Benjamin: a doctor back from Libya
Benjamin Wood is a medical doctor from Tasmania, Australia. He worked a couple of years as mainly an emergency doctor in Australia before moving to Berlin to undertake a Master of International Health, with a focus on humanitarian and refugee health. This year, he worked for Première Urgence Internationale for the Libya mission, as medical coordinator.
He tells us about his experience.
I have been in Tunis twice this year (1). The first time was as the health program manager, and that was for about two months between mid-April to mid-June, and the second time was as the medical coordinator, and that was for about 3 months from September through to now.
My first mission in Tunis was focused mainly on the recruitment of the mobile health teams in Benghazi, and relevant technical trainings amongst those recruited. It also gave me a great chance to represent Première Urgence Internationale in Tunis and create relationships with relevant partners. My second mission was focused more so on evaluating the current strategy of Première Urgence Internationale in Libya and developing ideas and plans for 2018, as well as conduct general day-to-day coordination activities.
The healthcare situation in Libya
Unfortunately, there is still a dearth of health-related information in many parts of Libya, including Benghazi. Looking at the health system itself, there is a lack of coordination and health governance in Benghazi, primarily due to the fragmentation of national governance since the fall of Qaddafi, and the ongoing political battles between the East of Libya (controlled by the House of Representatives) and Tripoli (‘controlled’ by the UN-backed Government of National Accord). There is a major shortage of medicines and supplies throughout Libya, including Benghazi, which the health sector has essentially described as the most urgent need to address for 2018. There is also considerable infrastructural damage in parts of Benghazi, where nearly half of the pre-existing health care facilities are no longer functional.
The major health issues faced in Libya essentially depend on where you come from
For Libyan nationals, particularly those residing coastally such as in Benghazi, the main burden is from chronic diseases such as diabetes, hypertension and mental health issues. For Libyan nationals residing in the south, there are many people who still are unable to access the most basic and essential health services (also mainly related to structural weakness and lack of investments for years, not only related to the on-going civil war). For forcibly displaced persons, including but not limited to migrants from West Africa, their concerns are very much different, and often are reportedly to enter into a realm of severe human rights’ issues.
Mental health and psychosocial support interventions
For most communities in Libya, most of which have been directly or indirectly affected by protracted conflict, the burden from mental health and psychosocial issues is enormous, and the current institution-centred psychiatric approach does little to address the socio-ecological needs of the people.
Currently, the primary health care system does not have the capacity to manage common mental health issues, and would benefit from institutional and systemic adaptions to shift the majority of the responsibility of mental health care away from institutional care.
Very importantly, what is needed from a prevention perspective is an inter-sectoral approach that looks at improving the security and safety of communities, improving employment and educational opportunities, facilitating social cohesion, seeking and applying justice to perpetrators of human rights’ violations and allowing community members to have their roles and identities returned.
Our point of view about actuality
The recent media attention is focused on the migrants situation in Libya, consequently to the CNN reportage diffusion about the existence of a “slave market” and detention centers, where people live in inhumane conditions.
This question has to be dibated in its context. Firstly, it is important to underline that this situation is unfortunately not a recent event. On the other side, we have to analyse it through a global approach by targeting all migratory routes and different strategies to contain them.
The actual denunciation of Human rights violation observed in Libya is only one of the dramas that thousands of refugees and economic migrants live, by trying to reach the European coast, as much as Mediterrean shipwrecks or the men, women and children who disappeared in Western Sahara.
Henceforth, by continuing to testify and giving assistance to people during all their migratory path, it’s imperative to consider that only a work that evaluate deep causes of this exodus can have an impact on the flux volume (3). Barriers erected, of any nature whatsoever, accentuates the vulnerability and the exposition to criminality of these victims of the world’s disorder.
(1) The mission benefits of a staff based in Tunis, because of the volatile security situation. In Libya, and of a local team based full time in Benghazi. The team of expatriates had the possibility to go to Benghazi for a first visit in November.
(2) Première Urgence Internationale has developed a rapid emergency response program in the field of health and psychological support, through 3 mobile clinics and in order to ensure the coverage of critics health needs for the most vulnerable displaced people.
(3) Première Urgence Internationale works since different weeks on an exploratory deployment in the western region of Libya to better understand current dynamics in the region and give a global answer to specific problems linked to migrants and asylum seekers. Aware of the reality that this population has suffered during their path from Libya to the Mediterrean cost, Première Urgence Internationale would like to better understand their global needs, when they are in the coast city, but also their upstream passage from the south to the north of Libya, in a regional comprehension of the migratory path. This approach, connected to the development of the evaluation in the Agadez region of Niger, is part of the will of Première Urgence Internationale to add some elements on the Libyan context and to propose a coherent strategic intervention to assure the protection of these people and to offer them an access to health.