Tensions continue, Misrata still volatile The general situation in Libya remains extremely tense and uncertain. In the country’s third-largest city, Misrata, the situation is very volatile: after the rebels claimed to have captured the city’s airport on May 11, the conditions seemed to slightly improve in some areas but over the past weekend, the city was the target of heavy shelling, killing at least 10 people and injuring around 20. The hospitals continue to work at full capacity. Although the Libyan medical teams are addressing the urgent needs related to the violent context, a certain number of patients with chronic illnesses or pregnant women are not systematically taken care of. In Benghazi, shortages of medical supplies are preventing some hospitals from carrying out lifesaving activities. To meet the high demand for healthcare, Médecins Sans Frontières (MSF) is setting up new projects and is stepping up its efforts in some of its current programs. Large influx of wounded in Zintan On April 30 an MSF team arrived in Zintan, a city located in western Libya, southwest of the capital, Tripoli. MSF medical staff are supporting the emergency unit of the local hospital, helping triage patients and providing training to hospital staff. Over the past weeks, scores of war-wounded have been admitted to the hospital in Zintan following clashes between pro-Gaddafi troops and insurgents. On May 1, 30 wounded people were admitted to the hospital. On May 7, 50 more were admitted following fighting 25 kilometres east of Zintan; that day, 20 to 25 of the patients had severe injuries, and 13 were operated on in the following days. On May11, 25 injured were admitted to the hospital following clashes in Riyayena, approximately 25 kilometres from Zintan. Eight severely wounded patients were transferred to hospitals across the border in Tunisia.

Libya © Florent Marcie
MSF and other medical staff providing emergency care for a patient in the hospital in Zintan. Because of security issues, and also to free up beds in preparation for renewed clashes, most of the patients were referred to hospitals in Tunisia for post-operative care. The MSF team is currently reorganizing the intensive care unit to deal with the large influx of wounded people. An MSF surgeon is on his way to Zintan to reinforce the hospital’s surgical team. MSF has also donated medicines, a ventilator and an oxygen concentrator to the hospital in Zintan. Misrata: Surgery, post-operative, pediatric and neonatal care The main medical needs in Misrata continue to be for surgery, primary healthcare, gynecological-obstetric care of pregnant women and post-operative care for wounded patients. In Al Abbad Medical Trauma Centre, northeast of Misrata, the Libyan medical team is not used to deal with war casualties and lacks experienced medical personnel. It has requested training in triage for the wounded, in sterilization and general hygiene techniques. A MSF surgical team – composed of two surgeons, two anesthetists, three nurses, a doctor and a logistician – has been working in the hospital for the past 10 days, carrying out an average of five major surgeries each day. On May 10, eight injured people arrived in the hospital and were immediately operated on. Among them, four were recently wounded, and the others suffered from older wounds that needed urgent attention. In Ras Thuba clinic, near the besieged city’s port, MSF medical staff are helping to care for emergency obstetrical surgery and deliver babies, and are providing pediatric and neonatal care. As well as improving the flow of patients in the outpatient department, MSF plans to increase the clinic’s capacity to around 60 beds and to open a second operating room. In Kasr Ahmed Hospital, in the eastern part of the city, a MSF team is working to rehabilitate the operating room, and plans to increase the hospital’s capacity from 12 to 50 beds. This hospital aims to accommodate all types of medical emergencies and should receive its first patients in the coming days. Libya © Daphné Lagrou
A newly delivered baby at the Ras Thuba clinic in Misrata, where MSF the medical team provide maternal care together with Libyan staff. Benghazi: Supplying essential medicines In Benghazi, medical supplies are urgently needed to care for chronic patients and those suffering from tuberculosis and HIV/AIDS. Since the conflict started, medical supplies from Tripoli have halted, hindering the ability of some hospitals to carry out lifesaving activities. MSF is helping to manage the two central pharmacies in Benghazi. These supply the hospitals in the area, including some medical supplies in Misrata. In addition, MSF staff are helping with waste management and placing orders for essential medicines. Benghazi: Implementing sexual violence programs MSF is supporting the Libyan Medical Committee to implement sexual and gender-based violence programs in several clinics in the Benghazi area. MSF plans to eventually scale up these activities throughout Libya in collaboration with local partners and specialists. Training has already begun, and a MSF psychologist has been requested to help improve local capacity to care for survivors of sexual violence. Assessments in the Ajdabiyah area An MSF team carried out assessments in the city of Ajdabiyah, 20 kilometres from Benghazi, and in the surrounding camps for internally displaced people. The team also visited Sultan, a coastal city near Ajdabiyah, where MSF plans to do prenatal consultations and set up maternity and mental healthcare programs. The team will also conduct medical activities in the camp of Al Bayda where some 900 families have taken refuge from the fighting. Mental health activities in Libya and Tunisia In Misrata, a MSF psychologist is focusing on providing psychological care for local medical staff who are suffering from stress, following continuous work under extremely difficult conditions. The psychologist is working in Ras Thuba clinic, in Kasr Ahmed Hospital and in Al Abbad Medical Trauma Centre. Several local psychologists are also being trained to carry out mental health activities in each location. MSF plans to send an additional psychologist who will be able to focus on delivering care to patients. Since March, MSF teams have been providing psychological support in the camps at Ben Garden, at the Tunisian-Libyan border, to people fleeing the conflict in Libya and awaiting repatriation or resettlement. While some are in transit in Tunisia before being repatriated to their home country, a growing number of refugees cannot be repatriated due to their country’s political situation. To date, the MSF team of psychologists has given more than 4,000 mental health consultations to people who have witnessed or experienced violence before or during the conflict, and who are facing an uncertain future. Since the beginning of April, thousands of Libyan families have crossed the southern end of Tunisia-Libya border, fleeing violence in the south of Libya. In Dehiba, the MSF team has been supporting the stabilization unit in the health centre. Forty-one war-wounded from both sides were stabilized in the unit between April 28 and May 1, as a result of the fighting that took place at the border between insurgents and pro-Gaddafi forces. In Tataouine, MSF started activities on May 4 with a mobile clinic providing psychological support to refugees in accommodation centres, in clinics and in the homes of host families. Since the conflict began in Libya, there has been a daily increase in the number of people as more and more Libyan refugees arrive. To date, about 40,000 Libyans are believed to have arrived in Tataouine – a city of 60,000 – almost doubling its population and putting increasing pressure on the city’s health infrastructure. The Libyan families are being hosted by Tunisian families or living in private houses lent by Tunisian people. Most of them come from the Libyan cities of Nalut, Zintan and Yafran. In the coming days, the MSF team will start medical consultations for these urban refugees and will support the hospital, including emergencies, surgery, chronic diseases and primary healthcare. In Remada, a city of around 5,000 people, located between Tataouine and Dehiba, a rapidly expanding refugee camp is currently hosting more than 1,000 people. MSF is investigating the medical needs and will most likely assist the refugees and the host community with primary and secondary healthcare as well as mental health support.