Libya is in the midst of a serious humanitarian crisis, as large numbers of migrants and refugees have arrived in the country – many seeking passage to Europe. Libya, however, has become a dangerous and inhospitable environment for those fleeing war, famine, and disease in their home countries. Many migrants and refugees in Libya have been robbed, tortured, imprisoned, and even killed.
Since July 2016, MSF has been providing lifesaving healthcare to refugees and migrants detained in Tripoli. In early 2017, MSF launched a new project to assist migrants, refugees and asylum-seekers in the Misrata area. In the following interview, Jean-Guy Vataux, head of mission in Libya, speaks about the challenging and crucial work of MSF teams in the country.
MSF provides medical and humanitarian aid inside detention centers in Misrata. What is the situation there?
In and around Misrata, the teams started activities a few months ago in three detention centres, formally under the authority of the Directorate for Combatting Illegal Migration (DCIM).
The number of detainees varies from a week to another. They have been stopped at sea by the Libyan coastguards, arrested in towns, at checkpoints, etc. Some arrive here after being transferred from other detention centers in Tripoli. We sometimes meet detainees who have lived and worked in Libya for years. Simply testing positive for Hepatitis C is grounds for detainment.
MSF teams have started to provide medical consultations inside the detention centres. The majority of health issues affecting the patients we see are directly linked to the detention conditions and the violence that marks their journey: skin diseases, scabies, diarrhea, respiratory infections, muscular pain, and wounds. MSF provides referrals to secondary and specialized care for those who need it, such as patients with bone fractures. Hygiene and non-food item kits are also distributed to the detention centres.
While it is possible to marginally improve the material conditions of detention centres, we must not lose sight of the core issue: people are jailed, ostensibly awaiting expulsion, in an opaque process which denies their basic rights.
According to IOM (International Organization for Migration), 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? Can you tell us more about them?
IOM has identified over 380,000 migrants currently in Libya. Indeed, people held in detention centres 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 was once an economic El Dorado for migrants from neighboring countries. Others either try to secure funding for the Mediterranean crossing – working under conditions that fall within the scope of forced labour, interrupted by periods of detention – or are at the very beginning of their journey across Libya.
The journey through the Libyan desert, and detentions in the “unofficial centers” – work houses run by criminal networks – are described as an excruciating experience by survivors. 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?
What is MSF doing to assist them?
This month, we opened an out-patient clinic in Misrata to reach out to the migrants and refugees who live and work there, in order to better understand their challenges and provide free and confidential healthcare. The respect of medical confidentiality is key in a context where developing certain diseases can be grounds for detention and expulsion. Additionally, we are continuing our activities in the detention centres.
We are also trying to negotiate access to people on the roads upstream of the coastal cities. We will see what kind of working space we are able to negotiate. The risk of failure is significant. There are certainly other operational models we have to develop, to devise. Our teams regularly travel south of Misrata, where the corpses of migrants fill the local morgue – reportedly about ten a week. In my opinion, we should do more to restore the dignity of these anonymous victims.
Since 2011, MSF has been supporting the Libyan health system, which has been devastated by war and economic recession. Libya's health system continues to struggle with shortages of medicine and staff. MSF has been working to bolster Libyan public health infrastructure, including infection control and emergency room departments. MSF also remains committed to responding to the consequences of conflict; for instance, MSF is assisting populations displaced by the fighting in Benghazi by providing pediatric, gynecological, and obstetrical care, as well as mental health services.