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Libya had a shaky health system during Muammar Qaddafi’s four-decade rule. Few Libyans worked in the sector as most medical professionals were foreigners who were hired on generous salaries.
Hundreds of doctors and 80 per cent of nurses fled once the protests against Qaddafi and the ensuing civil war erupted in February 2011. Their departure left a gaping hole in the country’s health system, which organizations such as Doctors Without Borders have tried to fill. But split governance, amid the ongoing conflict, has resulted in a myriad of challenges.
The health care crisis reached breaking point following the elections in June 2014. At the time, the ruling General National Congress (GNC) was voted out in favour of the House of Representatives (HoR). Backed by militias in the capital of Tripoli, the former refused to step down, forcing the latter to relocate to the eastern city of Tobruk.
As the country spiralled into another civil war, access to health care became severely limited. A report by the World Health Organization (WHO), published in May 2015, stated that patients could not reach hospitals due to the fighting. Medical workers also had a difficult time retrieving casualties.
The declining economy, brought on by a steep decline in oil exports in 2014, further limited funding to health facilities. Some medical workers refused to work until they were paid. Although oil revenues have somewhat recovered in recent years, Libya’s frozen assets continue to handicap the health system. Political infighting, rampant corruption and militia rule have paralyzed the Central Bank, denying the Health Ministry and WHO access to funds.
Hospitals thus function far below capacity. According to a WHO survey, all of Libya’s 98 hospitals and 1,600 health centres struggle to provide sufficient care for the country’s roughly 6 million inhabitants. The number of clinics and health centres is at least comparable to neighbouring Tunisia, which has 109 hospitals and 2,091 basic health centres to care for a population of nearly 10 million people. The difference, of course, is that the hospitals in Tunisia are not operating in a conflict zone.
“We assessed the readiness and functionality of staff and where they work,” Syed Jaffar Hussain, the WHO’s Libya representative, told The Libya Herald. “We found a major breakdown in the health system, with only four of the 98 hospitals performing at 75 percent of their capacity.”
Tripoli Medical Centre, the capital’s largest hospital, is only working at half capacity, while 25 others are functioning at quarter capacity.
“[Not having access to health care] is not like having a lack of electricity. Fine I am hot, my child is upset. Health is not like that. If you do not give insulin to a patient or an operation to someone seriously ill, they will die,” said Hussain.
Compounding the crisis, armed groups routinely target medical workers for various reasons. One incident in Benghazi saw a fighter threaten a medical professional unless he saved the life of a militant in his group. Armed men have also reportedly stormed hospitals to kill wounded patients.
A 2018 report by the UN Human Rights Office and UN Support Mission in Libya (UNSMIL) documented 36 attacks on medical facilities, staff workers or patients between May 2017 and May 2018.
The Sabha Medical Centre, in southern Libya, was shelled or shot at 15 times between February and May 2018. In February 2017, during the bloody Battle of Benghazi, men armed with AK-47s clashed in the corridors of a hospital.
“These attacks are a major violation of international law and a tragic disregard of our common humanity. All too often, there is no respect for the sick and no sanctity for those who provide care. This must end,” said Ghassan Salamé, the head of UNSMIL.
Many medical professionals have nonetheless braved the dangers to tend to those in need. Dr Tane Luna, an obstetrician gynecologist with Doctors Without Borders, worked in the maternity ward in a hospital near Benghazi. Despite the health care crisis, she said that she had a great relationship with the dedicated hospital staff but added that most of the workers have received little training or supervision for years.
“The [medical staff] also had little or no access to specific modules of training in obstetrics, and their workflow is generally not well organized,” she told Doctors Without Borders in September 2016.
Also during the Battle of Benghazi, which ended in December 2017, heavy fighting disrupted supply routes, spawning a medical disaster. At the time, most supplies were delivered through the city’s seaport and airport until clashes forced them to close.
Medical provision in Sirte, Qaddafi’s birthplace, is another example of where the health system has completely collapsed. Following the US-backed campaign to drive out the self-declared Islamic State (IS) group from the city, Claudio Colantoni, the International Medical Corps’ country director for Libya, said that aid agencies would have to help rebuild health services from scratch.
“The situation is dramatic. The health system is completely collapsed, there are no working hospitals, the needs are at 360 degrees,” he told Reuters in October 2016.
Health care continues to deteriorate across the country. Many patients are unable to get urgent care due to long delays at checkpoints and damaged facilities.
Hussain, from the WHO, also said that diseases that had not been reported in Libya for decades are returning. Malaria, for one, poses a serious threat. The WHO is trying to mitigate the crisis by providing life-saving medicines and equipment to clinics and hospitals. However, it is concerned that serious viruses such as HIV will spread rapidly due to a lack of sanitation and public awareness. The health care sector cannot stop diseases from spreading, Hussain warned, unless the civil war ends and Libya’s assets are unfrozen.