by Michael Karam

The Lebanese have a wonderful ability to adapt. I guess it comes from having to fend for themselves under various occupiers down the millennia. But even today, 74 years after winning independence from France, the average Lebanese knows that he cannot rely on the state for health care, education, electricity and water. It is a situation that has allowed sectarian politics to flourish to the extent that allegiance to a political party is often greater than that to the government, but it has also prompted the private sector to take matters into its own hands. Lebanon is, after all, arguably the purest expression of a mercantile culture.

I was thinking about this last week when the British media was once again in a fit of angst over the National Health Service (NHS). Now I happen to think, having lived full-time in the UK for over two decades, that the NHS, along with that of the Sécurité Sociale in France, is not only one of the best healthcare systems in the world, but also one of the greatest expressions of the welfare state anywhere on the planet. Even if it appears to be in terminal crisis: staff shortages, overcrowding (often attributed to so-called health tourists and EU immigration) and underfunding (the austerity measures implemented by the Conservative government have been blamed). Accident and Emergency departments across the country are the regular focus of "NHS in turmoil" stories, with tales of patients lying on stretchers in corridors for hours waiting for treatment. It’s a sorry situation all round. Part of the problem lies with the fact that many people will pop into A&E with non-life- threatening conditions such as a sprained ankle or a bad cold, either because their GP is not available or they are simply lazy and selfish, or both, and there have been calls to give pharmacists greater powers to treat conditions that do not really require a hospital visit. This would in theory free up hospitals to deal with more deserving cases.

The Lebanese have been doing this for decades. The local pharmacy is not just a place to buy Panadol and lozenges. Pharmacists in Lebanon are almost as highly regarded as physicians and play an integral role in coordinating with the ministry of health to ensure what healthcare system there is can function.

In fact in the cities, GPs as we know them in the UK no longer play a vital role. The Lebanese have access to highly trained specialists and can do this because everyone has basic health insurance, similar to that available in France where they are refunded either in full or in part for any consultations or procedures. In my 22 years in Lebanon, my family saw dermatologists, urologists, gynaecologists, paediatricians and orthopaedists. The country is awash with doctors, many trained in some of the world’s best teaching hospitals.

There is a state healthcare system but, like with schooling, most people prefer to go private: affordable private or expensive private. It’s their call. The country has something for all budgets, and that includes private hospitals.

In rural communities, the dispensary plays a crucial role in providing drugs to the less well off. There is often a local "seen it all" GP and local hospitals do run a relatively efficient ambulance service, often courtesy of the local Red Cross or Red Crescent. Meanwhile, Hizbollah, the often demonised Shia political party, can attribute much its success to giving health care and schooling to its constituents, while the Sunni community has the Makassed schools and the Hariri Foundation, while the church has for centuries offered affordable education and care to its flock.

Electricity and water are another issue altogether. The private sector has moved in to cover the state’s shortfall. It has almost become an established sector and, come the day the government can provide a plentiful and continuous supply of both, it will have the headache of what to do with people who have built businesses on the back of the state’s woeful inadequacy.

I get the feeling that when it comes to health and education, the Lebanese don’t mind paying a bit to get what they feel is a better service. All they really want from the state is power and water. As a friend told me last year during yet another power cut, "just give us these two things and the government can do what it wants. We don’t need it".

Michael Karam is a freelance writer who lives between Beirut and Brighton.

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