July 05, 2011

Doctors and other hospital staff in Libya are highly dedicated, but there is a lack of inpatient capacity in all areas of care. MSF is helping to fill the gaps in surgery, obstetrics, and neonatal care.

A nurse and president of Doctors Without Borders/Médecins Sans Frontières (MSF) in Belgium, Meinie Nicolai recently returned from Misrata, Libya, where she was on a medical assignment.


© Henrik Glette

Meinie Nicolai, nurse and president of MSF-Belgium

How would you describe the medical situation in Libya?

In Misrata, where I was working, health facilities have either been destroyed or are very difficult to access due to the fighting. There is a lack of inpatient capacity in all areas of care. While you have a lot of very dedicated doctors, ranging from specialists to junior doctors, or medical students, there are not enough nurses, midwives, or other hospital staff. Libya was very dependent on foreigners for this type of work and most of them left the country when the war started.

What kind of activities has MSF put in place in Misrata?

We started working in Misrata at the end of April, helping to fill the gaps in medical care. When it comes to surgical care, Libyan doctors are doing an incredible job and are taking charge of most trauma cases. But when there is a significant influx of wounded, they don’t have the capacity to treat all wounded patients. So they refer some to MSF-supported structures for surgery.

MSF has also gotten involved in obstetric and neonatal care. The main hospital carrying out obstetrics for Misrata is quite close to the frontline and therefore very difficult to get to. As a result, deliveries were being carried out in places with too little bed capacity and insufficient medical personnel, and staff were having to discharge women and their babies too early. MSF started working in the hospitals of Ras Tubah and Al Noor, carrying out a lot of logistical work to increase bed capacity for maternal care and improve nursing care. We have also rehabilitated some operating theaters and emergency departments, and provided training and supervision to Libyan staff.

Occasionally, MSF medical staff work shifts to assist local personnel. All kinds of people who have never worked in a hospital before are working in medical facilities and caring for others—trying to re-open medical structures or to help with nursing care. A dentist has been working in an emergency department, while an accountant has been sweeping floors. But how long can they hold on? They are constantly working, and they sometimes fall asleep the moment there are no emergency cases.

How extensive are maternal health needs?

Obstetric care is both an ongoing need and an emergency need. When a woman suffers from complications during labor, the situation becomes life-threatening. In many cases you have to carry out a surgical intervention. In a war zone, key medical staff focus on trauma cases. Obstetric emergencies are no longer the first priority. But the needs remain high. Moreover, war can put a lot of stress on pregnant women who are then more likely to face complications. In Ras Tubah, where we are supporting Libyan health staff, there are on average 500 deliveries per month. 

What is the security situation today?

This is a very intense war. The fighting is almost continuous. It is not an easy place to work. There have been hits not far from our compound so we have to respect strict security rules. But for MSF it has been possible to work. On days of very heavy bombing I would ask myself “When will it end?” And I only stayed for a short period of time.

I understand that it must be very difficult for the people who live in Misrata to hear all this fighting all the time in their city. People can get depressed or anxious. Everybody is suffering from loss. They try to live a normal life, but life is not normal and people are very worried. I can imagine that the situation is similar in Tripoli where the daily bombardments must make life equally hard for civilians.

Is MSF planning to expand its activities?

We continue to try to access and send supplies to Tripoli and to the west of Libya, on the other side of the frontline. However, we still haven’t been able to access these areas. We are considering expanding our activities; as the war goes on, needs are growing. For us it is very important to care for all victims of this conflict, on both sides of the frontline, including armed men, and working together with Libyan medical staff.

In Misrata, we have supported medical staff in caring for all wounded: civilians, government soldiers, and rebels. It is very important that any person who is sick or wounded receives medical care.

How is the civilian population coping?

You see an amazing solidarity. People from all sectors of society are getting involved in helping each other. But four months into the war, and not knowing exactly where it will go or how it will end, you are starting to see a certain fatigue among the population. Salaries have not been paid for four months, there is no income, schools are closed. They are living under the pressures of war. A lot of men go to the front line, and women and children stay behind and don’t know what their future will be.

Therefore, MSF’s activities also focus on mental healthcare. At first, MSF psychologists supported medical staff who had been working round the clock for weeks in a war zone. Then, a network of 20 to 25 student psychologists was created by a professor and dispatched to the city’s hospitals to provide psychological support to medical staff, as well as to wounded patients and pregnant women. Our psychologists are now supervising, training, and guiding this network.

People here don’t cry easily or show their emotions much. But when there has been a day of heavy fighting, you can see that your counterparts, the local medical staff, are very down. You see that it hits morale very hard. But they have no other way than carrying on.

MSF is an international medical humanitarian organization providing emergency medical assistance to people in need, independent of any military or political groups and irrespective of race, religion, ideology, or politics. To ensure the independence of our medical work, MSF relies solely on private financial donations to fund its activities in Libya and does not accept funding from any government, donor agency, nor from any military or politically affiliated group.