LEBANON: RESIGNED MINSTER OF HEALTH CONTINUES

C O N F I D E N T I A L SECTION 01 OF 04 BEIRUT 000746 SIPDIS DEPT FOR NEA/FO, NEA/ELA ALSO FOR IO A/S SILVERBERG AND PDAS WARLICK DEPT PASS USTR TREASURY FOR MNUGENT AND SBLEIWEISS NSC FOR ABRAMS/SINGH/YERGER/GAVITO E.O. 12958: DECL: 05/21/2018 TAGS: PGOV PINR ECON EFIN EAID LE SUBJECT: LEBANON: RESIGNED MINSTER OF HEALTH CONTINUES MAKING REFORMS REF: A. BEIRUT 536 ¶B. BEIRUT 733 ¶C. BEIRUT 618 Classified By: Charge d'Affaires a.i. Michele J. Sison for reasons 1.4 (b) and (d). SUMMARY -------------- ¶1. (C) "Resigned" yet still-active Minister of Health (MOH) Mohammed Khalifeh described the reforms he has undertaken at the Ministry since assuming office in 2005. Although he resigned in November 2006 when five Shia ministers left the Siniora cabinet, he told Charge that he continues to push decrees through the Cabinet, improve MOH's financial situation, and strategize about future projects such as universal national health care. Khalifeh provided an update on the Ministry of Health view of the financial disputes between the GOL and American University (of Beirut) Medical Center. Professing political independence, Khalifeh hinted at starting his own party in the future and at his aspirations to be re-appointed as the Minister of Health in the new Cabinet. ¶2. (C) Khalifeh, who is close to Parliament Speaker Nabih Berri although not an Amal Party member, believes Hizballah is open to discussing its arms "in a proper dialogue." He asserted that the GOL needs to provide more services to the people of Lebanon, "because if not, they will look elsewhere." He criticized the Cabinet's decisions to transfer the head of airport security and declare Hizballah's fiber optics network illegal, believing the issues could have been resolved better. The Lebanese Armed Forces performed according to its responsibilities during the previous two weeks of clashes, Khalifeh said. End summary. FINANCIAL ISSUES BETWEEN GOVERNMENT AND AMERICAN UNIVERSITY MEDICAL CENTER -------------- ¶3. (C) The Charge, accompanied by PolOff, met with "resigned" Minister of Health Mohammed Khalifeh on May 21. A medical doctor and Lebanon's liver transplant surgeon pioneer, Khalifeh explained his views on the issues of the estimated $4.5 million in arrears that the Ministry of Health and the National Social Security Fund, or NSSF, owes to the American University Medical Center (commonly called AUH, for American University Hospital),where he is the head of general surgery (Ref A). He said that the Health Ministry had recently approved the Finance Ministry paying approximately $400,000 to AUH. MOH's portion of the arrears dates back to 2004 when, Khalifeh said, the Ministry had a deficit. He claimed that as Minister, he improved the Health Ministry's financial situation. ¶4. (C) Delayed payments by the National Social Security Fund, the principal debtor to AUH and other hospitals, remains a problem, according to Khalifeh. He claimed that the NSSF does not effectively request from the Finance Ministry what it needs to pay service providers like AUH. Khalifeh asserted that the NSSF suffers from poor claims processing, adding that a good amount of the paperwork is not completed and the NSSF does not try hard enough to make collections. He said he offered assistance, but they did not respond. (Note: The NSSF is implementing a World Bank-recommended reform program. End note.) AUH HAS LOST ITS MISSION -------------- ¶5. (C) Indicating that there are some "difficult people" at AUH and the American University of Beirut, Khalifeh expounded on what he sees is a departure from AUH's founding principles dating back 140 years. He said AUH is attempting to treat only wealthy patients, and has stalled treatment for poor people referred by the MOH. "It is unacceptable for AUH to refuse a patient, especially when it is the only hospital which can perform a certain procedure," he complained. He BEIRUT 00000746 002 OF 004 reported that he asked AUH administrators how much they would want in order to treat the patients who cannot afford it themselves, but that AUH did not respond. He said he hopes to discuss this with Embassy at a later date. MAKING FINANCIAL HEADWAY AT MOH; EYEING A SECOND TERM AS MINISTER -------------- ¶6. (SBU) The MOH has been running an annual deficit of $40 million, Khalifeh said. He told us that during his service as Minister since 2005, the MOH ha undergone major reforms such as improved auditig, is treating 30,000 more patients annually, and now has a balanced budget. In the same breath, he told us that he was unable to achieve his full potential because he resigned in November 2006. Nevertheless, he continued to push through decrees, citing the Implementation Decree for Law 530 on registering, importing, marketing, and categorizing pharmaceutical products. The law was passed in 2003, but the decree was only approved by the Cabinet during its May 5 ten-hour session. ¶7. (SBU) Khalifeh said that when he assumed his ministerial post, there were no functioning public hospitals. Under his leadership, 20 public hospitals have been built and equipped and are now running, with no increase to MOH's budget. He noted that his budget is small, approximately 3.5 percent of the total national budget. ¶8. (SBU) To address the issue of political NGOs (Hizballah-influenced) claiming credit for MOH-distributed medicine, Khalifeh described a project MOH will roll out within the next few days, in conjunction with the YMCA. The project will distribute identity cards, bearing the MOH logo, to residents for accessing GOL-funded medicine so that they will know exactly who is providing the service. ¶9. (SBU) Looking ahead, Khalifeh said he aspires to roll out universal national health insurance, informing us that 54 percent of Lebanese are uninsured. When asked if he hoped to be re-appointed as the Minister of Health, he merely smiled. REFLECTING ON CABINET POSTS -------------- ¶10. (C) "In Lebanon, people will aim in one direction to get somewhere else," Khalifeh theorized when responding the Charge's inquiry on the new Cabinet. He believes that the Minister of Interior should be independent and therefore chosen by the new president. He said that while the new government will only exist until parliamentary elections are held at the end of spring 2009, it needs to be very active to catch up on what has been stagnant for the last two years. SOCIAL PROBLEMS AFFECTING LEBANON'S STABILITY -------------- ¶11. (C) Khalifeh voiced his concern that social security and financial safety nets in Lebanon are weak, which could drive people to support Hizballah if they are unemployed and poor. He lamented that very little has been spent on the people of Lebanon, "There is no health coverage, pension plan, facilities for elderly or disabled (who can apply for a disability certification, but receive no accompanying financial assistance)." These programs are easy to manage, he said, but have been largely ignored. ¶12. (C) He recommended the GOL undertake social stability programs to improve Lebanon's internal security situation, acknowledging that its external security depends on its neighbors. ¶13. (C) Recounting the events that led to his resignation, Khalifeh said that in the wake of the July 2006 war, there was no dialogue among the political leaders. Consequently, the Special Tribunal was pushed through without consensus, and by November 2006, he had submitted his resignation. Attributing his resignation to a normal process of Lebanese BEIRUT 00000746 003 OF 004 politics, he insisted that the GOL should not have continued without its Shia ministers. ASSESSMENT OF DOHA -------------- ¶14. (C) A close friend of Parliament Speaker Nabih Berri although not a member of Amal or any other political party, Khalifeh said that he knew a deal had been made in Doha (Ref B) when he saw Berri wearing the traditional Qatari white garment, claiming that it was a signal. He added that Berri purposefully wore the hotel slippers to his meetings to send the message to his wife that she did not pack well for his trip. ¶15. (C) Sharing what he has been hearing in the Beirut coffee shops, Khalifeh said that Sunnis are angry with March 14 leader Saad Hariri because they say he always talks about fighting for the Beirut Sunnis, yet he did not bring a single one with him to the talks in Doha. HIZBALLAH WILLING TO DISCUSS ITS ARMS -------------- ¶16. (C) Khalifeh stated with conviction that "Hizballah is open to discussing its arms." However, he caveated, the arms must be handled in a "proper dialogue." He continued, "The dialogue on arms will be very positive, I know. People should shut up and let a small committee work on this issue. In the end, people have to feel they belong to the state first. Then they will be willing to defend it." ELECTORAL LAW IS SHORT-TERM SOLUTION -------------- ¶17. (C) Khalifeh assessed that the new electoral law agreed upon in Doha (Ref B) is a short-term solution. He proposed a system in which each community nominates four or five individuals, who then fun in a larger district election. "This way," he argued, "everyone has a voice in selecting their representative. People will not turn to extremist language to appeal to voters because they will have to gain the support of a diverse population." He said that vote-buying and extremism are associated with a law based on small districts. CABINET'S DECISIONS COULD HAVE BEEN HANDLED DIFFERENTLY -------------- ¶18. (C) Khalifeh criticized the Cabinet's controversial decisions to transfer the head of airport security after finding Hizballah-installed surveillance cameras at the airport and declare Hizballah's fiber optics network illegal (Ref C). He said that the airport security chief BG Wafiq Chucair was used as a symbol, and deserved an investigation. Moreover, he said, the Lebanese Armed Forces (LAF) could have been involved. The Shia interpreted the Cabinet's move as an intentional provocation. ¶19. (C) As for the fiber optics network, Khalifeh said, "Even if Hizballah did not exist, the Shia would still build their own telecommunications network," implying that the GOL does not do enough for its people. "If the government provides services, they will use them. If not, they will look elsewhere," he stated. ¶20. (C) Originally from Sarafand in southern Lebanon (where his brother is Mayor),Khalifeh described the town as "quiet but tense." He said its residents were angered by what happened with the head of airport security, and were ready to fight over it. LAF DID WHAT IT COULD -------------- ¶21. (C) Acknowledging that some people are criticizing the BEIRUT 00000746 004 OF 004 LAF for not doing enough during the previous two weeks of clashes, Khalifeh asserted that "The LAF could have done more, but then it would not have survived." He said that the army is a fragile institution, and if it had entered the conflict, civil war could have broken out. The LAF's job is to protect Lebanon's border, not its interior. Suggesting that the Internal Security Forces (ISF) should have been responsible, Khalifeh said that the LAF did play a big role in keeping the opposing sides apart in Beirut. INDEPENDENT, FOR NOW -------------- ¶22. (C) When asked about his independent status, Khalifeh explained that he is not formally aligned with any party because he "is waiting for something in the future..." (Comment: We wonder if he has chosen to maintain ties to the Amal Party but not formally join it because he plans to form his own party. End comment.) SISON