by foreignpolicy.com — BETSY JOLES  — Fear of the COVID-19 epidemic has spread across the Middle East after Iran recorded the highest number of deaths from the virus outside of China this week. The high mortality rate indicates the outbreak might be larger than Iran’s official recorded figures. Saudi Arabia has responded by banning foreign pilgrims from traveling to the holy sites of Mecca and Medina. Lebanon has confirmed three cases so far, people who had returned from recent trips to Iran. The threat could not come at a worse time: The country is teetering on the edge of bankruptcy and reeling from several months of anti-government protests. Lebanon is facing its worst economic crisis since its 1975-1990 civil war, with a looming $1.2 billion Eurobond payment on March 9. If the government defaults, it would deal another major blow. These financial shortcomings limit the country’s ability to respond to the coronavirus, from hiring enough trained health workers to conduct fever screenings at the airport to equipping hospitals with specialized gear such as respirators for quarantine areas. Coming up with the human and capital resources needed to handle severe virus cases would put an already ailing health care system in dire straits.

The state of the economy has already overwhelmed Lebanon’s public health care system. Medical suppliers are unable to import the products they need due to a shortage of U.S. dollars caused in part by a slowdown of foreign currency injections into the banking sector. Health care is another item on the list of demonstrators’ public grievances, with medical professionals decrying corruption and inattention from the government when it comes to providing hospitals with what they need. Doctors are also protesting the government’s failure to reimburse hospitals for care provided to patients who should be covered by social security and military health funds, according to Human Rights Watch. The procedures put in place so far to prevent the spread of the virus inside Lebanon show the health care system’s strain.

The procedures put in place so far to prevent the spread of the virus inside Lebanon show the health care system’s strain. Fearing shortages, the government has banned the export of medical supplies to protect from infectious disease, such as face masks. People who arrive in Lebanon from countries with outbreaks are screened for fevers and told to self-quarantine at home and follow guidelines from the Ministry of Public Health. But there is no system in place to monitor them once they’ve left the airport, in contrast to countries such as South Korea, where potential sufferers were required to use an app to trace their movements. There are also limited resources available for mass isolation measures if people do show symptoms of the virus, according to Salim Adib, an epidemiologist and consultant to the Ministry of Public Health. The next few weeks will be crucial for determining the system’s ability to handle an outbreak. “There’s no cash to do anything, including for new public health measures,” said Adib. “If we needed to quarantine a lot of people, we would be at a loss.”

The problem of limited resources is compounded by a disjointed response from a government in flux. Since the anti-government protests began in October 2019, Lebanon has undergone a political overhaul. Prime Minister Saad Hariri resigned less than two weeks after the demonstrations started. Lebanon’s president named Hassan Diab as prime minister and a new cabinet was formed in late January, ending three months of political deadlock. Lebanon’s new government is controlled by the Iran-backed Hezbollah party and its allies. The political turmoil has coincided with the spread of the coronavirus. While Lebanon’s leadership focused on political restructuring and the economic crisis, they missed a crucial opportunity to fully develop an emergency response plan to the impending health crisis. That plan should have included procedures for mass quarantine and for monitoring people returning from countries with outbreaks, according to Fadi El-Jardali, a health policy professor at the American University of Beirut. “This has not been managed the way it should have been managed,” he said.

The Lebanese government has appealed to the World Health Organization for assistance in building additional quarantine facilities. But fighting an epidemic requires a level of government coordination that El-Jardali said he has not seen so far from the country’s leadership. “When dealing with outbreaks and pandemics, business is not as usual,” he said. “We don’t have the luxury of learning by doing here. We only have time to do, and [to] do what is right.” A coronavirus outbreak would put Lebanon’s vulnerable populations at especially high risk.A coronavirus outbreak would put Lebanon’s vulnerable populations at especially high risk. The country hosts the most refugees per capita in the world, including more than 1.5 million Syrian refugees and significant numbers of Ethiopians, Iraqis, Palestinians, and Sudanese. Overcrowded conditions and poor sanitation in camps and settlements could make them a breeding ground for disease. The risk extends to Lebanon’s poor. The World Bank warns that around half of Lebanon’s population could fall below the poverty line if economic conditions worsen. Communities with limited access to formal health care may be less likely to report virus symptoms—another challenge for Lebanon’s epidemic response.

On Friday, Lebanon halted travel for nonresidents from countries with the coronavirus, including China, Italy, South Korea—and Iran. Given the government’s relationship with Tehran, the travel restrictions are a political matter, said Mohanad Hage Ali, the director of communications at the Carnegie Middle East Center in Beirut. Initially, the government had stopped some flights to Iran, including those for pilgrims. But Hage Ali said he had not seen details about how the measures would be put into practice. “To what extent will it be implemented, that’s the question,” he said.