Why does Lebanon have some of the fastest-growing rates of cancer in the world?

The Lebanese people are resilient. They survived a civil war that lasted nearly two decades. Recently, they have been living through a conflict with their neighbor to the south, Israel, with bombs exploding in the heart of their capital, Beirut.  

Now, research has revealed another threat that kills even more people in Lebanon than war – cancer . An IHME-led study – published in The Lancet – showed that Lebanon has one of the fastest-growing cancer rates of any country in the world, with new cases increasing by 4% annually from 1990 to 2023. Many Lebanese worry about the effects of toxic waste and environmental pollution increasing their risk for cancer. People have good reason to be concerned, from the documented evidence of militias dumping industrial chemical waste from Europe during the Lebanese civil war to the pollution from diesel generators and agricultural chemicals.  

However, according to Dr. Ali H. Mokdad, a professor of Health Metrics Sciences at IHME and Chief Strategy Officer for Population Health at the University of Washington, the main driver of cancer in Lebanon is tobacco. 

In Lebanon, Big Tobacco is a state-owned business. “The government brags about how much money it makes from buying tobacco from Lebanese farmers in the South and reselling it,” said Dr. Mokdad.  

Argila or shisha (also known as hookah or waterpipe) is lucrative for cafés and restaurants, too – they purchase the tobacco for around 50 cents, then sell it to people for $10 or $15 per bowl, according to Dr. Mokdad. Each time he visits Lebanon, he notices that more people have taken up the habit. “Everywhere you go in Lebanon, people are smoking,” said Dr. Mokdad.  

According to IHME tobacco expert Dr. Luisa Flor, an assistant professor, an estimated 34% of people 15 and older in Lebanon are smokers, with the percentage of smokers having grown by 57% since 1990. Secondhand smoke is also a major hazard in Lebanon. Dr. Flor notes that the country ranks among the highest globally for secondhand smoke exposure. According to Dr. Flor, nearly 60% of children in Lebanon are exposed to tobacco smoke secondhand, increasing their risk for health problems later in life.  

For Dr. Mokdad, the fight against tobacco is personal. Many of his family and friends live in the country. “When my friends and family in Lebanon send me pictures of themselves smoking via WhatsApp, I urge them not to smoke. They tell me, ‘Ali, you don’t know what it is like here. At any moment, I could be killed in a bombing. Why shouldn’t I sit down at a café with my friend and smoke? Let us enjoy our lives.’”  

Tobacco is taking its toll on the country. Back in 1990, Lebanon had highest life expectancy in the North Africa and Middle East region. In 2023, however, Lebanon had fallen to fourth place for life expectancy, with Qatar, Kuwait, and the United Arab Emirates ranking higher, according to the Global Burden of Disease (GBD) study led by IHME. The researchers found that smoking was one of top risk factors for death in Lebanon. In Lebanon, smoking is linked to a wide range of negative health outcomes – 36 in total, including many different types of cancer, infectious diseases, lung disease, and cardiovascular diseases.  

Lebanese doctors are working to raise awareness of the deadly threat of smoking. When Dr. Mokdad and colleagues published their cancer study, Dr. Mokdad contacted Dr. Inaya Ezzeddine, a hematologist (a physician specializing in blood disorders) who also serves in the Lebanese parliament. To bring attention to the findings, Dr. Ezzeddine organized a meeting, inviting Dr. Mokdad to present his research to the different political parties within the parliament. In addition to members of parliament, people from the Lebanese Ministry of Public Health, the Ministry of the Interior, and academics attended the event.

Following the event, NPR contributor Ari Daniel interviewed Dr. Ezzeddine. “It’s a journey. It’s not something that we can implement overnight because it has to do with a lot of sectors. We have to work hard towards this political will,” said Dr. Ezzeddine.  

“Nothing will happen right away,” said Dr. Mokdad. Nevertheless, he is hopeful that his findings can empower health care leaders in the country to push for aggressive regulations against tobacco. If the country fails to act decisively, Dr. Mokdad fears that the percentage of smokers is likely to rise in the future, leading to worsening health outcomes. 

“A doctor from the International Lebanese Medical Association messaged me after I presented to the parliament, saying, ‘Thank you, Ali, for what you are doing in raising awareness about cancer and smoking.’”