Doctors Without Borders/ Médecins Sans Frontières (MSF) continued to provide lifesaving and primary healthcare to refugees and migrants detained in the capital Tripoli in Libya during the first quarter of 2017.
More than 4,000 medical consultations took place in seven different detention centres nominally under the control of the Directorate for Combating Illegal Migration (DCIM). Around 1,300 people in detention were treated every month via mobile clinics for conditions including skin disease, diarrheal disease, respiratory tract infections and urinary tract infections. These preventable diseases, as well as acute malnutrition, are the direct result of detention conditions. Conditions inside the detention centres do not meet any national, regional or international standards.
The food provided inside detention centres is often not sufficient in quantity and quality. In the first three months of 2017, interruptions in food supply were observed in two detention centres with detainees going for days without any food. As a result, MSF is treating adults suffering from malnutrition. There were 13 acutely malnourished patients in MSF’s therapeutic feeding program in January, 19 patients in February and 20 patients in March.
The number of detainees being held in each detention centre fluctuates significantly. With no rule of law in Libya, it currently remains unclear exactly how the detention system functions and people are held arbitrarily.
People appear from one day to the next after being intercepted at sea by the Libyan Coastguard, arrested on the streets, rounded up in night raids, or brought to a detention centre by individuals. Detainees are suddenly released overnight, or moved to an undisclosed location.
Confining a large number of people in a small space causes musculoskeletal pain and allows for transmission of various diseases and infections, including but not limited to outbreaks of scabies and chickenpox. The number of infectious respiratory diseases is also directly influenced by poor ventilation. Although the overcrowding did improve somewhat, MSF observed overcrowded cells throughout the entire first three months of the year.
Mental health support
Detention has a direct impact on the mental health of detainees who have no immediate prospect to improve their situation, and often no idea why, or for how long, they will be detained.
A large number of detainees suffer from hypervigilance, a condition where people are preoccupied with scanning their environment for possible threats and are easily startled. Many detainees have suicidal thoughts, difficulty sleeping, exhibit symptoms of Post-Traumatic Stress Disorder (PSTD), and suffer panic attacks, depression, and anxiety.
MSF runs psychosocial activities in detention centers, carries out individual counselling sessions and treats psychiatric patients with 17 people treated during this period.
MSF is treating trauma related injuries including visible scars, bruising, and lacerations. Five people were treated for these in January, eight people in February and three people in March.
In the event of a medical emergency, MSF will attempt to refer people to hospitals in Tripoli. During the first quarter of the year, MSF referred more than 53 people who urgently needed specialized medical care. Each referral is very complicated and time-consuming for MSF to organize and many hospitals do not want to admit detainees.
Access to drinking water and toilets
Access to sufficient and safe drinking water and access to latrines and showers are vital to counter diseases such as skin infections and infestations with lice, scabies and fleas. In most detention centres visited by MSF, daily water availability now meets (or surpasses) the minimum quantity for drinking and washing. MSF has been able to install water tanks, distribution pipelines and taps in several different centres, in an effort to improve the water quality and unhindered access to running water. These distribution systems are regularly inspected and maintained by MSF.
However, frequent power cuts and water shortages in Tripoli mean it is difficult for detention centres to maintain the supply of water during periods of limited availability. There are only limited possibilities to truck in water.
Unhindered 24-hour access to toilets is not facilitated in all centres. Efforts have been made to improve hygiene conditions inside the centers and MSF assists with supplying personal hygiene items to all detainees as well as soap and cleaning materials to keep the premises clean. However, detainees do not always have unhindered access to distributed materials and MSF observes that sometimes items are confiscated.
Limitations to medical work
The medical care provided by MSF takes place within a highly militarized environment. The daily lives of our patients are strongly controlled. Our doctors are not always given full freedom to do medical triage or to decide which patients get to see us. The privacy necessary for medical consultations is not guaranteed. In some detention centres, officials do allocate a designated area for MSF doctors to conduct medical consultations in private but in other detention centres they do not.
It is a difficult choice for MSF to work in an environment where people are kept in conditions without human dignity. However, our hope is that, by being present and providing medical care, MSF can improve the conditions of detention and alleviate the suffering experienced by detainees to some extent.
MSF remains opposed to the arbitrary detention of migrants, refugees and asylum-seekers in Libya.