The Impact of the Beirut Blast on Children

By: Marie Jo Abdul-Hay

On August 4th, 2020 in Beirut, Lebanon, a massive explosion occurred due to nearly 3,000 tons of Ammonium Nitrate ignited by an uncontrollable fire, devastating the population. Three hospitals were completely destroyed, and 26 additional healthcare facilities were severely damaged, leaving patients (including COVID-19 patients) as well as people injured from the explosion with no access to treatment. The traumatized medical staff were wounded themselves, and medical equipment was destroyed. The World Health Organization’s regional emergency director, Richard Brennan revealed that over 50% of the capital’s healthcare facilities were out of service (1). The explosion killed at least 230 people, including 6 children: Bissan Tibati, Alexandra Naggear, Elias Khoury, Isaac Oehlers, Hala Ibrahim Abdulrahman and Ahmad Khaled Al Mahmoud (2), and injured 6,500 people, including 1,000 children. Also, according to UNICEF, 80,000 children were displaced. Vulnerable children were the most affected and unable to get support due to various barriers like shortage of medication, healthcare facilities and medical personnel.

The explosion created lots of barriers to many children that were receiving treatment at the time. Primarily, it made essential response components, like drugs and equipment, inaccessible as most medical supplies and PPEs are stored in the port warehouse and were completely destroyed (3, 4). The global PPE shortage due to the pandemic greatly amplified those barriers and made it impossible to get access to those fundamental necessities. As Jawad Ahmed and colleagues stated in their recent article (5), medical staff in Pakistan and the United States early during the COVID-19 pandemic were providing care to COVID-19 patients with a lack of PPE, especially surgical masks, N-95/p100 respirators, gloves, goggles, gowns, face shields and hand sanitizer, and were dealing with a limited amount of ventilators, beds and intensive care units. It is in such extreme situations that the general public becomes aware of the importance of specialized equipment and machines: when they are needed and nowhere to be found.

A major group of vulnerable children were affected in that way: children with cancer (6). With no access to chemotherapy drugs, the destruction of medical equipment and the unstable situation, it has been reported that many patients missed chemotherapy sessions (6), which can have severe consequences on their chances of survival and recurrence of the disease. Besides, those children were already in a major emotional and psychological distress following their cancer diagnosis and treatment, as well as witnessing deaths of family members and hospital staff that worked closely with them so suddenly caused an urgent need for mental health support.

Children with cancer however were not the only children needing mental health support. Many children affected by the explosion also had a change in behavior. The most reported symptoms were separation anxiety and aggressive behaviors, which are not uncommon after traumatizing events (7). Mental health challenges in children is extremely common after disasters, a similar example would be Hurricane Maria in Puerto Rico in 2017. A survey revealed that children and teenagers were deeply affected by the hurricane, manifesting significant levels of PTSD (7.2% having clinically relevant symptoms) and depression (17.5%) due to the high levels of stress following this disaster danger (8). Mental health specialists unfortunately revealed that Beirut blast victims that needed help most were the least able to access it, which can be explained by the demolition of the clinics in the most affected areas, as well as the stigma associated with accessing those facilities (7).

Proper health care services during disasters is not new and has been seen in many other natural disasters, for example, during the Kermanshah earthquake that happened in 2017 at the borders of Iraq and Iran. It has been reported that the Iranian medical team, with a shortage of staff, was working without gloves, operating and stitching under non-sterilized conditions and working under the sun while being covered in dust, as hospitals were destroyed and yards were the only available areas to examine patients (9). Those extremely unsanitary conditions were also seen following the Beirut blast side by side with the forgotten measures that should be taken during the COVID-19 pandemic like social distancing and face mask practices (10), which is completely understandable in front of the alarming need for survival after the explosion.

This man-made disaster revealed how unprepared the country is to such emergencies. Clearly, storing all of the country’s medical supplies in one place was a huge mistake that could have been easily avoided by expanding drug storage, PPEs and equipment across the country (3). Moreover, it is clear now that integrating mental health services in non-governmental charitable and religious organizations is necessary to reduce the stigma, make these facilities accessible and ensure a better quality and sustainability of these services (6). Lastly, preparing health kits and mother-child packs has been proposed by Mohammadpour and their team (9), which could possibly be planned as a foresight for expected natural disasters.

I wish I could end by saying that Lebanese children are doing better. Unfortunately, a recent UNICEF survey revealed that two in three families have not had access to health care or medication since the explosions, a year ago (11). To make it even worse, one in four families had at least one household member who tested positive for COVID-19 since the explosions. One year after the blast, equitable access to healthcare is deeply questionable as the economic crisis became more apparent: the UNESCWA estimated that the current poverty rate of the Lebanese population exceeds 55%, and even if access to healthcare was to become available, shortage of medicine and lack of medical equipment are still a real problem (12).

Many children are suffering from this crisis to this day, sometimes fatally: Jury Al-Sayyed, a 10 month old baby, passed away recently due to a high fever that was not treated on time because of a shortage of antipyretics (13). An obvious solution would be to import medicine; however, the port which is the only route of importation was destroyed by the explosion. And even though medication was to become available, the economic crisis is causing consultation and drug prices to rise exponentially; therefore, the answer is not as simple as that and is tightly tied to political instability and deeply embedded inequalities in the healthcare system.

References

Primary articles

4. Al-Hajj, S., Mokdad, A. H., & Kazzi, A. (2021). Beirut explosion aftermath: lessons and guidelines. Emergency Medicine Journal.

6. Gourd, E. (2020). Patients with cancer hit hard by deadly explosions in Beirut. The Lancet. Oncology, 21(9), 1143.

Secondary articles

1. Loveluck L., Morris L. and Cunningham E. Half of Beirut’s health-care centers are out of commission after the explosion. 2020. [Accessed August 26, 2021]. Available from www.washingtonpost.com/world/half-of-beiruts-health-care-centers-are-out-of-commission-after-the-explosion/2020/08/12/8e52b552-dca8-11ea-b4f1-25b762cdbbf4_story.html

2.Dilati, J. (2021). The 234+ Beirut Blast Victims, Remember Their Names. [Accessed on August 26, 2021]. Available from www.the961.com/the-234-beirut-blast-victims-remember-their-names/

3. Cheaito, M. A., & Al-Hajj, S. (2020). A brief report on the Beirut port explosion. Mediterranean Journal of Emergency Medicine & Acute Care.

5. Ahmed, J., Malik, F., Arif, T. B., Majid, Z., Chaudhary, M. A., Ahmad, J., ... & Khalid, M. (2020). Availability of personal protective equipment (PPE) among US and Pakistani doctors in COVID-19 pandemic. Cureus, 12(6).

7. Medawar, B., Shabb, O., El Hayek, S., Ammar, J., Hammouche, S., & El Khoury, J. (2021). Responding to a major disaster: the trauma assessment and support clinic in Beirut. Psychiatric services, appi-ps.

8. Orengo-Aguayo, R., Stewart, R. W., de Arellano, M. A., Suárez-Kindy, J. L., & Young, J. (2019). Disaster exposure and mental health among Puerto Rican youths after Hurricane Maria. JAMA network open, 2(4), e192619-e192619.

9. Mohammadpour, M., Sadeghkhani, O., Bastani, P., Ravangard, R., & Rezaee, R. (2020). Iranian’s healthcare system challenges during natural disasters: the qualitative case study of Kermanshah earthquake. BMC emergency medicine, 20(1), 1-8.

10. Shelton, T., (2020). Beirut's blast leaves hospitals damaged or destroyed as coronavirus numbers soar. [Accessed on August 26, 2020]. Available from www.abc.net.au/news/2020-08-16/coronavirus-outbreak-hits-beirut-after-deadly-blast-lebanon/12561742

11. UNICEF. (2020). One year after the Beirut explosions, children’s needs remain acute, with 98% of families still in need. UNICEF. [Accessed August 26, 2021]. Available from www.unicef.org/mena/press-releases/one-year-after-beirut-explosions-childrens-needs-remain-acute-98-families-still-need

12. ESCWA. (2020). ESCWA warns: More than half of Lebanon’s population trapped in poverty. Retrieved from https://www.unescwa.org/news/Lebanon-poverty-2020

13. Shakkour, S. 2021 A Lebanese 10-Month-Old Angel Dies Due to Lack of Antipyretics. [Accessed on August 26, 2021]. Available from www.albawaba.com/news/lebanese-10-month-old-angel-passes-away-due-lack-antipyretics-1438196