Global Network for Academic Public Health statement on the Beirut explosion

The public health community expresses our deep concern and solidarity with the people of Lebanon, following the appalling explosion in Beirut of August 4^th, 2020. The work of public health professionals is to protect and improve the populations’ health. The current disaster highlights multiple problems contributing to a worsening health catastrophe in Lebanon, requiring urgent international support and solidarity.

Over the past 15 years, Lebanon has been witnessing political, military, and socio-economic turmoil as a result of corruption, terrorism, and wars; the culmination of these has imposed significant stress on the Lebanese healthcare system.[1] The latest catastrophe occurred on the 4^th of August, 2020 when 2,750 tonnes of improperly stored Ammonium Nitrate exploded in the port of Beirut and sent devastating shockwaves across the Lebanese capital, causing widespread destruction to buildings and putting the port out of commission. To date, 150 victims have been declared dead, more than 150 are still missing, roughly 5,000 have been wounded, and 300,000 have lost their homes.[2]

This tragic explosion has arisen at a time during which Lebanon has been facing a runaway economic collapse beginning in November of 2019, followed by the COVID-19 pandemic which reached Lebanese soil in February of 2020. Further to a shortage of foreign currencies in the Lebanese banking sector, the Lebanese pound has since lost around 80% of its value (inflation of 4.5%); this has resulted in a large and sudden increase in unemployment rates, business shutdowns, and prices of basic goods that are imported in majority. With the damaged port put out of service until further notice, and the national wheat supply blown away or contaminated, the economic situation is bound to worsen significantly over the near future.[3]

To make matters worse, the Lebanese economy has been struggling with strict off-and-on COVID-19 lockdowns to curb its spread after the confirmation of its first case in February. During the first strict lockdown period, the Ministry of Public Health and its partners enhanced the preparedness of hospitals by increasing the number of ventilators and hospital beds specific to COVID-19 cases, as well as training personnel, purchasing personal protective equipment, and increasing testing capabilities. Since easing the lockdown in July, COVID-19 cases have increased significantly, resulting in a large number of severe cases requiring hospitalization. This raises major concerns, as the healthcare system is not only threatened by the economic crisis but also by shortages in electrical power and medical supplies.[4,5]

In addition, one must not forget that Lebanon hosts the largest refugee population per capita in the world, with an estimated 1.5 million Syrian refugees and around 200,000 Palestinian refugees under UNRWA’s mandate.[6] Therefore, 30% of the total Lebanese population is composed of migrant workers and refugees residing in underserved camps or informal settlements, and thus require specific attention given their critical political and social situation.[7] In collaboration with the Lebanese government and the concerned United Nations offices in Lebanon, several initiatives were implemented such as testing, distributing hygiene kits, and raising awareness. Even though few COVID-19 cases have been recorded in camps, the vulnerable living conditions of this population poses a major public health threat if cases continue to rise sharply on Lebanese grounds.[7]

After the blast hit Beirut, the Lebanese Health Minister announced on the 6^th of August that they expected a huge rise in COVID-19 cases over the 10 days following the explosion.[8] In addition, the explosion has caused significant destruction to four large Beirut hospitals and the Ministry of Public Health’s central drug warehouse. Thankfully, the Ministry of Public Health and its partners have managed to move the drugs and vaccines to safe storage rooms across the capital to preserve the stock in good conditions and keep the vaccination services functional in the country.[9] Given all the above factors, the Lebanese public health sector is on the verge of collapse, as several hospitals have been damaged in the explosion and others have been overwhelmed with thousands of wounded from the explosion as well as from the violent protests that are beginning to emerge in Beirut. This exposes the healthcare system to an expected spike in COVID-19 cases, which will undoubtedly further overwhelm the struggling hospitals.

Shortly after the explosion, a large number of countries and international organizations expressed solidarity with the Lebanese people through medical and financial donations, rescue teams, and disaster management support.[10] In addition, French president Emmanuel

Macron visited Beirut on the 6^th of August to express his support to the people affected by this explosion.

Even though one of the United Nations Interim Force in Lebanon (UNIFIL) ships of the Maritime Task Force docked in Beirut port was damaged, leaving naval peacekeepers injured some which were severely injured, the UNIFIL head of mission and force commander Major General Del Col said: “We are with the people and the Government of Lebanon during this difficult time and stand ready to help and provide any assistance and support.”[11]

Lebanon is one of the most strategically located places in the world. To have an extremely bad situation there could easily create the perfect storm and transform an accident into an international public health crisis. This is very dangerous over the pandemic. Therefore, we must act fast and accordingly to ensure the safety and security of the Lebanese people as well as the rest of the world.

The Global Network for Academic Public Health (Global Network), is a convening body for academic public health leaders from around the world to share, learn, collaborate, to improve, and protect the health of the public and planet. The Global Network is committed to stand in solidarity with, reinforce, and coordinate the efforts of our members and member associations of public health worldwide as well as to make expertise available as requested.

• We call on international organizations to continue to send aid and assistance intended to support the needs of the communities residing in Lebanon (e.g. in the form of medical supplies, personal protective equipment, and personnel) directly to Lebanese non-governmental organizations, without it passing through the government, so as to ensure transparency and accountability;
• We call on governments to stand in solidarity with and maintain foreign aid and assistance to the Republic of Lebanon;
• We call on the international community to support the Lebanese government to maintain peace across its territory and to prevent any military action which might occur as a result;
• The Global Network calls on regional and national associations, societies, and schools of public health worldwide to continue to mobilize academic support to aid in the recovery and peacekeeping efforts in the Republic of Lebanon;
• We further call for solidarity across, within, and between continents, countries, associations, and schools of public health in support of the efforts to aid the Republic of Lebanon after this tragedy;
• We call for the international organizations to support the Ministry of Public Health to rehabilitate and reinforce the infrastructure of the central warehouse, primary health care facilities, and non-functional hospitals due to its close proximity to the explosion site.
• We call for the Ministry of Public health and the Ministry of Environment to conduct an environmental assessment on the impact of the hazardous smoke caused by the explosion and raise awareness through particular guidelines on how people can protect themselves from harmful polluted air.
• We call for the Ministry of Public Health and its partners to continue joining their efforts in the containment of COVID-19 to ensure the containment of COVID-19 through strict measures as cases begin to spike again in order to avoid straining the health care system more than it already has.
• We urgently call for the government and organizations to collaborate and address the country’s food security and nutrition for the 300,000 who are left stranded with no shelter and food after the explosion.

Prepared by Brian LH Wong*, Melissa Sawaya, Sandy Laham, Henrique Lopes, Robert Otok, John Middleton*, Association of Schools of Public Health in the European Region (ASPHER). Corresponding authors* Brian Li Han Wong, Clinical Epidemiologist, MRC Unit for Lifelong Health and Aging at UCL. John Middleton, ASPHER President.

Global Network endorsements and representatives

• Asia-Pacific Academic Consortium for Public Health (APACPH) – Wah Yun Low, President
• Association of Schools of Public Health in Africa (ASPHA) – Philip Baba Adongo, President
• Association of Schools of Public Health in the European Region (ASPHER) – John Middleton, President
• Association of Schools and Programs of Public Health (ASPPH) – Laura Magaña, President and CEO
• South East Asia Public Health Education Institutions Network (SEAPHEIN) – Rajendra Surenthirakumaran

References

1. Ammar A., Kdouh O, Hammoud R, Hamade R, Harb H, Ammar Z, Atun R, Christiani D, Zalloua P. Health System Resilience: Lebanon and the Syrian refugee crisis. J Glob Health. 2016 Dec; 6(2): 020704.
2. Gardner D. Lebanon: a nation brought to its knees. Financial Times. 2020 Aug 7. Available from: https://www.ft.com/content/0e8aff25-629c-4737-a1dc-8ed4ee32447e
3. The lights go out on Lebanon’s Economy as financial Collapse Accelerates. WP. 2020 July 19. Available from: https://www.washingtonpost.com/world/middle_east/the-lights-go-out-on-lebanons-economy-as-financial-collapse-accelerates/2020/07/19/3acfc33e-bb97-11ea-97c1-6cf116ffe26c_story.html
4. Ministry of Public Health. Novel Coronavirus 2019. Available from: https://www.moph.gov.lb/en/Pages/2/24870/novel-coronavirus-2019-
5. El-Jardali F, Melhem N, Daher N, Jabbour M, Bou Karroum L. K2P COVID-19 Rapid Response Series:Second Wave of COVID-19 in Lebanon: A Call for Action, Knowledge to Policy (K2P) Center. Beirut, Lebanon. 2020 July 27. Available from: hhttps://www.aub.edu.lb/k2p/Documents/K2P%20COVID19%20Rapid%20Response%20Series%20Second%20Wave%20of%20COVID%20in%20Lebanon%20A%20Call%20for%20Action%20July%2027%202020.pdf
6. UNHCR. Lebanon | Global Focus. Available from: https://reporting.unhcr.org/node/2520
7. Khoury P, Azar E, Hitti E. COVID-19 Response in Lebanon: Current Experience and Challenges in a Low-Resource Setting. JAMA. Published online July 23, 2020. doi:10.1001/jama.2020.12695
8. John T, Macaya M, Hayes M, Rocha V, Wagner M, Berlinger J, Renton A, Rahim Z and Upright E. Beirut explosion rocks Lebanon’s capital city . CNN. 2020 Aug 6. Available from: https://edition.cnn.com/middleeast/live-news/lebanon-beirut-explosion-live-updates-dle-intl/index.html
9. UNICEF. Geneva Palais briefing note on situation for children affected by Beirut explosions and UNICEF response. 2020 Aug 7. Available from: https://www.unicef.org/press-releases/geneva-palais-briefing-note-situation-children-affected-beirut-explosions-and-unicef?fbclid=IwAR2ogFHpJ5KreSoZzrHUCXErbWXSvtN6QG86pkgpg-b9K-fbHXQmRZ2JMTU
10. Reuters staff. This is how different countries are supporting Lebanon after the Beirut explosion. World Economic Forum. Available on: https://www.weforum.org/agenda/2020/08/lebanon-beirut-explosion-aid-support-international-donations/
11. UNIFIL. UNIFIL statement on the explosion in Beirut. 2020 Aug 4. Available from: https://unifil.unmissions.org/unifil-statement-explosion-beirut