Since the explosion, the public health system has also struggled to cope with the growing number of COVID-19 cases, which rose from less than 200 cases a day before the blast to an average of 1,500 in December 2020. To date, more than 226,000 cases have been reported nationwide.

In August 2020, MSF stepped up efforts to respond to COVID-19 in Lebanon and support the national health system in dealing with the pandemic. We temporarily turned our hospital in Bar Elias, in the Bekaa Valley, into a COVID-19 facility and now support an isolation center in Sibline, in the south of the country. MSF teams are also involved in testing, health promotion, and training activities in different locations across the country. Lockdown measures, although necessary, have worsened peoples economic difficulties.

My husband used to find daily laborer jobs in agriculture or construction, said Samaher, a 40-year-old Syrian refugee who lives in an informal tented settlement in Akkar governorate, near the Syrian border. But with the economic situation and the coronavirus, it has become more difficult. He only works two or three days a week, and sometimes theres no work for [two weeks]. When he doesnt find work, we have to borrow money from the neighbors so we can buy food.

For many people in Lebanon, whether they are Lebanese, refugees, or migrant workers, the current economic crisis and the deteriorating living conditions come on top of other traumatic events and stressful experiences, such as conflict or displacement, disrupting psychological wellbeing. Many patients who request MSFs mental health services in Lebanon show symptoms related to emotional distress, depression, anxiety, and hopelessness.

I feel completely down and useless. The economic situation in the country is a disaster. I only hope we wont end up in the streets, said Tawfik, a Palestinian refugee living in Shatila camp in Beirut. His family relies entirely on UN agencies and nongovernmental organizations to survive. We are so tired, adds Hanadi, his wife, unable to hold back her tears while she speaks.

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Lebanon: Overlapping crises exacerbate medical needs and worsen access to care - Doctors Without Borders