Libya: Crisis Within a Crisis
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Conflict and COVID-19 adds up to a crisis within a crisis in Libya

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The combination of several worrying developments – an escalating armed conflict, the arrival of COVID-19 to a war-torn country with a collapsing healthcare system and the reduction of the humanitarian space available for organisations due to travel and security restrictions – is creating a crisis within a crisis in Libya and could ultimately become a humanitarian catastrophe.

Libya: Crisis Within a Crisis
A couple look out over the Tripoli waterfront at sunset. Currently the only option out of Libya for people is via the sea. Libya, January 2020.
Giulio Piscitelli
Libya: Crisis Within a Crisis - Mohammed Testimony
Mohammed, from Mali, has lived in Libya since 2015. He wants to return to Mali but says at the moment he doesn't have enough money. He arrived in the country to escape the conflict and to find work to sustain him and his family. Since he arrived in Libya, he has found work as a labourer for the municipality, but due to the low payment, he also collects scrap metals in the dump close to the entrance of the city to earn more money. He receives 1 Libyan dinar (€0.64) for each 1kg of metal he collects. Libya, January 2020.
Giulio Piscitelli

Libya finds itself with the colliding emergencies of an escalating conflict and the outbreak of COVID-19 – each on their own difficult enough to manage in a country with a collapsing health system, but potentially catastrophic for people as they merge together.

Escalating conflict leaves people in danger

Despite high-level international meetings in January this year and the calls for a short break in the fighting on humanitarian grounds in order to respond to COVID-19, over one year on, the conflict in Libya continues to rage with a recent intensification of ground clashes, aerial attacks, and indiscriminate shelling.

Civilian infrastructures have also been deliberately targeted, resulting in water and electricity cuts, and leaving people with no access to basic services. Hospitals have continued to be hit by shelling, with the Al-Khadra General hospital in Tripoli hit in early April, damaging the fully functioning 400-bed hospital.

Libya: Crisis Within a Crisis
A Nigerian woman plays with her baby, born in Libya, outside Saint Francis church in Tripoli where the African community gathers for Friday mass. She says she has been living in Libya for more than four years as her husband found a job. Despite the difficult situation, they say at the moment they don’t think to leave the country. Libya, January 2020.
Giulio Piscitelli
Libya: Crisis Within a Crisis - Abdulbashir Testimony
Abdulbashir is a 28-year-old man from Mountain Marra in Darfur, Sudan. He says he arrived in Libya three years ago and spent almost two and half years in prisons for migrants. He has been detained in Gharyan detention centre, survived the bombing of Tajoura detention centre in July 2019, and was eventually detained in Tariq Al-Siqqa detention centre in Tripoli until a few months ago. During one of these detentions, he says a guard broke his right arm with a stick. During his first year in Libya, he tried to reach Europe by boat but was intercepted by the Libyan coastguard and forced back to detention. Libya, January 2020.
Giulio Piscitelli

COVID-19 exacerbates healthcare crisis for most vulnerable

As of 1 June, 156 cases of COVID-19 have been confirmed in Libya, including five deaths<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">WHO COVID-19 Situation report</a>. The World Health Organization (WHO) has classified Libya among the high-risk countries in the region. Yet with limited access to healthcare in many areas affected by the ongoing conflict, the current limited testing capacity (with just two testing laboratories in Tripoli and Benghazi), limited contract tracing, difficulties in reaching much of the population, and stigmatisation discouraging people to seek help when they are sick – we fear the number of positive cases could be much higher.

In the wake of the confirmation of the first cases and lockdown announcement, many healthcare centres have closed due to lack of training, unavailability of protective personal equipment or clear instructions and guidelines. In those facilities that are open, there is a lack of medicines, equipment and staff to provide critical services.

Meanwhile, it is not clear whether and how vulnerable groups - such as displaced people, refugees, asylum seekers and migrants in urban settings and official detention centres – will have access to health care services in the case of outbreak.

Libya: Crisis Within a Crisis - Muawia Testimony
38-year-old Muawia, originally from Darfur, Sudan, shows the scars on his shoulder, which he says are from  wounds inflicted on him when he was kidnapped for ransom by criminal groups in Libya. Muawia fled from war in his home country to Libya 10 years ago. He left his family behind. He now survives with the help of some friends and some daily jobs in Tripoli. He says that the living conditions for migrants and refugees are very dangerous, as they are continuously subjected to robbery and violence in the streets and are often kidnapped for extortion. He says he was kidnapped twice by criminal groups and during this time endured torture, including by the use of hot objects to burn his flesh. Libya, January 2020.
Giulio Piscitelli
Libya: Crisis Within a Crisis - Laia Testimony
Laia, the 13-year-old daughter of Mrs Awaia, a refugee from Darfur, Sudan, sits on a mattress on the floor of their accommodation in Gargaresh, on the outskirts of Tripoli. Mrs Awaja lives with her two daughters in a small unfinished house. The three have lived in Libya since 2018 after they fled war in their home country. They say once they arrived in Libya they were detained in a clandestine place of detention until a ransom was paid to their captors by friends. The facility was run by militia men linked to traffickers. Mrs Awaia and her family currently survives thanks to the help of some friends, but lives in constant fear for her safety, and in particular for the safety of her daughters ,who she says are at risk of being kidnapped, raped and tortured for ransom. Libya, January 2020.
Giulio Piscitelli
Libya: Crisis Within a Crisis

Caught between conflict and COVID-19

We are extremely concerned for all civilians who are at risk of death or injury due to indiscriminate shelling. We are also worried for people who are at risk of contracting COVID-19 or who might face difficulties accessing healthcare for the treatment of other illnesses.

MSF is particularly concerned for the following key groups:

  • People with pre-existing conditions: Those who are most at risk of severe forms of the illness include the elderly, but particularly those who also have medical problems, such as diabetes, non-communicable diseases (NCDs), or tuberculosis (TB).
  • Internally displaced people: Nearly 40 per cent of displaced people in Libya have acute humanitarian needs due to exposure to physical and mental harm and a partial or total decline in living conditions and access to basic services.
  • Refugees, asylum seekers and migrants in detention: The 1,500 people currently held in detention centres across Libya are being detained in over-crowded conditions with poor access to food, adequate water and hygiene and, no actual possibilities for physical distancing. The presence of humanitarian organisations in these detention centres is further reduced due to COVID-19 related movement restrictions and the escalation of the conflict.
  • Refugees, asylum seekers and migrants in urban settings: For the hundreds of thousands of refugees, asylum seekers and migrants estimated to be in Libya, the vast majority are living in precarious conditions and are at risk of arbitrary arrest and detention, trafficking, and exploitation. They are also at risk of being caught in fighting or indiscriminate attacks.
  • Migrants, refugees and asylum-seekers in need of evacuation/resettlement: UNHCR and IOM have stopped refugee resettlement departures and evacuations out of Libya, leaving the most vulnerable stranded.
  • Migrants, refugees, asylum-seekers, and Libyan nationals who have no other option but to take the sea: Currently the only option out of Libya is via the sea. All borders are closed and all repatriation, resettlement and evacuation departures are suspended.
Libya: Crisis Within a Crisis - Bannaga Testimony
35-year-old Bannaga is originally from Darfur, Sudan. He has been living in Libya for the past 10 years, where he found work as a labourer in a sawmill. He says he never thought to flee Libya because he feels lucky to have work and a small room to live in the sawmill workshop. He says that the situation in the country is hard, particularly for all the migrants and refugees who are vulnerable to violence by armed groups that often kidnap them for ransom. Libya, January 2020.
Giulio Piscitelli
Libya: Crisis Within a Crisis - Hassan Testimony
Hassan, a 17-year-old refugee from Darfur, Sudan arrived in Libya one year ago. He says he has been arrested and detained in detention centres. He broke both his feet while trying to escape from Tajoura detention centre, and was heavily beaten by the guards after he was caught. Since that day, he can’t wear shoes and can’t work. He says he wants to go to Europe to receive medical treatment, because in Libya he cannot access to medical care. Libya, January 2020.
Giulio Piscitelli

What is MSF doing to help

Our activities in Libya have been impacted by the restrictions and limitations imposed by the COVID-19 response and the escalation of the conflict. At the same time, these very same factors are a reason for increased humanitarian needs in the country. Regardless of the constraints, MSF is committed to continuing supporting people most in need in Libya, and we have intensified efforts to support the national health system cope with the COVID-19 outbreak.

In Tripoli, our teams are:

  • providing medical and humanitarian assistance to migrants and refugees in one detention centre, (others have been emptied or closed due to the COVID19 pandemic and the escalating conflict)
  • offering medical and humanitarian assistance to migrants and refugees living in urban settings
  • conducting COVID-19-related training on infection prevention and control, treatment and awareness raising in multiple hospitals and primary healthcare centres.

In Misrata and the Central Region, our teams are:

  • providing basic healthcare, psychosocial support, protection monitoring, and referring individual cases
  • distributing nutrition supplements and hygiene kits to refugees and migrants arbitrarily held in detention centres in Souk Al-Khamis, Zliten and Dhar El-Jebel
  • providing first aid medical care and distributing non-food items such as blankets at the disembarkation spot in Khoms for people attempting to leave for Europe
  • providing primary healthcare and medical referral services in Bani Walid to migrants who escaped from captivity and survivors of torture and trafficking
  • providing COVID-19 related trainings to medical staff in Zliten, Misrata, Khoms, Yefren and Bani Walid, as well as reinforcing infection prevention and control measures in detention centres.
Libya: Crisis Within a Crisis - Mustapha Testimony
The bed of 17-year-old Mustapha in a shared room where he sleeps with nine other people who are all from Darfur. Mustapha, from Darfur, has been in Libya for two years. He is one of the survivors of the Tajoura detention centre bombing from July 2019, which killed 53 people and injured an estimated 130 others. Mustapha says he spent two months in prison because he was without documents.
 He says he is registered with UNHCR to be relocated to a safe area, but like many others in his situation, he hasn't received any answer. Libya, January 2020.
Giulio Piscitelli
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