Libya remains fragmented by conflicts with fighting ongoing in several parts of the country. The insecurity, economic collapse and breakdown of law and order mean that daily life for many Libyans is a struggle. In addition, the country is both a destination and place of transit for hundreds of thousands of refugees, asylum-seekers and migrants fleeing conflict, extreme poverty, or persecution.
Inside Libya, many migrants are unable to return home. Refugees and asylum-seekers cannot receive protection due to the lack of a functioning asylum system, the limited role of UNHCR and the fact that Libya is not a party to the Refugee Convention.
They are exposed to an alarming level of violence and exploitation at the hands of security forces, militias, smuggling networks, criminal gangs and private individuals. MSF teams in search and rescue vessels on the Mediterranean Sea have heard the accounts of, and seen many scars among, the over 50,000 men, women and children (many unaccompanied, some as young as eight years old) who have transited through Libya and undertaken the treacherous journey to Europe.
Those intercepted at sea by the Libyan coastguard or detained inside Libya are sent to migrant detention centres – often former factories or warehouses – and face arbitrary detention for prolonged periods of time in unsanitary and inhumane conditions. There is no way to challenge the lawfulness of their detention, virtually no access to the outside world, ill-treatment and a lack of access to medical care.
Access to healthcare in detention facilities
MSF is currently running mobile clinics in seven migrant detention centres located in Tripoli and its surroundings which are under the administration of the Directorate for Combating Illegal Migration (DCIM), also known by the alternate translation Anti-Illegal Immigration Agency (AIIA).
Since activities started in July, MSF has been able to conduct 5,579 medical consultations, with medics currently carrying out around 500 consultations every week. Thirty-two pregnant women in detention received antenatal consultations and 41 consultations were provided for children less than five years of age, several of whom had been born in a detention facility. The youngest patient seen was only five hours old.
In the event of a medical emergency inside a detention facility, with the agreement of the DCIM, MSF attempts to arrange a referral to a hospital. So far, there have been 113 urgent or complicated medical cases referred to a health facility for further treatment, including seven people with severe psychiatric disorders. Each referral is complicated and time consuming, as many hospitals in Tripoli do not want to admit sub-Saharan Africans.
Medical cases linked to detention conditions
MSF medics are treating respiratory tract infections, acute watery diarrhoea, skin disease, and urinary tract infections. These complaints are mostly related to conditions inside the detention centres, which do not meet any national, regional or international standards. They are dangerously overcrowded with a lack of natural light and ventilation. In some facilities, the amount of space per detainee is so limited (as little as 0.41 square metres per person) that people are unable to stretch out at night, resulting in many complaints of body aches.
There is a also shortage of food in the detention centres, which makes people more susceptible to disease and acute illness. Significant numbers of detainees have suffered dramatic weight loss, have an extremely emaciated appearance and exhibit nutritional deficiencies due to small rations, averaging 600 to 800 calories per day, with unbalanced nutritional content. Food often consists of plain macaroni. Sometimes one food ration is shared between five or more detainees, or food is served in communal bowls, meaning that the weakest and sickest receive nothing.
The number of adult malnutrition cases MSF is seeing is increasing, with 41 people suffering from moderate to severe malnutrition screened in the first half of November. This represents around three per cent of all detainees in facilities visited by MSF. The number of adults suffering from this degree of malnutrition in a country not suffering from drought or natural disaster is of great concern.
Detainees do not have adequate access to safe drinking water, sometimes less than one litre per person per day, and as a result suffer from headaches, constipation and dehydration. Access to latrines or showers is severely limited and sanitation facilities are inadequate, resulting in high rates of skin infections and infestations with lice, scabies and fleas.
MSF has distributed hygiene kits to detainees in the detention centres visited by medical teams. There have also been distributions of water jerry cans, buckets and cleaning materials at several detention centres. In specific instances when food supplies have run out and the situation became critical, MSF has had to bring in sacks of bread and boxes of processed cheese from local markets to feed detainees. MSF continues to urge all relevant authorities to provide sufficient quality and quantities of food supplies.
Mental health support
A psychological first aid team supports detainees who have been involved in traumatic incidents at sea. Support was provided to 29 survivors of a shipwreck on 27 October, where at least 100 people drowned. The team aims to improve access to mental health services and psychosocial support, not only for migrant populations but also for Libyans in the Tripoli area.
A difficult choice to provide healthcare in detention facilities
It is difficult choice for MSF to work in an environment where people are kept in conditions without human dignity, with no immediate prospect to improve their situation, and with no idea why, or for how long, they will be detained.
However, our hope is that, by being present and providing medical care, MSF can ensure an immediate improvement in detainees' living conditions. Every day, MSF teams advocate for the humane treatment of those being held in detention, and stress the importance of detainees receiving adequate food and water and access to working latrines and washing facilities. MSF pushes the authorities to release pregnant women, women with babies and young children, detainees under the age of 18, and those who are disabled or have serious health conditions.
MSF remains opposed to the indefinite arbitrary detention of migrants, refugees and asylum-seekers in Libya.