The Beiruter

The pharmacist just told her the treatment would not come that day. Or the day after. No one knew when. There were “delays at the ministry,” she said. “Maybe next week.” That was in mid-July. But cancer does not wait.

Rwayda*, 55, has stage 3 breast cancer. She said she did not even cry. She felt numb.

She needed regular doses of chemotherapy, followed by surgery and targeted medication. She already sold her gold earrings, emptied her husband’s pension and borrowed from every person who once congratulated her at her wedding. Not to buy a cure, just a little bit more medicine. A few more days. Enough to say she tried.

Before Lebanon’s collapse, cancer treatment, though expensive, was largely accessible through a web of public insurance and institutional support. Patients covered by the National Social Security Fund, the army or private insurers received life-saving medications that often cost between $7,000 and $23,000 per box, some taken monthly, with little to no out-of-pocket cost. But after the financial crash of 2019 that saw Lebanon fall into one of the most severe economic crises in recent history, Rwayda and thousands of other Lebanese cancer patients’ lives hang by a thread.

“It’s not the illness that breaks you,” she said. “It’s the silence around it. The feeling that your life is negotiable. That somewhere, someone is deciding what your pain is worth.”

A legacy of medical corruption
As Lebanon’s institutions weakened after 2019 and the Lebanese Pound devalued by 90 percent, cancer patients found themselves entangled in a web of political favoritism and corruption. Medicines would “disappear” from shelves, stocks were always depleted, only to reappear in the hands of those with the right connections or be smuggled across the border, into Syria.

Patients queued at dawn, only to be told their medication was not available, unless a party official made a call. “If you had a connection, you got your treatment. If not, you were on your own,” said Hani Nassar, head of the Barbara Nassar Cancer Foundation. Nassar established the foundation in 2014, shortly after his wife passed away. The NGO raises funds and supports cancer patients and their parents financially and emotionally, often by covering the costs of medicine and hospitalization.

He explained that cancer medications have become commodities in a transnational black market. Subsidized drugs, meant to save lives, are smuggled across the border to Syria and resold at a higher price, generating enormous profits for traffickers and insiders.

“A box worth $10,000 is bought for $200 at the subsidized rate and flipped abroad for thousands,” Nassar explained. Patients are then forced to buy back their own medications, in dollars, from the same black market that had siphoned them off.

Quarantine Center stockrooms, intended to safeguard the country’s most critical medicines, turned into sieves, leaking treatments into illegal circuits while cancer patients searched pharmacy shelves in vain.

Counterfeit medication
Simultaneously, as official supply chains collapse, desperate patients turn to unofficial routes. “Private” suppliers, travelers, and online dealers. Many of whom provide counterfeit or unverified medications. “You think you’re saving money, but what you’re really buying could kill you,” Nassar warned.

Lebanon is flooded with medications smuggled from Turkey through Syria, some of which are laced with impurities or entirely inactive, he added.

The death toll rose. One patient died after a counterfeit injection crystallized in her bloodstream. Others never knew the drugs they took were fake, only that their conditions worsened.

“We’ve been screaming for four years,” Nassar said. “Where was everyone while our people were dying?”

Oncologist Mansour Salem sees the death toll rising firsthand. "I had a patient with multiple myeloma," he says. "His numbers were improving, until suddenly they weren't. When we changed the source of his medication, his condition stabilized again. Same drug, different outcome. That’s when I knew he’d been taking a fake."

Salem explained that even well-meaning patients unknowingly endanger themselves by sourcing medication from unofficial suppliers in Turkey, India or Iran. “What are they taking? We don’t know. Maybe cortisone, maybe antidepressants, enough to make them feel better for a while, until it’s too late.”

Efforts to intervene
Nassar pleaded with politicians and people in power; the reply was chilling: “When people from your side start dying, let us know so we can do something,” he was told.

The next day, the activists staged a protest outside the United Nations headquarters in Beirut under the banner: “This country is killing us.” Nassar brought with him a list of names, 29 patients who had died waiting for treatment, and read them aloud like a roll call of the abandoned. The next day, certain cancer drugs were briefly distributed. But it was not nearly enough.

Elise Hajjar, who Nassar works with, is not just an ovarian cancer patient; she is a survivor navigating a system designed to abandon her. After her cancer returned in 2021, Elise was prescribed Lynparza, a targeted therapy drug that could keep the disease from progressing. But the drug costs over $6,000 per month, an impossible sum in a country where the minimum wage, set at 675,000 LBP (roughly $6), cannot cover basic living costs.

Despite repeated appeals, Lebanon’s Health Ministry does not subsidize treatment. According to Amnesty International, the Lebanese government stopped subsidizing medicine in November 2019.

“Every month, I have to wonder: will I live or die based on whether I can find this pill?” Hajjar said. Occasionally, she says she manages to obtain a sample from a doctor abroad or through informal channels, but it remains a question of luck. Even when she succeeds, the relief is haunted by grief. In online support groups, she has read of other women dying because they could not access the same medication. Hence, while fighting to stay alive, she explains she also bears the weight of survivor’s guilt.

Rwayda* says she has grown exhausted from fighting. “You don’t die from cancer here. You die waiting for medicine.”

*Some of the names in the stories were changed for privacy reasons at the request of the interviewees.