An Update on Health Care in Libya

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TRIPOLI, Libya — For the past eight years, a violent civil war has dominated life in the North African nation of Libya. After the demise of longtime dictator Muammar Ghaddafi in 2011, the country began to disintegrate as competing factions struggled to find consensus. Today, two rival governments are still vying for control, with the hundreds of autonomous militias scattered across the country adding confusion to an already complex picture.
The instability in Libya has led to porous borders and rampant lawlessness, making the country a haven for human trafficking, slavery and ethnic violence. The war has weighed heavily on Libyans, with some reports placing the civilian death toll at 50,000, though the real number is unknown.

Often lost in the media coverage of the conflict is the decline of Libya’s once flourishing society, many aspects of which are still in shambles. Perhaps most devastated by the war is health care in Libya. Already burdened by a lack of funding, since 2011 Libyan hospitals have seen an increase in patients and a decrease in medical supplies and health care providers. In February of 2019, the World Health Organization (WHO) issued a request for $43 million to provide basic yet life-saving treatment to nearly 388,000 Libyans in need.

Roadblocks to Improving Health Care in Libya

In 2017 the WHO, which operates in 12 Libyan states, reported that only four of the country’s 80 hospitals were functioning above 75 percent of normal capacity. Meanwhile, 17 percent of Libyan hospitals and 20 percent of primary health care facilities remain either damaged or completely destroyed. Hospitals and health care providers are themselves targeted, a disturbing trend that amounted to over 41 attacks across the country since the start of 2018.

These attacks have resulted in devastating personnel shortages. Many Libyan health care providers fled the country after the collapse of the Gaddafi regime, crippling a health care system that still largely relies on foreign aid. While urban areas benefit from a high concentration of medical personnel, hospitals and clinics in rural regions are chronically short staffed. According to the WHO, Libyan hospitals are in need of roughly 5,000 nurses, 3,500 specialists and 400 midwives.

Additionally, medicine and equipment shortages continue to impact Libyans as delivering supplies across the fractured country is a daunting, sometimes impossible task. In March 2018, a siege by pro-government forces in the Ganfouda region of Benghazi restricted access to medical treatment for hundreds of people, while sporadic fighting between militias in Tripoli continues to prevent medical supply shipments from reaching parts of the city. And in the largely rural and semi-autonomous south, communities are often at the mercy of nongovernmental aid organizations for health care as neither of the competing governments has the funds or resources to address the region’s needs.

With chronic medicine, supply and personnel shortages, public health efforts are almost non-existent. Roughly 75 percent of Libya’s public health facilities have shut down, while those remaining are functioning at a fraction of regular capacity. This has contributed to rising rates of HIV/AIDS, especially in Tripoli where the U.N. reported that roughly 87 percent of people who inject drugs test positive for the virus. In the south, vaccine shortages have resulted in deadly outbreaks, with 80 measles cases reported during the summer of 2018.

NGOs Filling the Void

Where government solutions have failed, nongovernmental organizations have stepped in to assist health care in Libya. Despite receiving less than half of the requested funds for their 2018 Libyan Humanitarian Response Plan, the WHO conducted 405,000 medical consultations, 188 major surgeries and offered dozens of clinics for Libyan doctors and nurses. In addition, the WHO has distributed medicine and supplies to hospitals and clinics across Libya, dispatched mobile health teams to disadvantaged rural regions and partnered with UNICEF to provide roughly 2.5 million children with measles, rubella and polio vaccines.

Stationed in northern Libya, Doctors Without Borders (MSF) has worked to address the health care needs of migrants and refugees detained in urban areas. The chaos from the war has made the coast a hub for human trafficking and immigration, as thousands of African migrants destined for Europe travel through Libya first. Amnesty International estimates nearly 20,000 people — many of them asylum seekers — remain arbitrarily held in massive detention centers across the north, lacking access to medical care and subjected to inhumane treatment. With offices in seven cities across the Libyan coast, MSF has been working since 2016 to provide basic health services to detainees, who often suffer from respiratory tract infections, musculoskeletal pain and diarrhoeal diseases.

What’s Next?

In January 2019, Libya’s rival factions met in Benghazi to discuss a possible ceasefire. Though fighting across the country has since continued, the meetings suggest tensions could be cooling. Yet both governments are tremendously underequipped to handle the large scale crisis plaguing health care in Libya. With roughly 1.1 million people still in need of humanitarian aid, it’s likely that organizations like the WHO, UNICEF and MSF will be essential aspects of Libyan society for years to come.

– Kyle Dunphey
Photo: Flickr

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