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Long before Mexico, Colombia, and Afghanistan became notorious for their contributions to the global drug traffic, Lebanon was a special target of U.S. drug agents for harboring the world's greatest single transit port in the international traffic in narcotics. In the words of one American official, \"certain of the largest traffickers are so influential politically, and certain highly placed officials so deeply involved in the narcotic traffic, that one might well state that the Lebanese Government is in the narcotics business.\" Using previously secret government records, The Lebanese Connection uncovers for the first time the story of how Lebanon's economy and political system were corrupted by drug profits—and how, by financing its many ruthless militia, Lebanon's drug trade contributed to the country's greatest catastrophe, its fifteen-year civil war from 1975 to 1990. In so doing, this book sheds new light on the dangerous role of vast criminal enterprises in the collapse of states and the creation of war economies that thrive in the midst of civil conflicts. Taking a regional approach to the drug issue, Jonathan Marshall assesses the culpability of Syria, Israel, and of Palestinian factions and other groups that used Lebanon as their battleground. On the international level, he documents Lebanon's contribution to the hard drug problem of major consuming countries, from the days of the \"French Connection\" through the \"Pizza Connection,\" as well as Lebanon's unrivaled place in the global hashish market.

\"Why are democracies pursuing more military conflicts, but achieving worse results? Democratic Militarism shows that a combination of economic inequality and military technical change enables an average voter to pay very little of the costs of large militaries and armed conflict, in terms of both death and taxes. Jonathan Caverley provides an original statistical analysis of public opinion and international aggression, combined with historical evidence from the late Victorian British Empire, the US Vietnam War effort, and Israel's Second Lebanon War. This book undermines conventional wisdom regarding democracy's exceptional foreign policy characteristics, and challenges elite-centered explanations for poor foreign policy. This accessible and wide ranging book offers a new account of democratic warfare, and will help readers to understand the implications of the revolution in military affairs\"-- Provided by publisher.

Background: Due to Russia and Ukraine’s key roles in supplying cereals and oilseeds, the Russia–Ukraine war intensifies the current food availability and price challenges in Lebanon, which is a major wheat importer. Given these constraints, we conducted this study to assess the prevalence and correlates of food insecurity, low dietary diversity (DD), unhealthy dietary patterns, and the shifts in households’ food-related habits in response to the Russia–Ukraine war among a representative sample of Lebanese household’s members aged 18 years and above (N = 914). Methods: Data were collected between June and July 2022 using self-administered questionnaires; Results: Findings showed that nearly half of the households consume an undiversified diet (46%), and 55.3% ate fewer than two meals per day. The prevalence of food insecurity among Lebanese households was 74%, with one in every four households being severely food insecure. In addition, the majority of households’ members went out shopping and purchased food less than the pre-war period (68.7% and 70.3%, respectively). Furthermore, almost 68.3% of households’ members highlighted price increases for cereal products, which were the least available and most stocked items. Findings obtained through binary logistic regression also showed that food insecurity was two times higher among households with low monthly income, 35% higher among females, and three times higher among married participants; Conclusions: The impact of the Russia–Ukraine conflict on food security in Lebanon requires a systems-thinking approach as well as international effort to understand the challenges and find solutions to minimize the war’s negative effects.

Background This paper describes the design and cohort profile of the Lebanon Study on Aging and HeAlth (LSAHA), the first population-level study of Alzheimer’s Disease and Related Dementias (ADRD) in an Arab country. The burden due to ADRD in the Middle East and North Africa (MENA) region is among the highest in the world, but reliable population-level data on ADRD in the region are lacking. Older adults in Lebanon have experienced prolonged periods of social and economic instability due to political conflicts and chronic government mismanagement. The effects of these destabilizing experiences throughout the life course on ADRD risk and other late-life health outcomes are currently unknown. Methods LSAHA is designed as a prospective cohort study of ADRD in a large sample of adults aged  ≥  60 years in Lebanon [baseline data presented here]. We employed a probability-based multi-stage sampling design in two pre-selected areas, the city of Beirut and district of Zahle, to represent the full range of urban-rural, socio-economic, and religious diversity in Lebanon. Data collection included a standardized survey questionnaire including validated cognitive tests and anthropometric measurements, a household interview, key informant assessments, and a blood sample. Survey weights were computed to account for differential non-response and calibrated for the age- and sex-distribution in the two study areas. Results LSAHA enrolled 3,027 participants, 1,510 from Beirut and 1,517 from Zahle, realizing a response rate of 69%. The average age of the sample was 71.7 years and 55.3% was female, 43.1% had primary education or less, while 19.9% had university training. There was a high prevalence of chronic medical conditions, such as hypertension (57.2%), heart disease (32.4%), and diabetes (32.7%). There was also a high prevalence of moderate/severe symptoms of depression (51.4%) and anxiety (34.1%). A substantial percentage reported fair or poor self-rated memory (52.1%) or having worse memory compared to 2 years ago (38.4%). Conclusions We successfully launched a new cohort study of older adults in Lebanon to investigate ADRD and its risk factors. Data from this study will inform clinical care and policy goals in Lebanon and other settings that face a rapidly growing number of older adults with ADRD.

Background COVID-19 has hit the world in an unprecedented way causing serious repercussions on several aspects of our life. Multiple determinants have affected various nations’ level of success in their responses towards the pandemic. The Arab Levant region in the Middle East, notoriously known for repeated wars and conflicts, has been affected, similarly to other regions, by this pandemic. The combination of war, conflict, and a pandemic brings too much of a burden for any nation to handle. Methods A descriptive analysis of data obtained from the health departments of various Arab Levant Countries (ALC) was performed. ALC include Lebanon, Syria, Jordan, Iraq and Palestine. The data collected involves incidence, recovery rate, case fatality rate and number of tests performed per million population, Global Health Security index, government stringency index, and political stability index. The information obtained was compared and analyzed among the ALC and compared to global figures. An extensive electronic literature search to review all relevant articles and reports published from the region was conducted. The 2019 Global Health Security (GHS) index was obtained from the “GHS index” website which was made by John Hopkins University’s center for health security, the Nuclear threat Initiative (NTI) and the Economist Intelligence Unit (EIU). Government stringency index and political stability index were obtained from the University of Oxford and the website of “The Global Economy”, respectively. Other world governance indicators such as government effectiveness were obtained from the World Bank website. Results In terms of incidence of COVID-19, Iraq has the highest with 9665 per one million population, Syria the lowest at 256 per million. Deaths per million population was highest in Iraq at 237, and the lowest in Syria at 12. As for number of tests per million population, Lebanon ranked first at 136,033 with Iraq fourth at 59,795. There is no data available for the tests administered in Syria and subsequently no value for tests per million population. In terms of recoveries from COVID-19 per million population, Iraq had the highest number at 7903 per million, and Syria the lowest at 68 per million. When compared as percent recovery per million, Palestine ranked first (84%) and Syria last (27%). The government response stringency index shows that Jordan had the highest index (100) early in the pandemic among the other countries. Palestine’s index remained stable between 80 and 96. The other countries’ indices ranged from 50 to 85, with Lebanon seeing a drop to 24 in mid-August. Even with improved stringency index, Iraq reported an increased number of deaths. Conclusion In countries devastated by war and conflict, a pandemic such as COVID-19 can easily spread. The Arab Levant countries represent a breeding ground for pandemics given their unstable political and economic climate that has undoubtedly affected their healthcare systems. In the era of COVID-19, looking at healthcare systems as well as political determinants is needed to assess a country’s readiness towards the pandemic. The unrest in Lebanon, the uprising in Iraq, the restrictions placed on Syria, and the economic difficulties in Palestine are all examples of determinants affecting pandemic management. Jordan, on the contrary, is a good example of a stable state, able to implement proper measures. Political stability index should be used as a predictor for pandemic management capacity, and individual measures should be tailored towards countries depending on their index.

This article argues that the Lebanese Civil War (1975–90) was in essence a terror of state directed by mercantile economic and political elites (the comprador class) controlling the Lebanese state and society against the middle and poorer classes (the working class). The aim of this terror or organized violence was to subdue the subordinate classes, which in the late 1960s and early 1970s rebelled against the confessional system that operated for the benefit of the comprador class. The rebellion was expressed by members of the working-class joining cross-confessional nationalist and leftist parties. Hence, violence was aimed at reestablishing the confessional order as a means to restore a hegemonic system that served the interests of the comprador class at a time when this class was rehabilitating its economic role by resurrecting the financial system, which had received a severe blow in the late 1960s. It effected this rehabilitation through the Taif Agreement signed between Lebanese parliamentarians in 1989, under the auspices of Syria, Saudi Arabia, and the United States, to favor the new mercantile elite led by Rafiq Hariri.

Despite ongoing local and international peace efforts, the Jews, Arabs, and other residents of Israel and the Palestinian territories (i.e., the West Bank and Gaza) have endured decades of political, social, and physical upheaval, with periodic eruptions of violence. It has been theorized that the psychological impact of the Israeli–Palestinian conflict extends beyond the bounds of psychiatric disorders such as posttraumatic stress disorder (PTSD). Exposure to the ongoing conflict may lead to changes in the way Israelis and Palestinians think, feel, and act; while these changes may not meet the thresholds of PTSD or depression, they nonetheless could have a strong public health impact. It is unclear whether existing studies have found associations between exposure to the conflict and nonclinical psychological outcomes. We conducted a systematic review to synthesize the empirical research on the Israeli–Palestinian conflict and its psychological consequences. As a whole, the body of literature we reviewed suggests that exposure to regional political conflict and violence may have detrimental effects on psychological well-being and that these effects likely extend beyond the psychiatric disorders and symptoms most commonly studied. We found evidence that exposure to the conflict informs not only the way Israelis and Palestinians think, feel, and act but also their attitudes toward different religious and ethnic groups and their degree of support for peace or war. We also found that Palestinians may be at particularly high risk of experiencing psychological distress as a result of the conflict, though more research is needed to determine the extent to which this is due to socioeconomic stress. Our review suggests the need for more studies on the nonclinical psychological aspects of the Israeli–Palestinian conflict as well as for longitudinal studies on the impact of the conflict on both Israelis and Palestinians.

Lebanese public debt has been accumulating since 1990, after the end of the civil war. Recently, concerns about the ability of the government to keep servicing its debt have emerged, particularly because the debt-to-GDP ratio reached almost 147% at the end of 2018. This study aims to examine whether a cointegrating relationship exists among primary fiscal performance, real economic growth, and public debt in Lebanon using an autoregressive distributed lag (ARDL) model between 2000 and 2018. The ARDL results suggest the non-existence of a cointegrating relationship and hence the unsustainability of the Lebanese public debt. The evidence of the short-run estimation indicates that better primary fiscal performance and a higher economic growth rate reduce Lebanese public debt in the short run. This study proposes that immediate reforms that increase the primary fiscal surplus and attract investors are crucial to prevent a debt crisis in the country.

The Syrian crisis has caused one of the greatest episodes of forced displacement since World War II and some of the densest refugee-hosting situations in modern history. Lebanon has hosted more than 1 million Syrian refugees. This article is based on a large multisectoral survey of Syrian refugees’ households in Bekaa, conducted by the Union of Relief and Development Associations (URDA) in the period 2016–17 with a total of 1614 households and 6199 individuals. It assesses the socio-economic and living conditions of this representative sample (i.e., the location of refugees and housing conditions, the legal status of refugees, family expenditure, shelter, displacement, education, work, health, child health including child marriage). Among many vulnerabilities experienced by Syrian refugees, we identify three salient domains of precariousness, which are education, health, and early marriage. A particular analysis covers the differential analysis between camp dwellers versus urban ones, and the conviviality of the former compared with the latter.