In Libya, fears of rain, clouds, and climate change

MSF’s mental health patients in flood-struck Derna are “haunted by the fear that the floods could happen again."

A damaged bridge with water flowing through in Derna, where MSF is providing mental health care.

Libya 2023 © Halil Fidan/Anadolu Agency

Three months after thousands of people in Libya lost their lives in devastating floods caused by Storm Daniel, residents of the badly-hit city of Derna are facing the psychological aftermath. Doctors and psychologists with Doctors Without Borders/Médecins Sans Frontières (MSF) have been providing medical care and mental health support for people impacted. 

Before Storm Daniel made landfall in Libya on September 10, it had already caused extensive damage in Spain and Greece, and strengthened as it passed over the Mediterranean Sea to reach the Libyan coast. The strong winds and intense rainfall caused two dams to burst upstream of the coastal city of Derna in northeastern Libya. At around 2:30 a.m. on September 11, a deadly wave of water from the burst dams engulfed part of the city center, destroying apartment buildings and sweeping away thousands of sleeping residents in a torrent of mud.  

Storm Daniel destruction in the city of Derna, Libya.
Destruction in Derna on September 27. Libya 2023 © Jean-Paul Delain/MSF

Urgent need for mental health care

Official figures have stopped counting at 4,500 dead—but more than 8,000 people remain missing. Meanwhile, the survivors are struggling to cope with their shock and grief. 

"Derna is currently in a terrible state of grief and silence,” said MSF psychologist Asma Amaraa. “People are still in constant mourning."

The first MSF team arrived in Derna three days after the disaster to assess people’s medical and humanitarian needs and donate body bags and other emergency supplies to health authorities.

At the time, the most urgent need identified by our team was to provide psychological support to displaced people who had lost family members, homes, and belongings in the destruction, and had taken refuge in classrooms converted into temporary shelters. The other group they identified as needing support consisted of medical staff and volunteers—some of whom had themselves been bereaved by the floods—who were struggling to cope with exposure to the psychological distress of the survivors. 

Ten days after the disaster, the MSF team started providing general medical consultations at two health centers, one on each side of the destroyed city center, as well as psychological support through individual and group sessions. 

Destruction from Storm Daniel in Derna, Libya
Destruction from Storm Daniel in Derna on September 16. Libya 2023 © MSF

The psychological impact on physical symptoms

To date, MSF doctors have provided medical consultations to more than 4,480 patients (both children and adults) in Derna, the majority for hypertension, upper respiratory tract infections, and stomachaches. Many complained of headaches, chest tightness, shortness of breath, back and stomach pains, and hot flashes.

"We quickly noticed that in many cases, patients were coming with symptoms that were more psychological than physical," said MSF’s Dr. Mohamed Ibrahim Algablawi.

More than 230 patients were referred for mental health support from MSF’s team during primary health consultations, despite the stigma of mental health issues in the community. "In Derna, everyone knows everyone else,” said an MSF psychologist. “Coming to see a psychologist is still often stigmatized.” 

Since the disaster, MSF psychologists have provided mental health support to 1,000 patients. They report that many of their patients show signs of anxiety or violent tendencies; others cry constantly or describe feelings of distress, sadness, and fear. 

Floods brought debris and objects in the streets of Derna, Libya.
Floods brought debris and objects in the streets of Derna. Libya 2023 © Jean-Paul Delain/MSF

Healing and rebuilding begins

"[Our patients] have nightmares, they have the impression that the disaster could happen again, they are afraid of rain, clouds, climate change,” said an MSF psychologist. “They are haunted by the fear that the floods could happen again."

Despite the deep psychological wounds of many residents and the visible scars left in the flood-damaged city, life in Derna is now slowly returning to normal. The temporary shelters for displaced people have gradually been closed, and reconstruction has begun. When schools finally reopened, MSF psychologists also helped teachers cope with this particularly difficult start to the new school year. 

Flood damage to the land of Susah, a town near Derna, Libya.
Flood damage to the land of Susah, a town near Derna. Libya 2023 © Manoelle Carton/MSF