Lebanon: Mental health medication shortages bring new source of distress
When 23-year-old Sacha found out that her local pharmacy had run out of Seroquel and Manicarb, she felt an all too familiar sense of distress.
The medication has been crucial in helping the young Lebanese woman manage her condition - which has been diagnosed as either bipolar II disorder or borderline personality disorder. But the series of crises that have befallen Lebanon in less than two years have now left those in the country who rely on medication to treat mental health conditions in a tenuous position.
“You’re just living with this constant anxiety that you might go back to living without your medication,” Sacha said. “You’re just like ‘no, no, no I don’t want to go back there’.”
Since late 2019, a financial crisis has crippled the economy, dragging over half of the population under the poverty line and leading the Lebanese lira to spiral downwards, losing 90 percent of its value.
Economic conditions further worsened with the Covid-19 pandemic, while the catastrophic Beirut port explosion in August, which killed at least 200 and wounded more than 6,000 people, has further added to the anguish and trauma of residents of the country.
Lebanon is facing growing shortages of some essential goods as it runs out of cash to maintain an expensive subsidies programme for wheat, fuel, some food items, and medicine. In recent weeks, hundreds of cars have been queueing up at gas stations in hopes of filling up their tanks with increasingly rationed fuel.
Medication has not been spared. While many prescriptions for drugs treating mental health conditions are still subsidised by the Lebanese central bank, the currency’s dramatic devaluation has led pharmaceutical distributors to hoard stockpiles of medicine, while pharmacists are left to ration whatever stocks they have left.
Already dealing with a lack of viable healthcare and mental health services and social stigma, people dealing with mental illness in Lebanon are now faced with the moral dilemma of trying to secure as much of their medicine as possible, or risk losing access entirely - all while navigating a deeply strained and distressing national context.
'Sense of guilt'
Upon finding out that her usual pharmacy in her hometown near Beirut no longer had her medicine in stock, Sacha said she and her family began driving to pharmacies as far away as the towns of Jbeil and Zahle, to make sure she had the stock she needed.
“My family was panicking, because they knew what life was like for me before medication,” she told MEE.
“My dad would finish work, then start going from pharmacy to pharmacy,” she recalled, admitting she felt a sense of guilt for being able to secure several months’ worth of her medication while others in the country were not as fortunate.
She’s fine for now, but a new dread now continually buffets her emotional wellbeing: the fear of running out of medication and having to cope without it.
Sacha is far from alone in her situation. According to the International Medical Corps, 17 percent of people in Lebanon suffered from a mental illness back in 2011, though about 90 percent of the population did not have access to treatment.
A decade later, the series of crises have only caused more hardship and trauma for those living in the country.
'This is how the country is'
Doctors Without Borders (MSF) pharmacy manager Mahmoud Khalifa told MEE that it now takes the organisation more time to obtain medicine needed by its patients.
“This is of course worrying, as it makes access to mental health care, among other medical services, more difficult for people,” he said.
“But until now, we have been able to adapt to the situation. However, we continue to monitor the situation closely as it is evolving rapidly.”
In September, 22-year-old Jinan - who requested to use a pseudonym - decided that it was time to consider taking medication to help her cope with the pressure of the crisis in Lebanon, soon after her therapist diagnosed her with borderline personality disorder.
“The deteriorating situation in the country certainly amplified the personal issues that eventually led me to seek professional help,” she told MEE. “But by January, I couldn’t find [my medicine] anywhere.”
When Jinan asked pharmacists to tell her where all the medicine went, she only received one of two answers: delayed shipments and - a Lebanese classic reply - “this is how the country is”.
Her psychiatrist reluctantly prescribed her an alternative medication with unpleasant side effects.
“It had to be done, we had to take this risk,” Jinan explained. “This one comes with side effects like loss of appetite and insomnia.”
Despite the physical discomfort, Jinan says she’s thankful that the medicine does the trick for now; her medication helps her stop thinking about taking her own life.
Solidarity on social media
But what happens to those who cannot find any medicine? Increasingly, people have been sharing whatever they have with each other.
Last April, Thurayya Zreik was able to get four sachets of lithium through a friend’s wife. She then gave one to a friend in need.
Transactions like these have become common in Beirut, with Zreik saying that this informal network has been life-saving at times.
Recently, she offered to give away some Seroquel in an Instagram post. “Please message me, I have a modest amount extra I don’t need,” she wrote.
Zreik heard from someone soon after; they had been looking for the medicine for their mother.
On a Facebook group, where users trade belongings and barter, a Lebanese poster expressed concerns earlier this month, saying they had been unable to take their anti-depressants for days simply because pharmacies had run out both of their prescription and of alternatives.
Shortly afterwards, another group member offered them an entire package of the medication, free of charge. “God bless you,” the initial poster replied.
'It's not something we should tolerate'
The emerging network of mutual aid is yet another case of people helping each other out in the face of inaction from Lebanese authorities.
The Lebanese Health Ministry and security agencies have been raiding warehouses belonging to people allegedly smuggling or hoarding medicine, though that has not impacted the current shortages.
“If you have medication, you share it with everyone – but then you run out of it,” Zreik said, fully accustomed to this new way of securing medication for months now. “Now, you rely on people coming from abroad to bring them.”
With the country’s security agencies unable to stop baby formula and fuel from being smuggled out of the country or hoarded, Zreik, Sacha, Jinan, and many others know that it is only a matter of time before the little resources people are able to share amongst themselves run out.
When that happens, they will have to come up with another solution - another burden further compounding their distress.
Lebanon’s crises forced many young people to become “financially literate”, Jinan explained, and adjust to constant uncertainties while having little to nothing to fall back on.
While she was still at university, she said she started writing other students’ papers to make some money, so she did not have to rely on her parents, who were coping with their own financial losses.
“But I started to feel like all my efforts were useless because the dollar rate kept going up and I was earning in lira,” she said.
“I almost felt that buying meds was money down the drain, since I am stuck in this country for a while.”
Much like people driving from one petrol station to another to top up their cars, Sacha’s long drives from pharmacy to pharmacy have become a routine experience for many people trying to secure their mental health medication.
“It’s something we’re used to,” she said. “But it’s not something we should tolerate."