXNEUVANCE B Pneumococcal polysaccharide for serotypes 1, 3, 4, 5 , 6A, 7F, 9V,14, 18C, 19A, 19F, 22F, 23F,33F (2mcg) Pneumococcal polysaccharide for serotypes 6B (4.4mcg) Conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate adjuvant - Injectable suspension 6,988,413 L.L
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