Ismaël and Masjdi were both 19-year old students when the revolt began in Libya in 2011. Like thousands of others, the two fervent idealists took up arms against Mu’ammar Gaddafi regime with no training or understanding of military strategy. The two young men, who both narrowly escaped death, met much later in Malta. During the fighting Masjdi sustained wounds to the face and was blinded while Ismaël was paralysed and can only move his right hand. They became friends from the moment they met in the intensive care unit. Separated during their convalescence, they kept in touch and now meet up in Misrata whenever they get the opportunity. “We’re like brothers,” they told me in chorus. Masjdi pushes his friend’s wheelchair and Ismaël reads to his blind friend.
Misrata is steeped in history. Strategically located on the Mediterranean Sea, the city is known as much for its pride and independence as its traders, smugglers and pirates. Subjected to heavy fighting between February and May 2011, Misrata is a sandy and dusty but bustling desert city. Economically and militarily powerful, its hospitals are well equipped and its health system better organised than in the east. Compared to Benghazi and Tripoli, Misrata is for now relatively safe so this was where we decided to set up base.
Everyday we saw Sub-Saharan Africans, each with their own agricultural or construction tools, brushes and drills, stationed at the city’s crossroads looking for work as day labourers. Few are arrested, but some get caught at police checkpoints and interned in camps before being deported back to their home countries. There are around 10,000 migrants in Misrata, mostly from Niger, Chad and Sudan. Fearful of arrest and deportation, when they fall sick they usually go to pharmacies and buy the often high-priced drugs they are advised to take. For more serious problems, they prefer private medical facilities because, although expensive, these are not required to report undocumented patients. But when they have a chronic illness, their only choice is to go home. When I asked them if they didn’t want to get on a boat to Europe, they smiled and shook their heads: “It’s too dangerous. We don’t want to die in the sea.”
Between Misrata and Tripoli
Living conditions and hygiene are truly appalling in the detention centre in a small town halfway between Misrata and the Libyan capital. Intended for 400 refugees, there were only 43 detainees, 39 of them women from Egypt, Guinea, Niger or Nigeria who’d been there for a month with no contact with the outside world or their families. Most come from Nigeria and told me their homes had been bombed. The Libyan coastguard intercepted their inflatable dinghy near the Mediterranean coast and they were sent to the detention center.
Rooms were small, dirty and jam-packed with mattresses. As we entered the hall, there was a putrid stench. We walked through puddles of urine. There were no showers, the toilets didn’t flush and the women had to relieve themselves in buckets. They used a little of their drinking water to wash. They were utterly desperate and begged me to help them get back to Nigeria. When I told them I was a doctor, they didn’t believe me to start with but then they accepted the treatment we offered them. Their average age was 22 and almost all of them (93%) had health issues. Many had scabies (58%), which we gave them prescriptions for, and some various aches and pains (48%). Other non-specific ailments were due to emotional trauma — or at least, that’s what we deduced from the stories they told us about their flight and from their almost palpable fear. When I asked them if they thought they would try to get to Europe again, they replied, horrified, “Never again!”
Our visit to Syrte was a real eye-opener. Close to the oil fields, the town is known for being the birthplace of Mu’ammar Gaddafi who died in October 2011. In spring 2015, so-called Islamic State who controlled 300 kilometres of the country’s coastline made Syrte its stronghold in Libya. It was only in December that militias from Misrata succeeded in retaking the town with help from the US Air Force. The battle lasted seven months. Many fighters died and over 3,000 people were wounded. Ten ambulances were damaged and three rescue workers were killed.
Armed with a special permit and a police escort we managed to enter the coastal town. Reduced to rubble, not one building has been left intact. Syrte was subjected to a brutal war that left a trail of total destruction. A deathly silence hangs over the town that, from the historical perspective, was most probably unique.
We went to Ibn Sina hospital. Relatively unscathed by the bombs, it had been ransacked. Abandoned over a year ago, the hospital was once a modern, 350-bed facility equipped with several operating theatres, an intensive care unit, MRI scanner, a cardiac catheterisation laboratory and twenty practically new dialysis machines. It’s completely destroyed, with ripped up flooded floors, smashed windows and sagging ceiling tiles.
When we reached Tripoli I was stunned by the towering height of the ruins. MSF colleagues were in the capital providing assistance to people spread among seven detention centres.
Most of those wanting to cross the Mediterranean to Italy are from Sub-Saharan Africa — Nigeria, which is mired in conflict, Eritrea that is governed by an authoritarian regime and Somalia, a country embroiled in a civil war. People flee northwards to escape poverty and terror. To reach the Libyan coast, they have to pass through Chad and Niger, both particularly poor countries. According to the International Organization for Migrations (IOM), over 300,000 people crossed through them last year. However, there are no precise figures on how many have died of hunger or thirst or from falling off a truck along the way. According to most estimates, at least as many people have died crossing the desert as those who have drowned in the Mediterranean Sea — the statistics on people who drowned are more reliable. Be that as it may, survivors are insistent that the desert is by far the hardest part of the journey.
The many dead migrants also pose a problem. We went to hospital mortuaries over-flowed with unidentified corpses washed up on beaches or of people who simply died. Many have been there for months. As the authorities don’t have the resources for DNA testing, it’s impossible to identify the dead and ship them back home or bury them.
Author: Dr Tankred Stoebe
Based on personal experience in January 2017. Please note that due to volatile context, situation changes quickly in Libya.
 As of April 21, 2017, the Ibn Sina hospital is expected to re-open by end of the month.
 For comprehensive overview of MSF response in Tripoli, visit http://www.msf.org/en/article/libya-providing-healthcare-detained-refugees-and-migrants