Image: AUBMC Palliative Care Team
Lebanon lies in a region marked by repeated conflict, creating ongoing disruptions to its health system and deep uncertainty for patients, families, and healthcare teams. Janane Hanna, a clinical nurse specialist, has worked for years at Balsam, the Lebanese Center for Palliative Care, and the American University of Beirut Medical Center (AUBMC). As a founding member who helped establish palliative care services, she demonstrates that locally designed palliative care models are possible even in settings of chronic insecurity and limited resources. Drawing on her own experience, Mrs. Hanna shows how care can be shaped to meet the needs of patients and families despite constant pressure.
Care in Lebanon is deeply influenced by the country’s socio-economic and cultural context. Breaking difficult diagnoses, discussing prognosis, and guiding families through decisions differ significantly from Western practices. The challenge is not only what to say, but how to care in ways aligned with families’ expectations, language, and beliefs. In Arabic, words related to suffering, death, and truth-telling carry strong emotional and cultural weight, making direct translation of Western models ineffective. Flexibility and personalization are therefore essential.
Spirituality also requires adaptation. Western chaplaincy frameworks do not fit easily in Lebanon or the broader Arab region, where spiritual expression is closely tied to religion, and especially hope. In practice, caregivers often rely on open-ended spiritual questions that allow patients and families to express their needs in their own terms.
Building Capacity Through Education and Training
One of the most significant structural barriers to palliative care in Lebanon is the shortage of trained healthcare professionals. Few clinicians receive formal training in pain management, communication, or palliative care, leaving many unprepared for truth-telling, ethical dilemmas, and complex symptom control. In response, Mrs. Hanna helped establish a post-graduate academic diploma in palliative care at American University of Beirut Medical Center (AUBMC), the first interdisciplinary programme in Lebanon and the region.
The programme content supports palliative care provision during humanitarian crises. Rather importantly, it reframes core concepts in palliative care from the Global North perspective to the Eastern Mediterranean Region’s context to meet the needs of the communities being served. Three cohorts have completed the diploma with strong feedback. Caregivers themselves shaped the curriculum, emphasizing preparedness, truth-telling, and role-play exercises grounded in real community experiences. While volunteer-based programs have proven unsustainable due to national instability, AUBridge, a medical-student–led initiative at AUBMC has recently emerged to support distressed caregivers in acute care settings.
Fight for Access and Sustainability
Despite these advances, access to opioids and essential medicines remains severely limited. Political instability, regulatory barriers, and repeated supply-chain disruptions mean that even basic pain-relief medications are difficult to obtain. Key formulations such as methadone and oral liquid opioids were entirely unavailable. At that point collaboration with the minister of public health and a local pharmaceutical company was key. This required prolonged advocacy and sustained efforts. As of now, instant release oral morphine is being produced in Lebanon at a very cost-effective price.
As an important note, for Mrs. Hanna, establishing reimbursement is a foundational step toward equity, sustainability, and dignity in palliative care. Although palliative care reimbursement was formally recognized by a Ministry of Health decree in 2019, access today depends on private donations, arrangements, and negotiation between hospitals and home-based NGOs, forcing providers to spend plenty of energy securing funds. Advocacy with private insurance companies, The Ministry of Public Health and Ministry of Economy is still required to call for a dedicated budget line that would translate recognition into real access, working with the private system and ensuring sustainable financing for the caregivers, patients, and families.
“We need to keep on dreaming and hoping,” Mrs. Hanna said, recalling an image of a rainbow appearing even in the rain. Advancing palliative care in Lebanon will require ongoing collaboration, stronger partnerships, and sustained national and international solidarity to turn resilience into lasting, system-level change.
About the author
Janane Hanna (front row, second from the left) is a founding team member of Balsam, a founding Board member of the palliative care association of nursing in Lebanon, and a pioneering Clinical Nurse Specialist in pain and palliative care. With a master’s degree and specialized training from Johns Hopkins and MD Anderson, she established the hospital-based palliative care service at AUBMC. She is an Academic Associate at the AUB Hariri School of Nursing, dedicated to improving pain management through international education, advocacy, and policy work.
