Heavy fighting continues in Libya, with the eastern part of the country being controlled by the insurgency and pro-Gaddafi forces holding the western area. Fighting is ongoing around Misrata in the west, and the situation for civilians caught up in the conflict is becoming increasingly difficult. The situation of migrant workers in Libya is another particular concern. Many have left by boat to Europe in very insecure conditions or have fled to refugee camps in Tunisia where they face further violence and insecurity.

MSF has been present in Libya since Feb. 25. As the conflict continues, MSF is expanding its assistance in the cities of Misrata, Benghazi, Zintan, in camps along the Libya-Tunisia border, and on the Italian islands of Lampedusa and Sicily. Offers by MSF to set up activities in pro-Gaddafi areas have so far been declined by the government.

Difficult conditions persist in Misrata

As fighting continues around Misrata, MSF is performing war and post-conflict surgeries such as skin grafts and plastic surgery in the Abbad hospital. MSF has set up two operating theatres in Kasr Ahmed hospital to respond to other surgical and medical needs. Each day, MSF staff working alongside Libyan medical staff also assist approximately 15 deliveries in the Ras Tubah hospital.

MSF has trained a team of 20 psychologists who are now delivering psychological care to medical staff and patients in four hospitals in the city. “Although the frontline has moved outside of the city centre, people here are still having to cope with very difficult conditions,” says Renzo Fricke, MSF’s emergency coordinator in Misrata. “They suffer the psychological trauma of having experienced heavy fighting on their doorstep, and are living under siege. It’s inhumane to be forced to endure such conditions.”

Libyan medical staff lacking experience performing trauma surgery  being given training by MSF surgeons. Basic training has also been provided to medical students who have volunteered to work as nurses, as most nurses in the city were foreigners who have now fled the country.

Outside of Misrata, MSF is providing support to advanced medical posts near the frontline. Libyan staff at these posts are delivering first aid to the wounded before referring them to Misrata hospitals by ambulances. This MSF support includes training the medical staff on how to stabilize the wounded, and providing donations of medical and communication equipment.

Ongoing shelling in Zintan forces MSF to evacuate

In the western city of Zintan, an MSF team has been supporting the hospital, managing the influx of wounded – more than 120 were admitted in the last month – following fighting in the Nafusa Mountain region. MSF has also been providing training, medical equipment and medicines to the hospital.

On May 27, the MSF team was forced to evacuate following repeated shelling, with several rockets landing only metres away from the hospital. A reduced team of two returned to Zintan on June 4 to assess the situation and resume medical activities. The security situation remains highly precarious, with ongoing shelling over the city and surrounding areas. Patients admitted to the hospital are currently being referred to medical facilities in Tunisia or the nearby Libyan city of Jadu.

Providing psychological, maternal and pediatric care in Benghazi

In the former battleground of Benghazi, MSF focuses on mental health care for women and children as well as medical staff who have been working while fighting was taking place in the city. An MSF psychologist is training Libyan psychologists to help screen patients with trauma or trauma-related syndromes, especially depression.

MSF is also providing support to the central pharmacy in the procurement of drugs, although less support is needed now as more international organizations are present in the city.

Outside Benghazi, MSF supports gynecological and prenatal care in three sites located between Benghazi and the town of Ajdabiya.

Libya © MSF
MSF medical staff providing gynecological and obstetrical training to Libyan staff.

Refugees fleeing to Tunisia and Italy

Thousands of Libyan families have fled the Nafusa Mountain region and have made their way over the Tunisian border. From early April to the beginning of June, more than 60,000 Libyans have fled the conflict to find refuge along the Tunisia-Libya border.

MSF is supporting local health infrastructures to cope with growing medical needs of these refugees. MSF has also set up mobile clinics in refugee camps in the areas of Remada and Dehibat, providing medical care and mental health care to the refugee population. The situation in Dehibat is tense, with fighting and shelling crossing over the Tunisian border.

In the Ras Adjir transit camps, located at the northern Tunisia-Libya border, nearly 4,000 people – mainly sub-Saharan Africans – face an uncertain future because they cannot be repatriated due to the situation in their country of origin. Since early March, MSF has been running a mental health program in the camps, as many people have either witnessed or directly experienced violence in the course of their escape from Libya.

In Shousha, the largest camp, the protracted situation has lead to increasing tensions. At the end of May, four refugees died when a fire spread through the camp. This event was followed by violent demonstrations against the poor living conditions in the camp. At least two people were killed, while many more were injured and two-thirds of the camp was burnt down. The day after the incidents, MSF distributed food, water and non-food items to approximately 4,000 people, in addition to providing medical care and mental health care. While the situation in the camp has returned to normal, a climate of fear and mistrust reigns and many have reportedly crossed the border back to Libya, ready to risk their lives again in search for a better future. Since the end May, MSF is also providing primary healthcare to people living in the Shousha camp, as a number of refugees present injuries linked to the recent violent events, while other complaints are linked to the poor living conditions and over-crowding inside the camp.

On the island of Lampedusa, MSF looks after the triage of patients at the port and their medical follow-up in the island’s detention and reception centres. Between the beginning of February and the end of May, MSF assisted close to 12,000 people in Lampedusa who have fled the conflict in Libya. MSF is also providing mental health support project in a reception centre in Mineo in Sicily, where approximately 3,500 migrants of various nationalities have been transferred since March. In addition, MSF has taken on the role of evaluating the migrants’ living conditions and access to care in detention centres in mainland Italy.

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