Lebanon
An Eastern Mediterranean country that scores well on policy and education indicators but went through a financial collapse, which tests whether those gains translate into access and survive a crisis.
8 domains reviewed · 8 high-confidence · 1 dated estimate · 9 material gaps
WHO region: Eastern Mediterranean. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 8 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 13
- Newest source 2026
Lessons from Lebanon
- Strong policy and education indicators did not reach the second city, where there were no services and almost no awareness. Reach outside the major cities should be measured, not only national policy milestones.49,141
- Mandatory palliative teaching in every medical and nursing school is Lebanon's strongest feature. It is a low-cost reform that medical and nursing councils elsewhere could adopt.49
- A budget line and a strategy did not protect services from an economic collapse that drove out health workers and cut financing. Workforce retention belongs in a resilience plan.141
- A donor-funded home team with 24/7 phone access, emergency medicine kits and caregiver training kept end-of-life care running through economic collapse, a pandemic and war.327
- Emergency symptom kits, caregiver training by video and a 24-hour nurse phone line let a donation-funded home care team keep patients at home through financial collapse, lockdown and war.327
- Working with a local manufacturer to produce low-cost immediate-release morphine can protect pain relief when imports fail during an economic crisis.327
Palliative care
Is morphine available in Lebanon?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
Lebanon was named among Middle Eastern countries with severe opioid formulary deficiencies and over-regulation, and was not among the regional countries reporting oral and injectable morphine consistently available.140,49
Did the 2019 collapse cause opioid shortages specifically, and what is consumption before and after?
Help answer it:Search PubMedHow does Lebanon regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
The Ministry of Health's Narcotic Department adjusted opioid prescription rules and registered new opioids in 2012. Lebanon reports a national palliative care strategy.139,49
Which decree now governs narcotics prescribing, and has it changed since the crisis?
Help answer it:Search PubMedWho can prescribe morphine in Lebanon?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Which professions may prescribe oral morphine, and under what conditions?
Help answer it:Search PubMedHow does palliative care reach patients in Lebanon?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 0.09 per 100,000SOURCE-CHECKED · 2020 DATA
Specialised palliative care services per 100,000 population, Lebanon, 202049
Last checked 2026-09-24.
Tied for the highest ratio in the regional survey.
Cite this figure: - 95.80 percentSOURCE-CHECKED
Adults surveyed in Tripoli who had never heard of palliative care, Lebanon, 2023141
Last checked 2026-09-24.
383 of 400 adults at one NGO serving a disadvantaged population.
Cite this figure:
Service density ties for the highest in the region, but services sit mainly in the capital. The second city had none, and almost no one surveyed there had heard of palliative care.49,141
Who pays for palliative care in Lebanon?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Palliative care has a line in the national health budget, yet lack of reimbursement remains a barrier, and the post-2019 crisis cut health financing and drove health workers abroad.49,141
How has the mix of public, out-of-pocket and NGO funding shifted since 2019?
Help answer it:Search PubMedHow are palliative care clinicians trained in Lebanon?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Lebanon recognises palliative care as a full specialty, not only a subspecialty, and teaches it as a mandatory subject in all medical schools and in all nursing degrees.49
How does Lebanon prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Lebanon launched a national buprenorphine substitution program in 2011, and users reported that registration protected them from arrest while access was geographically restricted. The narcotics department adjusted prescription rules and registered new opioids in 2012. Before the 2019 crisis there was no methadone, hydromorphone or liquid immediate-release morphine, and a local company later began producing immediate-release morphine at low cost.637,638,139,327
Is naloxone available outside hospitals, and has the buprenorphine program kept supply and enrollment through the economic collapse and 2024 war?
Help answer it:Search PubMedHow do children get palliative care in Lebanon?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
Pediatric palliative care delivery and fee coverage emerged through a partnership with the Children's Cancer Center of Lebanon. A 2013 study at that center found symptom management was inadequate and focused mainly on physical symptoms, and liquid or granule immediate-release morphine has been unavailable.327,639
How many children receive palliative care each year, and are child-appropriate oral opioid formulations now registered?
Help answer it:Search PubMedHow is palliative care delivered during crises in Lebanon?
During the 2024 war and displacement, the Balsam home care team visited patients in shelters and used telemedicine, emergency medication kits with morphine and midazolam, and caregiver training to keep care going. Earlier, after the 2019 collapse caused medicine shortages, expatriate donations and medication recycling sustained symptom control. These accounts come from the service's own staff.327
How many palliative patients lost care during the 2024 displacement, and what reaches Syrian refugees with serious illness?
Help answer it:Search PubMedHospice care in Lebanon
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Lebanon?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Hospice-type care in Lebanon is home based and run by nonprofits. Balsam, founded in 2010 as the country's first palliative care service, draws on French mobile teams and North American hospice and offers 24/7 home care; a 2024 overview counts three nonprofits giving home-based palliative care mainly to end-of-life patients. Local papers use 'home-based hospice' and 'home-based palliative care' for the same kind of service.327,328,329
Do any inpatient hospice beds exist in Lebanon outside hospital palliative wards?
Help answer it:Search PubMedWho can get hospice care in Lebanon?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
Balsam reports that access does not depend on a prognosis of 6 months or less or on giving up curative treatment, and the same team follows patients through the illness. Patients come from hospital palliative teams under memoranda of understanding and from referring physicians. Self-description by the provider.327
How late in the illness do patients reach home-based services, and do the other nonprofits use the same rules?
Help answer it:Search PubMedWho pays for hospice care in Lebanon?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
Home-based services are free to patients, and Balsam runs without public funding on community donations, charity events and family support. Hospital-based palliative care is not reimbursed, so only those who can pay can use it.327,328
What did the reported National Social Security reimbursement changes cover, and do they reach home-based providers?
Help answer it:Search PubMedHow many people reach hospice in Lebanon?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Balsam cares for over 300 patients a year, and three nonprofits provide home-based end-of-life care nationally. Hospital palliative services sit mainly in private facilities in Beirut, and Balsam built a telephone program for rural and remote villages.327,328
How many people who die in Lebanon each year receive home-based end-of-life care, including refugees and non-cancer patients?
Help answer it:Search PubMedWhat fills the gap in Lebanon
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
At one Beirut center, 58.8% of 165 seriously ill adults preferred to die at home, and this preference was linked to having family caregivers and social support. Family caregivers described staying present, meeting personal and medical needs and managing finances, with caregiving underpinned by religious values and duty.463,464
Single-site evidence- Substitute and informal pain relief
During the post-2019 crisis, Lebanese expatriates carried suitcases of medicines to local NGOs, and a home-care NGO collected unused medicines from discharged or deceased patients for redistribution. The same NGO gave families emergency kits with morphine, midazolam and antiseizure drugs to manage symptoms at home.327
Single-site evidenceSelf-reported- Charity, religious giving and mutual aid
In a 2022 Beirut hospital survey, 69.60% of cancer patients paid for medication themselves and 11.20% relied on donations. Authors note patients rely on social media fundraising, telethons and diaspora remittances, and a leading home palliative care NGO runs on community donations and family support.465,327
Single-site evidenceSelf-reported- Phone and remote support
A Lebanese home palliative care NGO offers a 24-hour phone line to an assigned nurse and scaled a telephone support program into telemedicine during COVID-19. Families were trained by video to give medicines and monitor symptoms, which the team also relied on during the 2024 war and displacement.327
Single-site evidenceSelf-reported
Sources cited here
- 140Cleary J, Silbermann M, Scholten W, Radbruch L, Torode J, Cherny NI.
Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East: a report from the Global Opioid Policy Initiative (GOPI). Annals of Oncology 2013;24(Suppl 11):xi51-xi59. DOI 10.1093/annonc/mdt503. Abstract read. Lebanon among Middle Eastern countries with severe formulary deficiencies and over-regulation.
- 49Sanchez-Cardenas MA, Pourghazian N, Garralda E, et al.
Palliative care in the Eastern Mediterranean: comparative analysis using specific indicators. BMC Palliative Care 2022;21:168. DOI 10.1186/s12904-022-01047-7. Expert survey of 12 EMR countries, including Iran, Jordan, Egypt, Morocco and Pakistan. Iran and Jordan are among the countries reported to have a national palliative care strategy, a designated Ministry of Health officer for palliative care and palliative care recognised as a subspecialty; recognition years are not given. Full text read.
- 139Yamout R, Ayoub E, Naccache N, Abou Zeid H, Matar MT, Antakly MC.
Opioid drugs: what is next for Lebanon? Journal Medical Libanais 2013;61(4):210-215. DOI 10.12816/0001464. Abstract read. The Ministry of Health's Narcotic Department adjusted opioid prescription regulations and registered new opioid drugs in 2012 to improve access.
- 141Demachkieh F, Kassab A, Darwich M, Chaiban L, Kasir D, Naji YR, et al.
Awareness and knowledge of palliative care in Tripoli, Lebanon: a cross-sectional study in a disadvantaged population. Palliative Care and Social Practice 2026;20:26323524261449268. DOI 10.1177/26323524261449268. Crisis since 2019 with health worker migration, financing cuts and medicine shortages; services concentrated in the capital, none in Tripoli at the time; awareness survey in 2023; lack of reimbursement as a barrier; home hospice length of stay. Full text read.
- 637El-Khoury J, Abbas Z, Nakhle PE, et al.
Implementing opioid substitution in Lebanon: Inception and challenges. Int J Drug Policy 2016;31:178-83. Program description of the national buprenorphine substitution program launched in 2011; co-authors from the Ministry of Public Health narcotics department, so partly a self-evaluation. Abstract read.
- 638Ghaddar A, Khandaqji S, Abbass Z.
Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective. Subst Abuse Treat Prev Policy 2018;13(1):14. Qualitative interviews with 81 male OAT users in 2016; one co-author from the Ministry of Public Health narcotics department. Abstract read.
- 327El Khoury J, Yamout R, Hanna J, et al.
Shaped by crisis, rooted in community: Lessons from Lebanon's palliative care model. Palliat Care Soc Pract 2025;19:26323524251386061. Editorial describing the Balsam home-based model, its eligibility, donor funding and crisis adaptations; written by Balsam clinicians and advocates (self-evaluation, advocacy). Full text read.
- 639Abu-Saad Huijer H, Sagherian K, Tamim H, et al.
Quality of palliative care in children with cancer in Lebanon. J Med Liban 2013;61(4):228-36. Cross-sectional survey of 85 children aged 7 to 18 on therapy at the Children's Cancer Center of Lebanon (2010 to 2011); single-center convenience sample, pre-2012 data. Abstract read.
- 328Sailian SD, Hanna J, Asmar RE, et al.
Palliative Care in the Midst of Adversity: Insights from a Low-Income Country. J Palliat Care 2024;41(1):8-14. National overview of Lebanese palliative care services based on stakeholder presentations at the 2023 National Palliative Care Conference; authors include service leaders (possible self-report bias). Abstract read.
- 329Sailian SD, Salifu Y, Preston N
Dignity enhanced through faith & family support in palliative care: a qualitative study. BMC Palliat Care 2024;23(1):142. Qualitative study of 14 patients recruited from a home-based hospice service and a hospital outpatient clinic in Beirut; used here only for terminology and setting. Full text read.
- 463Jaber F, Kassem J, Othman RE, et al.
Preferred Place of Death in Serious Chronic Illness: Single-Center Study in Lebanon. J Pain Symptom Manage 2026;71(5):610-617. Structured interviews with 165 seriously ill adults at one Beirut tertiary center on preferred place of death and its predictors; single center. Abstract read.
- 464Sailian SD, Salifu Y, Preston N
Dignity in Serious Illness: A Qualitative Exploration of Family Caregivers' Contributions in low middle-income country. Palliat Support Care 2025;23:e61. In-depth interviews with 15 Lebanese family caregivers on how they preserve a seriously ill relative's dignity, with caregiving underpinned by religious values and duty. Abstract read.
- 465Eid D, Jabbour J, Moujaes E, et al.
Impact of the economic crisis and drug shortage on Lebanese cancer patients' care. World J Clin Oncol 2024;15(5):644-652. Questionnaire of 182 outpatients at one Beirut university hospital in February 2022 on drug shortages, self-payment and donations; single tertiary site. Full text read.