Fighting continues in Libya, a country fragmented by a multitude of power centers. Since mid-2014, the humanitarian situation has deteriorated due to political instability. Millions of people across Libya are impacted, including refugees, asylum-seekers and migrants. Dr. Tankred Stoebe, who works with Doctors Without Borders (MSF), spent the month of January in the country coordinating a medical assessment that took him from Misrata to Tripoli. He told us what he saw.
Ismael and Masjdi were both 19-year old
students when the revolt began in Libya in 2011. Like thousands of others, the
two fervent idealists took up arms against the Muammar Gaddafi regime with no
training or understanding of military strategy. The two young men, who both
narrowly escaped death, met much later in Malta. During the fighting, Masjdi sustained
wounds to the face and was blinded while Ismael was paralysed and can only move
his right hand now. They became friends from the moment they met in the
intensive care unit. Separated during their convalescence, they kept in touch
and now meet up in Misrata whenever they get the opportunity. "We’re like
brothers," they told me in chorus. Masjdi pushes his friend’s wheelchair and
Ismael reads to his blind friend.
Misrata is steeped in history. Strategically located on the Mediterranean Sea, the city is known as much for its pride and independence as its traders, smugglers and pirates. Subjected to heavy fighting between February and May 2011, Misrata is a sandy and dusty, but bustling desert city. Economically and militarily powerful, its hospitals are well equipped and its health system better organised than in the east. Compared to Benghazi and Tripoli, Misrata is for now, relatively safe, so this was where we decided to set up base.
Everyday we saw Sub-Saharan Africans, each with their own agricultural or construction tools, brushes and drills, stationed at the city’s crossroads looking for work as day labourers. Few were arrested, but some got caught at police checkpoints and interned in camps before being deported back to their home countries.
There are around 10,000 migrants in Misrata, mostly from Niger, Chad and Sudan. Fearful of arrest and deportation, when they fall sick they usually go to pharmacies and buy the often high-priced drugs they are advised to take. For more serious problems, they prefer private medical facilities because, although expensive, these are not required to report undocumented patients. But when the migrants have a chronic illness, their only choice is to go home. When I asked them if they didn’t want to get on a boat to Europe, they smiled and shook their heads: "It’s too dangerous. We don’t want to die in the sea."
Between Misrata and Tripoli
Living conditions and hygiene are truly
appalling in the detention centre in a small town halfway between Misrata and
the Libyan capital. Intended for 400 refugees, there were only 43 detainees -
39 of them women from Egypt, Guinea, Niger or Nigeria who’d been there for a
month with no contact with the outside world or their families. Most came from
Nigeria and told me their homes had been bombed. The Libyan coastguard intercepted
their inflatable dinghy near the Mediterranean coast and they were sent to the detention
The rooms were small, dirty and jam-packed
with mattresses. As we entered the hall, there was a putrid stench. We walked through
puddles of urine. There were no showers, the toilets didn’t flush and the women
had to relieve themselves in buckets. They used a little of their drinking
water to wash. They were utterly desperate and begged me to help them get back
to Nigeria. When I told them I was a doctor, they didn’t believe me at first,
but then they accepted the treatment we offered them.
Their average age was 22 and almost all of
them (93 percent) had health issues. Many had scabies (58 percent), which we
gave prescriptions for and some various aches and pains (48 percent). Other
non-specific ailments were due to emotional trauma - or at least, that’s what
we deduced from the stories they told us about their flight and from their
almost palpable fear. When I asked them if they thought they would try to get
to Europe again, they replied, horrified, "Never again!"
When we reached Tripoli, I was stunned by the
towering height of the ruins. MSF colleagues were in the capital providing
assistance to people spread among seven detention centres.
Most of those wanting to cross the Mediterranean to Italy are from Sub-Saharan Africa - Nigeria, which is mired in conflict, Eritrea that is governed by an authoritarian regime and Somalia, a country embroiled in a civil war. People flee northwards to escape poverty and terror. To reach the Libyan coast, they have to pass through Chad and Niger, both particularly poor countries. According to the International Organization for Migrations (IOM), over 300,000 people crossed through them last year.
However, there are no precise figures on how many have died of hunger or thirst or from falling off a truck along the way. According to most estimates, at least as many people have died crossing the desert as those who have drowned in the Mediterranean Sea, but the statistics on people who drowned are more reliable. Be that as it may, survivors are insistent that the desert is by far the hardest part of the journey.
The many dead migrants also pose a problem. We
went to hospital mortuaries overflowed with unidentified corpses washed up on
beaches or of people who simply died. Many have been there for months. As the
authorities don’t have the resources for DNA testing and it’s impossible to
identify the dead and ship them back home or bury them.
Author: Tankred Stoebe
Note: This article is based on Dr. Stoebe's personal experiences in January 2017. Please note that due to volatile context, situation changes quickly in Libya.
 For comprehensive overview of MSF response in Tripoli, visit http://www.msf.org/en/article/libya-providing-healthcare-detained-refugees-and-migrants