Lebanon’s fragmented blood transfusion system faces major risks during humanitarian crises. We describe the national blood-supply response to a mass-casualty event (the pager explosion, Sept 17, 2024) followed by a two-month escalation of hostilities (Sept 21–Nov 20, 2024). The objective is to evaluate the effectiveness, operational challenges, and lessons learned from the coordinated Ministry of Public Health (MOPH) – Lebanese Red Cross (LRC) blood management response during this crisis.

Retrospective review of MOPH reports, LRC dashboard data, meeting minutes, and quarterly narrative reports covering the acute (72 hours after the explosion) and chronic (two-month war) phases. Key operational metrics (units collected, units distributed, delivery missions, donor characteristics) were extracted and summarized.

The Pager explosion injured around 2,750 people. Over the first 72 hours the LRC prepared and delivered 373 packed red blood cells (PRBCs) to 25 hospitals in 48 missions (median delivery time 1.5 hours) and collected more than 900 donor units (61% first-time donors). During the subsequent two-month conflict, the LRC distributed 2,481 PRBCs and 1,150 fresh frozen plasma units to 56 hospitals, despite center damage, security restrictions, staff fatigue, and declining donor turnout. Centralized command, real-time inventory visibility, pre-approved transport clearances, donor management, and targeted communication sustained supply and safety.

Rapid centralization of coordination, real-time data sharing, standardized communication, and predefined protocols preserved transfusion capacity in an extreme, resource-limited crisis. Institutionalizing these mechanisms and integrating all hospital blood banks would strengthen national transfusion resilience and offer a scalable model for other low- and middle-income settings.