Palliative Care in Lebanon Amid War and Displacement

By Hibah Osman, MD
Former IAHPC Board Member and
Founder, Balsam—the Lebanese Center for Palliative Care

Across our global community, our mission is the same: to relieve suffering, uphold dignity, and support the most vulnerable. In Lebanon, the Balsam team is living that mission under bombing, displacement, and profound uncertainty.

Aftermath of a bombing

It was 2 pm in Beirut. We were meeting on Zoom planning new hires. Suddenly, everyone jumped. "That was very loud," one said. "That one was really close," said the other. Then the frenzy began. Texting. Calling. Trying to locate family and team members and ensure that everyone was safe. One nurse had just picked up her baby after work. Another was on her way back from visiting a patient, and had just driven past a location that was struck moments later. This is the reality of providing palliative care in Lebanon today.

Ongoing struggle of instability

For Balsam’s patients—already facing serious illness—the war has stripped away their last remaining foundations of security. Some have lost their homes. All have lost their sense of stability. Families who were already managing pain and the uncertainty of living with serious illness are now also struggling with lack of safety and loss of basic resources.

Palliative care continues

Despite the chaos, Balsam’s medical team has not stopped doing its critical work. Our team continues to provide at-home palliative care, while navigating personal stressors, risks to their own safety and supply shortages. Some members of our team have themselves been displaced. They continue to care for their patients despite the challenges.

Funding diverted to emergency relief

With the escalating war, donations to Balsam have been significantly impacted. Most funding has been understandably redirected to emergency relief for the over one million displaced. Planned fundraising initiatives have been cancelled. At the moment when patients need palliative care most, the resources to provide it are disappearing.

Insurance integration offers hope

There is good news though. One of the larger insurance companies in the country has agreed to integrate palliative care into their policies. As you all know, this is a huge step forward for the country and something we've been working toward for many years. Perhaps it was partly due to persistence and building personal relationships. Undoubtedly, welcoming an insurance broker and an ex-minister of health to the Balsam board had a big impact: they took on the task, leveraging their relationships. They also used language and approaches that are different from those that clinicians use.

A surge will strain resources, cash flow

It's exciting, but also a bit overwhelming. Lebanon’s palliative care providers have a lot of work to do in the coming year to meet the anticipated increase in demand while ensuring that palliative care providers meet quality standards.

At Balsam, my concern is that we need to increase our operational capacity to be ready for a surge in demand, and that requires resources. We also anticipate a lag in payments from insurance companies and will need to be able to sustain our work through this. 

Fundraising drive launched

In March, Balsam launched a fundraising drive with the hope of closing that gap, and in response to need. We are asking our palliative care colleagues—who understand exactly why this work matters—to step up. In a country being torn apart by war, maintaining palliative care services becomes more urgent and essential. The Balsam team has continued to show up despite the challenges. We need the support to continue to do so.

Please consider making a donation to help us continue providing free at-home palliative care services to people with serious illness in Lebanon through our Global Giving campaign. No amount is too small. You can also help by amplifying the call by sharing our campaign on Facebook, Instagram and LinkedIn.