People gather outside American University of Beirut Medical Center (AUBMC) as more than 1,000 people, including Hezbollah fighters and medics, were wounded when the pagers they use to communicate exploded across Lebanon, according to a security source, in Beirut, Lebanon on Sept. 17.Mohamed Azakir/AFP/Getty Images
In the century and a half since its founding, the American University of Beirut and its hospital have seen one tragedy after another, including civil wars, world wars, invasions, the 1982 kidnapping of its president by pro-Iran extremists and, a decade later, a car bomb that demolished the administrative building.
Many of these bloody events filled the emergency ward of the AUBMC, as the medical centre is known, with victims, sometimes taking it near breaking point. But few onslaughts came as hard and fast as the afternoon of Sept. 17, when thousands of pagers handed out to members of Hezbollah, Lebanon’s Iranian-backed militia and political group, exploded simultaneously.
Within two hours, the AUBMC, located in the packed heart of Beirut, was filled with people with horrific wounds. Salah Zeineldine, 51, the chief medical officer, was on the spot and placed the hospital in emergency mode. “We had no idea what we were dealing with at first,” he said, explaining that the hospital had never before seen so many similar injuries at once.
Salah Zeineldine, the chief medical officer of the American University of Beirut hospital on Oct. 7.Eric Reguly/The Globe and Mail
Elective surgeries were stopped, non-emergency patients were diverted to other hospitals, off-duty medics were ordered to return immediately, and the Lebanese Army was called in to keep distressed family members, thousands of them, from flooding into the hospital to find their loved ones. “The street outside was fully packed with crying and screaming relatives trying to get in,” Dr. Zeineldine said.
Inside, the scene was grisly. Of the 190 victims of pager attacks the AUBMC saw, 148 were admitted for emergency surgery. “The majority of the injuries were to the eyes, facial bones, hands and abdomens,” Dr. Zeineldine said. “Most lost one or two fingers, 31 lost both eyes, and almost all the rest lost one eye or had eye injuries. For four days, we did non-stop surgeries in 12 operating rooms.”
The next day, a second wave of explosions, this time the result of booby-trapped walkie-talkies, sent another influx of victims to the AUBMC. One of them detonated in a car in the hospital parking lot; another was destroyed in a controlled explosion.
No one has publicly claimed responsibility for the explosions, but they are widely considered the work of Israeli intelligence services.
Since the attacks, which killed 42 people, including two children, the number of emergency admissions has fallen. But neither Dr. Zeineldine nor the university’s president, Fadlo Khuri, are confident the worst is over. Dr. Khuri, a Columbia University-trained oncologist of Lebanese descent who was born in Boston, said the Lebanese health care system is in “crisis” and the Israel-Hezbollah war could devastate it in the short, medium and long term.
Sign on one of the outside doors at the American University of Beirut hospital on Oct. 7.Eric Reguly/The Globe and Mail
“Lebanon produces a significant number of well-trained physicians, nurses and health care providers,” he told The Globe and Mail. “That is why it is critical to protect the universities and hospitals and allow them to function. That’s the pipeline of talent. My fear is that, intentionally or unintentionally, this highly productive Lebanese medical training system would get strangled at the source by a long-lasting, highly destructive war that would discourage the best and brightest young people to get their education in Lebanon.”
The AUBMC is an institution in Lebanon. Together with a second, smaller hospital just north of Beirut, the private American medical system has 340 physicians, 440 residents (doctors in training), 1,000 nurses and 1,000 other staff. The AUBMC is ranked as the top hospital in Lebanon and one of the best in the Middle East. Dr. Khuri has been its president since 2015 and oversees a combined university and hospitals’ budget of more than US$400-million.
The main hospital has learned to cope with hardship. It has, for instance, formed alliances with local Lebanese hospitals to create a buying consortium for medical supplies. When one hospital is overwhelmed, it can send patients to another in the alliance. They can trade expertise. The AUBMC has a number of surgeons who specialize in reconstructive surgery. Their talents were tested on the day of the pager explosions.
Fadlo Khuri, president of the American University of Beirut, speaks during an interview with AFP on campus, on June 23, 2020.JOSEPH EID/AFP/Getty Images
Trouble may lie ahead. The AUBMC fears it could run short of supplies as the war cripples large parts of the country and destroys infrastructure. So far, Beirut’s Rafic Hariri International Airport remains open, but only one carrier, Middle East Airlines, is landing planes with any frequency. Israel bombed the airport in the 34-day Israel-Hezbollah war in 2006, and Lebanese hospitals fear it will happen again in this war. “We have adequate supplies for now, but we do not have adequate supplies should there be a blockade or the airport closes,” Dr. Khuri said.
Another risk is financial. Emergency-ward patients, such as those from the pager attack, generally do not have medical insurance and cannot afford treatment. The AUBMC does get support from the Lebanese government, but it covers only 10 to 20 per cent of the cost of trauma care, Dr. Khuri said. “We are looking at being US$10-million in the red just in the last three weeks.”
Still another risk is a possible overwhelming influx of patients from southern Lebanon, the scene of intense bombing by Israel and ground combat between Hezbollah fighters and Israeli soldiers. Already, at least four hospitals in the country have closed owing to bomb damage or a shortage of supplies. One of them is in Beirut’s southern suburbs, which Israel considers a Hezbollah stronghold and has bombed almost every night in the past two weeks.
The Lebanese Red Cross is struggling to cope with the crisis as attacks continue in south Beirut. “When there is bombing in the area, we cannot send ambulances in for security reasons,” Ayad Mounzer, the Red Cross’s communications director, told The Globe. “We need to protect our volunteers.”
If more Lebanese hospitals close in hot spots, it seems inevitable that the AUBMC will get inundated with trauma victims, as it has in previous wars. The hospital will not turn away patients as long as it is capable of treating them. “We will always be there,” Dr. Khuri said. “History has shown that the longer the wars in Lebanon, the more we get pulled into caring for patients from all sectors and groups.”