Imad Uthman is an associate professor and rheumatologist at the American University of Beirut Medical Center, Lebanon

Friday, 1 September

Field hospitals in the wrong fields
Soon after the clashes erupted in Lebanon on July 12, three Arab countries (Jordan, Egypt, and Saudi Arabia) sent 3 military field hospitals to Beirut, with an intention in helping the large numbers of casualties of war. However, these hospitals were all placed in the city of Beirut, and they have only treated few if any injuries. One of these hospitals has been stationed close to where I live in Verdun Street, which is an upscale shopping and entertainment street in Beirut. As I pass through this hospital, I watch these bored soldiers sun tanning and holding daily volleyball matches with the youngsters from the neighbourhood.

The health services in the city of Beirut were not really affected by the war except by the lack of fuel, but all the hospitals and medical centres were functioning normally. In fact what these hospitals are doing so far is treating the local neighbours for simple everyday illnesses, and ironically these hospitals are starting to have a negative impact on the local health providers (physicians and pharmacists), who are now out of business. Lebanon is a country that depends primarily on the private medical sector, a large segment of the population gets reimbursement of the physician fees and drugs from the national social security fund, with these ?field hospitals? in action, most of the private medical services are suffering from a an unfair competition. Therefore these hospitals did not meet their intended goals from the beginning by avoiding the areas where they are really need (south Lebanon), and now they are becoming a real burden on hundreds of physicians and pharmacists in Beirut.

Friday, 25 August

It is not over yet
Although the guns are still silent, however things on the ground don?t seem to be promising. People here feel they are in a hostage situation, to be more specific the whole country is still under siege. After the cease fire was declared on August 14, a couple of fuel tankers were allowed to go through the sea blockade imposed by Israel, and that?s it, no more fuel. The fuel supply that was allowed in is starting to disappear and we are back to more electricity shortage and for the long lines of cars in front of the gas stations. After so many interventions through the UN another fuel tanker was allowed in yesterday, and many fuel ships have been waiting for more than 2 weeks in the sea near Beirut. Regular freighters are still not allowed to enter to the Lebanese ports yet.

Although people cheered when the airport opened last week, however only the national carrier was allowed to fly, with one stringent restriction is that each plane has to land on its way in and out of Beirut in Amman airport for a security check. All of the European and other carriers have cancelled their plans to resume flights to Beirut.

So we are still under complete sea blockade and very restricted air blockade, supermarket shelves are emptying rapidly and most of the imported food items are missing.

Announcing new tourist attractions in Lebanon
Lebanon is famous for its rich history which dates back to thousand of years, and many archaeological sites in the country are the remnants of the oldest civilisations on earth. Now we are adding some new sites to our heritage. After the dust of the battle has settled, the scenes of destruction incurred by 9000 air strikes appeared more clearly. All of the international delegates visiting Beirut these days pass through the southern suburb as an essential part of their visit to the capital. The scenes are probably unseen before in recent history (except may be in World War II). Whole blocks of buildings are erased from the ground; one of the environmental problems we will soon be facing is where to get rid of the rubble of these buildings?

Monday, 21 August

The first week of cease fire was relatively quiet save for an Israeli commando attack early Saturday near the town of Baalbeck. This event created a lot of fear that things may again get worse.

In Beirut, things are rapidly getting back to normal; the return of people to their hometowns in the south and to the southern suburb is progressing at a rapid pace. It was like a vacuum phenomenon, overnight most of centers for the displaced were evacuated, and people went back to their hometowns. This has shifted the problem of these people to other areas. Official sources now estimate that around 30,000 residential units were either completely destroyed or damaged. In addition many schools were completely destroyed; some of these were for the special needs children (deaf and blind). This is another additional major social problem for the days to come.

Fuel tankers were allowed to enter last week which has helped to start easing the energy crisis. Beirut International airport also opened partially for the first time for commercial flights since July 13. The first European carrier to touch down in Beirut was a British Airways flight carrying some humanitarian aid and a “Save the Children” team.

Last week was also marked by the extensive “search and recovery” operations for missing people in the rubble of the many collapsed buildings and the burial of the dead. Mass funerals were held in different parts of the country, 250 dead bodies were released from just one hospital (Tyr hospital). Things at the American University of Beirut hospital are also getting back to normal with plans to resume the summer session at the university on the 28th of August. People in the city feel more relaxed, and many restaurants and cafes around the city opened for business for the first time since 5 weeks.

Monday, 14 August

The Day After
Yesterday was the second day in which the Lebanese enjoyed the calm of the cease fire. Things are starting to look normal in Beirut, and at the hospital, people seem more relaxed and slowly the normal pace of life in Beirut is returning. The large crowds of patients (displaced people) that used to fill our out-patient department are starting to decrease, and teaching conferences and rounds on the medical wards are resuming gradually.

You can spot residents at the many centers for the displaced packing their belongings to head back to their towns and villages. Tens of thousands of people filled the roads to the southern suburb and the various villages in the south. People spent around 8 hours to reach their villages, because most of the roads and bridges to these areas were destroyed. The problems of the displaced have now shifted to other areas, these people who insist to go back to their hometowns to stay in a tent on the rubble of their homes. So the problems of the displaced is shifting to other areas, the efforts now is to secure temporary homes for the residents of the estimated 15,000 homes lost. Currently the number of people still displaced stands at 702,413.

Yesterday rescue teams started to remove the remnants of the dead people who were still scattered on the streets or below the rubble. Around 50 dead bodies were recovered yesterday. In addition, hospitals in the south started clearing their morgue spaces from the excess dead bodies, today the Tyr governmental hospital will hold a mass funeral for an additional 126 dead persons from its morgue.

Aid convoys started also to move to the different areas of the south to help supply the necessary medical supplies to the hospitals in the region. The main problem however is still the lack of fuel and subsequently lack of electricity. The long awaited fuel tankers are still docked in Cyprus, pending the clearance to head towards Lebanon from the Israeli army.

Ceasefire
The cease fire took effect at 8:00 AM today, up till 7:50 AM; the Israeli air force was still bombarding different civilian targets throughout the country. Remarkably at 8:00 AM many of the displaced people started rolling their vehicles to go back to their towns and villages to check on their homes and their loved ones. Very long lines of vehicles filled what remained of the roads to the south. In addition many people were joyfully cheering people on the streets, despite all the losses in lives and belongings they sustained, their reason for joy was that they have beaten for the second time (first time in 2000) what they perceive as the “unbeatable enemy”. Unfortunately many of these returning people will not find except the rubble of their homes and the problems of the displaced people will haunt Lebanon for some times. The return of people to their homes was not without a price, 2 persons were killed including one child died and several were injured yesterday when remnants of the Israeli cluster bombs exploded.

Finally, a word to our fallen children
Since the start of this war 34 days ago not a single day has passed without claiming the life of a number of children of all age groups, from the fetuses in their mother?s tummies to the adolescents. We were sickened each night as we watch the dead bodies of these little angels being removed from the rubble. Scores of families have been completely eradicated from existence. I am pretty sure that this war will go in the world records of the highest pediatric death toll of any previous war in history. I ask all our colleagues all over the world to pray for the fallen children of this conflict. May their souls rest in peace.

Sunday, 13 August

A journey in the Lebanese psyche
One remarkable observation about the Lebanese population is the absence of acute stress reactions, or at least people don?t seek medical attention for these reactions in times of crises. Yesterday afternoon I was at the supermarket shopping with my 2 kids, when around 20 huge explosions were heard within 2 minutes, it turned out that Israeli warplanes have hit a residential complex in the southern suburb of Beirut with 20 tons of explosives destroying to the ground eight 12 story buildings, on their inhabitants. The interesting observation is that people looked worried however they continued shopping as usual.

During my rotations in the emergency department at times of war and at the present time, I have rarely encountered people who present with acute stress reactions. One explanation for this ?immunity? is of course the civil war that erupted in 1975 and lasted for several years, followed by the ?booster shots? during the decades of Israeli Lebanese conflicts. Nevertheless people started throwing jokes about the current events, several of these jokes are widely circulated by emails or short messages on the mobile phones. The latest in these series of jokes revolves around the world cup, it warns that people should go to shelters the next time Italy wins the world cup because on the 2 occasions (1982 & 2006) where Italy made it to this cup were followed by Israeli invasions to Lebanon.

This does not mean that people are insensitive to all the tragedies and the persistent sense of insecurity, around them. To cope with these events people usually gets support from their religious beliefs. Most people pray to god, so that god will save them and destroy their enemy and its supporters. Unfortunately these atrocities are also translated into deep rooted hatred to the enemy that in view of the ?Recurrent Boosters? will persists for generations to come.

Saturday, 12 August

Update on the health situation in the south
The health status in the south has reached the state of disaster. I will no more discuss the number of casualties, you can easily estimate at least 2 dozens dead and around 4 times this number injured each single day. Red Cross volunteers are being constantly targeted; one of these brave guys passed away after he sustained lethal shrapnel injuries over the weekend. In fact this rescuer died when his ambulance which was part of a convoy of around 1000 cars was allowed safe passage by the Israeli army out of their village in the south, however midway their convoy was attacked by Israeli planes killing 8 people.

In addition to the road blockades which rendered many areas unreachable except by foot, and has hampered or even prevented the supply of medicines and essential hospital supplies, the Israeli jets targeted the main power stations in Saida and Tyr the 2 largest cities in the south which resulted in a complete electricity blackout. This was a knock out blow to the hospitals in the area, it will be pretty certain that by the time you read these lines these hospitals would have closed their doors, forcing hundreds of injured and sick people to their doom.

The structure of the health system in Lebanon relies primarily on the private sector. There are only a handful of governmental hospitals in the south, which are mostly located in the most affected areas, and have closed their doors by now. In fact one of these hospitals (Tebnin hospital) is actually sending SOS messages to save some 340 patients and staff stranded in the hospital. The major hospitals in the south are private institutions, which despite some governmental subsidy, cannot remain viable under these circumstances. In addition the basic medical services in the villages and towns in the south are non existent now, if a person sustains a myocardial infarction or if a lady goes into labor, the chance that they will not find a physician or a hospital to care of them is almost certain. This is only the tip of the iceberg, what is below the surface in terms of health tragedies will soon emerge.

 Friday, 11 August

The American University of Beirut facing the challenge
This crisis, one of the longest in the history of conflicts in Lebanon, has brought a sense of national solidarity in the country, unseen before. Lebanese citizens displaced from their homes were well taken care of by their fellow citizens. The students of the American University of Beirut (AUB) who were forced out of their classrooms, soon gathered hands and were on the forefront of volunteer efforts, despite the all the associated risks. The Lebanese Red Cross Youth Department at AUB jumped right in with AUB?s relief volunteer team, focusing on developing hygiene and children?s entertainment programs for those displaced because of the war. Hygiene has been a major concern, because the centers for the displaced are packed with people, up to 100 people would share one bathroom, in addition to a major shortage in cleaning supplies in these centers. Cases of scabies jaundice and lice have been identified threatening to reach epidemic levels, if measures are not taken to control them. The Red Cross volunteers concentrated on raising the awareness about these hygiene-related diseases and created children?s games and songs that teach the concept of hygiene. They also distributed two types of kits, ones meant to be used by displaced centers and others catering to the personal hygiene needs of the displaced. The kits include things like brooms, trash cans, mops, cleaning detergents, soaps and shampoos. In addition to taking care of the environment for the displaced the AUB community joined hands to clean the streets around AUB. The regular street cleaning services were greatly affected because garbage collectors fled the country, out of fear of the bombing and the spreading war, resulting in piles of trash in the streets. For this purpose about 30 AUB professors, staff and students were joined by friends and neighbors in a clean-up drive of the Street around the campus and the hospital. Brooms, trash bags, dustpans and rubber gloves were distributed to all volunteers, courtesy of AUB. Similar initiatives were initiated by a number of other universities and public groups in Beirut to clean the streets of the city.

Volunteers work with displaced people in Beirut
Things are getting harder with each passing day. The fuel supply is reaching alarmingly low level. Now you should expect to wait between 6 ? 8 hours to fill your car with 5 liters of fuel if you are lucky to find an open gas station in Beirut. Yesterday was marked by an unexpected attack by an Israeli air strike on a building in the city center of Beirut, nearly half a mile from the campus. This caused a state of panic in the city, local residents in Beirut were somehow reassured that Beirut would be spared the air raids however it seems that there is no safe roof to any body in Lebanon, and the tireless killing machine is still rolling at full speed. Just this morning 12 persons were killed in a single air strike in North Lebanon.

As for the role of our institution in the current events, The American University of Beirut (AUB) and its medical center have always been at the forefront in times of crisis. The president of the university addressed the faculty in a message this morning, stating that: ?We don?t know what comes next. What we do know is that AUB is our anchor in the storm. Its legacy is in our hands, and that legacy is one of fortitude, patience and resolve. Together we will write another great chapter in the university?s long history.? As the level of fear, insecurity, and uncertainty is growing; the will and determination among all the physicians and hospital staff to carry on with our duties, despite all the challenges ahead is also increasing. Although many physicians working at the hospital had the chance to be evacuated (many have dual nationalities) with the foreigners who fled the country, none left. All the services of the hospital are functioning normally. Having passed through several military conflicts for the last 3 decades has given us a great level of immunity and resilience. From the first week of the conflict a number of doctors and public health professors set up a volunteer medical team that could check up on the thousands of displaced people being housed in dozens of Beirut public schools. The main concern was to prevent the spread of disease as a result of crammed spaces and a shortage of cleaning supplies. The volunteer teams have been visiting 12 schools, housing a total of about 5,000 displaced people to distribute cleaning detergents, medicines, and conduct medical exams and vaccines. A total of about 250-300 sick patients each day. Two volunteer teams, each composed of about 20 doctors and medical students are dispatched every day. At first, the volunteers were most worried about providing medication for people suffering from chronic diseases, like hypertension and diabetes. But as the war prolonged and more refugees started flooding in, hygiene-related problems, such as lice and scabies, began to arise. Already, the team managed to set up a special clinic where refugees could be examined for health problems that cannot be taken care of at the schools. AUB has also set up an emergency medical fund to collect donations that would support the volunteer team?s work, including raising the required funds to allow any displaced person in the area to be admitted to hospital for free, should the need arise.

The hospital administration has also decided to share our remaining fuel reserves with other hospitals in town in order to keep at least one operating room functioning in each of these hospital. So far the Israeli army, despite all the international interventions, did not grant permission for the entry of the fuel tankers waiting for more than 2 weeks in Cyprus. To make things even worse the Israeli air force is also attacking any moving fuel tanker on the ground.

Wednesday, 9 August

Afternoon update: The South Lacks Medication for Chronic Diseases
Aid agencies and doctors in south Lebanon say that unless Israeli-imposed travel restrictions ease, thousands of people receiving treatment will suffer due to the growing shortage of medication for chronic diseases, such as diabetes and cancer.

Hakim Khalji, M?decins Sans Fronti?res (MSF) coordinator in the port city of Tyre, stated that ?Many people remain in the villages near the border, who have been taking treatments for years and now suddenly their supply is cut.? MSF is providing medical supplies to people in and around Tyre but is not making deliveries of chronic disease medication to outlying villages because of dangerous conditions created by the conflict.

International agencies have to get permission from Israeli authorities to assure safe passage of their vehicles, but this is often not granted for security reasons. An Israeli bombardment has cut the road to Tyre, and the military dropped leaflets on south Lebanon on Tuesday, warning it would strike any vehicle travelling south of the Litani River, an area that includes Tyre. The United Nations Humanitarian Coordinator in Lebanon, David Shearer, on Monday called on the Israeli Defense Forces (IDF) to end its attacks on civilian infrastructure and cease all actions hindering the supply of humanitarian relief to the hundreds of thousands of displaced people across the country. Shearer said the destruction had pushed Lebanon to the brink of a humanitarian disaster and was threatening to paralyze relief efforts.

Alissar Rady, National Officer for the World Health Organization (WHO), said the agency had organized delivery of three WHO medical kits to Tyre, including medication for chronic diseases, for up to 10,000 people for three months, but this was far from enough. According to the WHO, chronic diseases accounted for 77 percent of all deaths in Lebanon in 2002. Aid agencies estimate that up to 25,000 civilians are still in Tyre, with a further 25,000 IDPs and as many as 30,000 people in the 38 villages dotted along Lebanon?s southern border with Israel. (Source: Higher Relief Council of Lebanon)

Things are a bit chaotic now in Beirut, and it is panic in the city after a building in the city center around half a mile from the hospital (and for the first time), was hit by a couple of missiles. I had to run to make sure my children are safe.

Morning  update
“Observation from the War, Seeking Shelter: A Fallen Theory.”

Seeking shelter at times of danger is a natural human and animal instinct. As we are going into the second month of this conflict, and because humans in general are fast learners, people soon came to the conclusion that there is no point in seeking shelter, to start with we don’t have shelters, save for few unequipped building basements which in many times lack the basic necessities like running water or toilets, and second from the earliest days of the war people rapidly witnessed the great achievements in explosive research. A single bomb can level any building to the ground, so people nowadays stay where they are when their area is hit. The lucky ones are in the upper floors, reason: they will be retrieved first. This may look funny, but in fact this is a sad truth.

Tuesday, 8 August

Evening evening
The 28th day of the war is coming to a close; a feeling of disgust prevails on everybody?s face. Human life has no more meaning in this conflict, the death of a one or two persons here and there, is not news any more. Twenty-four people are still missing and under the rubble of their houses after yesterday?s air strikes on the southern suburbs. Today 5 people were killed and many injured in the town of Ghazieh in the south, so what !!!!

Ironically these poor people were attending the funeral of their relatives and neighbours who died in an earlier air strike, when their gathering was stricken by a couple of airborne missiles. So death is dragging death, and so on.

Yesterday I was chatting with my 6 year old son, who confessed to me that he envies his cousin who had to flee the country one week ago. On questioning him why? He answered, because he will not be killed by the planes. I will leave you to draw the conclusions for yourself out of this, but in other words this is an open invitation to all the researchers in the field of child psychiatry and posttraumatic stress disorders around the world to visit Lebanon and study whoever remains of our little children.

Morning update
Yesterday was the bloodiest day in the this conflict now approaching to close its first month, As I mentioned in my previous emails the conditions are getting miserable, the catastrophe is with no exaggeration in the magnitude of an earthquake or a tsunami.

Different parts of the country are now cut out from each other; the countdown to run out of fuel is ticking rapidly, as Israel has not yet allowed the entry of the fuel ships. The health services are functioning in very difficult conditions. Yesterday a couple of rescue workers succumbed under the rubble when a badly hit building collapsed on their heads in the city of Tyr in the south.

There is no enough ambulances, or trucks to remove the collapsed building. You must have seen on TV the rescuers and the local residents, after yesterday?s bombing in an area near Beirut, trying to remove the rubble of the buildings destroyed by the air strikes. We are not blaming or accusing any body, we don?t want to go into politics but the scale of human sufferings in my country deserves a lot of attention from the civilized world around.

Our tragedy probably deserves a cover story from BMJ only to highlight the sufferings of the innocent people on both sides of the border.

Monday, 7 August

Second evening update
The situation is overwhelming and beyond our capacity to handle in every aspect. The last air raids in the evening destroyed several buildings in a densely populated  area in the greater city of Beirut. Death toll: ten dead bodies recovered and 40 injured so far, dozens are still under the rubble. To make things worse tens of thousands of the people already in this area are starting to flee and assemble in a park in Beirut where they cannot find even a place to stand. It is a catastrophic health problem looming in the near future. Frankly, words cannot in any way describe the scale of human tragedy we see around us. Please Save our Souls.

Evening update
The number of casualties (mainly) the dead, is climbing in 2 digits increments, at a time, after my last email (5 hours ago), Another building was rocked down on its inhabitants in the town of Ghazieh, south Lebanon, the death toll 14 persons, add to the 48 dead in the morning.

As I am writing this message, several large explosions, throwing panic in the city of Beirut. The target:  Israeli warplanes bombarded a new heavily populated area, in the greater Beirut area, death toll: unknown so far, but you can bet on a heavy death toll. The day is not over yet, so keep counting.

Daytime update
Another bloody day of this wild war is passing by, until 3:00 PM; the death toll has climbed for today to 48 persons, in 2 attacks only. We have crossed the 4 digits number in the dead count. Eight people succumbed under the rubble of their house in my own hometown in the south, and later in the afternoon 40 people succumbed also in a single air strike in another southern village. Didn?t we ask for more body bags and coffins few days ago?

As I cross the entrance of our emergency room, I always spot a large bag filled with colored and numbered tags, intended to label the mass casualties expected one day, with the killing machine rolling uncontrollably all of us have the feeling that we will be soon starting to use these tags.

Sunday, 6 August

The pressing health problem that is threatening the displaced people and the stranded people in the villages in south Lebanon now is the lack of water. Many water stations have been directly targeted; in addition a major electricity station supplying large parts of the south and the Bekaa valley was also directly hit yesterday. Daniel Toole, director of emergency programs at the United Nations Children?s Fund (UNICEF), said that shortage of water sanitation equipment, the destruction of roads and the heavy fighting in the south means the United Nations has so far only managed to transport kits to provide 1,000 families with fresh water. ?Sanitation is a big issue. Without proper sanitation children will get diarrhea, they will get sick and they will die. If we cannot get in with means to store water and to transport clean water we will have disease. We will have very serious problems very soon.? The International Committee of the Red Cross, which described the health, water and nutrition problems in the southern villages as alarming, added that ?The material we are getting in is only a little bit bigger than a drop in the sea, It helps but there is much more needed.? The organization said the situation was particularly alarming at border villages. ?People who had fled these villages told ICRC delegates that people were drinking foul water from a pool used to collect water for irrigation.?

If the areas around the city are still able to get some fuel to keep the remaining cars running (expect to wait at least 1.5 ? 2 hours) to fill your gas tank with just 8 liters of fuel), the situation in many areas in the country, especially in the south and Bekaa valley is much worse. The Israeli air force has almost completely destroyed the majority of the gas stations in these areas, and with no fuel supply since almost a month, so expect that in few days there will be no more fuel to keep the highly needed ambulances running. Another major problem in the highly bombarded areas is the lack of heavy machinery to remove the rubble of the collapsed buildings. Air strikes these days can collapse a 10-story building to the ground instantly. So rescue teams face great challenges in rescuing whoever remains alive in these buildings. To make things worse in these situations is that bombarded areas are usually continuously monitored by aerial surveillance, which has randomly targeted ambulances in these sites.

Saturday, 5 August

Late night update
Cassandra Nelson, senior communications officer for Mercy Corps, said schools, municipal buildings and parks in Beirut and the nearby Chouf mountains were full and refugees were running out of places to seek shelter. ?These options have really been maxed out. The schools are full, hospital basements are full. With these additional people coming in, there?s no place to put them,? she said. ?If even one case of a disease like mumps or measles happens it will spread like wildfire, and it will first hit the children, who make up 45 percent of the displaced.? The United Nations? refugee agency UNHCR said strikes this week against the Lebanese city of Baalbek and other areas had increased the flow of people fleeing the country.

Its monitoring teams reported 5,000 people a day had crossed the border and 140,000 were now in Syria.

The U.N.?s World Food Programme (WFP) found a new route to bring in aid a day after Israeli warplanes struck four bridges to cut what the agency called its ?umbilical cord? for supplies. It distributed food to 8,000 displaced in Beirut and will resume large convoys on Sunday to bring supplies from Syria and northern Lebanon to the bomb-ravaged south. ?We?ve found there is a route accessible for our trucks on small secondary roads, but it?s going to be slow and difficult because of the heavy traffic,? said WFP spokesman Robin Lodge.

The WFP said it had distributed food for 80,000 people for a week but tens of thousands more were trapped without aid. Certain areas of the country are totally cut out from any access to the outside world. All roads to Hermel, a large village in the Bekaa valley, have been severed. The only access out of this village is through small footpaths.

Medical group Medecins San Frontieres (MSF) said fighting in the south had prevented it from sending convoys there. MSF spokesman Bart Rijs said the war had especially hit displaced people with chronic illnesses who could not get treatment. He added water was running out in many places. ?Sanitary conditions are worsening due to problems with water for drinking, showers and cleaning,? he said. ?Over time the living conditions of the (displaced) are deteriorating.?

The threat of fuel shortages for power plants, hospitals and water pumping stations is getting closer, as two ships loaded with 87,000 tons of fuel intended for Lebanon refused to approach Beirut for lack of written safety guarantees from Israel. The U.N. and Lebanon?s government say the country will come to a halt within days when fuel runs out. As a final late Night note this is the latest casualties count: 933 dead 3322 injured, 915,762 displaced.

I hope we?ll a have a good night sleep tonight (we missed that the last 2 nights). Please remember us in your prayers.

Daytime update
Our hospital so far is still functioning so far; we actually get casualties after they have been taken care in frontline hospitals. Our hospital is around 5 kilometers from the closest bombed site in the southern suburb of Beirut, and the sound of exploding bombs is heard quite clearly throughout the hospital. At present all hospital (inpatient & outpatient) services are functioning normally so far. However our many so far is the lack of fuel, just this morning the syndicate of hospitals in Lebanon cried for help in this regard, and stated that within a maximum of one week most hospitals in Lebanon will have to shut down for lack of energy supply. The raid carried out yesterday on the bridges north of the capital, was a major blow to the last remaining channel of life to the remaining hospitals.

As for my role in the hospital, I am currently an associate professor, in the division of Internal Medicine I practice clinical work and teaching for medical students, our university is one of the oldest schools of medicine in the Middle East, established in 1866. I am still reporting to work regularly; in fact the university has carried out an emergency plan so that the essential personnel necessary for the functioning of the medical center have been relocated to on-campus housing. So actually I have moved with my family to the campus, I am reporting to work normally, but the number of outpatients in the clinics has dropped by 90%.

Many hospitals in the south and the southern suburb of Beirut had to shut down. In fact three large hospitals in the southern suburb had to shut down, in the earliest days of the war because they sustained direct damage from the air raids. Each of these hospitals had at least a 200-bed capacity. As for the hospitals in the south the situation is much worse. In fact although some aid is being airlifted to Beirut international airport however the main problem is that there are no safe roads to transport this aid. The main targets in this war have been moving vehicles and trucks, which were hit by the Israeli air force, all across the country.

In conclusion, the situation will soon reach the state of catastrophe if in the first place fuel does not reach the hospitals. The younger population has been the most hardly hit by the conflict in Lebanon, according to preliminary statistics 45% of the dead, one third of the injured, and nearly half of the displaced are children. Some of them have been attacked even before they were borne, few days ago, an expectant lady, whose labor contractions coincided with a commando attack on the town of Baalbeck, sustained lethal bullet injuries from an Israeli helicopter and succumbed with her fetus few meters before reaching the hospital.

So far only one ?lucky? child who lost one eye and had major wounds in his head and face was escorted and transferred to France for further therapy by a French medical team accompanying the French health minister who was visiting Beirut. To note this child has also lost his father and sister under the rubble of their destroyed house in the south. Hundreds of other children lay in miserable conditions in their hospital beds struggling to stay alive.

When the dust of this war settles down, scores of orphan and homeless children will emerge. Unfortunately some major orphanage homes in the south and southern suburbs were ruined to dust by the air raids.

Friday, 4 August 2006

Another day of this crazy war is coming to a close and scores of casualties are falling each passing hour. Today 33 farmers (mostly women & children) working in the field were killed by a single air strike. Hospitals, in certain areas, especially in south Lebanon, are running out of places in the morgue, rather than hospital beds, since they receive more dead bodies than wounded people. For this purpose refrigerator trucks are used to store the dead bodies, when these are filled, temporary graves are dug to bury these cadavers till hopefully one day the situation will improve so that each will be transferred to his hometown, as is the tradition is Lebanon. Ironically in these areas, these hospitals are only functioning as mortuaries and all what they ask for from the relief agencies are the coffins and the body bags.

Things have gotten worse, just this morning the Israeli warplanes hit 4 major bridges north of Beirut, which has cut all possible routes out of the capital. This was the only remaining escape route and channel out of the country.

At this moment we are only left with one more week of fuel, Israel yesterday prevented the entrance of 2 fuel tankers which were turned back to Cyprus.

Thursday, 3 August 2006

The conditions on the ground are disastrous, this is really a national disaster, you can easily compare what has happened to a major earthquake that has stricken the country. At the time of writing this Email, the number of casualties (already accounted for) has reached 860 Dead; 3,265 Injured; and 913,760 Displaced.

I can assure you that there are scores of people who are buried under the rubble of their destroyed buildings. The displaced people are living in open air parks or in deserted ruined buildings with no sanitary facilities. Epidemics of diarrheas and certain skin diseases have already appeared.

Wednesday, 2 August 2006

So far everybody has been aware of the war ravaging our country Lebanon. Besides the casualties that have so far exceeded 700 dead and more than 2000 injured, a more serious problem or disaster is looming in the near future. With more than a million person displaced from their homes and living in miserable sanitary conditions (in schools, or even in parks), it is pretty certain that all sorts of epidemics will soon spread among these people. We at the American University of Beirut Medical center, one of the largest teaching medical centers in Lebanon, are doing the best we can to provide essential primary health care services to the centers for the displaced in Beirut. However the scary problem that we will soon face is the lack of fuel to run the hospital. With a complete embargo since 3 weeks on the supply of fuel to the country, we are left with only around 10 days of power supply, and a real fear that we will have to close the hospital soon. Our hospital has been the main provider of emergency health care throughout the wars that have ravaged our country in the last 30 years, and has never closed its doors throughout this period.

Although currently aid is pouring to the country through the humanitarian corridors, however the lack of energy supplies will shut down most of the hospitals in the coming two weeks and with no foreseeable end to the military conflict in the near future, the country will soon be facing a major health disaster.

Therefore we urge the medical communities around the world, and solely on the basis of humanitarian grounds, to do whatever is possible to help us face this potential crisis [written with Ali Taher]

Read rapid responses to this blog.