Professor Fadi Nassar, a cancer doctor at the Hotel Dieu Hospital, talks regarding a daily tragedy in doctors’ clinics: “It is no exaggeration if we say that people die because of the absence of medicine. Patients are of two types, one receiving treatment to recover, and the other to prolong life. Patients of the first category deteriorate their conditions from the first and second degrees of the disease to the third and fourth degrees, and it becomes difficult for them to be cured following they had chances in that. As for patients of the second category, the absence of treatment accelerates their death.”
The Lebanese market needs to import cancer drugs at a cost of $30 million per month, following the Banque du Liban approved the requests of importing companies because this type of medicine is still 100% subsidized. However, the Central Bank provides “barely” a quarter of the required amount, according to Nassar, which made the Karantina Center, which is frequented by patients of the Ministry of Health, empty of most essential medicines in most cases, and the same applies to pharmacies designated to sell them in coordination with importing companies. In order to ensure the continuity of the medically required treatment due to the effects of the intermittent reception on the patient’s health, Nassar suggests that the official authorities approve an annual budget for cancer drugs, which the Central Bank signs and pledges to abide by, “in order for patients to ensure the availability of their medicines throughout the year, and free them from being at the mercy of what is happening.” The Central Bank allocates it from an amount for the monthly import and the mood for signing orders.
Health Minister Firas Abyad confirms that the shipments that arrive are not enough to meet a small part of the patients’ needs, because the support allocated to imports is many times less than what is required.
Weeks ago, for example, a shipment of medication arrived and ran out in one day, and shipments often contained only a few types of medication. Therefore, doctors reluctantly resort to the use of alternative medicines with no guarantee of results on the basis of trial. This, according to Nassar, “violates the principle of regularity in treatment, and has implications for the patient’s health condition.”
The suffering of cancer patients does not stop at the “legalization” of medicines, but also goes to hospitals. According to testimonies of patients undergoing chemotherapy, most major hospitals in Beirut always claim that they do not have beds at the expense of the Ministry of Health. Hani Nassar, head of the Barbara Nassar Association, explains that “the price for half a day to complete a chemotherapy session varies between 3 and 5 million pounds between one hospital and another, excluding the price of the drug.” Some hospitals, contrary to the law, set the price for this “service” in fresh dollars. It amounts to, for example, but not limited to, “200 dollars according to the market price in Rizk Hospital. In Mount Lebanon Hospital, $135 will be added to the insurance fund pricing differences. A hospital requested 20 million pounds for a session of chemotherapy following refusing to hospitalize the patient at the expense of the state employees’ cooperative, before raising the bill to 40 million pounds, because the drug required to be used was not available in other hospitals. Patients receiving treatment at the American University Hospital reported that the hospital contacted bone marrow cancer patients to inform them that the drug “Darazalex” is available to it at a price of $1,000 per 400mg, knowing that the patient needs more than 1000mg per session. One of the patients confirms that one of the major hospitals in Beirut asked for 5 million pounds in exchange for providing the chemotherapy session service and charging 25% of the price of the drug that the patient bought from abroad, Lebanon, and “as if you are coming to a restaurant and bringing your lunch with you.” Noting that patients need regarding two million Syrian pounds per month to cover the expenses of side medicines, such as immunosuppressive drugs, pain relievers, and stomach protection.
The madness of imaginary prices extends to chemotherapy, lab tests, and x-rays
Patients who are treated at the expense of the Social Security Fund are not doing much better. Previously, the difference in the price of the guarantee for each chemotherapy session (medicine + service) ranged between 100 and 800 thousand Syrian pounds, depending on the drug used. Today, there is no fixed tariff, as hospitals add one or two million liras to their bills regardless of the price of the medicine used and without any explanation. When reviewing the guarantee, it ends with “the concerned people’s admission of a clear violation of the law without this having any tangible repercussions,” according to Nassar. For all these reasons, a number of patients refrain from chemotherapy sessions, which prompted Mount Lebanon Hospital, for example, to close one of the floors designated for these sessions, and Rizk Hospital reduced the number of days receiving chemotherapy patients from 5 to 3 days.
The chaos of imaginary prices extends to everything related to laboratory tests and x-rays, which patients are supposed to perform every three months. In the midst of this scene, Nassar appeals to those wishing to donate that their donations be direct to patients and not to hospitals that break laws with prices in fresh dollars.
Rachel is one of thousands of stories
Rachel Sanifer, who suffers from a rare type of cancer, closes her eyes every evening, wishing for death, and for age to draw its curtains in a country where darkness is no longer the preserve of its night. Rachel is one of the cancer fighters. The economic crisis intensified its battles. Today it is fighting the “malignant” and the most insidious authority. Until the port explosion on August 4, 2020, she went to Karantina Center every month to get “Revlimid”, the only drug to treat a rare type of cancer worldwide (two types of cancer combined in one case) that afflicted and disabled her bone marrow. After the explosion, the medicine was cut off for two months, and then over a period of 7 months, I got the Iranian substitute as part of a donation that came to the benefit of the Ministry of Health. With the intensification of the drug crisis, “Revlimid” is still missing from Karantina for the eighth month in a row. The limited family cannot buy it from abroad, at a monthly cost of $6000. The options in front of Sanifer are not many, and the best of them is bitter. The availability of the drug at the subsidized price is to buy it at its expense at a value of 8 million and 200 thousand pounds per pack, in addition to side medicines, so that the monthly hospitalization bill reaches 12 million pounds. And when luck does not help her and the “Revlimid” drops from the applications signed by the Banque du Liban, she stops the treatment. While doctors place great importance on the morale of patients receiving treatment, Rachel embarks on the journey with doubly anxious for her fate. In a trembling voice, she says: “States support their mentally ill, and we demonstrated in the rain a few days ago, begging for our medicines.” Rachel wrestles herself. She refuses to die at times, hoping for more years to live with her three-year-old granddaughter, “she might remember me later.” She prays to reach it sometimes for fear of an intensification of the disease, because the family has no financial ability to pay for hospitalization costs or even call for an ambulance…! This is how the system responsible for creating the crisis practices the daily killing of those who have survived until the hour of death. Compelling feelings were not lacking those created by the crisis. “Self-flagellation eats our depths because our families incur the expenses of our treatment that exceed their capabilities, and most of us rely on the help of friends and relatives,” says Sanifer.
White: a close solution
The Minister of Health, Firas Abyad, describes what is happening in hospitals as “chaos”, promising to control it soon. In an interview with Al-Akhbar, he returns the problem to the fact that “the funds allocated to support the drug are less than what is required. The Banque du Liban allocates $35 million per month to support cancer drugs and other incurable diseases and medical supplies, while our need for cancer drugs alone amounts to $25 million.” He added that the importing companies had to organize their requests sent to the Central Bank within the ceiling of the 25 million they all share to import all kinds of medicines. However, companies continued to send invoices worth $70 million, creating chaos that prompted the central bank to stop signing for a period during which companies used their stockpile of medicines. Abyad confirmed that he will announce “soon” steps on how to work to secure larger quantities of medicines in general, relying on “what has been achieved in the regularity of the drug import cycle between importers and the Banque du Liban through its automation under the supervision and follow-up of the ministry, which will lead to accelerating the import process, and it has begun The results appear with the arrival of large quantities of medicines in the recent period, and we expect to import additional quantities successively and in a continuous and more organized form and to meet the actual needs.” Abyad also attaches importance to launching the executive and experimental phase of the “Meditrack” program to track drugs for cancer and incurable diseases, whereby patients’ files will be automated and they will obtain a “Unique ID” health card, which will allow ensuring that each patient obtains his medication and in return ensuring that the drug is not smuggled, monopolized, or store it.