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Like many other countries in the region, Lebanon established successful measures to contain COVID-19, prompting a slow, but steady return to pre-COVID behavior following an Omicron wave peak in February 2022.

The number of infections, reported cases, hospitalizations, and daily deaths continue to decline, an accomplishment worthy of celebration in the midst of hyperinflation, all-time high unemployment, nadir purchasing power, and a health sector on the verge of collapse.

Lebanon's program proved successful during the initial phases of the pandemic only to wane over time in the midst of growing economic and political turmoil. Our study, conducted between February and May 2021, identified challenges in COVID-19 response faced by the country as well as successes and innovations that sought to address these challenges.

Pre-existing health system capacity challenges intensified during the pandemic resulting in long waits for intensive care unit beds and uneven access to services. Hospitals reached capacity, leading to alternative patient management methods such as coordinating home care and cancelation of all non-urgent surgeries. Medical equipment was scarce and expensive, given that it is imported using U.S. dollars and there is an extreme dollar shortage along with a liquidity crisis and a devalued local currency.

Already struggling with shortages of medicine and an exodus of medical staff abroad, the country's health facilities also contended with extended power cuts and a need for fuel oil to operate power generators.

In responding to the pandemic, the government established a national committee to seek ways to contain the virus and to buy time for the health system to increase its capacity. Stringent measures were implemented from lockdowns, to limiting vehicle mobility, an air travel ban and sealing ports of entry.

Public concern and panic about the disease caused an explosion in social media postings (PDF) that spread rumors, conspiracy theories, misguided reassurances, and false information about COVID-19 prevention, medication, vaccination, and symptoms. Many self-medicated instead of seeking medical referral and took hydroxychloroquine, prompting the Ministry of Health to issue a warning prohibiting its sale without a medical prescription. The WHO supported the distribution of health information through media outlets and sought to debunk false information.

Increased risk of poor mental health in Lebanon is related to decades of political instability and, more recently, an economic crisis. The combined effect with the COVID-19 lockdown measures significantly increased stress and anxiety among both health care workers and the general population.

Vaccines were funded by the World Bank and the UN-supported COVAX program. The health ministry approved the emergency use of Russia's Sputnik V vaccine, allowing for private-sector imports. However, the vaccination drive slowed due to worldwide vaccine shortages, vaccine hesitancy, and concerns about the AstraZeneca vaccine.

Aid was sought from the government and external donors to help keep hospitals open, care for patients with COVID-19 and those with other ailments, save jobs in the sector, pay salaries, and cope with the effect of the pandemic. Complex politics prevented this assistance from materializing.

Despite the lack of stable electricity and the absence of internet access in some segments of the population, some physicians relied on WhatsApp®, phone calls, and email to provide medical consultations or prescriptions to their patients.

At a community level, the role of local municipalities in mobilizing the community to track cases and impose quarantines has been a successful approach for containment.

Similar to many other countries, a contact tracing app, “Ma3an,” which translates to “together,” was created to notify people who may have been exposed to COVID-19.

While a designated central hospital received COVID patients initially, other hospitals were recruited to relieve patient load and receive patients in newly emptied wards. WHO, foreign, and local nongovernmental aid supported public hospitals by importing COVID-19 diagnostic kits, PCR instruments, personal protective equipment, and medical supplies and equipment (PDF).

Like other countries in our study, Lebanon had its successes and its setbacks. Where it goes from here could provide a measure of the country's health care resilience moving forward.

Nasma Berri is a policy analyst at the University of Michigan Acute Care Research Unit and Mahshid Abir is a senior physician policy researcher at the nonprofit RAND Corporation.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.