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.