The stagnation and decline in economic activity since 1998 put a heavy burden on the middle and low-income segments of the population. This has affected the status and development of health. The social effects of fiscal policy have accentuated somewhat the socio-economic disparities that emerged during the years of civil war. In fact Lebanon enjoyed a high standard of healthcare precivil war (1975). 15 years of war however took its toll. Due to lack of administration and funding, services steadily deteriorated. During the civil war in Lebanon, the role of the Government in health progressively declined.
However, the private and NGO sectors continued their efforts, becoming the main provider of health services. In 1990 there were only 14 operational government hospitals (5 central with 100-150 beds) and 9 district hospitals with less than 50 beds each, well below the required provision for a population of 3 million. The government budget expenditures on social services as a percent of the overall budget, including spending on health and social welfare, recorded a notable increase during the last five years. Total allocations for ministries dealing with social issues were 13 percent of budgeted government expenditures in 1994-98, of which more than a fifth went to the Ministry of Public Health. Though government spending on health as a share of GDP reached one of the highest levels by world standards (more than 10 percent), its efficiency and equality remain controversial. It is very important to underline the fact that in Lebanon there is a wide difference between public and private sector in a health field, in fact the spending public on health as GDP 2.2 while spending private on health as GDP 9.7.
Economic growth and reconstruction have favoured some regions, like Beirut, to the detriment of other parts of the country, service sectors have grown at the expense of agriculture and industry. Without adequate social integration, without good development of the health care system giving access to poorer people, the problem of poverty particularly in cities, cannot be solved. In this context the status of public health in Lebanon will be analysed.