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The WHO country office in Lebanon convened a technical mission to assess the management of malnutrition at primary and secondary health care levels in the context of the current crises in Lebanon.

A public health nutrition expert from WHO headquarters undertook a 1-week mission in which key informant interviews were conducted with stakeholders involved in the field of nutrition. Stakeholders included experts from the Ministry of Public Health, United Nations agencies, as well as nongovernmental organizations working on the management of malnutrition.

Field visits to primary health care centres and hospitals that provide screening and treatment for malnutrition for children under 5 years of age were conducted. The outcome of the mission was to gather data to review the national guidelines around the management of malnutrition and their use at field level, as well as to provide recommendations for improvement in regard to malnutrition programming in Lebanon.

Lebanon has been struggling with the consequences of an unprecedented fiscal and economic crisis and political instability since late 2019, in addition to the protracted Syrian crisis, with an ongoing rise in humanitarian needs.

In February 2020, Lebanon reported its first coronavirus (COVID-19) case, and a subsequent surge in cases and health needs further burdened the already stretched health care system, which struggled to cope with rising demand.

The massive Beirut Port explosion that struck the city on 4 August 2020 came at a tough time for Lebanon, while it was not only trying to control the spread of COVID-19 but also challenged with ongoing multifaceted crises, including a protracted Syrian refugee crisis and a severe and unprecedented financial and sociopolitical crisis with deleterious repercussions on the country’s economy. While the health system was already working at the limits of its capacity, the explosion further shook it, putting 500 hospital beds out of order for almost one year, and partially or completely destroying more than 50 primary health care (PHC) centres. The city’s infrastructure, particularly water and sanitation and housing, were severely affected. The explosion left thousands injured and hundreds of thousands displaced, with the already overlapping emergencies pushing the population into poverty and further impairing their capacity to cope, leaving many vulnerable Lebanese and refugees on the brink of being able to secure a livelihood.

Despite the general instability, the country was able to sustain continued access for vulnerable populations to PHC and maintain low levels of maternal and child mortality in addition to a polio-free status. Interventions such as strengthening the capacities of public health systems were accelerated. WHO support focused on filling critical gaps in the complex crisis response and bridging it to the development of the health system capacity and infrastructure, in line with the UN humanitarian-development nexus.

We thank our donors for their generous support and contributions, the Ministry of Public Health for its strong commitment, and all health partners for their involvement and sustained solidarity. Through timely response and work around the clock, WHO was able to support the health sector against all odds. Lebanon will remain irrepressible, setting an example of a resilient community and a health system that continues to build back better in the face of all hardships. We should ensure sustained support and solidarity to effectively deliver health care services to everyone in both the short and longer term.

1. What are the COVID-19 community isolation centres?

These centres have been established to provide persons who tested positive for COVID-19, both asymptomatic or mild symptoms, with a temporary place to safely self-isolate. They are also for persons who have been exposed to COVID-19 and need to be quarantined. Some of these community isolation sites have been designated by the Government of Lebanon after consultation with the municipalities and an assessment by the Orders of Nurses and Lebanese Armed Forces. These centres are managed by the Government of Lebanon with operational support from international and local agencies. In addition, to meet the needs of Palestinian refugees in Lebanon, UNRWA and Médecins Sans Frontières (MSF) also manage quarantine and isolation centres, for both confirmed and suspected cases.

2. Why is isolating or quarantining important?

Isolation is for positive COVID-19 cases. Quarantine is for suspected cases. For quarantine, the purpose is to separate healthy persons who may have been exposed to the virus from the rest of the population in order to observe symptoms and identify cases at an early stage. For isolation, the purpose is to isolate the people who got the virus from the remaining population till they are no more at risk of transmitting the disease to others. Both quarantine and isolation are the most effective measures to control the spread of 2019 coronavirus disease (COVID-19), since till this date, there are no vaccines and no medications to treat the 2019 coronavirus disease (COVID-19).

3. Who are the community isolation centres for?

These centres are intended for people who have been confirmed to be infected with the virus (as a result of PCR) and who cannot quarantine or isolate at home due to living in an overcrowded household or home (such as not having access to a private room and or toilet). This includes those living in informal tented settlements, camps, collective shelters and congested urban settings, such as houses without a private bedroom and toilet. If home isolation or quarantine is feasible and safe, people may adopt home isolation or quarantine.

4. Are the community isolation centres for everyone to access?

The community isolation centres are open to all persons whose living situation prevents them from self-quarantining or self-isolating when in contact/or infected with COVID-19. Access to all isolation centres is based on a strict non-discrimination policy: centres are accessible for any persons regardless of their nationality, background, gender, sexual orientation, age, nationality, or any other identity factors. Centres are open for Lebanese nationals, refugees, migrants or other foreign workers in need.

5. What are the requirements for entering the centres?

If you are referred to a community isolation centers you must meet the following criteria:

• Receive a referral by the district physician or other competent health authority, following Ministry of Public Health instructions for following up on coronavirus (COVID-19) cases.

• Person with PCR positive must have either no symptoms or mild symptoms of COVID-19.

• Quarantined/isolated person with associated medical conditions (including chronic conditions) must be medically well controlled for these conditions. In case of severe medical conditions, the person will be referred to hospital.

• Quarantined/isolated person must be capable of maintaining basic care of his/herself and/or be accompanied by a caregiver if he/she has specific needs: elderly, disabled, or other needs. The same caregiver should accompany the child or adult for the entire quarantine period.

• Children under the age of 18 years must be accompanied by a caregiver.

• A commitment to comply with quarantine/isolation conditions must be signed.

6. How can community isolation centres be accessed and how are these decisions made?

Any persons needing to access the community isolation centres must be referred through the MoPH district physicians or other relevant medical authorities, following the official COVID-19 Lebanon protocol (i.e. through the district risk management committee, syndicate of social workers assessment, and transportation from the Lebanese Red cross).

Persons cannot and should not go directly to the isolation centers. If you think you are in need, you may call MoPH COVID-19 hotline 01 594 459. The type of quarantine or isolation needed is assessed and determined by the competent health authorities and according to the World Health Organization guidance and the MOPH protocol.

For UNRWA and MSF managed centres, Palestine refugees can also be referred through UNRWA Area Health officers, and other nationalities will be referred through coordination with the MoPH.

Palestine refugees can also contact Area Health Officers as per the list below:

70888542 - 76683644 Central Lebanon Area

70088003 - 76683657 03936777 Saida

70088002 - 03010243 North

70088004 - 03927974 Tyre

03935777 Beqaa (Hospitalization Medical Officer)

7. How long can persons expect to stay in the community isolation centres?

Length of stay is variable based on each case (isolation or quarantine), however the average duration is between 10 to 14 days. In case of medical deterioration, the person will be transorted to the hospital through the Lebanese Red Cross.

8. What care will persons receive in the community isolation centres?

Persons in the community isolation centres will receive food, water, hygiene materials, and medical monitoring of COVID-19 symptoms (i.e. provision of daily check-ups and medical information by medical staff). Internet and phone access may or may not be available. Admission and discharge are upon the MoPH or relevant medical authorities. No visitors are permitted within the community isolation centres in order to prevent the spread of COVID-19. Access to or referrals for social services may be available, including for mental health and psychosocial support, child protection and specialized support for women and girls, elderly persons, and persons with disabilities. This would be done through the Association of Social Workers, the Ministry of Social Affairs and local organizations

9. Do persons in the community isolation centres receive medical care to address COVID-19 symptoms while at the centre?

No. The primary purpose of the isolation centres is to monitor the associated symptoms for COVID-19; the community isolation centres are not equipped for other medical services. If you have other medical conditions, or your health condition worsens during your stay, you will be referred to a public hospital for further care.

10. Are these isolation centres safe?

Your safety and well-being is our priority. There will be a private or shared room for each person and caregiver, when necessary as well as security on site. There will also be gender separate bathrooms and areas, as well as female staff for women and girls and male staff for men and boys. Any form of discrimination, abuse or exploitation is strictly prohibited.

11. Can I leave the centre if I decide I am not comfortable here?

Going to an isolation centres is voluntary. No one will be obliged to stay, however persons choosing to leave will need to prove that they can go to another place where they will not spread the virus to others. It is the responsibility of the physician to give the needed approval for admission to or discharge from the centres.

12. What if I have children and no alternative caregiver and need to stay at the centre due to COVID-19?

Children can accompany the caregiver only in case they have the same positive or suspect status. Where the status of the child and caregiver are different, efforts should be made to find solutions for temporary care for the child(ren) in the community. In case solutions for extended relatives or trusted community members are not available for childcare, the municipality will contact the Ministry of Social Affairs and Syndicate of Social Workers to request support in the appointment of a caregiver for the child during this period.

13. What if my child is a COVID-19 positive and needs to access the isolation centres?

Anyone under the age of 18 must be accompanied by a caregiver. The same caregiver should accompany the child for the entire quarantine/isolation period. The caregiver should be in good health, not have underlying medical conditions and able to take care of themselves and the child.

14. How will I be able to maintain contact with my family while at the centre? What if I don't have a mobile phone?

The site manager will facilitate for all residents in the community isolation centres to have communication with families by all means available.

15. I still have concerns and questions about COVID-19?

You may call the MoPH COVID-19 hotline 01 594 459.

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