As of March 13, Lebanon has 77 confirmed coronavirus cases. Universities and schools have been closed as a precautionary measure [1].  The outbreak comes at a time in which Lebanon is already struggling with its worst economic and financial crisis in a generation due to neoliberal policies. Lebanon is officially one of the most indebted nations in the world.  The ongoing crisis has led to the devaluation of the national currency by more than 40 percent, with spiked inflation, and thousands  have lost jobs or their wages slashed.

Lebanon’s worsening financial crisis has had dreadful consequences on the country’s medical care system. As recent as this February, public officials, including doctors, announced that there is a shortage of lifesaving drugs and medical supplies, which can no longer be obtained from international suppliers due to Lebanon’s shortage of U.S. dollars.

So naturally, the coronavirus outbreak has hit the country at a time where it is least prepared.

So far, there is only one public hospital being used to quarantine and treat COVID-19 patients for free – the Rafik Hariri University Hospital (RFUH) in Beirut. Private hospitals are currently working on making some sections available to treat coronavirus patients. COVID-19 tests can be taken for free at RFUH, but it is not clear whether the hospital staff has the capacity to conduct hundreds of tests per day. On March 11th, the Lebanese Ministry of Health announced that it already asked private hospitals to do coronavirus tests for 150,000 L.L (US$98), or nearly 1/3 of an average Palestinian’s monthly wage. This means that once the numbers of tests surge, people might have to go to private hospitals and pay for testing – at a price that at least 40% of the population cannot afford amid the current economic crisis.

Up until now, Palestinian refugees, who have been living in Lebanon for decades yet remain without rights, are not clear about what actions are being taken to protect and support their communities. In a recent interview, the United Nations Relief and Works Agency for Palestinian Refugees (UNRWA) stated that an emergency room has been set up for Palestinians. It hasn’t, however, shared any information about an actual response plan beyond “awareness” campaigns. Awareness can be helpful but not necessarily effective to people who have no access to healthcare, or the right to access healthcare. Moreover, the Lebanese Red Cross recently refused to transfer a patient from a refugee camp to the RFUH, causing more anxiety amid camps residents.

Many Palestinians worry that they might be forced to pay for testing and hospitalization, money they don’t have. Making the situation worse, xenophobic discourses remain and intensify with no end in sight, even in a raging epidemic [2]. Several Lebanese officials such as Samir Geagea, for instance, have called for greater control in refugee camps, places where Palestinians are  already under complete surveillance and control. These practices separate those who are deemed “deserving” of treatment from those who are “not deserving.” Citizens, in cases of pandemics, are typically framed as sanitary subjects deserving to survive whereas the non-citizen, the refugees, are “un-sanitized” and a “burden” and, thus, not deserving of treatment or allowed to live. This is complicated by the normalized xenophobic treatment causing Palestinians to be wary of health services in Lebanon. In 2018, for instance,  a three-year-old Palestinian boy died after hospitals across Lebanon refused to provide him with a bed in an intensive care unit because of his nationality.

Palestinian refugees in Lebanon lack health and other forms of social security, and those who live in camps face added challenges. Palestinians in refugee camps experienced health complications caused by deteriorating living conditions, low wages, 66% poverty rate and increasing deprivation. Without access to health care, anxieties and fear intensified as refugees face the increasing threat of a COVID-19 outbreak, even as many pertinent questions remain unanswered. Meanwhile, the UNRWA has been experiencing an ongoing drastic cutback, especially its health services.

Palestinians living in Lebanon are  almost entirely dependent on the UNRWA and other humanitarian NGOs for most aspects of their lives because they are excluded from (Lebanese) public education, public health and other social services. Labor discriminatory practices further depressed Palestinian wages. The average monthly income of Palestinian workers is US$356, considerably below Lebanon’s official minimum wage of US$447, and 20% less than the average monthly income of Lebanese workers. Palestinian workers in general do not receive equal remuneration as their Lebanese counterparts for the same jobs.

The Lebanese healthcare system is already strained. The main question that everyone should be asking at the moment is: how will the government manage a significant increase in patient flows and accommodate patients from different nationalities, especially when as recent as a month ago, public officials warned that due to financial troubles, hospitals may soon not able to provide patients with life-saving surgery and urgent medical care?

As a response to the above question, the UNRWA and other aid organizations have been trying to police people’s fears through sharing awareness videos on hygiene and asking people not to “be scared.” What’s truly scary is that most Palestinians don’t have adequate and affordable access to healthcare services for treatment of various chronic illnesses. One could argue that the enabling conditions of the spread of this virus among Palestinian refugees are more terrifying than the virus itself.

This pandemic exposes the realities of most healthcare systems, and in particular, the Lebanese healthcare system. The fact remains that the current healthcare system in Lebanon is xenophobic and classist, manufacturing a false dichotomy between people – those who deserve treatment and those who don’t, and turns Palestinians into “some competing entities” vying for aids, and into categories of clients and beneficiaries that exist in a political vacuum. An effective response to the outbreak requires us to collectively challenge such xenophobic, racist and classist measures taken by all governments. Despite the fact that many of us are panic-stricken, as a Palestinian living in Lebanon, I believe that now is the time to assert that access to healthcare is a fundamental right to everyone everywhere. Now is the time to turn solidarity into tangible actions that make sure that no one is left behind.

[1] Note to reflect the most updated data on Lebanon.

[2] Note that many in Lebanon frequently use the term “racist” (in Arabic) instead of “xenophobic” to convey these dynamics.

This article was originally published by the Praxis Center on March 17 2020.