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 h 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 2750 people. Over the first 72 h the LRC prepared and delivered 373 packed red blood cells (PRBCs) to 25 hospitals in 48 missions (median delivery time 1.5 h) and collected more than 900 donor units (61% first-time donors). During the subsequent two-month conflict, the LRC distributed 2481 PRBCs and 1150 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.