This article was originally published by L’Orient Today.

When Christina*, a woman in her 30s, began feeling short of breath and suffering a severe cough this past January, she went to the doctor for help. After several tests and scans, that doctor sent her to one of their colleagues: an oncologist.

“I requested the tests be repeated three times to confirm her condition, and the result was shocking,” Dr. Hassan Kanaan, head of oncology at the Sahel General Hospital in southern Beirut’s Haret Hreik, tells L’Orient Today.

“I couldn’t believe that a healthy young woman in her 30s, with no family history of cancer, was indeed suffering from lung cancer.”

Kanaan fears her case, which he says is among the most unusual in his career, is emblematic of a rising problem.

A soon-to-be-published study by AUB researchers found that “the rate of carcinogenic pollutants in the atmosphere,” resulting from widespread dependence on private, diesel-powered electrical generators, “has doubled since 2017,” according to Parliament member and scientist Najat Saliba (Forces of Change/Chouf), who led the research.

In other words, cancer-causing pollutants in Beirut have risen twofold since their pre-crisis numbers.

The health results could be devastating. While Lebanon’s Health Ministry estimates an increase in cancer rates of 10 to 15 percent since 2016, heads of hospital oncology departments tell L’Orient Today they estimate a much higher 30 percent increase in recent years.

Lung cancer makes up the largest share of cases, oncologists add. They, like the AUB researchers, blame toxic air pollutants from electrical generators — which are often running 24 hours per day as Lebanon’s ongoing financial crisis means state power simply isn’t enough to keep the lights on in homes, businesses and elsewhere.

Electric generators are widespread in Lebanon. They are in public squares, parking lots, mounted on trucks, on rooftops, in residential neighborhoods, in hospital courtyards, and in front of shops.

A 2006 study found that 370,000 diesel generators operate across Lebanon, emitting more than 40 toxic substances — such as nitrogen dioxide and sulfur dioxide — into the air for up to 24 hours a day. The number of generators in use has almost certainly risen since 2006.

Younger cancer patients, more aggressive cancer

Lebanon ranks first among Western Asian countries in cancer incidence per population, with a rate of 242 cases per 100,000 citizens in 2018, according to the World Health Organization (WHO). Lebanon recorded 28,764 cancer cases in the last five years, with 11,600 cases in 2020 alone, a WHO report found in 2021.

There is no single cause for cancer, according to Dr. Kanaan. While factors such as “smoking, alcohol and obesity” can lead to cancer, they are compounded by pollution, which “not only increases cancer rates but also makes them more aggressive, with cases often reaching the doctor in their third or even fourth stage,” once the cancer has already spread throughout the body. This makes the disease harder to treat.

Dr. Maroun Sadik, head of oncology at the Lebanese Hospital Geitaoui in Beirut, is worried. He states that the number of patients coming to his oncology clinics has increased by at least 30 percent compared to before 2020. Meanwhile, the occupancy rate for patients undergoing chemotherapy sessions in the hospital has risen by up to 40 percent. Sadid adds that about 30 to 40 percent of these cases were diagnosed with lung cancer, some of them younger than 50 years old.

“The average age of patients visiting the clinic in the hospital in the last three years has decreased, and we have begun to see individuals under the age of 50 and 40 in our clinics,” adds Dr. Fadi Nasr, head of oncology at Beirut’s Hotel Hieu Hospital. Nasr also notes that 30 to 40 percent of those patients were diagnosed with lung cancer.

Lung cancer ranks third in terms of prevalence in Lebanon, after bladder cancer and breast cancer, according to 2020 figures published by the World Health Organization.

Lebanon’s Health Ministry stopped analyzing and publishing data on cancer rates in 2016. Ghada Gebran, advisor to Health Minister Firass al-Abiad, says that the ministry is in the process of resuming data collection and publishing the results. According to her, the ministry’s doctors estimate that the increase in cancer rates from 2016 to now ranges between 10 and 15 percent — lower than the 30 percent increase estimated by oncologists at Beirut hospitals.

One potential reason for that gap: oncologists at several hospitals tell L’Orient Today that a large number of cancer patients they encounter are not registered on the Health Ministry’s cancer tracking platform. That’s due to widespread shortages of the medications the platform is meant to provide, for free, to cancer patients.

Can the Environment Ministry do anything?

Diesel-powered generators are supposed to be a backup electricity source in emergencies.

But in Lebanon, they have become a primary source of electricity, replacing state supplier Electricite du Liban (EDL).

Yet private generators that distribute electricity across all regions and neighborhoods in Lebanon are considered illegal, as they violate the electricity regulation law No. 462/2002, which restricts the production and distribution of electricity only to EDL and other institutions with EDL contracts (like Electricite de Zahle).

The Energy and Environment Ministries have issued several different circulars in recent months in an attempt to regulate this sector, the latest of which was in September. In it, Environment Minister Nasser Yassin mandates the immediate treatment of generator exhaust smoke by equipping the generator exhaust with an efficient and more effective system capable of removing even fine particles.

This circular could be enforced if the relevant authorities were to monitor its implementation and hold violators accountable. However, since 2011, similar circulars have been issued (even though the latest circular is considered by experts to be the best in terms of the technical conditions imposed), but throughout these years, few generator owners have actually been investigated.

Issam Laqqis is the head of AUB’s Mechanical Engineering Department and took part in previous pollutants studies. According to him, generators should be placed on private properties with necessary ventilation and the generator’s exhaust located at the highest possible point in the building. However, authorities have allowed generators to be placed in locations surrounded by buildings in a way that prevents necessary ventilation, leaving residents at risk of inhaling toxic emissions.

Furthermore, generator owners have obtained permission to place their generators in public spaces. For example, in the Qoreitem area, one person was allowed to place an electric generator inside a small public park in exchange for paying fees and lighting a number of streets at night, according to Laqqis. A local resident confirmed there were generators now taking up most of the space in the park, blocking entry.

Laqqis believes that “there is a significant difficulty in providing effective oversight of these generators, as the cost of hiring experts and collecting hundreds of thousands of samples from generator exhausts for regular inspection is prohibitively expensive.”

“It might be more cost-effective for the relevant authorities to operate power plants or rent ships instead.”

Meanwhile, the Environment Ministry’s air quality testing stations have reportedly been out of service since 2019 and just received World Bank funds in February to undertake maintenance work, Environment Minister Nasser Yassin told L’Orient Today. He added that the ministry is “fixing” the station’s machinery and launching an assessment of the stations “in the coming weeks.”

Yassin previously stated in an interview on Voice of Lebanon that “air pollution caused by diesel generators is evidence of mismanagement of the electricity file, in addition to the lack of a public transportation policy.”

There are other air quality testing machines owned by the National Council for Scientific Research, a source from the council told L’Orient Today on condition of anonymity. But the council reportedly does not publish the results of its work, while its researchers are still analyzing samples collected in 2017.

In the meantime, Dr. Kanaan’s patient Christina has begun chemotherapy sessions and radiation treatments. She has stage III cancer, which means the cancerous cells have advanced to areas around her lungs.

According to Kanaan, Christina suffered severe depression upon learning of her diagnosis, and worries for your young daughter — though her family has provided emotional support.

For now, he simply hopes she’ll respond well to the treatment.

*Name changed to protect patient privacy