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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
J01DH03 ERTAPENEM ARROW G Ertapenem - 1g 1g Injectable concentrate for solution 2,650,057 L.L
L01CE02 IRINOGEN G Irinotecan HCl - 100mg 100mg Injectable solution 5,239,642 L.L
L01XG01 BORTEZOMIB GP PHARM G Bortezomib - 3.5mg 3.5mg Injectable powder for solution 13,007,658 L.L
L04AX04 SOTIRA G Lenalidomide - 15mg 15mg Capsule 76,208,289 L.L
M05BA04 OREK G Alendronate - 70mg 70mg Tablet, coated 2,404,838 L.L
N05AX08 RISCHOTIC OD 1 G Risperidone - 1mg 1mg Tablet, orally disintegrating 371,157 L.L
R05CB01 TREBON N G Acetylcysteine - 600mg 600mg Granules for suspension 596,666 L.L
A04AA02 SANCUSO G Granisetron - 3.1mg/24h 3.1mg/24h Patch 7,590,728 L.L
A10BD11 INAGLIMET G Metformin - 1000mg, Linagliptin - 2.5mg Tablet, film coated 1,670,844 L.L
B05BB02 DEXTROSE 5% & SODIUM CHLORIDE 0.2% G Sodium chloride - 0.2g/100ml, Dextrose, H2O - 5g/100ml Injectable solution 194,165 L.L
C01DX16 NICORANDIL BIOGARAN G Nicorandil - 10mg 10mg Tablet, scored 431,373 L.L
C10AA01 SIMVASTATIN-REMEDICA G Simvastatin - 20mg 20mg Tablet, film coated 542,912 L.L
D06AX08 TYROSUR G Tyrothricin - 1mg/g 1mg/g Gel 510,660 L.L
J01AA08 VULGA XR G Minocycline - 80mg 80mg Tablet, film coated 2,832,820 L.L
J01DH03 ERTAPENEM INJECTION G Ertapenem - 1g 1g Injectable concentrate for solution 26,153,163 L.L
J05AF07 TENOFOVIR DISOPROXIL ARROW G Tenofovir disoproxil - 245mg 245mg Tablet, film coated 9,747,613 L.L
L01CE02 IRINOTECAN GP PHARM G Irinotecan HCl trihydrate - 100mg/5ml 100mg/5ml Injectable concentrated solution 5,239,642 L.L
L01XG01 BORTEZOMIB NEAPOLIS G Bortezomib - 3.5mg 3.5mg Injectable lyophilised powder for solution 14,169,600 L.L
M05BA04 OSTEOMED G Alendronic acid (sodium alendronate) - 70mg 70mg Tablet, scored 950,929 L.L
N02BG06 NEO-PAN G Nefopam HCl - 20mg/2ml 20mg/2ml Injectable solution 483,783 L.L
N05AX08 RISCHOTIC OD 2 G Risperidone - 2mg 2mg Tablet, orally disintegrating 371,157 L.L
N07CA01 ALVIGO G Betahistine dihydrochloride - 16mg 16mg Tablet, scored 1,204,339 L.L
S01XA18 DRYFREE G Ciclosporin - 0.05% 0.05% Drops 2,257,655 L.L
B05BB02 DEXTROSE 5% & SODIUM CHLORIDE 0.2% G Sodium chloride - 0.2g/100ml, Dextrose, H2O - 5g/100ml Injectable solution 220,643 L.L
C01DX16 NICORANDIL BIOGARAN G Nicorandil - 10mg 10mg Tablet, scored 431,373 L.L
C09AA05 TRILTEC G Ramipril - 1.25mg 1.25mg Capsule 524,739 L.L
C10AA01 STAVINE G Simvastatin - 20mg 20mg Tablet 207,336 L.L
D06AX09 AVALON AVOBAN G Mupirocin - 2% w/w 2% Ointment 460,938 L.L
J01AA08 VULGA XR G Minocycline - 55mg 55mg Tablet, film coated 1,983,512 L.L
J01DH51 CELLABAXIN G Imipenem (monohydrate) - 500mg, Cilastatin (sodium) - 500mg Injectable solution 10,699,559 L.L
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