On the afternoon of August 4, approximately 2,750 tons of ammonium nitrate stored in the port of Beirut, Lebanon, exploded accidentally due to a long-term lack of proper and safe
storage measures. The powerful explosions – equivalent to about 1.2 kilotons of trinitrotoluene (TNT) or a magnitude 3.3 earthquake – led to over 100 deaths and thousands of injuries (The event).

Dr. Zein El-Abidine from Najjar Hospital in Beirut shared details regarding the on-site situation, challenges and healthcare needs. Our discussion uncovered 4 core themes. These themes and their supporting insights are highlighted below.

1. “It was… like hell opened its doors.”
Dr. Zein El-Abidine’s account details a huge blast that, within seconds killed and injured thousands. The explosion was so huge and sudden that everyone in Beirut felt it and were affected in some way. People were running to the nearby hospital because the streets
were blocked and traffic was stopped. Many injuries were severe and tragic.

“What happened is a big explosion. No matter which area you live in
Beirut, you think that this explosion happened in your building. In one second, you see everybody injured in the street. It was really, just like hell opened its doors […] We have the deep wounds of bleeding. We have people coming with their stomach in their hands, people holding their fingers in the other hand. It was really a tragedy.”  —  Dr. Zein El-Abidine

2. The First Wave of Injuries to Hospital
In each hospital, emergency rooms were flooded with hundreds of injured people. It was about 6pm when injured people started to arrive at the hospital, when the full medical team was not at work.

The city streets were all blocked because of the many falling objects from buildings caused by the explosion. By the time more medical team members managed to get through all the difficulties on the road on their way back to the hospital for emergency duties, only 2 to 3 residents and 1 surgeon were managing 100 to 500 patients with injuries.

The explosions caused a lot of damage to the hospital:

  • There was no power and no lights. It got dark after 7pm, when more and more injured people were entering the hospitals. The medical teams had to wait for generators to start to have electricity.
  • Most of the windows and doors in the hospital building were broken.
  • A cancer center near the port was destroyed. There is now a lack of cancer medication.

The healthcare workers in the hospitals (who were on their shifts) were also injured. There is an urgent need for medical care.

There are a large number of patients who need care.

3. Strategic triage and management of cases

“There’s going to be all sorts of musculoskeletal injuries. Some are just going to be lifesaving, some are going to be limb saving, and some are just going to be managing open wounds. How much time did you have to organize all this from the moment you knew something terrible happened?” — Dr. Bhandari

“We had a lot of plans, but really when you are on site, with this destruction, it’s not the same. But definitely there is something in your mind, back mind, that will tell you how to go, which way to go. And this is what happened. Within about 10 to 15 minutes we were on track again.”  —  Dr. Zein El-Abidine

Dr. Zein El-Abidine also shared the importance of effective communication with injured people and their families. As an example, a worrying father brought in his child with a small injury but was requesting his child be made a priority to treat. Dr. Zein El-Abidine had to explain to the father that there were more severely injured victims who needed more urgent care; the doctors have responsibilities to help everybody and need to triage patients accordingly.

Dr. Zein El-Abidine said that on the day following the explosion, August 5, there were still people coming into the hospital but they were less injured. People who had minor injuries chose to stay at home on August 4 mainly because of closure of traffic. These patients visited the hospital on the following days and surgeries were continued.

4. Basic supplies, prosthetic devices and rehabilitation facilities are needed

“Every hour we have 100, 200 extra patients. We expect a first wave, second wave, and third wave of treatment.” — Dr. Zein El-Abidine

In the first, acute phase, basic supplies and drugs including plates, staples, sutures, external fixators and antibiotics are greatly in need due to the following reasons: 1) hospitals are not prepared for such a great and sudden demand of supplies with usual in-hospital stocks; 2) some hospitals’ stocks were near to the port and were therefore destroyed in the explosion; and 3) the country has been in a financial crisis for a while; the COVID-19 pandemic intensified
the financial crisis; and hospitals were experiencing a shortage of supplies even before the explosions happened.

“We were in shortage of any kind of medication, antibiotics, any products for surgeries, plates, screws, external fixators, all these needed for emergencies. We even lack supply for suturing, all types of suturing, even the basic ones like staples and everything […] We need them because we used tons of these products yesterday […] If we want to make an order now for any company, it will definitely take a minimum two or three weeks.

What I really feel is that we are losing the capacity to bring the best to our patients. Now I don’t think I can bring the best plates and screws from the best companies […] We cannot afford any more of these new technologies, because of our economic crisis.” — Dr. Zein El-Abidine

In the second wave of treatments, there will be a need for prosthetic replacements for patients who will need to undergo amputations.

“With time (going on), we will see more patients having amputations. We need the prostheses, legs and arms. We don’t have them. These are not emergency cases, but they are needed cases to treat.”  —  Dr. Zein El-Abidine

In the third wave, rehabilitation tools and infrastructure will be in needed. Despite focus on immediate triage and care, we must all be looking to the future to secure the necessary support to ensure all patients are properly rehabilitated. In the longer term, this is the critical gap we will face.

Questions and Answers:
Dr. Bhandari: Did you, at any point, have healthcare providers leaving the hospital environment and heading into the streets and trying to help directly on the streets?
Dr. Zein El-Abidine: No, the doctors and nurses were working in hospitals. Many organizations including the Red Cross team and the Civil Defense were working very actively everywhere in Beirut
to help the people in the streets.

Dr. Bhandari: How about human power, human health care workers? What is the current healthcare capacity for you?
Dr. Zein El-Abidine: In Lebanon, we are not in shortage of manpower. We have enough doctors and nurses. We need basic supplies for surgeries, and prostheses and rehabilitation tools later on.

Dr. Zein El-Abidine talked about the explosion that happened in Beirut. The healthcare human resource is enough but there is an urgent need of orthopaedic supplies. We must not forget the second and third waves of health cares which include prosthetics and rehabilitation.

How to Cite:
Fadi Zein El-Abidine. (2020, August). Mass Casualties in Lebanon: “We Urgently Need Orthopaedic Supplies”.  Available from: