June 22, 2017

As they pass through Libya in hopes of traveling on to safety in other countries, many refugees and migrants are robbed, abused, jailed, tortured, or even killed. Since July 2016, Doctors Without Borders/Médecins Sans Frontières (MSF) has provided lifesaving health care to refugees and migrants detained in Tripoli, and, in early 2017, expanded its operations to include a new project in Misrata. Here, MSF head of mission in Libya Jean-Guy Vataux describes how MSF is providing care for people in transit.

What kind of health care services does MSF provide in Misrata?

In and around Misrata, the teams started activities a few months ago in three detention centers formally under the authority of the Directorate for Combating Illegal Migration (DCIM).

The number of detainees varies from one week to another. They have been stopped at sea by the Libyan coast guards, arrested in towns, at checkpoints, et cetera. Some arrive here after being transferred from other detention centers in Tripoli. We sometimes met in detention people who used to live and work in Libya for years. Being tested positive for hepatitis C is enough to send a migrant who moved to Libya with his family to jail.

MSF teams have started to provide medical consultations inside the detention centers. The majority of health issues affecting the patients are directly linked to the detention conditions and the violence that marks their journey: skin diseases, scabies, diarrhea, respiratory infections, muscular pain, wounds and psychosomatic disorders. MSF provides referrals to secondary and specialized care for those who need it, such as patients with fractures. Hygiene supplies are distributed to the detention centers.

While it is possible to marginally improve the material detention conditions, let us not lose sight of the core issue: People are jailed—theoretically waiting for expulsion—following an opaque process, which denies their basic rights.

According to the International Organization for Migration (IOM), about 7,100 people are detained in the 27 detention centers officially operated by the DCIM, mostly in Tripoli. What about other migrants, refugees, and asylum seekers in the country?

IOM identified over 380,000 migrants currently in Libya. Indeed, people held in detention centers under the authority of the DCIM only account for a relatively small part of the total migrant and refugee population in Libya.

Some came to work in Libya, which once was an economic “El Dorado” for nationals from neighboring countries. Others work to try to secure funding for the Mediterranean crossing, working under conditions that fell within the scope of forced labor and were interrupted by periods of detention or are at the very beginning of their journey across Libya.

The journey through the Libyan Desert and the stays in the “unofficial” centers, meaning the connection houses and warehouses run by criminal networks, are described as an excruciating experience by those who survived it. It remains a blind spot for us.

In 2016, about 5,000 people drowned in the Mediterranean, and in 2017 the toll is already estimated at 2,000 people as of June. But how many die before reaching the coast and embarking on boats? There is every reason to believe that this is a silent disaster.

What is MSF doing to assist them?

This month we opened an outpatient clinic in Misrata town to reach out to migrants and refugees who live and work here under various conditions, in order to better understand their challenges and provide free and confidential health care. The respect of medical confidentiality is key in such a context, where developing certain diseases can be grounds for detention and expulsion. Additionally, we continue our activities in the detention centers.

Then, how to be alongside people in the worst moments of their migration journey? So far, we do not have an answer. We continue to attempt to negotiate access to people on the road before they reach the coastal cities. We will see what kind of working space we are able to negotiate or not.

The risk of failure is significant.  There are certainly other operational models we have to develop; to devise.  Our team regularly goes south of Misrata, where the corpses of those who are referred to as “migrants” arrive at the local morgue—reportedly about ten a week. In my opinion, we could at least do more to restore the dignity of these anonymous dead.

Video: In Libya, Helping Refugees Who Did Not Survive

MSF has supported the Libyan health system since 2011, which has been impacted by the renewed war and the ensuing economic recession. Libyan health structures struggle with shortages of medicines and staff. MSF responds with donations to public health structures, including in the fields of infection control and emergency room departments.

MSF remains committed to responding to the consequences of conflict when needed, for instance by assisting populations displaced by the fighting in Benghazi, where the organization also provides pediatric, gynecological, and obstetrical care and mental health services to children and families affected by the conflict.

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