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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
J05AF13 VEMLIDY B Tenofovir alafenamide fumarate - 25mg 25mg Tablet, film coated 26,997,299 L.L
L01XG02 KYPROLIS B Carfilzomib - 60mg 60mg Injectable powder for solution 96,642,005 L.L
N05AX08 RISPERDAL B Risperidone - 1mg/ml 1mg/ml Solution 1,377,439 L.L
R03DX10 FASENRA B Benralizumab - 30mg 30mg Injectable solution 214,213,273 L.L
L01EA04 BOSULIF B Bosutinib - 100mg 100mg Tablet, film coated L.L
A01AD11 PYRALVEX B Salicylic acid - 0.01g/ml, Rhubarb (Anthraquinone Glycosides) - 0.05g/ml Solution 327,898 L.L
A06AD11 DUPHALAC B Lactulose - 6.7g/10ml 6.7g/10ml Solution 454,219 L.L
A10BD20 SYNJARDY B Empagliflozin - 5mg, Metformin HCl - 850mg 5mg/850mg Tablet, film coated 3,287,711 L.L
C09BA03 ZESTORETIC B Lisinopril (dihydrate) - 20mg, Hydrochlorothiazide - 12.5mg Tablet 663,858 L.L
D07AB02 LOCOID B Hydrocortisone butyrate - 0.1% 0.1% Lotion 201,576 L.L
J01FA09 KLACID B Clarithromycin - 500mg 500mg Tablet, film coated 1,329,060 L.L
L01XG03 NINLARO B Ixazomib - 4mg 4mg Capsule, hard 388,991,058 L.L
S01EE06 VYZULTA B Latanoprostene bunod - 0.024% 0.024% Solution 1,948,572 L.L
A02AC10 RENNIE B Magnesium carbonate - 80mg, Calcium carbonate - 680mg Tablet, chewable 240,548 L.L
A10BD20 SYNJARDY B Empagliflozin - 5mg, Metformin HCl - 1000mg 5mg/1000mg Tablet, film coated 3,399,653 L.L
D07AC01 BETNOVATE B Betamethasone - 0.1% 0.1% Solution 235,172 L.L
G03HB01 DIANE '35' B Ethinylestradiol - 0.035mg, Cyproterone acetate - 2mg Tablet 494,534 L.L
L01DB01 CAELYX B Doxorubicin HCl pegylated liposomes - 20mg/10ml 20mg/10ml Injectable concentrated solution 34,821,487 L.L
L01XG03 NINLARO B Ixazomib - 3mg 3mg Capsule, hard 348,420,676 L.L
A02AC10 TUMS EXTRA STRENGTH 750 ASSORTED FRUIT B Calcium carbonate - 750mg Tablet, chewable 421,967 L.L
C09BA04 BI-PRETERAX ARGININE B Perindopril arginine - 5mg, Indapamide - 1.25mg Tablet, film coated 452,875 L.L
D07AC01 BETNOVATE B Betamethasone (valerate) - 0.1% 0.1% w/w Cream 279,519 L.L
J05AG06 PIFELTRO B Doravirine - 100mg 100mg Tablet, film coated 27,819,434 L.L
L01DB02 CERUBIDINE B Daunorubicin (HCl) - 20mg 20mg Injectable powder for solution 10,943,137 L.L
L01XG03 NINLARO B Ixazomib - 2.3mg 2.3mg Capsule, hard 272,619,919 L.L
M04AA03 ADENURIC B Febuxostat - 40mg 40mg Tablet, film coated 1,687,866 L.L
N05AX08 RISPERDAL B Risperidone - 2mg 2mg Tablet, film coated 323,866 L.L
N07AA02 MESTINON B Pyridostigmine bromide - 60mg 60mg Tablet, sugar coated 3,090,838 L.L
S01FA06 MYDRIACYL B Tropicamide - 1% 1% Drops solution 430,030 L.L
A02AF02 MAALOX PLUS B Dimethicone - 25mg, Aluminium hydroxide - 200mg, Magnesium hydroxide - 200mg Tablet, chewable 166,636 L.L
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