Libya: Overstretched health service needs sustained support

Recent fighting in Libya, especially in the capital Tripoli, has taken a toll on medical services with overstretched personnel working under very difficult conditions, and seriously ill and injured patients unable to reach hospitals and clinics, health workers say.

"No matter how mighty a health system, nobody can deal with this huge influx of injured patients," said Khalid Shibib, head of the World Health Organization (WHO) in Libya.

Emphasizing the importance of strong international support for Libya's embattled health system as the country's internal conflict looks to be moving towards a conclusion, Shibid told IRIN from Benghazi on 31 August: "This is not about politics, it is about health needs."

The interim administration led by the National Transitional Council, he added, now had its health officials in Tripoli and so had a responsibility to take charge, but international help was vital, particularly given critical shortages of supplies and the heavy casualty rates from recent clashes.

Médecins Sans Frontières (MSF) said that in the past few days there has been an improvement in the situation in Tripoli. Speaking from Brussels, MSF Emergency Coordinator Rosa Crestani told IRIN: "One week ago, the hospitals were overwhelmed and some were not accessible. Now the situation is calming down and the majority of hospitals are running at capacity."

Crestani said local Libyan volunteers had played a vital role in cleaning up badly damaged facilities, enabling medical personnel to extend their activities and treat more patients in hospitals and clinics that had previously been off-limits.

"This doesn't mean everything is fine," Crestani emphasized, noting that MSF was running mobile clinics to help treat a large, vulnerable migrant population, living in what she described as "appalling conditions".

Apart from understaffing, and shortages of medical supplies for treatment of the war-wounded and those with chronic diseases in Tripoli, other reports speak of the failure to remove waste from health facilities and the shortage of water. On 26 August, there were reports of at least 200 decomposing bodies at Abu Salim hospital.

Outside Tripoli, there is still major concern about health needs in areas like Misrata and Zlitan, which were badly affected by the conflict and the breakdown in medical supplies. Crestani said it was important to provide psychological support services to populations who had lived through the fighting.

Changing priorities

A recurring theme since the outbreak of hostilities in February has been the strain the crisis has placed on both ordinary Libyans and medical practitioners unfamiliar with the realities of war. As a middle-income country with very little past experience of internal conflict, Libya had little prior experience of treating the war wounded or coping with the psychological trauma of those affected by war.

That has changed. The scale of war-related injuries has inevitably meant a change in medical priorities, diverting resources from more routine, non-emergency health care. "War injuries have heavy implications for the health system because they are very difficult to treat," Shibib of WHO told IRIN. "They block hospital beds; they displace other patients, and they take enormous amounts of supplies and working hours from health providers."

In normal circumstances, he added, Libya's health care system was more than capable of covering the needs of the population, with over 100 hospitals spread across the country. Along with advances in areas like ante-natal health care, it has been successful in past vaccination campaigns against measles, tetanus and whooping cough. Polio, for example was eliminated in 1991.

"In other countries, the Ministry of Health and other organizations have to run after the population and promote the vaccination of children, engaging community leaders and so on," Shibib added. "This is not needed in Libya because the population is very aware of the importance of vaccination."

Medical experts warn that this progress must be consolidated because six months of crisis and division have inevitably had an impact. For example, Libya has witnessed the flight of thousands of medical personnel at all levels, many of them third-country nationals from Asia or sub-Saharan Africa. Hospitals and clinics have faced highly damaging fuel shortages and power cuts.

Working in a heavily centralized system, where procurement was done from Tripoli with huge consignments of drugs ordered every year, health officials in areas like Benghazi have warned of the struggle to keep supply lines open, particularly in maintaining access to more specialized drugs required to treat conditions like cancer or diabetes.

Rural areas vulnerable

"There is a compromise in the quality of health care," warned Sammeh Youssef, health adviser with Save the Children. "You see the problems much more in the rural areas." There was extreme vulnerability of rural clinics and other health facilities, he added, particularly with the exodus of third-country nationals.

Other experts talk of an inevitable "shrinkage" of the whole health sector, from primary to tertiary.

Chrestani of MSF said her organization had yet to come to a clear decision on how long it will stay in Libya, waiting to see how the scenario unfolds. Shibib warned the international community not to think simply of giving a "one-off" donation and walking way, stressing the need for a flexible approach, based on changing needs.

"The world sees Libya as a rich country and it is," Shibib told IRIN. "But this rich country is in a crisis now."