Update on Lebanon: testimony from President of the Order of Nurses of Lebanon

The International Council of Nurses (ICN) has been in close contact with the Order of Nurses of Lebanon during the recent escalation of the conflict in the last two weeks. Today, ICN CEO Howard Catton spoke to the Order’s President Abir Kurdi Alame, who described the devastating situation in the country and how nurses are being affected.

President Alame said that although Lebanon’s nurses have been trained in how to work in and manage disasters, they were not prepared for the mass casualties they have witnessed in recent weeks, nor the type and extent of the injuries they have seen.

“We were faced by a large number of casualties where the type of injury was really scary. We faced injuries that we have never seen before in Lebanon: young people coming with no eyes, with arms that are ripped, no fingers, lots of bleeding, and for sure, lots of pain. We had to work with more than 2,800 casualties at the same time and also [deal with the] deceased.

‘Now, what is more alarming is the number of hospitals that are being targeted, the number of healthcare people who are targeted, like firefighters, ambulances and lots of healthcare workers being directly attacked.

‘The numbers are rising every day. We have four nurses that are deceased, we have more that severely wounded, and lots of nurses now are risking their lives to be at work: they are afraid for their lives. After all, we're all human beings, and they are also afraid for their families.

‘Now we are operating with a minimum of nurses in these areas. More than 40% of the hospitals are now in the dangerous zones, and 11 were directly targeted. We are obliged to be operating, but in very dangerous situations: imagine the physical and the mental effect of being unsafe, targeted, and at the same time you have an obligation to be there to at least rescue whoever you have to rescue.”

President Alame said of the 11 hospitals that were targeted, two are no longer functioning at all, and the others have reduced facilities and have lost the ability to carry out operations: they are effectively only functioning on an emergency basis. She said some of the hospitals that were attacked were issued with a 30-minute warning to evacuate, but that none of the hospitals should have been targeted because they were not doing anything other than carrying out medical care.

Mr Catton expressed his deep concern that international humanitarian law (IHL) was not being respected and applied, observing that ICN had reported on an increased number of attacks of healthcare facilities in conflict zones across the globe over the last two years. He asked President Alame whether this normalisation of such attacks was resulting in a loss of confidence in international law.

President Alame said: “Yes, this is a very important concern. I've been talking to many nursing directors, and they were really asking our order to raise the voice and say that we need to be at least safe in our facilities in order to be able to deliver the care. Their nurses are leaving, and I cannot blame them, because they have lots of dependents and their families.”

Mr Catton commented: “Nurses have said to me that it can feel as though humanity has been lost, and that has a huge impact on those nurses’ mental health as well.”

Nurses in Lebanon are currently either working in the front line with casualties, working in other hospitals that are overwhelmed by the workload, or working in primary health situations helping with the 1.2 million displaced persons, 300,000 of them in makeshift shelters, that Lebanon is coping with.

President Alame said the Order of Nurses of Lebanon is working to improve the workforce situation by getting many retired nurses to return to work. And many nursing students have interrupted their nursing studies to work wherever they are needed.

“Our nurses are overwhelmed. We are exhausting all our nurses, but I believe they are there for each other. We are there for our people to deliver the best health care we can. As always, nurses do.”

Mr Catton said that ICN estimates more than 1,000 nurses and other health care workers have been killed in conflict zones in the last two to three years. He asked President Alame how nurses were coping with the tragic deaths of their colleagues.

President Alame said in Lebanon the number is increasing: “We have more than 120 martyred health care workers, we have more than 230 wounded. We have 11 hospitals directly targeted, ambulances, fire trucks. If we are without tools, if we are without our hospitals or institutions, how can we deliver a quality care?

‘We really fear that this situation will escalate. We fear that our healthcare facilities remain targeted. We fear that we will lose our remaining nurses, we worry that the enrolment in the nursing profession might decrease, seeing all these difficulties that nurses are facing.

‘I hope that this situation finishes - peace is really needed. Political or other solutions are the best in solving anything. Let's end war. Let's end any type of violence. Let's stick to all the international laws. Let's stick to humanity.

‘We need to be really working towards a better future with better health for everyone. You know, peace is a must for anyone, for all countries for all the nations. Let's get health for all and a peaceful situation.”

At the end of the discussion, Mr Catton passed on the best wishes of the world’s nurses to their colleagues in Lebanon.

“Let me please just extend, on behalf of ICN nurses around the world, our deepest condolences and sympathies for the loss that you have suffered and honour the sacrifice that those nurses and healthcare workers who have died have made.

‘It's clear that nurses and healthcare workers are paying the ultimate price for the political failure to maintain and restore peace. We need a diplomatic solution for peace and a peace settlement, urgently.”

To see a video of the interview click here.