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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
A10BA02 METFORMINE ARROW LAB G Metformin - 850mg 850mg Tablet, film coated 237,860 L.L
A12AX OSTRONG G Vitamin D3 - 500IU, Calcium hydrogen phosphate - 600mg Tablet 435,149 L.L
B05XA03 SODIUM CHLORIDE 0.9% INJECTION, USP G Sodium chloride - 0.9% 0.9% Injectable solution 163,184 L.L
C07AB07 BISOPROLOL NORMON G Bisoprolol hemifumarate - 2.5mg 2.5mg Tablet, film coated 235,172 L.L
C09DA04 IRBAVEL PLUS 300/25 G Irbesartan - 300mg, Hydrochlorothiazide - 25mg Tablet, film coated 624,567 L.L
J01DD04 MEDAXONUM G Ceftriaxone (disodium) - 1g 1g Injectable powder for solution 15,482,229 L.L
J01XE01 NITROFURANTOIN G Nitrofurantoin - 100mg 100mg Tablet 972,942 L.L
L01BA04 PEMETREXED NEAPOLIS G Pemetrexed (disodium) - 500mg Injectable powder 41,289,202 L.L
M01AH01 JOSWE FLAMEX 200 G Celecoxib - 200mg 200mg Capsule 636,981 L.L
N02BE01 DOLOPAN G Paracetamol - 500mg 500mg Tablet, film coated 317,403 L.L
N04BA02 CARLEVO G Levodopa - 100mg, Carbidopa - 25mg Tablet 2,431,715 L.L
N06AB10 PRYLEX 20 G Escitalopram (oxalate) - 20mg 20mg Tablet, film coated 972,686 L.L
R03AK06 PROPIONATE DE FLUTICASONE/ SALMETEROL ARROW G Salmeterol - 50mcg/dose, Fluticasone propionate - 250mcg/dose Inhalation powder 1,980,824 L.L
R06AX27 RINA 5 G Desloratadine - 5mg 0.5mg/ml Tablet, film coated 134,384 L.L
A03AX12 PHLOROGLUCINOL/TRIMETHYLPHLOROGLUCINOL ARROW G Phloroglucinol - 40mg/4ml, Trimethylphloroglucinol - 0.04mg/4ml Injectable solution 940,690 L.L
A10BA02 MET-FORTE G Metformin HCl - 850mg 850mg Tablet 355,798 L.L
B05XA03 SODIUM CHLORIDE 0.9% INJECTION, USP G Sodium chloride - 0.9% 0.9% Injectable solution 156,288 L.L
C07AB07 BISOPROLOL QUIVER LAB G Bisoprolol fumarate - 2.5mg 2.5mg Tablet, coated, scored 292,958 L.L
C09DA04 IRTAN PLUS G Irbesartan - 300mg, Hydrochlorothiazide - 25mg 300mg Tablet 601,530 L.L
G01AF02 CANAGYN G Clotrimazole - 100mg 100mg Tablet 229,797 L.L
J01DD04 MEGION-A G Ceftriaxone - 1g/3.5ml, Lidocaine (ampoule) - 1g/3.5ml Injectable powder + solvent 623,468 L.L
J01XE01 UVAMIN RETARD G Nitrofurantoin (macrocrystals) - 100mg 100mg Capsule 392,402 L.L
L01BA04 PEMETREXED SPC G Pemetrexed (disodium) - 500mg 500mg Injectable concentrated powder for solution 43,746,515 L.L
M01AH01 NORMOCOXIB G Celecoxib - 200mg 200mg Capsule, hard 798,242 L.L
N02BE01 DOLOPAN G Paracetamol - 500mg 500mg Tablet, film coated 380,115 L.L
N04BA03 COMBIPAR G Levodopa - 100mg, Carbidopa - 25mg, Entacapone - 200mg Tablet, film coated 1,249,926 L.L
N06AB10 ZELAX 20 G Escitalopram (oxalate) - 20mg 20mg Caplet 1,544,075 L.L
A10BA02 SIOFOR G Metformin HCl - 850mg 850mg Tablet, film coated 174,700 L.L
B05XA03 SODIUM CHLORIDE INJECTION/ DEMO G Sodium chloride - 0.9% w/v 0.9% w/v Injectable solution 1,182,581 L.L
C07AB07 BISOPROLOL REF G Bisoprolol hemifumarate - 2.5mg 2.5mg Tablet, coated, scored 272,800 L.L
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