Before 1975, Lebanon boasted one of the region's most developed economies. Beirut was the financial centre of the Middle East and home to some of the region's leading health services and medical institutions. The violent civil war, which spanned 16 years, caused enormous problems. In addition was a 22 year occupation of the south by Israel, which ended only three years ago.

The war led to the closure of most state health centres and triggered the expansion of the private sector. The healthcare sector is now dominated by ambulatory care, mostly provided by private medical practitioners and to a small extent by non-governmental organisations.1 Such healthcare delivery is important for the health of poor people and people in rural underprivileged areas.

Half of the population's health care is covered by private or public insurance schemes, for the rest, insurance is purchased by the state.1 Thus the private sector is highly dependent on public funding. In 1999, 75% of the Ministry of Health's budget was channeled into reimbursements for private services.2 Due to the lack of regulation, the cost per patient has increased dramatically over the past three years and a lack of coordination among health providers has led to an oversupply of advanced medical services, a large number of specialised doctors, inflated billing, and lengthy waiting lists. Lebanon has three doctors for every 1000 people, more than nearly all developed countries. The country also boasts advanced medical treatment, with as many open heart surgery centres as Germany. Yet due to out of pocket payments, the doctors and specialist treatment remain inaccessible to many.1

Imbalances before the war and during reconstruction have led to most public funding being concentrated on services around cities. In view of the role played by the private sector, and the weak preventive and primary care provided by the state, the structure of the healthcare system is conducive to disparities. Differences in infant mortality rates are three or four times higher in deprived areas.3

The burden of disease is characterised by problems of the urban environment. Recent studies state that a high percentage of the Lebanese population is obese.4 This is likely to contribute to the rise in diabetes and hypertension. In light of this, the Ministry of Health's 1998 strategy aims to influence behaviour related to health.4

Despite the war and the problems of the healthcare system, the health of the Lebanese population has improved greatly throughout the past few decades. The life expectancy at birth rose from 64 to 72 years between 1970 and 2000, much higher than the average for most developing countries. The infant mortality rate has fallen from 65/1000 live births in 1970 to 28/1000 live births in 1996.2 Under a reconstruction programme, Horizon 2002, and the election of a new government in 2000, the rebuilding of Lebanon has begun. The government has promised increased spending towards health and there is much room for healthcare reform.