Healthcare Worker Migration Intensifies as Lebanese Hospitals Struggle to Hold Staff
Lebanon’s public hospital workforce is being pulled apart by crisis pressure, and Rafik Hariri University Hospital in Beirut offers a clear view of the strain. In a mixed-method study of frontline healthcare workers and department chiefs, migration intentions were widespread, driven most often by money and personal safety rather than professional ambition alone. The pattern is stark: when compensation fails to keep pace with inflation, and insecurity becomes part of daily life, retention stops being an administrative goal and becomes a systems survival problem.
Among 120 healthcare workers surveyed, 70% expressed an intention to migrate. Financial concerns dominated those decisions, cited by 93% of respondents, while security issues followed closely at 81%. The numbers point to a workforce that is not merely dissatisfied but actively weighing departure as a rational response to deteriorating conditions. In a hospital setting, this kind of exodus does more than thin payrolls; it weakens continuity of care, stretches remaining staff across more shifts, and makes clinical coverage harder to sustain across departments.
The findings also linked lower satisfaction with pay to migration intentions. The adjusted odds ratio was 0.85 with a 95% confidence interval of 0.72 to 0.996, a result that fits the clinical and organizational reality on the ground. When compensation loses credibility, even highly committed staff begin to reconsider whether staying is financially viable. For frontline teams, that calculation is not abstract. It affects whether nurses, physicians, and other hospital workers can cover living costs, maintain transportation, and remain in the workplace with any sense of stability.
Pay, Safety, and the Daily Logic of Leaving
The migration drivers identified in the survey are consistent with the pressures confronting many health systems under prolonged economic collapse. Salary erosion can undermine morale, but in this setting it does more than that: it changes the threshold at which professional loyalty gives way to exit planning. Security concerns add another layer, since unsafe conditions affect not only workers’ families and commutes but also the broader expectation that a hospital can function predictably during crisis periods.
A single sentence captures the operational consequence. Critical shortages were already visible across departments.
Qualitative interviews with department chiefs filled in what the survey only hinted at. Leaders described widespread staff migration since 2019, with the result being heavier workloads, critical staffing gaps, and even department closures. Those consequences are especially damaging in a public university hospital, where teaching, service delivery, and institutional continuity depend on a stable workforce. Once staff leave in clusters, the remaining team absorbs more clinical volume, more administrative burden, and more emotional fatigue, all while trying to preserve patient care standards.
The mixed-method design strengthens the clinical meaning of the findings. Survey data quantified migration intentions and their main drivers, while interviews with department chiefs showed how those intentions translate into organizational damage. The two streams of evidence converge on the same point: retention in Lebanon cannot be managed as a narrow human resources issue. It is tied to broader economic stability, institutional support, and the ability of hospitals to create working conditions that make staying possible.
What Department Chiefs Say Hospitals Need to Retain Staff
Department chiefs did not frame retention as a single-policy problem. They pointed instead to a package of interventions: financial incentives, professional development opportunities, supportive management, and flexible scheduling. Each of these levers speaks to a different level of the workforce crisis. Financial incentives address the immediate pressure of low pay. Professional development gives staff a reason to envision a future inside the system rather than outside it. Supportive management reduces day-to-day friction. Flexible scheduling can help absorb the burden placed on workers who are already overextended.
These proposals are practical because they match the causes of attrition. Staff do not leave for one reason alone, and no single fix is likely to reverse years of instability. Still, the study makes clear that compensation remains central. If pay dissatisfaction is already associated with migration intentions, then salary stabilization is not a cosmetic reform. It is one of the few interventions that speaks directly to the economic calculus driving departure.
The staffing consequences are not theoretical. When departments close or reduce service, patients wait longer, surviving staff carry more responsibility, and hospital leadership is forced into reactive triage rather than planned workforce management. In a system under strain, each additional resignation has a compounding effect. One departure can trigger another, especially when workloads are already high and morale is already brittle.
Retention Strategy Will Require More Than Recruitment Language
Lebanon’s healthcare migration problem is rooted in a complex interaction of financial, professional, and systemic stressors. The study’s central message is that retention strategies must be immediate and durable, not symbolic. Financial stabilization is essential, but so are working conditions that protect staff from exhaustion and uncertainty. Hospitals cannot keep experienced personnel if workers see no realistic path to stability, advancement, or safety.
The setting matters here. Rafik Hariri University Hospital sits within a country facing ongoing economic and political crises, and that context shapes everything from salary value to the credibility of long-term planning. For health systems in low- and middle-income countries, the lesson is clear in operational terms: workforce retention depends on whether institutions can make staying more viable than leaving. Without that shift, migration will continue to erode service capacity, one department at a time.
The study leaves an urgent policy question in plain view. Can hospitals and national decision-makers build enough financial and organizational support to slow the departure of skilled staff before more services are pushed beyond recovery?