Lebanon continues to face complex and overlapping crises that place significant pressure on its public health system, making it increasingly important to continuously voice needs and highlight emerging gaps. In such fragile and evolving contexts, advocacy plays a critical role in ensuring that public health priorities remain visible, that vulnerable populations are not overlooked, and that evidence informs timely and coordinated action.

In this context, we present key insights from an interview with Dr. Kassem Chaalan from the Lebanese Red Cross, highlighting perspectives on strengthening early warning and surveillance systems, addressing gaps in women’s and children’s health, and reinforcing the resilience of essential health services during emergencies and beyond.

1) How can strengthening the public health system and early warning functions improve the timely detection of health threats in Lebanon during emergencies and beyond, and what key actions are needed to sustain these capacities in crisis settings?

Strengthening the public health system and early warning functions is essential for detecting health threats early, especially during emergencies when population movement, overcrowding, disrupted services, and poor WASH conditions increase the risk of outbreaks. In Lebanon, early detection depends not only on technical surveillance systems, but also on community trust, two-way communication, and the ability of people at community level to report unusual events quickly and safely.

Timely detection can be improved by reinforcing coordination and interoperability between community actors, municipalities, PHCCs, hospitals, NGOs, the Lebanese Red Cross, and the Ministry of Public Health, particularly the Epidemiological Surveillance Unit. Community Based Surveillance can play a critical role by enabling trained community focal points and volunteers to identify and report early warning signs such as clusters of diarrhea, suspected measles, hepatitis A, food poisoning, respiratory symptoms, or other epidemic-prone diseases.

To sustain these capacities in crisis settings, key actions are needed:

• Continuous training and refresher sessions for community focal points, volunteers, and frontline health workers.
• Clear reporting channels, simplified case definitions, and feedback loops from national authorities to field teams.
• Functional digital reporting systems that allow real-time data sharing and stronger links between community-level surveillance and national systems.
• strong coordination mechanisms that connect surveillance with verification, investigation, referral, and response.
• Risk communication and community engagement approaches that build trust, address rumors, and encourage early reporting.
• Investment in local capacities, including municipalities, PHCCs, community structures, and national society volunteers.
• More anticipatory and preventive approaches, using field data and community feedback to identify risks before they become larger outbreaks.

Surveillance should therefore not be seen as data collection only. It must be linked to timely public health action, so that alerts are verified, investigated, communicated back to communities, and followed by appropriate response measures. This helps Lebanon move from a reactive model to a more risk informed, anticipatory, and resilient public health system.

2) In the context of ongoing emergencies in Lebanon, how can the public health system better identify and address gaps affecting women’s and children’s health, while supporting timely response and building more resilient essential health services?

During emergencies, women and children are among the most affected groups because they face higher risks related to interrupted vaccination, malnutrition, pregnancy care, unsafe living conditions, limited access to PHCC services, mental health and psychosocial stress, and increased exposure to communicable diseases. These risks are even higher for displaced populations, persons with disabilities, female headed households, refugees, migrants, and communities living in hard-to-reach or underserved areas.

The public health system can better identify gaps affecting women and children through triangulation of different data sources, including:

• Regular field and rapid needs assessments
• Community feedback and two-way communication channels
• PHCC service data and referral information
• Mobile medical unit and outreach reports
• Vaccination data to identify missed and under vaccinated children
• nutrition screening results, including MUAC screening where relevant
• Community- based surveillance and alerts from shelters, municipalities, and community focal points
• Sex, age, disability, and displacement-disaggregated data to better understand who is being missed

These sources help identify where children are missing routine vaccines, where caregivers lack access to reliable health information, where women face barriers in accessing maternal and reproductive health services, and where families need referrals for nutrition, mental health and psychosocial support, or other essential care.

To address these gaps, essential services should be brought closer to vulnerable communities through mobile units, PHCC referral pathways, outreach and door-to-door awareness, nutrition screening, risk communication and community engagement, and clear information on available PHCC services. Continuity of essential services is particularly important during crises, including routine immunization, maternal and child health, antenatal and postnatal care, child growth monitoring, disease prevention, and referral for mental health and psychosocial support.

Response should be coordinated with MoPH and partners to avoid duplication, ensure equity, and prioritize areas with the greatest needs. Building resilience means ensuring that PHCCs, mobile teams, community networks, and referral systems can continue functioning during shocks, while maintaining inclusive access for women, children, persons with disabilities, displaced populations, and hard-to-reach communities.

3) What are the main challenges facing the public health system in Lebanon, and how can they be strengthened to support timely detection of health risks, evidence-informed decision-making, and effective public health response during crises?

The public health system in Lebanon faces several interlinked challenges, including the economic crisis, repeated emergencies, displacement, pressure on PHCCs and hospitals, shortages of medicines and supplies, workforce fatigue and retention challenges, fragmented data systems, limited resources, and increased risk of communicable disease outbreaks. These challenges can weaken timely detection, delay response, and make evidence-informed decision-making more difficult.

Strengthening the system requires a multi-layered approach that connects preparedness, surveillance, response, and service continuity. Key priorities include:

• Strengthening early warning, alert, and response systems, including stronger integration between community-level reporting and national surveillance platforms.
• Improving real-time data sharing, data quality, and interoperability between PHCCs, hospitals, community actors, NGOs, and MoPH systems.
• Using evidence from disease alerts, vaccination gaps, community feedback, service access barriers, and field assessments to guide decisions and prioritize resources.
• Investing in the health workforce through continuous training, supportive supervision, surge capacity planning, and measures to reduce burnout.
• Protecting the continuity and resilience of PHC services during crises, including immunization, maternal and child health, communicable disease prevention, nutrition, chronic disease follow-up, and mental health and psychosocial support.
• Strengthening local capacities through municipalities, PHCCs, community focal points, National Society volunteers, and local organizations.
• Conducting preparedness planning, simulation exercises, after-action reviews, and regular coordination exercises with MoPH and partners.
• Ensuring inclusion of vulnerable groups, including women, children, persons with disabilities, older people, displaced populations, refugees, migrants, and hard-to-reach communities.

Sustainability is also a major priority. Strengthening the public health system should not rely only on short-term emergency projects, but should build local capacity, institutionalize coordination mechanisms, and support national systems that remain functional during and beyond crises.

Overall, Lebanon needs to move from a mainly reactive response model toward a more anticipatory, preventive, and risk-informed public health system. This means using real-time data, community insights, and preparedness planning to detect risks early, guide timely action, maintain essential services, and protect the most vulnerable populations.

Photo: ©UNICEF/Dar Al Mussawir