'I'm Helping Beirut Medics Recover From an Unthinkable Year'

I was born, raised and currently live in Beirut. I hold a master's degree in health care management, but I went directly into the humanitarian field because I graduated just when the Syrian crisis hit. I first worked in the health sector, and then specifically in mental health with the National Mental Health Programme at the Ministry of Public Health. I later moved to Washington, D.C. and joined Project HOPE, a global health and humanitarian relief organization, where I am responsible for leading global mental health programs and resiliency trainings for frontline health care workers responding to COVID-19.

Emotional scars linger the longest—and in this case, they're from the Beirut port explosion in August 2020 that killed over 200 people and left over 300,000 others homeless.

When the explosion hit, I was still in D.C., but I hurried back to my home country. It took me five days to get back home. I was crying the whole time yet feeling like I couldn't possibly stay away; I felt like I absolutely had to go and do something—anything.

The immediate needs after a crisis or disaster often focus on emergency medical support, but I think it is still extremely important for people to deal with mental health illnesses just as they would any other type of physical distress. There is no health without mental health.

My people of Lebanon have faced instability for so long that they think of it as a normal part of life. It was already badly hit by COVID-19—on top of an ongoing economic and political crisis—but 2,750 tons of fertilizers blowing up in the port was a disaster of a different order. It affected everyone: the general population, the doctors, the psychologists, the psychiatrists. Everyone who was needed to provide mental health support was directly traumatized by the blast themselves.

Like in so many other places, we're only now beginning to have conversations about mental health. It's still a stigmatized topic in Lebanon, as is self-care. With Project HOPE, I work to increase awareness, encouraging people to acknowledge that it's okay not to feel okay at this point, it's totally normal, it's not something that you should hide. I promote talking and learning more about mental health issues. We must normalize them and support each other to seek the appropriate care needed to save our lives – care many don't even realize or know that they need as the relationship between mental health and well-being is directly proportionate. Mental illness, especially depression, increases the risk for many types of physical health problems, particularly long-lasting conditions like stroke, Type 2 diabetes, and heart disease.

From my work, I see a unique burden on health care workers. Nearly 1 in 5 have faced depression, anxiety and/or PTSD during the pandemic, and those in the Middle East are showing the highest rates. Many of Lebanon's biggest hospitals are near the port, so they were directly hit by the blast. Doctors and nurses were injured. The infrastructure of many hospitals went down. They're still trying to rebuild, all this time later.

"We were unprepared, uninformed, confused and trying to learn from other countries in how to deal with the COVID-19 situation, and then the blast happened," a doctor from Karantina Hospital in Beirut told us. "It was the worst moment of my life, even though I grew up in Lebanon during the civil war. This situation was something completely different. It was like the apocalypse."

Our health care system was already extremely stretched because of the economic crisis, the lack of support from the government to the public and private hospitals, and the additional burden of COVID-19. And now we have an even bigger problem - physicians and nurses are leaving the country in droves: they don't want to live here anymore. They go to the Gulf countries, to Europe or to the U.S., seeking a better life and a better future for their families. "To be a nurse in Lebanon is to be qualified, trained, and educated. However, it also means we are overworked and underpaid. We are now putting our lives in danger for barely nothing in return. Even the lives of our loved ones are now in danger," a Beirut-based nurse shared with us.

Today, eight months later, people are still having nightmares, they have become paranoid whenever they hear loud noises, they are having flashbacks, and they are experiencing post-traumatic stress disorder (PTSD) symptoms without knowing what they are and what they should do about them. Health care workers, my parents, my colleagues, my friends – everyone is still struggling. Many are constantly physically fatigued, and many have increased irritability. People are making sure the windows next to their beds or the doors next to their children are open, so they don't risk shattered glass everywhere. The children, meanwhile, are exhibiting signs of PTSD and social withdrawal, a massive increase in involuntary urination, and an increased desire to be constantly near their parents. Kids don't even necessarily understand what happened, but they are obviously traumatized, and the effects will be there for a very long time.

This makes it a lot more difficult to rebuild, but we are supporting the health workforce as best we can. We have partnered with the Rene Moawad Foundation (RMF) Lebanon to provide trauma care and psychosocial support, in addition to immediate assistance through the procurement and distribution of medicines, medical supplies, disaster health kits and PPEs. So far, we have supported more than 10 hospitals in Beirut, 12 Public Health Centers and several local INGOs, reaching more than 100,000 people in need and affected by the blast, as well as health workers. But it can't stop there.

I am desperately trying to link people up with specialised services, to scale up the mental health and resiliency training we've been doing in other countries and to bring it to Lebanon because while we know that across the globe, health care workers are traumatized and burnt out by this pandemic, I think mental health vulnerabilities are one of the crises Lebanon faces. Just like the economic crisis and the COVID crisis, the brunt of meeting this crisis is falling on international agencies. Without cooperation, collaboration, localized efforts, and mental health and resiliency support, all of Lebanon's crises will only get worse. And we must strive to rebuild not only to get through the current pandemic, but for other unforeseen events to come.

Rawan Hamadeh is the Associate Project Coordinator for Mental Health at Project HOPE.

The views expressed in this article are the author's own.