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close this bookWIT's World Ecology Report - Vol. 08, No. 3 - Critical Issues in Health and the Environment (WIT, 1996, 16 pages)
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Health and Environment From War to Recovery: The Case of Lebanon

Keynote Address by H.E. Mr. Marwan Hamadeh, Minister of Health of Lebanon, at the Fifth Conference on Health and Environment: Global Partners for Global Solutions, United Nations, New York, April 25 and 26, 1996.

The biggest preventable environmental disaster of all is the disaster of war, for healthy people and a healthy environment cannot prevail except in peace. In the mid-1970s, Lebanon was a prosperous, upper middle-income country with a market economy expanding by about 6 percent a year. Later Lebanon was imperiled with an environmental disaster that extended for more than 15 years, claimed more than 150,000 lives and maimed an even greater number.

When a country is at war, development and health are the first victims. During the war, more than a million individuals were forced to relocate or were displaced at least once. Of these, more than half returned to their homes or settled somewhere else and the other half is expected to return to their villages and towns within a couple of years. The population displacement put a great deal of pressure on the physical infrastructure and environmental and health services that were not upgraded for more than a decade. A shift in the population distribution occurred with new urban areas developed under no government control and obviously in the absence of any comprehensive development plan.

By the end of the war in 1990, the following was the situation in Lebanon.

Environment: 1) a large proportion of our forests were lost to fires and bombing; 2) agricultural lands and terraces were abandoned for safety or job opportunities; 3) many manufacturing industries were either destroyed or forced to shut down; 4) the water distribution system or network was either destroyed or debilitated; 5) main power plants in the country were non-operational or operating at minimal capacity; 6) a number of small and medium sized industrial firms emerged in residential areas or were surrounded by emerging human settlements; 7) the two main refineries in Lebanon became non-operational and oil was imported under no license or control by several interest groups in the different areas of the country.

Health: 1) life expectancy declined from 65 to 60 years; 2) infant mortality rates jumped to 44 per thousand; 3) urban population increased to almost 87% as city suburbs were flooded with refugees; 4) health services declined with less preventive care and less vaccination and more focus on the war emergency needs; 5) the poor lost almost all access to basic hospital care; 6) the Public Health Sector was completely depleted, looted or destroyed by the various war factions.

Lebanon today represents a typical case of war and near-recovery in the health and environment sectors. The state of recovery is indicated by the current environmental and health conditions. Lebanon generates close to 3,000 tons of solid waste daily. About one-fourth (800 tons) of the total waste is generated by Beirut alone. Before the war, the waste was composted, burnt in the open, or dumped in land fills. During the war and for difficulties in transportation, different regions in Beirut and in the country reverted to easier ways out. In West Beirut, for example, solid waste was dumped in a bay which continued to receive solid wastes and construction rubble until 1993. In other areas of the country, wastes were dumped in open landfills, public lands, river streams, or the sea. Now, 6 years into internal peace, the Ministry of Environment is launching a comprehensive solid waste management plan for the country. The three approaches of sanitary landfills, composting, and incineration will be adopted all over the country based on proper environmental impact assessment. The Government, Ministry of Environment, and the Parliament are reviewing this US $150 million plan with the intention to pay more attention to the management in terms of waste reduction, reuse, and final disposition.

As for wastewater, the few waste-water treatment plants that were established before the war in selected coastal and mountainous towns were destroyed during the was. The Ministry of Environment and the Ministry of Energy and Water Resources are preparing to build wastewater management plants close to each of the main coastal cities. Work is active in constructing sewerage systems in the towns and villages that lack it. The almost total absence of maintenance of the water pipelines during the war and its potential exposure to unkept sewer systems led to the contamination of the potable water supply. In Beirut and other coastal cities, the interruption of water services and the increased demand during the war forced people to dig hundreds of unlicensed artesian wells which led to salination as a result of sea water intrusion.

The Ministry of Public Health is working on upgrading its Central Laboratory which monitors communicable diseases, the quality of the water, food and other consumer products. The Ministry of Energy and Water Resources is collaborating with UNICEF and private universities to upgrade their quality monitoring laboratory units all over the country. This is running in parallel to the rehabilitation of the physical infrastructure of the water sector. The cost is estimated at US $45 million.

Lebanon lacks an air quality control program or even an air pollution monitoring station. It is believed that vehicular exhaust emissions are the main source of air pollution in the country. More than a million vehicles are currently operating in Lebanon. Most of them are old makes. The Ministry of Interior has banned the import of cars that are more than 10 years old. The newer cars tend to use unleaded gasoline which became more available and whose consumption is steadily increasing. Lebanon is reintroducing a public transportation system which should reduce the dependency on private cars.

Diseases Targeted for Eradication or Elimination


Estimated Prevalence (000) 1995

Target for 2000

Dracunculiasis

122

Eradication

Poliomyelitis

82

Eradication

Leprosy

1,833

Elimination

Neonatal tetanus

10,000 a

Elimination

Chagas disease

18,000

Elimination

Iodine deficiency disorders

655,000 b

Elimination

SOURCE: The World Health Report, 1996.

Industrial air pollution is limited to a few medium and large sized industries. These include a power plant, 5-6 cement industries, and a fertilizer plant. The Ministry of Environment and the Ministry of Public Health have imposed several restrictions over the past years, but enforcement has been partially successful.

The sale and use of pesticides is just beginning to be controlled. Reports of banned pesticides illegally imported into the country were numerous. Some were sold under new trade names. During the war, farmers lost all the public support system which provided advise as to the type and quantity of pesticides to be used for their crops. Currently, farmers use pesticides intensively and apply them improperly. They also harvest their crops without any consideration for the waiting period following pesticide spraying. A national committee has been established to control the sale and use of pesticides in the country.

During the years of war, the Ministry of Public Health was consumed in emergency care and provision of clinical care for the needy through subsidizing their medical management at private hospitals. The Ministry was minimally involved in preventive measures except for a few immunization and health awareness campaigns. Quality control of medical care, reporting of diseases and illnesses and surveillance systems were totally absent.

Lebanon is currently experiencing an epidemiological transition in which fertility and infant mortality rates are declining. Life expectancy rates are rising with an overall life expectancy of 69 years compared with 65 years before the war. Infectious diseases are becoming less prevalent. Malnutrition is rare and parasitic disease has been brought under control. More than 95% of our children are now vaccinated against diphtheria, tetanus, pertusis and poliomyelitis. The coverage against measles is approaching 80%. With electricity restored and as a result of better and safer water quality, alimentary intoxications and summer diarrheal diseases are remarkably less. Subsequently, mortality rates for children less than 5 years old has dropped from 44 per thousand to less than 30 per thousand. However, improvements in the health of the Lebanese people and nation's environment are uneven. Effects of the extended period of civil war can be seen in high incidence of tuberculosis, which is more prevalent now than in 1975. The Government of Lebanon is committed to developing a health care system that will provide equitable access to essential health care for all Lebanese. It has embarked on US $510 million project to rehabilitate the health sector and upgrade health services. In addition, a US $48 million World Bank project was started in February 1996 to be executed in multiple phases over a 6 year period.

During the war, Lebanon joined the list of victims to the silent trade of hazardous waste. In September 1987, more than 2000 tons of toxic industrial material from Italy in about 16,000 barrels stored in 20 containers were discharged in one of the several illegal ports of Lebanon. Months passed before the Government of Lebanon was alerted to the incident and the possibility that the illegally imported material was dumped in different sites. The Italian government agreed on July 13, 1988, to handle the issue and the barrels were subsequently reported deported by the Italian commission. The world community has to act urgently to prevent the recurrence of incidents such as the 1987 illegal import of hazardous waste into Lebanon. Public participation is the best safety gauge against the potential greed of unethical and corrupt business people, industrialists, and public officials.

I leave you today with the promise that Lebanon will adhere to its commitment to biodiversity, environmental protection, and peace. Lebanon has launched a vast reconstruction scheme aiming at restoring its infrastructure and improving socio-economic conditions or our people. Thus, we hope to restore Lebanon to its leading cultural, financial and scientific role in the Middle East.