Can A Small Lebanese Town Become a Model for Conquering COVID-19?

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The coronavirus hit Lebanon in the middle of an economic crisis. Unless the country can overcome rampant corruption and provide adequate social services, it won’t stop the pandemic.

Foreign Policy

BEIRUT—The remote northern Lebanese town of Bsharri doesn’t usually make national headlines, but its unique response to the coronavirus pandemic has thrust it into the spotlight.

“Today marks seven days since we’ve closed off Bsharri,” Mayor Freddy Keyrouz said in a phone interview with Foreign Policy on April 17. “We are on the offensive against this virus.”

The municipality’s decision to close off the small mountainous town raised eyebrows across Lebanon, followed by a media frenzy over whether a devastating outbreak would be imminent in Bsharri, and ultimately across the country. Apart from a nighttime curfew and travel restrictions to minimize traffic, Lebanon’s national government has yet to close off towns from each other.

With an estimated 5,000 residents, Bsharri resembles some other remote towns around the world that have taken matters into their own hands, like Zahara de la Sierra in southern Spain. And much like the Spanish hilltop town, both geographically and functionally, Bsharri has primarily relied on its local community to contain the situation, while the national government struggles to secure financial and medical aid.

The town’s first reported coronavirus case was a doctor at a hospital earlier this month, which gave the local government the green light to implement its strict measures. “We already had a preemptive strategy well before the first case hit the Bsharri or Lebanon,” Keyrouz added.

The director of Bsharri’s government hospital, Eddie Lazem, said that a floor of the hospital was allocated for coronavirus patients, while a floor in an unfinished hospital building was set up as a quarantine facility. “We set up a response team preemptively,” Lazem told Foreign Policy by phone—reporting locally was made impossible after the town was sealed off. “And despite financial limitations we took the strictest measures possible for our facilities—sanitization, masks, everything.”

Critical cases are sent to Beirut’s government-run Rafik Hariri University Hospital or to a hospital in the northern city of Tripoli.

One month since its first positive case, Bsharri has at least 70 confirmed cases, over 10 percent of confirmed cases across the entire country. But at the same time, Bsharri has administered a significantly greater number of tests per capita compared to other municipalities in Lebanon.

“We did 400 tests just this week so we can see where to take things going forward,” Keyrouz said. Mass testing has since become part of the global consensus on how to best respond to the coronavirus pandemic. Medical workers in Brazil, where President Jair Bolsonaro downplayed the pandemic as “a little flu,” have said the underreporting of coronavirus cases ignores a “mountain of other deaths.” Keyrouz echoed these sentiments.

“The high numbers isn’t because we have a bad situation—it’s because we’re testing widely. … We started testing in places where lots of human interactions take place: gas stations, stores, pharmacies, and so on,” he said.

Lebanon’s Health Ministry has documented over 720 coronavirus cases and 24 related deaths thus far with roughly 1,000 daily tests; medical practitioners, however, have called for at least 2,500 tests per day, and to be more inclusive of patients in rural areas and refugee camps. Those calls appear to have been in vain, however.

Following the first confirmed case on April 21 in Lebanon’s Jalil Palestinian refugee camp—one of 12 Palestinian refugee camps in Lebanon administered by the United Nations Relief and Works Agency—a series of tests the following day revealed that there were at least four other positive cases there. An overreliance on private health care facilities that have thus far only provided a minimal response has also placed a huge burden on the underfunded government-run Rafik Hariri University Hospital in Beirut to lead the country’s response to the pandemic.

The coronavirus hit Lebanon just as the country was going through what is arguably the worst fiscal crisis in its history. The local currency, the Lebanese pound, officially pegged to the U.S. dollar, has lost half of its value on the black market in just six months, and a shortage of U.S. dollars means the country has struggled to import essential food items, fuel, medical equipment, and life-saving medicines.

One of the most indebted countries in the world, Lebanon eventually defaulted on its enormous foreign debt in March. Factor in state budget cuts, including a 7 percent cut to health care, and it couldn’t be a worse time for Lebanon to deal with a pandemic.

Though Lebanon has high-quality private health care facilities, they’ve taken a very conservative approach to the situation; hospitals that want to take in COVID-19 patients can only allocate up to 20 beds per facility. Despite a recent United States government donation of $5.3 million to private hospitals to help “mitigate” the virus, it is unclear whether that will incentivize them to take in more patients. (The government’s requests that they do so are nonbinding.)

To further bolster its patchwork response, Lebanon has received aid from UNICEF and the French government, and it has won the approval of the World Bank to reallocate $40 million in loans to be used for the COVID-19 effort. The country has also been struggling to implement reforms mandatory to unlock a pledged $11.1 billion in loans from the international community in April 2018. It has also reached out to the International Monetary Fund for emergency aid but has been unsuccessful so far.

Crucially, in economically depressed Lebanon, mass government borrowing to extend the social safety net isn’t an option. There are no grants to small businesses, nor are there rent and utility payment exemptions to prevent further layoffs as is the case in France—about half of Lebanon’s population is unemployed. There certainly aren’t any grants for freelance workers and others in the gig economy, like those offered in Germany.

About 40,000 Lebanese families, however, were set to benefit from a one-time payment of roughly $133. But this aid was postponed due to “errors,” which the army has now been tasked with remedying. Parliament was set to vote on a wider proposal to include zero-interest loans to small businesses and workers, but to no avail; with too few members of parliament present to establish a quorum, the session ended early with no vote on the matter.

Back in Bsharri, Ghiwa Fakhry isn’t getting used to working from home; she’s part of a community initiative called the Bsharri Crisis Team. Though politically unaffiliated, this collective has reached out to everyone for collaboration. Fakhry and her colleagues are among many people in Bsharri who quickly set up community groups to coordinate effective aid efforts and distribution for vulnerable families—now more in need than ever as a result of the pandemic.

“We’ve been in contact with the local government, priests, MPs, and other stakeholders in the community—and the majority were supportive and cooperative,” Fakhry told Foreign Policy. “Our goal is to make sure that everyone in need‚ with no exceptions, gets their fair share of support and to do this in an organized and transparent way.”

But as in the rest of Lebanon, where state-funded social services are minimal, Bsharri residents also rely on the country’s wide patronage networks of political parties, warlords, and business magnates that have filled the state’s gap for decades. For example, Iran-backed Hezbollah, known for its sophisticated welfare and services, has allocated about $1.75 million to fund their efforts against the coronavirus, with a team of 24,500 medical workers.

A key political stronghold for the Lebanese Forces, a prominent Christian party and key ally of the United States and Saudi Arabia in Lebanon, Bsharri is the hometown of both the party’s leader, Samir Geagea, and his spouse, Bsharri MP Sethrida Geagea.

“The Lebanese Forces helped upscale the hospital and provided testing [kits],” Hany Rahme, an activist with the party, said. “And also 1,500 food packages.”

Among the party’s donors is a former health minister, the Lebanese British businessman Ghassan Hasbani, who donated 100 test kits. Just days after the first case was confirmed in Bsharri, its hospital announced that it received 800 testing kits: 300 from the Lebanese diaspora in Australia and 500 from the office of William Tawk—a rival of the Lebanese Forces.

Political parties across the country have undertaken similar initiatives, including billionaires and ex-Prime Ministers Saad Hariri and Najib Mikati, and political rivals Hezbollah and the Free Patriotic Movement across their constituencies—but these top-down efforts haven’t matched Bsharri’s targeted community-driven mobilizations.

“I encourage all the capitalists and businessmen to donate to the efforts of their hometowns,” Keyrouz, Bsharri’s mayor, said, emphasizing the need for wider tests. “We’d have a better understanding of the situation in Lebanon that way.”

He compared his town’s response to Germany’s and South Korea’s, which included implementing wider testing and tracking the whereabouts of positive cases. And while this resulted in skyrocketing documented cases due to the high rate of testing, Germany and South Korea had significantly lower mortality rates. Large-scale testing and effective aid distribution is a far cry from what the rest of Lebanon has witnessed thus far.

The number of people testing positive for the coronavirus has started dwindling in Bsharri, as all positive cases were quarantined and their whereabouts were tracked to test other potential cases. Fakhry, the Bsharri community activist, believes that this tells a story about what an adequate response to the outbreak should look like for the rest of the country—and perhaps elsewhere.

“There is no other way than to implement wider testing,” she said. “The vast majority of the cases here were asymptomatic, including the elderly. You’re putting people at risk.”

Fakhry added that Lebanon, though its economy is on life-support, ought to have implemented a preemptive and holistic strategy prior to its first case in late February. “For such a small country, I think we could have implemented these kinds of procedures within two weeks,” she said. “We’d have been in a more comfortable situation with less pressure on the hospitals.” Slovakia, a country of similar size, was ahead of the curve in implementing border closures and social distancing measures—despite its reliance on the European market and the potential economic consequences down the road.

As Lebanon continues to slash public spending, it’s unlikely that an increase in spending on social services is imminent.

And now with the spotlight on Bsharri, it was unsurprising that some speculation came about that the town was trying to score points against Health Minister Hamad Hassan of Hezbollah, a Lebanese Forces rival.

Lazem, the Bsharri hospital director, said that there is no tension. “The health minister visited Bsharri, and he was very supportive,” Lazem said. “His visit was in good faith, despite political differences.”

Meanwhile in Bsharri, closed off from the rest of the country, there is a sense of both optimism and caution among residents of different political stripes. There was a sense of urgency to put people’s immediate health and economic needs at the forefront, especially at a time where popular protests swept across Lebanon calling for the downfall of its ruling political parties.

“We united at this difficult time because the people of Bsharri love each other—whether it’s civil society or Lebanese Forces such as myself,” Rahme told Foreign Policy.

But whether everyone feels the same way is questionable. Renewed protests and riots across Lebanon over the economic crisis continue to target the country’s ruling elite—including the Lebanese Forces and their allies—as a seething population demands change.

As Bsharri’s case numbers go down, numerous towns and cities in Lebanon have been protesting over the past week, now over lack of economic compensation and skyrocketing food prices. This could lead to greater demand for medical resources, and it’s clear that the situation in Lebanon as a whole is far from under control.

While acknowledging the positive trajectory in Bsharri, Lazem insisted that people must stay vigilant, even in his town. “Now we’re fine,” he said. “Tomorrow morning, who knows?”

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