DUBAI: As the coronavirus pandemic sweeps the world, many countries are finding themselves in dire need of a machine that until now was used to support the odd patient with severe respiratory conditions.
In the Middle East, the problem is especially acute given the region鈥檚 history of conflict, instability and weak governance.
Buying ventilators in large numbers (at a rate of $25,000 per unit) was never a priority for governments with long, pressing to-do lists.
But now, suddenly, across the Arab region people face a choice between waiting and watching, or doing something on their own before coronavirus cases overwhelm their country鈥檚 health system.
In Lebanon, several groups of people have taken the second option. Their objective is straightforward: To build a low-cost ventilator, a machine that mechanically assists a patient in the exchange of oxygen and carbon dioxide by a process of artificial respiration.

One of the initiatives is the brainchild of two alumni of the Lebanese University鈥檚 Faculty of Engineering, Hisham Issa and Hussein Hamdan, both engineers currently working abroad. Together with Dr. Hussein Al-Hajj Hassan, 30, they launched a Facebook drive to create an artificial ventilator entitled 鈥淎 Breather for All Lebanon.鈥�

鈥淲e might not be capable of serving everyone in hospitals, but there鈥檚 a possibility of manufacturing the machine here,鈥� Hassan, who holds a Ph.D. in engineering from IMT Atlantique in France, told Arab News.
鈥淪o we conducted a study on the expertise we needed, whose results I posted on my Facebook page. The post went viral and people started calling me.鈥�

To ensure its suitability for use by hospitals, the ventilator will be fabricated as per the specifications contained in a nine-page document issued by the UK鈥檚 Medicines and Healthcare Products Regulatory Agency (MHRA).
鈥淲e鈥檙e working to meet the MHRA specifications,鈥� Hassan said. 鈥淲e鈥檙e working in an incremental way, setting milestones and going forward toward each of them.鈥�
According to the three engineers, although their ventilator is now in an advanced stage of development, they are struggling with the lack of availability of key components in Lebanon.
鈥淚f you want a perfect medical device, you need medical equipment, which isn鈥檛 available here, so we鈥檙e trying to find alternatives,鈥� said Hassan.
Once the team has fabricated a successful prototype, ramping up production to meet the shortage of ventilators should not be a problem, he added. 鈥淲hat鈥檚 important is that the prototype meets all the requirements,鈥� he said.
Hassan believes the Arab region is aware of the dangers of a shortage of ventilators at this time, pointing to countries such as Jordan, Palestine, Morocco, Algeria and others that have contacted him.

鈥淚t鈥檚 nice to see that people are aware,鈥� he said. 鈥淟ebanese people are skilled and full of energy. This, coupled with their determination, will enable them to achieve their goal.鈥�
Another Lebanese innovator who is not counting on divine providence is Jad Berro, who said it became obvious to him about two weeks ago that the coronavirus pandemic was not going to spare Lebanon.
He began working in mid-March on a prototype of a basic automated bag valve mask.
鈥淟acking enough medical information at the time on mechanical ventilation, the general thought was that something simple could solve the imminent problem of ventilator shortage,鈥� he told Arab News.

鈥淚 make a living out of making products and prototypes, so we had a basic ventilator running (within a few days). This was a record by any standards.鈥�
Elaborating on the contraption, Berro said: 鈥淭he prototype can control the tidal volume, breaths per minute and the inhale-to-exhale ratio, with monitoring of excess pressure and internal self-tests to guarantee that the mechanism is functioning normally at all times.鈥� But the functions are 鈥渧ery basic鈥� and cannot be a replacement for a ventilator, he admits. 
Berro said he halted production out of 鈥渆thical and moral concerns鈥� as using it would have meant hooking patients to a device that had not been properly tested and did not offer any guarantee it would work for extended periods of time.
鈥淲hat鈥檚 needed is a unified basic design that鈥檚 proven and tested, after which it might be possible to actually manufacture the machine,鈥� he said.

鈥淣umbers in Lebanon show that we have close to around 600 ventilators. The absolute worst-case surge requirement would be around 2,800. The crisis is global and the deficiencies are the same worldwide.鈥�
It is estimated that worldwide, about 10 percent of patients with COVID-19 infection need ventilators.
Reports say about 880,000 more ventilators will be needed to deal with the demand caused by the global coronavirus pandemic.
Berro said efforts are being made to technologically enable one ventilator to service multiple patients of similar lung capacities.
鈥淎s global manufacturers are gearing up production of ventilators and medical devices, we can expect a slight relief,鈥� he added.

鈥淐hina seems to have successfully flattened the curve and might be able to send ventilators and medical supplies to other parts of the globe. A used ventilator is certainly better than a makeshift one.鈥�
Another Lebanese ventilator prototype has been unveiled by MP Neemat Frem two weeks after he initiated a project in collaboration with a group of specialized engineers and doctors.
The machine, targeted for use in intensive care units (ICUs) in Lebanese hospitals, is being built to high specifications, incorporating the latest technological features developed by Phoenix Co., an affiliate of Lebanon鈥檚 INDEVCO Industrial Group.
鈥淲e decided to fight with all our means in Lebanon,鈥� said Frem, who is also the group CEO. 鈥淲e wouldn鈥檛 have accepted the prospect of dying without doing anything, so we decided to put in all our efforts and strength, and it鈥檚 starting to yield results.鈥�
Clinical trials of the ventilators are estimated very soon, he said, adding that plans are simultaneously afoot to manufacture face masks.

鈥淲e still need some progress on the human-to-machine interface, which is the design,鈥� he told Arab News.
鈥淲e鈥檙e fabricating the most complicated version of the ventilator 鈥� that is, the one used in ICUs.鈥�
Phoenix Co.鈥檚 project had kicked off with a six-hour briefing by doctors, which was followed by the creation of a small taskforce comprising doctors, suppliers and biomedical engineers.
The challenge for Lebanon and other Arab countries, according to Frem, will be in purchasing material used to build ventilators in the needed quantities.
鈥淚 presume the coronavirus crisis will add stress on suppliers in Europe, the US and the Far East,鈥� he said.
鈥淪o we鈥檙e now in sourcing mode 鈥� to locate what鈥檚 available, starting with our main suppliers.鈥�
Frem feels Lebanon is not prepared for a sharp spike in COVID-19 cases, noting that at the current rate, 鈥渨e鈥檒l have big numbers in 50 days, which is worrying.鈥�
Nevertheless, 鈥渋t鈥檚 encouraging to see the fantastic work of startups and engineers,鈥� he said. 鈥淲e have to get rid of this 鈥榗an鈥檛 do鈥� attitude in the Middle East once and for all. We鈥檒l never surrender.鈥�
Berro offered a similar take on the looming ventilator shortage amid the regional coronavirus crisis.
鈥淎rabs survive on imports in times of prosperity as well as in times of crises,鈥� he said. 鈥淭his isn鈥檛 acceptable and needs to change.鈥�