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Libya: Experiences of a doctor in Libya's detention centres
MSF teams have recently started to provide health care in detention centres operated by local authorities in and around Misrata, Libya.
This is Dr Tankred Stoebe's personal account of what he witnessed during this assignment that took him to Misrata, Syrte and Tripoli.
Civil war resumes
Since mid-2014, the humanitarian situation in Libya has deteriorated due to the resume of the civil war and political instability. Millions of people across the fragmented country have been impacted, including refugees, asylum-seekers and migrants.
Ismaël and Masjdi were both 19-year old students when the revolt began in Libya in 2011. Like thousands of others, the two fervent idealists took up arms against Mu’ammar Gaddafi regime with no training or understanding of military strategy. The two young men, who both narrowly escaped death, met much later in Malta. During the fighting, Masjdi sustained wounds to the face and was blinded, while Ismaël was paralysed and can only move his right hand.
"When I asked them if they want to get on a boat to Europe, they smiled and shook their heads: “It’s too dangerous. We don’t want to die in the sea.”
They became friends from the moment they met in the intensive care unit. Separated during their convalescence, they kept in touch and now meet up in Misrata whenever they get the opportunity. “We’re like brothers,” they told me in chorus. Masjdi pushes his friend’s wheelchair and Ismaël reads to his blind friend.
Economically and militarily powerful, its hospitals are well equipped and its health system better organised than in the east. There are around 10,000 migrants in Misrata, mostly from Niger, Chad and Sudan.
"At least as many people have died crossing the desert as those who have drowned in the Mediterranean Sea. Survivors are insistent that the desert is by far the hardest part of the journey."
Fearful of arrest and deportation, when they fall sick they usually go to pharmacies and buy the often high-priced drugs they are advised to take. `But when they have a chronic illness, their only choice is to go home. When I asked them if they want to get on a boat to Europe, they smiled and shook their heads: “It’s too dangerous. We don’t want to die in the sea.”
Between Misrata and Tripoli
Living conditions and hygiene are truly appalling in the detention centre in a small town halfway between Misrata and the Libyan capital. Intended for 400 refugees, there were only 43 detainees, 39 of them women from Egypt, Guinea, Niger or Nigeria who’d been there for a month with no contact with the outside world or their families.
"Rooms were small, dirty and jam-packed with mattresses. As we entered the hall, there was a putrid stench. We walked through puddles of urine. There were no showers, the toilets didn’t flush and the women had to relieve themselves in buckets. They used a little of their drinking water to wash."
They were utterly desperate and begged me to help them get back to Nigeria. When I told them I was a doctor, they didn’t believe me to start with but then they accepted the treatment we offered them. Their average age was 22 and almost all of them had health issues. Many had scabies, which we gave them prescriptions for.
Other non-specific ailments were due to emotional trauma — or at least, that’s what we deduced from the stories they told us and from their almost palpable fear. When I asked them if they thought they would try to get to Europe again, they replied, horrified, “Never again!.”
Our visit to Syrte was a real eye-opener. Close to the oil fields, the town is known for being the birthplace of Mu’ammar Gaddafi who died in October 2011. In spring 2015, so-called Islamic State who controlled 300 kilometres of the country’s coastline made Syrte its stronghold in Libya.
It was only in December that militias from Misrata succeeded in retaking the town with help from the US Air Force.
"The battle lasted seven months. Many fighters died and over 3,000 people were wounded. Ten ambulances were damaged and three rescue workers were killed."
Armed with a special permit and a police escort we managed to enter the coastal town. Reduced to rubble, not one building has been left intact. Syrte was subjected to a brutal war that left a trail of total destruction. A deathly silence hangs over the town that, from the historical perspective, was most probably unique.
We went to Ibn Sina hospital. Relatively unscathed by the bombs, it had been ransacked. Abandoned over a year ago, the hospital was once a modern, 350-bed facility equipped with several operating theatres, an intensive care unit, MRI scanner, a cardiac catheterisation laboratory and twenty practically new dialysis machines. It’s completely destroyed, with ripped up flooded floors, smashed windows and sagging ceiling tiles.
When we reached Tripoli I was stunned by the towering height of the ruins. MSF colleagues were in the capital providing assistance to people spread among seven detention centres. Most of those wanting to cross the Mediterranean to Italy are from Sub-Saharan Africa — Nigeria, which is mired in conflict, Eritrea that is governed by an authoritarian regime and Somalia, a country embroiled in a civil war.
People flee northwards to escape poverty and terror. To reach the Libyan coast, they have to pass through Chad and Niger, both particularly poor countries. Over 300,000 people crossed through them last year. However, there are no precise figures on how many have died of hunger or thirst or from falling off a truck along the way.
Death in the desert
According to most recent estimates, at least as many people have died crossing the desert as those who have drowned in the Mediterranean Sea — the statistics on people who drowned are more reliable. Be that as it may, survivors are insistent that the desert is by far the hardest part of the journey.
The many dead migrants also pose a problem. We went to hospital mortuaries overflowed with unidentified corpses washed up on beaches or of people who simply died. Many have been there for months. As the authorities don’t have the resources for DNA testing, it’s impossible to identify the dead and ship them back home or bury them.