Lebanese Emergency Services Are Overwhelmed and Need Better Gear to Save Lives in Wartime

Search and rescue team members try to find victims following an overnight raid by the Israel army on the Palestinian camp of Ain el-Hilweh, in Sidon, Lebanon, 01 October 2024. (EPA)
Search and rescue team members try to find victims following an overnight raid by the Israel army on the Palestinian camp of Ain el-Hilweh, in Sidon, Lebanon, 01 October 2024. (EPA)
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Lebanese Emergency Services Are Overwhelmed and Need Better Gear to Save Lives in Wartime

Search and rescue team members try to find victims following an overnight raid by the Israel army on the Palestinian camp of Ain el-Hilweh, in Sidon, Lebanon, 01 October 2024. (EPA)
Search and rescue team members try to find victims following an overnight raid by the Israel army on the Palestinian camp of Ain el-Hilweh, in Sidon, Lebanon, 01 October 2024. (EPA)

When Israel bombed buildings outside the southern Lebanese city of Sidon, Mohamed Arkadan and his team rushed to an emergency unlike anything they had ever seen.

About a dozen apartments had collapsed onto the hillside they once overlooked, burying more than 100 people. Even after 17 years with the civil defense forces of one of the world's most war-torn nations, Arkadan was shocked at the destruction. By Monday afternoon — about 24 hours after the bombing — his team had pulled more than 40 bodies — including children's — from the rubble, along with 60 survivors.

The children's bodies broke his heart, said Arkadan, 38, but his team of over 30 first responders' inability to help further pained him more. Firetrucks and ambulances haven’t been replaced in years. Rescue tools and equipment are in short supply. His team has to buy their uniforms out of pocket.

An economic crisis that began in 2019 and a massive 2020 port explosion have left Lebanon struggling to provide basic services such as electricity and medical care. Political divisions have left the country of 6 million without a president or functioning government for more than two years, deepening a national sense of abandonment reaching down to the men whom the people depend on in emergencies.

“We have zero capabilities, zero logistics,” Arkadan said. “We have no gloves, no personal protection gear.”

War has upended Lebanon again Israel’s intensified air campaign against Hezbollah has upended the country. Over 1,000 people have been killed in Israeli strikes since Sept. 17, nearly a quarter of them women and children, according to the Health Ministry. Hundreds of thousands of people have fled their homes, sleeping on beaches and streets.

The World Health Organization said over 30 primary health care centers around Lebanon’s affected areas have been closed.

On Tuesday, Israel said it began a limited ground operation against Hezbollah and warned people to evacuate several southern communities, promising further escalation.

Lebanon is “grappling with multiple crises, which have overwhelmed the country’s capacity to cope,” said Imran Riza, the UN's humanitarian coordinator for Lebanon, who said the UN had allocated $24 million in emergency funding for people affected by the fighting.

Exhausted medical staff are struggling to cope with the daily influx of new patients. Under government emergency plans, hospitals and medical workers have halted non-urgent operations.

Government shelters are full

In the southern province of Tyre, many doctors have fled along with residents. In Nabatiyeh, the largest province in southern Lebanon, first responders say they have been working around the clock since last week to reach hundreds of people wounded in bombings that hit dozens of villages and towns, often many on the same day.

After the bombing in Sidon nearly 250 first responders joined Arkadan's team, including a specialized search-and-rescue unit from Beirut, some 45 kilometers (28 miles) to the north. His team didn't have the modern equipment needed to pull people from a disaster.

“We used traditional tools, like scissors, cables, shovels,” Arkadan said.

“Anyone here?” rescuers shouted through the gaps in mounds of rubble, searching for survivors buried deeper underground. One excavator removed the debris slowly, to avoid shaking the heaps of bricks and mangled steel.

Many sought refuge in the ancient city of Tyre, 20 kilometers (12 miles) north of the border with Israel, thinking it was likely to be spared bombardment. More than 8,000 people arrived, said Hassan Dbouk, the head of its disaster management unit.

He said that there were no pre-positioned supplies, such as food parcels, hygiene kits and mattresses, and moving trucks now is fraught with danger. Farmers have been denied access to their land because of the bombings and the municipality is struggling to pay salaries.

Meanwhile, garbage is piling up on the streets. The number of municipal workers has shrunk from 160 to 10.

“The humanitarian situation is catastrophic,” Dbouk said.

Wissam Ghazal, the health ministry official in Tyre, said in one hospital, only five of 35 doctors have remained. In Tyre province, eight medics, including three with a medical organization affiliated with Hezbollah, were killed over two days, he said.

Over the weekend, the city itself became a focus of attacks.

Israeli warplanes struck near the port city’s famed ruins, along its beaches and in residential and commercial areas, forcing thousands of residents to flee. At least 15 civilians were killed Saturday and Sunday, including two municipal workers, a soldier and several children, all but one from two families.

It took rescuers two days to comb through the rubble of a home in the Kharab neighborhood in the city’s center, where a bomb had killed nine members of the al-Samra family.

Six premature babies in incubators around the city were moved to Beirut. The city’s only doctor, who looked after them, couldn’t move between hospitals under fire, Ghazal said.

One of the district’s four hospitals shut after sustaining damage from a strike that affected its electricity supply and damaged the operations room. In two other hospitals, glass windows were broken. For now, the city’s hospitals are receiving more killed than wounded.

“But you don’t know what will happen when the intensity of attacks increases. We will definitely need more.”

Making do with what they have

Hussein Faqih, head of civil defense in the Nabatiyeh province, said that “we are working in very difficult and critical circumstances because the strikes are random. We have no protection. We have no shields, no helmets, no extra hoses. The newest vehicle is 25 years old. We are still working despite all that.”

At least three of his firefighters’ team were killed in early September. Ten have been injured since then. Of 45 vehicles, six were hit and are now out of service.

Faqih said he is limiting his team’s search-and-rescue missions to residential areas, keeping them away from forests or open areas where they used to put out fires.

“These days, there is something difficult every day. Body parts are everywhere, children, civilians and bodies under rubble,” Faqih said. Still, he said, he considers his job to be the safety net for the people.

“We serve the people, and we will work with what we have.”



The Fragile Israel-Hezbollah Truce is Holding so Far, Despite Violations

Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
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The Fragile Israel-Hezbollah Truce is Holding so Far, Despite Violations

Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)

A fragile ceasefire between Israel and the Lebanon's Hezbollah has held up for over a month, even as its terms seem unlikely to be met by the agreed-upon deadline.

The deal struck on Nov. 27 to halt the war required Hezbollah to immediately lay down its arms in southern Lebanon and gave Israel 60 days to withdraw its forces there and hand over control to the Lebanese army and UN peacekeepers.

So far, Israel has withdrawn from just two of the dozens of towns it holds in southern Lebanon. And it has continued striking what it says are bases belonging to Hezbollah, which it accuses of attempting to launch rockets and move weapons before they can be confiscated and destroyed, The AP reported.

Hezbollah, which was severely diminished during nearly 14 months of war, has threatened to resume fighting if Israel does not fully withdraw its forces by the 60-day deadline.

Yet despite accusations from both sides about hundreds of ceasefire violations, the truce is likely to hold, analysts say. That is good news for thousands of Israeli and Lebanese families displaced by the war still waiting to return home.

“The ceasefire agreement is rather opaque and open to interpretation,” said Firas Maksad, a senior fellow with the Middle East Institute in Washington. That flexibility, he said, may give it a better chance of holding in the face of changing circumstances, including the ouster of Syria's longtime leader, Bashar Assad, just days after the ceasefire took effect.

With Assad gone, Hezbollah lost a vital route for smuggling weapons from Iran. While that further weakened Hezbollah’s hand, Israel had already agreed to the US-brokered ceasefire.

Hezbollah began firing rockets into Israel on Oct. 8, 2023 — the day after Hamas launched a deadly attack into Israel that ignited the ongoing war in Gaza. Since then, Israeli air and ground assaults have killed more than 4,000 people in Lebanon, including hundreds of civilians. At the height of the war, more than 1 million Lebanese people were displaced.

Hezbollah rockets forced some 60,000 from their homes in northern Israel, and killed 76 people in Israel, including 31 soldiers. Almost 50 Israeli soldiers were killed during operations inside Lebanon.

Here’s a look at the terms of the ceasefire and its prospects for ending hostilities over the long-term.

What does the ceasefire agreement say? The agreement says that both Hezbollah and Israel will halt “offensive” military actions, but that they can act in self-defense, although it is not entirely clear how that term may be interpreted.

The Lebanese army is tasked with preventing Hezbollah and other militant groups from launching attacks into Israel. It is also required to dismantle Hezbollah facilities and weapons in southern Lebanon — activities that might eventually be expanded to the rest of Lebanon, although it is not explicit in the ceasefire agreement.

The United States, France, Israel, Lebanon and the UN peacekeeping force in Lebanon, known as UNIFIL, are responsible for overseeing implementation of the agreement.

“The key question is not whether the deal will hold, but what version of it will be implemented,” Maksad, the analyst, said.

Is the ceasefire being implemented? Hezbollah has for the most part halted its rocket and drone fire into Israel, and Israel has stopped attacking Hezbollah in most areas of Lebanon. But Israel has launched regular airstrikes on what it says are militant sites in southern Lebanon and in the Bekaa Valley.

Israeli forces have so far withdrawn from two towns in southern Lebanon - Khiam and Shamaa. They remain in some 60 others, according to the International Organization for Migration, and around 160,000 Lebanese remain displaced.

Lebanon has accused Israel of repeatedly violating the ceasefire agreement and last week submitted a complaint to the UN Security Council that says Israel launched some 816 “ground and air attacks” between the start of the ceasefire and Dec. 22, 2024.

The complaint said the attacks have hindered the Lebanese army's efforts to deploy in the south and uphold its end of the ceasefire agreement.

Until Israel hands over control of more towns to the Lebanese army, Israeli troops have been destroying Hezbollah infrastructure, including weapons warehouses and underground tunnels. Lebanese authorities say Israel has also destroyed civilian houses and infrastructure.

What happens after the ceasefire has been in place for 60 days? Israel's withdrawal from Lebanese towns has been slower than anticipated because of a lack of Lebanese army troops ready to take over, according to Lt. Col. Nadav Shoshani, a military spokesman. Lebanon disputes this, and says it is waiting for Israel to withdraw before entering the towns.

Shoshani said Israel is satisfied with the Lebanese army's control of the areas it has already withdrawn from, and that while it would prefer a faster transfer of power, security is its most important objective.

Israel does not consider the 60-day timetable for withdrawal to be “sacred,” said Harel Chorev, an expert on Israel-Lebanon relations at Tel Aviv University who estimates that Lebanon will need to recruit and deploy thousands more troops before Israel will be ready to hand over control.

Hezbollah officials have said that if Israeli forces remain in Lebanon 60 days past the start of the ceasefire, the militant group might return to attacking them. But Hezbollah Secretary General Naim Kassem said Wednesday that, for now, the group is holding off to give the Lebanese state a chance to "take responsibility” for enforcing the agreement.

Over the final two months of the war, Hezbollah suffered major blows to its leadership, weapons and forces from a barrage of Israeli airstrikes, and a ground invasion that led to fierce battles in southern Lebanon. The fall of Assad was another big setback.

“The power imbalance suggests Israel may want to ensure greater freedom of action after the 60-day period,” Maksad, the analyst, said. And Hezbollah, in its weakened position, now has a “strong interest” in making sure the deal doesn't fall apart altogether “despite Israeli violations,” he said.

While Hezbollah may not be in a position to return to open war with Israel, it or other groups could mount guerilla attacks using light weaponry if Israeli troops remain in southern Lebanon, said former Lebanese army Gen. Hassan Jouni. And even if Israel does withdraw all of its ground forces, Jouni said, the Israeli military could could continue to carry out sporadic airstrikes in Lebanon, much as it has done in Syria for years.