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Libya

Since the end of the Muammar Gaddafi regime in 2011, Libya has been divided by armed conflict and the violence has escalated in recent years

On the North African shore of the Mediterranean Sea, Libya – a mostly desert and oil-rich country – has an ancient history stretching back to the time of the Romans.

Map of MSF's activities in Libya, 2015

More recently, it has been renowned for the capricious 42-year rule of Colonel Muammar Gadaffi and is now a springboard for migrants and refugees heading for Europe.

Following years of conflict, a new UN-backed "unity" government is installed in Tripoli. It faces opposition from two rival governments and a host of militias.

The country is crisscrossed by many dividing lines, along which the so-called ‘Islamic State’ has risen in power.

Médecins Sans Frontières/Doctors Without Borders (MSF) first began working in Libya in 2011, when the country was plunged into chaos after fighting between rival factions caused people to flee their homes.

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MSF’s work in Libya: 2017

MSF continues to provide medical care to refugees and migrants detained in Tripoli.

In 2017, widespread violence and insecurity in Libya meant that MSF was one of the few international organisations working in the country.

Despite the instability and ongoing conflict, Libya remained a destination for migrant workers from across the African continent and a transit country for migrants, asylum seekers and refugees attempting to cross the Mediterranean and reach Europe.

In 2017, MSF provided medical assistance to migrants and refugees arbitrarily held in detention centres that are nominally under the control of the Ministry of the Interior. Most medical complaints were related to the conditions in which they were detained, with overcrowding, inadequate food and drinking water, and insufficient latrines resulting in respiratory tract infections, musculoskeletal pain, skin diseases such as scabies, and diarrhoeal diseases.

MSF publicly called for an end to the arbitrary detention of migrants and refugees in Libya, calling it harmful and exploitative. MSF denounced European governments’ migration policies to seal off the coast of Libya and ‘contain’ migrants, asylum seekers and refugees in a country where they are exposed to extreme, widespread violence and exploitation.

In Tripoli, MSF conducted 17,219 medical consultations and referred 470 patients to secondary healthcare facilities. During October and November, a massive increase in the number of people detained caused extreme overcrowding and further deterioration of conditions inside detention centres there. The pressure was eased in December, when the International Organization for Migration repatriated thousands of people.

In Misrata, MSF supported the main hospital to improve infection control, and also scaled up its response to the needs of migrants and refugees in the area. Medical teams started working in five detention centres in Misrata, Khoms and Zliten, carrying out a total of 1,351 consultations and referring 49 patients for further treatment.

The majority of migrants and refugees in Libya live outside detention centres and, like the local communities, they are affected by the deterioration in public health facilities, which face drug and staff shortages. In Misrata, MSF opened an outpatient clinic offering free, primary healthcare and referrals to patients of all ages and nationalities.

In mid-2017, MSF also started to work in Bani Walid, reportedly a major transit hub for smugglers and traffickers. In partnership with a local organisation, MSF assisted people who had been held captive by criminal networks in the area but had managed to escape. Many had survived kidnapping for ransom, extortion and torture. The team provided 479 medical consultations to survivors and referred 24 patients to hospitals in Misrata and Tripoli.

In the east of the country, MSF ran a clinic in Benghazi in collaboration with a Libyan NGO, offering paediatric and gynaecology consultations to displaced and vulnerable people, as well as mental health support to children and families affected by trauma and violence. MSF ended its support of Al Abyar and Al-Marj hospitals in 2017 due to a reduction in the number of patients. 




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Adult malnutrition

The food provided is often not sufficient in quantity and quality. 

In the first three months of 2017, there were 42 acutely malnourished patients in our therapeutic feeding programme.

During this period, we observed interruptions in food supply in two centres - leaving detainees days without any food. 

Overcrowding

It is unclear exactly how the detention system functions. With no rule of law in Libya, many detention centres are dangerously overcrowded.

People are held arbitrarily, appearing from one day to the next after being intercepted at sea, arrested on the streets, or rounded up in night raids. 

Confining a large number of people in such small spaces causes musculoskeletal pain, and is a hotbed for the easy transmission of diseases such as scabies and chickenpox.

MSF visits a desperately overcrowded detention centre in Tripoli.

Mental health support

Many detainees often have no idea why, or for how long, they will be detained – having a direct impact on their mental health.

A large number suffer from hypervigilance, while many others have suicidal thoughts, difficulty sleeping, post-traumatic stress disorder (PSTD), panic attacks, depression and anxiety.

MSF runs psychosocial activities in detention centres and carries out individual counselling sessions.

Violence-related injuries 

MSF is treating violence-related injuries including visible scars, bruising, and lacerations.

Lifesaving referrals

In the event of a medical emergency, MSF will attempt to refer people to hospitals in Tripoli. 

During the first quarter of the year, we referred more than 53 people who urgently needed specialised medical care. 

Each referral is very complicated and time-consuming, as hospitals do not want to admit detainees.

Access to drinking water and toilets

MSF installed water tanks, pipelines and tanks in several detention centres. Daily water availability now meets or surpasses the minimum quantity for drinking and washing.

We supplied personal hygiene items to all detainees, plus soap and cleaning materials to keep the premises clean. 

However, we have observed that items are sometimes confiscated and people do not always have 24-hour access to the bathroom.

Limitations to medical work

This all takes place within a highly militarised environment: our doctors are not always given full freedom to decide which patients get help, and privacy is not guaranteed.

It is a difficult choice for us to work where people are kept in conditions without human dignity. 

However, our hope is that, by being present and providing medical care, we can improve detention conditions and alleviate peoples’ suffering to some extent.

MSF remains opposed to the arbitrary detention of migrants, refugees and asylum-seekers in Libya.

 

 find out more in our international activity report 

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