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Beirut explosion aftermath: lessons and guidelines
  1. Samar Al-Hajj1,
  2. Ali H Mokdad2,
  3. Amin Kazzi3
  1. 1 Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  2. 2 Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, Washington, USA
  3. 3 Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  1. Correspondence to Dr Samar Al-Hajj, American University of Beirut, Beirut 1107, Lebanon; sh137{at}

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On 4 August 2020, around 2750 tonnes of ammonium nitrate (AN) stored at the Port of Beirut, Lebanon, exploded causing one of the largest chemical explosions in history and the third most devastating explosion in recent time.1 We believe there are lessons for other countries to learn and to avoid such manmade disasters and for recovery after such incidents.

For Lebanon, the devastating effects of the explosion amplified the pre-existing social, economic and health challenges the country has been enduring for countless years. Moreover, Lebanon has been faced with a refugee crisis; nearly 1.2 million refugees were displaced from Syria and settled in Lebanon resulting in the highest refugee per capita worldwide.2 Decades of political corruption and sectarian dissection have laid the foundation for a collapsing state that failed to secure safety and to provide basic services to its citizens.

The Beirut port explosion triggered further ripple effects on the country’s fragile social, economic and health infrastructure. The Beirut explosion severely affected the Lebanese healthcare sector. The massive influx of blast casualties and severely injured individuals further strained the fragmented and under-resourced healthcare system, exposing its vulnerability in addressing complex emergencies and managing large-scale mass casualty incidents. The blast overburdened medical providers, hospitals and medical facilities that have been already struggling to control the fast-spreading COVID-19 pandemic since February 2020 due to limited resources and financial constraints. The port destruction further challenged the provision of imported medical equipment and supplies that are critical to sustain clinical operations and to ensure the safety of both the patients and healthcare workers.

Due to the proximity of the Port of Beirut to its urban and densely populated area, nearly one-quarter of the city’s metropolis was destroyed, resulting in around 6500 injuries, 220 deaths and more than 300 000 displaced individuals,1 many of whom were children. Furthermore, 6 hospitals and more than 22 healthcare facilities suffered from damages of varying degrees,1 further reducing local hospital bed capacity to care for the blast casualties. Additionally, the toxic gases released by the ammonium nitrate detonation (eg, ammonia gas, nitrogen oxides, etc)3 had the potential for triggering respiratory problems that would drive other individuals to health facilities.

The blast caused an upsurge in COVID-19 cases as displaced individuals who lost their homes were forced to live in extended families and overcrowded settings. With an estimated 300 000 people homeless, many individuals were directly affected by the blast and not only just witnessed the event, which increases their risk of developing adverse long-term psychiatric illnesses including post-traumatic stress disorder, anxiety, depression and psychosomatic illnesses.4 There are reports of increased psychological disorders manifested in the number of patients presented to the American University of Beirut Psychiatric clinic.

We recommend a series of guidelines that will serve to target limited resources healthcare systems, inform safety policies and promote for the physical and mental health of individuals.

Storage and transportation safety

The Port of Beirut violated safety regulations of ammonium nitrate storage. Strict implementation and enforcement of ports safety procedures and policies are needed to ensure that ships are prohibited from docking at foreign ports and ships commuting across international ports should meet international inspection and maintenance requirements and safety standards. Reducing storage quantities of hazardous materials, integrating safety barriers while ensuring the required separation storage distance, and selecting non-urban storage sites are critical for population safety.

Response and recovery

Communication and coordination among multiple entities are vital to ensure a harmonised multisite and multidisciplinary timely response and service provision in large-scale disasters. Response and recovery efforts should be coordinated with the international community to ensure speedy reconstruction and mobilisation of aid to people in dire need. Non-governmental organisations should also coordinate their efforts to provide emotional support to traumatic stress victims during the acute period following the explosion.

Hospital emergency preparedness

Although most hospitals have formal emergency and disaster preparedness plans, significant gaps in disaster preparedness had already been identified before the blast5 . The Beirut port explosion highlighted the importance of dispersing the storage of medical supplies, equipment and medicines across multiple sites to avoid the one-time loss of all essential response components, similar to the grains and medicine warehouses at Beirut Port. Future initiatives should focus on exploring and addressing all the deficiencies in a post-blast reformed healthcare system, building upon existing resources and capacities to strengthen system response and preparedness.

A plan for economic recovery and conflict resolution is highly needed for Lebanon. Other countries should avoid the Lebanese mistake in terms of storage, response coordination and emergency preparedness for natural and man-made disasters.

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  • Handling editor Kirsty Challen

  • Twitter @DrSamarHajj

  • Contributors All authors have contributed to the conception, writing and revision of the viewpoint.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.