On August 4, 2020, an unexpected explosion of over 2,700 tons of ammonium nitrate neglected for years at the Beirut port resulted in a humanitarian catastrophe in one of the region’s most populous cities. Over 200 people are estimated to have died, more than 6,500 were injured, and over 300,000 of Beirut residents, a third of them children, were displaced from their homes. The severity of the explosion at the port, with damages estimated at $350 million, was and continues to be exacerbated by a series of protracted challenges facing Lebanon. This includes a rapidly deteriorating economic and financial crisis, worsened by lockdowns imposed in response to the COVID-19 pandemic. Lebanon remains host to the largest number of refugees per capita in the world, with slightly over 202,000 registered refugees in Beirut alone; over 34 victims of the explosion were registered refugees, and another 124 refugees were injured, 20 of whom experienced serious injuries. The majority of neighborhoods impacted by the 6-mile radius of the explosion are considered low-income, at a time when 23 percent of Beirut’s population already lives in extreme poverty.
Following the explosion, shock and grief quickly turned into anger and demands for state accountability, as the government’s chronic neglect of the city’s infrastructure, economy, and calls for reform have resulted in a national crisis. Most of the 300,000 who were immediately displaced following the explosion (including about 80,000 children) remain displaced due to the widespread damage on residential and commercial areas—estimated to be between $3.8 and $4.6 billion in physical damages and between $1.8 and $2.2 billion in reconstruction costs. Winter conditions in Lebanon have already resulted in drops in temperature and heavy rains, worsening the already precarious living situations of thousands of vulnerable families impacted by the explosion. Meanwhile, COVID-19 continues to surge across Lebanon, with over 324,000 confirmed cases and 3,737 deaths as of February 10, 2021, over 30,000 of which are in Beirut.
Invisible impacts of the explosion
Six months on, the extent of the invisible mental health impacts of the explosion remain less known. Multiple reports have highlighted the collective trauma experienced by survivors of the explosion, including nightmares, flashbacks and fatigue, as well as an increased need for mental health consultations. Even in the months preceding the explosion, there were reports of increased prevalence of depression and anxiety as well as higher rates of suicides and calls to suicide hotlines—much of which was attributed to the deteriorating economic situation in Lebanon that resulted in an unemployment rate of over 30 percent, devaluation of the Lebanese pound, and hyperinflation of food and essential medications.
The explosion also revived previous traumas experienced by generations of Lebanese citizens who suffered from multiple civil wars, displacement, and most recently, increased violence and civil unrest during mass anti-government demonstrations. Particularly impacted were those on the frontlines, including health workers who—already overwhelmed with the sharp rise in COVID-19 cases—were unprepared for the aftermath of the explosion and worked for days on end to treat the injured despite limited resources. Humanitarian staff and volunteers who responded in the immediate aftermath of the blast, such as those with the Lebanese Red Cross, reported the devastation they experienced digging through the rubble to rescue victims and the grief felt by aid workers who had also lost friends and family. Psychologists and social workers, who were directly traumatized by the explosion, also experienced symptoms of severe distress after working with survivors.
Children, 100,000 of whom are estimated to have been directly impacted by the explosion, were also reported to be significantly affected by the explosions, with over 50 percent of those surveyed in a post-explosion UNICEF survey demonstrating signs of trauma. In fact, child specialists in Beirut have noted symptoms of post-traumatic stress disorder, such as involuntary urination and social withdrawal symptoms among young children. Dima Wehbi, policy advisor with the International Rescue Committee (IRC) in Lebanon, said that the explosion has had a particularly severe impact on children and youth. “They are showing distress, trauma, and anxiety disorders,” said Wehbi. “Many of them keep recalling the moments when the blast happened and all the negative emotions they felt and lived at this moment. Many needed specialized mental health services to recover.”
Impact on Beirut’s refugee and migrant populations
The majority of Beirut’s refugee population, estimated to be over 1.5 million in total, have also been re-traumatized by the blast. Nearly 60 percent of Syrian refugees were reported to have lost their jobs during the lockdown in the months ahead of the blast; and estimates indicate an increase in the percentage of refugees living below the poverty line, from 60-65 percent prior to the blast to nearly 90-95 percent. Palestinian refugees living in the Greater Beirut area are also experiencing high poverty rates and limited access to employment opportunities. Pressures on refugee populations across Beirut have only heightened after the explosion, with increasing anti-refugee sentiments and mounting resentment from the Lebanese host community and politicians. In early November, when a Syrian male with refugee status set himself on fire in front of the UNHCR office in Beirut, spectators commented on the increasingly dire condition of refugees in Lebanon after the explosion and the breakout of COVID-19. In fact, many refugees are opting for return. In 2020, a total of 38,233 registered Syrian refugees have returned to Syria from Lebanon (as of December 31, 2020)—a nearly 500 percent increase since the last reported number of 6,595 returns on July 31, 2020, days before the Beirut explosion. The overall situation in Lebanon remains challenging for most, with some refugees feeling that their life is a “misery” and that they are a “burden” to their families.
“Particularly for refugees living in urban areas, our protection monitoring has indicated that they are particularly likely to be resorting to negative coping strategies such as cutting the number of meals consumed,” said Wehbi. “Across Beirut, severe mental health impacts have been reported in multiple studies, and directly by the IRC’s clients due to the multiple stressors of COVID-19, a financial and economic collapse, political instability, and the Beirut port explosions.”
Also impacted by the explosion is Lebanon’s migrant worker population, the majority of whom are female domestic workers sponsored by the national visa (kafala) system. In the last six months, these workers have faced increased rates of unemployment, homelessness, and discrimination, with reports of feeling abandoned and forgotten by their employers and the Lebanese government. According to a post-explosion needs assessment, the needs of migrant households notably vary from Lebanese households, with migrant households prioritizing acute needs such as cash and food followed by shelter repairs and medication. Furthermore, access to healthcare for migrant workers is usually contingent on the presence of a sponsor and the presentation of a work permit. To fill this gap, organizations like Medecins Sans Frontieres (MSF) have set up a medical helpline specifically for migrant workers—which has reached nearly 170 migrant workers since November 2020. Nonetheless, the deteriorating situation across the country continues to threaten the well-being and security of migrant workers and requires urgent attention from both the local and global community.
Mental health service disparities: Opportunities and gaps
Within the last decade, Lebanon has made significant strides in reforming its national mental health policy, including the launch of a Mental Health and Substance Use Prevention, Promotion, and Treatment Strategy for Lebanon (2015-2020) led by the Ministry of Public Health. This came after the establishment of the National Mental Health Programme (NMHP) in 2014, which aimed to expand the numbers of trained mental health professionals in Lebanon and integrate mental health services into primary healthcare settings to increase accessibility and acceptance. However, there remain significant structural barriers, including limited numbers of psychiatric units and mental health professionals, such as psychiatrists, psychiatric nurses, and social workers. Fear of stigmatization and stigma surrounding mental health services is also estimated to prevent about 90 percent of individuals in Lebanon from seeking mental health services in the first place. Moreover, Lebanon’s highly privatized health system, and the limited insurance coverage for this particular type of health service, deters prospective patients concerned about the high cost of mental health services. Drug shortages preceding the explosion have also threatened the availability and affordability of essential medications and have fueled the expansion of the black market. Particularly in recent months, with reports of over half of Lebanon’s population in poverty, mental health services may be perceived as a last resort.
Following the explosion, there has been a renewed interest in scaling up mental health and psychosocial support (MHPSS) services provided by local and international humanitarian organizations, UN agencies, and government facilities. The Lebanese Red Cross (LRC) has been one of the most responsive organizations on the ground, receiving over $3 million in donations in a matter of weeks and providing mental health and psychosocial support to over 16,400 individuals since the explosion. Over 6,200 individuals in Lebanon have been supported with MHPSS services, with the majority of individuals being reached by both specialized and non-specialized PSS programs. However, there remain significant gaps in the provision of MHPSS services, particularly in rural or hard-to-reach areas, and for specific populations such as the LGBTQI+ community. The World Bank Rapid Damage and Needs Assessment emphasized that continued access to MHPSS support for communities impacted by the explosion remains a priority in the immediate-term.
Of particular concern are those who were disproportionately impacted by the explosions, including elderly populations, women, and individuals with disabilities. These populations experience greater obstacles in accessing MHPSS services, both due to challenges posed by COVID-19 as well as fear of potential discrimination from peers or family members they rely on to access services. School-age children are also more subject to negative coping strategies, especially due to lack of access to protection, including insufficient shelter and risk of gender-based violence.
Existing non-profits and civil society organizations have stepped up to support civilians affected by the blast, particularly those who are hardest-to-reach or remain in vulnerable situations following the explosion. This included one of the oldest mental health non-profits in the region, the Institute for Development, Research, Advocacy and Applied Care (IDRAAC), whose staff immediately expanded its hotline services to provide remote consultations to those affected by the blast. Embrace, another non-profit organization raising awareness regarding mental health in Lebanon, increased its clinic capacity following the explosion and offered a national helpline for emotional support and suicide prevention.
Other grassroots initiatives were launched in the immediate aftermath of the explosion. One such example is Khaddit Beirut, which aims to provide recovery through a number of smaller impact initiatives, one of which prioritizes increasing partnerships to improve community health and provide accessible mental health services. Additional post-explosion initiatives have taken to social media platforms, such as Beirut Explosions Emotions on Instagram, to provide a network for survivors of the explosion. Beirut Disaster Relief, an app which provides a directory of individuals and experts who can provide humanitarian support, has also been a useful tool to connect those affected by the blast with mental health experts who can offer remote consultations. While these initiatives have helped meet short-term needs, more sustainable approaches are necessary, including increased funding to rehabilitate hospitals destroyed during the explosion, expand community-based mental health services, train mental health specialists, and increase the availability of psychotropic medications.
As Dr. Rabih Chammay, psychiatrist and head of the NMHP, stated, for many affected by the blast, “justice is essential to recovery.” The explosion at the port was a critical breaking point following months of civil and political unrest, compounded by a protracted economic crisis, months of protests, and COVID-19. As 2021 brings more stringent lockdown measures in Lebanon due to the increasing threat of COVID-19, as well as growing poverty rates among the Lebanese population, mental health solutions are increasingly warranted and necessary for recovery.
To access mental health resources in Beirut, IDRAAC provides mental health services through a walk-in clinic available in St. George’s Hospital University Center as well as a 24/7 hotline (+961 03730475) for free consultations and the provision of Psychological First Aid (PFA). Please visit the following link for a list of additional mental health resources in Lebanon (both in-person and remote options available).