Mental health impacts of Lebanon's economic crisis on healthcare workers amidst COVID‐19

Abstract

Lebanon, identified as a Fragility, Conflict and Violence (FCV) state by the World Bank, is enduring one of the world's worst economic crises since the mid-19th century. 1 Also known as the Lebanese Republic, it is one of the most densely populated countries in the Mediterranean area bound northeast by Syria, and south by Israel. 1,2 In 2020, GDP shrunk by 20.3% amounting to US$33 billion loss, whereas GDP per capita decreased by 40%. 1 Additionally, inflation has averaged to 84.3%. 1 This economic crisis is projected to be worse in 2021 with an expected 9.5% contraction in GDP. 1 Coupled with a 6.7% decrease in GDP in 2019 and a loss of US$55 billion in 2018, the economic impacts are catastrophic, especially for healthcare workers (HCW). 1 Besides this, the Lebanese pound has lost 81% value since 2019, 3 marking high inflation all whilst coping with a pandemic, recovering from the Beirut Port explosion, and experiencing social unrest. 4 The Beirut Port explosion, which rendered half of the capital's healthcare centres non-functional brought new challenges to health care. 4 Not only this, poverty has increased by 27% from 2019 to 2020. 3 Fiscal mismanagement, a weak healthcare system, inflation, higher rates of poverty, social unrest, scarcity of resources, increasing workload and previous traumas have challenged HCWs trying to battle a pandemic in Lebanon, severely affecting their mental health. 3 Since 2019, 1000 of 15,000 doctors have left Lebanon to neighbouring Iraq and other countries, and alone at American University Beirut Medical Centre in Beirut, 40% emergency staff and 50% nurses have left. 5 As a result of this crisis, HCWs are experiencing a deduction in their salary that amounts to a couple thousand dollars a year. 5 A country that primarily relies on import (80% of medications in Lebanon are imported), the crisis has impacted availability of essential healthcare equipment, and has exacerbated workload for HCWs grappling with financial stress, and insecurity further fuelling their anxieties and contributing to burnout. [4][5][6] In addition, there are only 40 HCWs per 10 ,000 people in Lebanon, reported in 2018 prior to the economic crisis, which contrasts with WHO's requirement of 4.45 HCWs per 1000 people. 3 Mental health needs are poorly addressed as there are only 60 psychiatrists and 100 psychologists per 4 million people, and the country has no national mental health policy. 6 This not only complicates availability of mental health services, it creates issues for a healthcare system that is rapidly losing all its frontline workers. 3 Thus, the aim of this paper is to address the mental health crisis faced by HCWs in Lebanon, the implications of it and provide some recommendations. | DISCUSSIONMajority of the Lebanese people including frontline healthcare workers, elderly, juveniles and grownups suffer from alarming levels of anxiety and stress due to occasional periods of violence, specifically bombings in civilian areas, and political and economic instability. 7 Such pre-existing challenges h...

The impact of violence on healthcare workers' mental health in conflict based settings amidst COVID‐19 pandemic, and potential interventions: A narrative review

“…Data from Lebanon depicts severe levels of distress among its population 36 . Lebanon is under‐resourced to meet the mental health needs of its population as only 5% of the total governmental health budget is allocated to it 11 . HCWs struggle to manage the deteriorating conditions and meet the exceeded burden during COVID‐19, thus they face greater stress and lesser motivation to continue their jobs 11 .…”

“…36 Lebanon is under-resourced to meet the mental health needs of its population as only 5% of the total governmental health budget is allocated to it. 11 HCWs struggle to manage the deteriorating conditions and meet the exceeded burden during COVID-19, thus they face greater stress and lesser motivation to continue their jobs. 11 The experiences of HCWs have worsened due to the healthcare system being targeted with violence and threats.…”

“…A systematic review including more than 16,000 HCWs from 15 studies reported exacerbation of violence towards HCWs during COVID‐19, and mental health problems to be substantially higher in HCWs who faced Workplace Violence than those who did not 5 . The HCWs face greater challenges in conflict‐based settings, such as Syria, 7 Palestine, 8 Yemen, 9 Afghanistan, 10 and Lebanon 11 . Political instability, economic burden, limited resources, lack of safety and a fragile healthcare system, predispose a complex ordeal difficult for HCWs to navigate through 10 .…”

Dengue Virus Cases Surge Amidst COVID-19 in Pakistan: Challenges, Efforts and Recommendations

“…More importantly, efforts such as counseling services and a mental health hotline are to be considered for HCPs who face high levels of burnout. [26][27][28] In conclusion, Pakistan is currently facing multiple outbreaks of Dengue and COVID-19 that have exacerbated challenges for a weak healthcare system. Coupled with socioeconomic disparities, financial challenges, a slow vaccination rate, multiple clinical similarities, weak social distancing and increasing workload for HCPs, it is becoming difficult to mitigate these outbreaks.…”

Impact of ongoing conflict on the mental health of healthcare workers in Palestine

“…21 As a result of these factors, poor workplace efficacy and workplace detachment are commonly observed which have also been seen in Lebanon and Yemen. 22,23 Poor healthcare policies, unavailability of resources such as PPE kits, trauma due to conflict, and an escalating number of COVID cases have significantly impacted the mental well-being of HCWs in Palestine. To cope with the anxiety of infecting family members and themselves due to the scarcity of protective equipment provided and lack of sanitization measures, a lot of HCWs practised isolation from family members which exacerbated feelings of loneliness, abandonment and remoteness due to lack of emotional support.…”