It was an unpleasant surprise when Doctors Without Borders received notice at the end of March this year that the aid organization had to cease its activities in Libya, says Steve Purbrick by telephone from the Tunisian capital Tunis. Purbrick is the Libya director at Doctors Without Borders and has been working in the North African country on and off since 2011.
It is not the first time that the organization, which provides emergency medical assistance in countries around the world, was temporarily denied access to Libya. So the Libyan MSF team held out hope that the ban would be lifted soon. And there was reason for hope, because their contacts within the Libyan government gave positive signals, says Purbrick. Yet bad news arrived again in October. Doctors Without Borders must leave the country by November 9 at the latest, said the letter from the Ministry of Foreign Affairs of the government in Tripoli (GNU, the Government of National Unity). And that has major consequences.
Steve Purbrick.
Photo private
What did your relief efforts look like in Libya at the beginning of this year?
“Libya has a functioning public health system, but it has significant shortcomings. In addition, there are large numbers of refugees and migrants in the country, the vast majority of whom do not have access to Libyan health care. It is not clear exactly how many refugees there are. For example, there is much debate about the number of Sudanese refugees. According to the most recent estimate from [VN-vluchtelingenorganisatie] UNHCR estimates at least 500,000 people, but that is probably an underestimate. And people are still arriving.
“We support the Libyan health system with consultations for both Libyans and refugees and the fight against tuberculosis, a major problem in Libya. Not all cases are detected by the national system. For example, we worked with the only public tuberculosis control center in the country.
“Until March we were active in western Libya, mostly in Zuwara, but we also worked in Tripoli and Misrata. In the past we have also worked in eastern Libya, for example in Benghazi [waar een andere regering zit, Libië wordt door twee regeringen bestuurd]. We also provided emergency aid after the floods in Derna in 2023. Now we mainly monitored the situation in the east, in order to intervene if necessary, for example if the cholera outbreak in Sudan also caused infections in Libya.”
Doctors Without Borders conducted last year 15,018 medical consultations in Libya, 3,024 consultations for mental health care and 2,035 consultations for tuberculosis. The organization was also involved in the evacuation of dozens of particularly vulnerable patients to Italy.
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Why did you have to stop activities earlier this year?
“In March, the government cracked down on NGOs in western Libya: we and nine others had to cease our activities. Our employees were also threatened and interrogated by the authorities during that period. We were therefore forced to dismiss our Libyan employees, approximately 105 at the time. We had to evacuate the fifteen international employees. Our office in Tripoli has since been sealed.
“The reason given by the government was that the NGOs were trying to settle undocumented migrants in Libya. The idea that NGOs, the United Nations and the European Union are trying to force Libya to accommodate migrants has received a lot of attention, but the accusations were not substantiated. In July, the Attorney General in Libya also said that he would not initiate legal proceedings and that he saw no reason why NGOs should not be able to resume their activities. We saw this as a rejection of the initially harsh approach of the government.
“We then waited for communication about when we could get back to work in Libya, but then we received a new letter saying that we had to leave the country. That message also came as a surprise to our contacts within the western Libyan government. There was nothing else in the letter: no explanation, no reason, no answer to our questions to the Ministry of Foreign Affairs. There is a complete lack of transparency.”
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What are the consequences for people in need of care in Libya?
“The most direct effect is that the migrants and refugees we helped are now reporting to Libyan institutions. But without our support, the Libyan health care system does not have the capacity to respond. I do not have precise figures, but from our contacts in the hospitals we work with we hear that there is an increase in the number of migrants and refugees and that they cannot cope with the demand for help. We also hear stories about neglected migrants, deaths and inadequate care.
“There are also major consequences in the field of tuberculosis control. Fewer cases will now be detected and fewer people will be treated, which will lead to more infections. Properly identifying the extent of tuberculosis has always been a problem, which is now only getting worse. Since the suspension of our activities, we have received reports of eighteen deaths from tuberculosis and forty admissions. That is an extraordinary increase in the mortality rate.
“It is also becoming more difficult for the Libyan health system to respond to outbreaks and emergencies: that is one of our core capabilities.”
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