The day the pagers exploded

It was an ordinary Tuesday at the clinic; a long day as usual. As I reviewed the schedule, I noticed there were only 2 patients left. My clinic, situated in the Department of Family Medicine at the American University of Beirut Medical Center in Lebanon, faced the emergency department (ED). Over time, the sound of ambulances rushing to the ED became familiar background noise, so much so I developed selective deafness to it. However, on that afternoon the sirens were alarmingly frequent, creating an almost uninterrupted rhythm. I looked out my window and saw the ED entrance overwhelmed by people. Moments later, a mass casualty event was announced. Along with many other physicians, I immediately rushed to the ED.

As physicians in Lebanon, we have unfortunately become accustomed to witnessing tragedies on an unprecedented scale. From recurrent wars and invasions to the devastating August 4, 2020, explosion (one of the most powerful nonnuclear anthropogenic explosions in history¹) that wiped out the port of Beirut injuring thousands and killing more than 200 people,² we have seen our share of horror. That Tuesday afternoon, September 17, 2024, marked yet another tragic event: the simultaneous detonation of hundreds of pagers.³

As I pushed through the chaos at the ED entrance, amid the flood of injured people and their families, I wasn’t sure what to expect. The first patient I encountered was a man in his 40s with blood pouring from his right hand. Several of his fingers were barely attached, hanging by threads of tissue. He had multiple lacerations across his face and a foreign object lodged in his left eye. Realizing there was little I could do for his hand, I cleaned the wound, wrapped it, and began suturing his chin. As more patients arrived, it was evident most of the injuries were concentrated in 3 areas: the hands and faces of those who held pagers close to read the messages, and the perineal areas of those who had pagers in the pockets of their pants.

In the midst of more than 3 hours of chaos, 2 thoughts stood out in my mind. First, I felt an overwhelming sense of pride to be part of an institution like the American University of Beirut Medical Center. Lebanon has grappled with a series of crises since 2019, including the collapse of the banking system, a currency devaluation exceeding 90%,⁴ severe fuel and electricity shortages, political deadlock, the devastation of the 2020 Beirut port explosion, the COVID-19 pandemic, and an exodus of health care professionals from the country.

Despite these overwhelming challenges, our hospital responded to this latest crisis with unmatched professionalism and efficiency. Treating and caring for over 200 severely injured patients simultaneously is a task only elite hospitals are equipped to handle. Our teams—nurses, physicians from all specialties, pharmacists, information technology personnel, and housekeepers—came together seamlessly to deliver the highest level of care. We operated with unwavering dedication, professionalism, and solidarity, exemplifying what it truly means to be part of a centre of excellence in the face of immense adversity.

Second, I was struck by the composure of the patients and their families. Despite their serious injuries, there was no panic. There were no screams or chaotic outbursts. Young men with amputated fingers or damaged eyes waited calmly for medical attention, while their families stood beside them silently offering comfort and prayers. I struggle to find the right words to describe the scene: strength, resilience, denial, endurance, faith, indoctrination; perhaps a mix of all these. Whatever it was, it is something that deserves to be shared with the world.

• Copyright © 2025 the College of Family Physicians of Canada