Middle East Health eNews

In an IRIN report on 18 April, civilians evacuated from the war-ravaged western Libyan city of Misrata have described the humanitarian situation there as grim, saying families are barely able to find enough food and water, that medical treatment is hard to come by, and corpses are lying in the streets.

“We could hear the snipers picking people off in the street outside,” said Mariam Doua, a teacher in the city. “Eventually some [rebel fighters] came to lead us to safety in the middle of the night when the militia were dozing. We covered the mouths of the children and ran out into the street, barefoot.

“Eventually we made it to the port and were able to get on a fishing boat to [rebel-controlled] Benghazi.”

Prior to their escape, Doua’s family laid low at the family house on Tripoli Street, Misrata’s frontline, for four days before spending two weeks at the house of a relative, living on two bottles of water and a few cans of food.

No official transport has yet been arranged for local Libyan people trying to flee Misrata, but many are reaching Benghazi by fishing boat, some of which are not sea-worthy.

Doua’s mother-in-law, Halima, said she saw entire families lying dead in the street outside their home.

“I lost my son; he was killed by a sniper,” she said. “Another of my sons was evacuated to a hospital in Tunisia. The third is still fighting in Misrata. When we left, the street was a war zone. There were corpses in the gutter and in the vegetable market where I buy produce. The militia raped women, slaughtered men and killed children.”

She showed IRIN wounds on her leg and abdomen where she was hit by stray bullets.

“I bled for days because it was not safe to travel to the hospital,” she said. “I have seen a doctor in Benghazi but I am lucky. Many people are in a worse situation than me. A friend was heavily pregnant and became anaemic after having no food. One of our cousins, who is paraplegic, was tortured by electrocution. Militia poured urine over his face and tried to strangle him with a plastic bag.”

But, she said, when one of his captors recognized his surname, he was wh eeled into the street and allowed to leave.

“I am sick because of what I saw,” Halima added.

Nightmares

Raju, a dentist from Hyderabad in India who moved to Misrata in 2010, has had daily nightmares for three weeks, dreaming that government militia were trying to kill him.

“Last night was the first time I fell asleep without hearing shelling,” said Raju, who arrived in Benghazi a few days ago from Misrata on a vessel chartered by the International Organization for Migration (IOM).

“The situation was horrendous,” he told IRIN from a camp run by the Libyan Red Crescent. “I hid for 20 days in a house with very little food or water, living on whatever the [rebels] would bring me when it was safe to do so. One night a missile landed on the balcony.”

Raju had hoped to earn enough money to pay for his eldest son’s university education, but conflict broke out across Libya in February, and Misrata became a battleground almost impossible to flee.

Aid workers and rights groups say with attacks by pro-Gaddafi militia escalating in Misrata, a strategic city between Tripoli and Col Muammar Gaddafi’s hometown of Sirte, the situation there is dire. Residents told IRIN the contested city has become an obstacle because it has prevented Gaddafi from reaching Sirte.

“It is good to be in a safe place now,” Raju said. “But this morning I woke at 3am in a cold sweat. I dreamt that my son called out to me, ‘Papa, why are you dying and leaving me alone?’ It will take me a long time to heal, but when I see my wife and kids, I’ll forget everything.

“I left with the clothes I’m wearing now and my passport,” he added. “The bank has closed so I could not withdraw the money I had earned. I don’t expect I’ll get it. I came to Libya to save up money for my family and I left without it. Even my degree certificate is gone. It was in the company office, which burnt down.”

Red Crescent helping migrants

The Libyan Red Crescent says it is helping to establish contact with foreign nationals’ embassies and consulates.

“Migrant workers require food and shelter, but the most important thing they need is contact with their families,” spokesman Omar Abdusalam said. “Once the basic needs are taken care of, we try to establish contact with their embassies or consulates, and then the IOM takes over the process, transporting them to Egyp t for onward travel.”

Dina Jarbon, a Libyan Red Crescent volunteer from Benghazi, told IRIN she placed 127 two-minute satellite phone calls on 17 April to connect migrant workers with their families. “Most of the migrant workers hadn’t had contact with their families for several weeks,” she said. “Some families presumed their husband, son or father had been killed. I’m a mother so I knew how they might be feeling.”

When 45-year-old Ghayasuddin, a mechanical engineer from Islamabad, called his wife after arriving in Benghazi from Misrata, she thought he had died. “Even though we only spoke for a minute, at least she knows I’m safe.”

“Appalling situation”

In Misrata more than 267 bodies had been brought to hospital morgues as of 15 April, most of them civilians, Human Rights Watch quoted local doctors as saying. It added that the number of dead is higher because some families have not brought their relatives to the morgues.

It said rocket fragments and remains in Misrata indicated the use – by both sides – of Soviet-designed Grad rocket launchers, often fired in salvos to cover a wide area and causing indiscriminate death and injury. Cluster munitions, which are banned by over 108 countries, have also reportedly been used.

The fighting has particularly been intense in the last four days. On 16 April, government forces hit the parking lot just outside the Zawiyat el-Mahjoub medical clinic in the residential Zawiya neighbourhood, apparently with an 82mm high explosive mortar round, spraying shrapnel into the clinic and wounding a medical technician and three other civilians.

The Libyan government denies targeting civilians in its fight against armed opposition fighters.

About 10,000 third-country nationals were living in Misrata when the unrest began, according to UN Office for the Coordination of Humanitarian Affairs The IOM, which is working to evacuate them, has been using a vessel able to carry 800 people, and it brought out 2,400 between 14 and 18 April. Another 3,600 are waiting.

But IOM is struggling to raise money: “We should not be put in a position of deciding who we save when so many people are in an appalling situation,” said Fernando Calado, IOM’s head of emergencies.

Some aid workers have begun arriving in Misrata, but say it is dangerous for teams based there. One of these is the Italian medical group, Emergency, which brought a surgical team in from Benghazi by sea. According to the organization, most of the nurses in Misrata’s six hospitals – mainly from Philippines, Ukraine and Sudan – left when the bombing started.

“One thing that has touched me is the spirit in which Libyans are working together to take care of us,” Raju said. “Even when I didn’t have food, I would see the smiles on people’s faces and my stomach would feel full. Despite the circumstances, we have been treated with excellence.

“Even the journey here, over 10-foot waves, was beautiful,” he added. “On the boat I was given a piece of chicken. I relished it.

• Republished with permission from IRIN

MSF evacuates war wounded from Libya conflict. CREDIT: Alison Criado-Perez/MSF

Médecins Sans Frontières (MSF) evacuated 99 people, including 64 war-wounded and 35 accompanying persons, by boat on Friday 15 April from Misrata to Zarzis, Tunisia. This operation took place two weeks after the first MSF evacuation by boat of 71 war-wounded by MSF.

This time, the MSF team was able to assess the medical facilities in Mistrata, where ongoing fighting has cut-off the population from external assistance. The organisation reports that hospitals and clinics in Misrata are overwhelmed with casualties.

“For weeks now, health structures have been struggling to cope with the influx of patients. They lack medical equipment and personnel to treat the wounded and the sick suffering from chronic diseases,” said Dr Morten Rostrup, a MSF doctor who was on the boat. “With the latest heavy bombardments in Mistrata, the situation is worsening as hospitals have to discharge patients before their treatment is completed in order to treat the new wounded from fighting. Many injured cannot even access medical facilities without further risking their life.”

In Misrata, the MSF team assessed the situation in a camp located near the port where thousands of migrants have taken refuge and are awaiting repatriation.

“What we have seen is that these people live in extremely difficult conditions, lacking proper shelter and food. They are desperate to go back to their home countries,” added Dr Rostrup.

During this second medical evacuation, the MSF team onboard was composed of seven doctors, six nurses, and one psychologist, including nine Tunisian volunteers. They provided emergency medical care to 64 patients while the boat sailed back to Tunisia. Among them, 10 were reported in a critical state, three on mechanical ventilation and another three on oxygen, while another one was suffering from severe anaemia and needed a blood transfusion.

The boat docked in the port of Zarzis early on Saturday. The patients were transferred to the city Sfax, which has several hospitals and clinics. This transfer was organised by the Tunisian health authorities and the Red Crescent.

This medical evacuation was carried out independently from all the parties involved in the conflict in accordance with MSF’s principles of neutrality and impartiality. While conflict persists inside Libya, MSF is scaling up its assistance to people affected by the violence, regardless of their affiliation or origin and independently of any political considerations.

MSF reiterates its call to allow unhindered access to medical assistance for all Libyans affected by the violence. MSF also calls for the respect of medical facilities, healthcare personnel, and vehicles transporting patients.

MSF in Libya
During a first medical evacuation by boat on 3 April, MSF evacuated 71 patients from Misrata. Six tons of emergency medical materials were donated to the Libyan medical committee in order to help health facilities cope with the influx of patients. On 21 March, MSF had sent a first shipment of surgical kits for 300 wounded to the hospital of Misrata, where large numbers of injured persons and severe shortages of medicine had been reported.

In the eastern city of Benghazi, MSF teams continue to work with the medical committee and to provide support wherever needed, including technical support to the Benghazi central pharmacy in waste management and stock organisation. In Al Jalaa hospital, which is both the main trauma hospital and the referral facility for eastern Libya, MSF medical teams are supporting existing hospital staff with nursing care organisation. MSF continues to send medical supplies to Libya, so that they can be dispatched to areas where the ongoing fighting has created the most needs. Since 24 February, 44 tons of medicine and medical products, including treatment for burns, have arrived in Benghazi.

In Ras Ajdir, Tunisia, at the border with Libya, MSF teams have been providing psychological support to people fleeing the conflict. They are also working in the transit camp at Choucha, where people are awaiting repatriation or resettlement. From the onset of violence in Libya, MSF’s priority has been to access areas with the largest needs.

After coming under siege and fire for 40 days, the city of Misurata, about 200 km east of Libya’s capital Tripoli, is facing a deteriorating health situation. This has put the lives of thousands of civilians at risk and as the fighting continues the humanitarian crisis is worsening the World Health Organisation (WHO) warns.

In statement issued today, Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, appealed for “days of tranquility” to allow WHO and partners to evacuate the injured and sick, and provide much needed medical and humanitarian assistance to the besieged people in Misurata and other parts of Libya.

“WHO calls upon the international community and donor agencies to provide immediate support to the people of Misurata to prevent further deterioration of the humanitarian crisis. Medical personnel and equipment, medicine, surgical kits, ventilators, sterilization equipment and water purification units are among the priority needs,” Dr Gezairy added.

“The city’s main polyclinic has become inaccessible to both doctors and the injured. Smaller and unequipped clinics are facing an influx of injured and patients who are in dire need of medical assistance. Privately owned medical facilities fall short on capacity, space, equipment and personnel to cope with the unprecedented number of casualties and regular patients”, a local doctor said.

“Routine vaccination programmes have been interrupted, as there is no stock of vaccines left in the city. Medicines for the treatment of communicable and chronic diseases are needed and the deployment of medical teams.”

The city’s water supply and sewage system have been interrupted and the roads to the nearby desalination station, as an alternative source for drinking-water, are under fire and not safe. Lack of safe drinking-water and poor sanitation may lead to epidemics with serious public health consequences, the WHO said in statement.

In addition to Misurata’s local residents, a large number of immigrants from Egypt, Chad, Niger, Bangladesh and other nationalities, are under siege in makeshift camps where access to basic human and medical necessities is very limited.

Despite the efforts exerted by WHO and partners in supporting relief efforts and providing medicines and medical supplies to those affected by the violence in Libya, there are still many areas in the west and the middle of the country, which are reported to be besieged and unfortunately out of reach of aid agencies. WHO warns of increasing health threats and reiterates its call for immediate action.

A World Food Programme (WFP) humanitarian vessel carrying life-saving food, medical supplies, doctors and other relief items has finally been able to reach Misrata port, opening up a new humanitarian lifeline to civilians trapped in the Libyan conflict.

“This is a breakthrough for the UN humanitarian operation in Libya and allows us to reach tens of thousands of people who are caught in one of the fiercest areas of conflict,” said WFP Executive Director, Josette Sheeran. “It is vital that we get these relief supplies to the vulnerable – especially women and children – and we are working with local partners, including the Libyan Red Crescent, to ensure their needs are met.”

The WFP-chartered vessel, Marianne Danica, docked in Misrata on Thursday 7 April carrying more than 600 tonnes of WFP food including wheat flour, vegetable oil and High Energy Biscuits – enough to feed more than 40,000 people for a month. The ship is also delivering medical supplies on behalf of UNICEF and the World Health Organisation (WHO). The UNICEF and WHO emergency health kits and surgical material will cover the urgent needs for 50,000 people for a month. Other materials will enable thousands of children to play in the relative safety of indoors. Two doctors are on board and will disembark at Misrata.

“The situation is urgent for tens of thousands of children in Misrata and across Libya, who are potential victims of the fighting or who have already paid a terrible price,” said UNICEF executive director Anthony Lake. “These supplies are a lifeline to them and all those trapped in the fighting.”

WFP began moving food supplies into Libya soon after the conflict erupted and has pre-positioned more than 17,000 tonnes of food stocks inside the country and across the region, as part of a US$42 million emergency operation that will provide food assistance to more than 1 million people in Libya and neighbouring countries. Working with partners such as the Libyan Red Crescent, WFP plans to provide food to more than 600,000 people inside Libya over the next three months.

“The operation in Libya is complex and dangerous, but we are exploring every possible avenue to get food to the hungry,” Sheeran added. “This means moving food assistance and other relief supplies by road from Egypt, and by sea into the main ports along Libya’s Mediterranean coastline.”

The international medical humanitarian organisation Medecins Sans Frontieres (MSF) evacuated 71 patients by boat on Sunday 3 April from the Libyan city of Misrata, where ongoing violence has overwhelmed medical facilities with the injured.

“We managed to dock at Misrata on Sunday afternoon, despite intense fighting in the city over the past few days” said Helmy Mekaoui, an MSF doctor who coordinated the medical evacuation. “The violence caused an influx of wounded people and it was fortunate we could be there and get them onboard”. Among the evacuated patients were three people on life support, 11 people suffering from major trauma, and many others with abdominal wounds and open fractures. Intensive medical care was provided on board as the boat sailed to Tunisia.

The hospital in Misrata has reportedly been bombarded Sunday early morning, while the remaining functioning clinics are overflowing with severely injured patients and are desperately running short of medical supplies.

In Misrata, six tonnes of emergency medical materials – including 300 surgical kits to perform 1,000 surgical operations, drugs, sterilisation materials, and intravenous fluids — were donated to the Libyan Health Committee in Misrata, in order to help health facilities in the city cope with the influx of war-wounded people.

The boat arrived 4 April at the port-city of Sfax, Tunisia and the patients were transferred to hospitals to receive urgent medical care. The MSF medical team on board was composed of seven doctors, three nurses, and one psychologist, including seven Tunisian medical personnel who volunteered to be part of the operation. Upon arrival in Sfax, the Tunisian health authorities organised the transfer of the patients to a dozen medical facilities. Thanks to their support as well as the efforts of the medical staff in Misrata who risked their safety, the evacuation and medical treatment of the patients was made possible.

The evacuation was carried out independently from all the parties involved in the conflict in accordance with the organisation’s principles of neutrality and impartiality.

As conflict continues inside Libya, MSF is scaling up its assistance to people affected by the violence, regardless of their affiliation or origin. The organisation is reinforcing its teams on the ground, sending additional medical supplies, and facilitating the evacuation of wounded and sick patients. However, it remains very concerning that many injured people reportedly cannot safely access life-saving medical care without further risking their life.

MSF reiterates its call on all belligerents to allow unhindered access to medical assistance for all Libyans affected by the violence. MSF also calls for the respect of medical facilities, healthcare personnel, and vehicles transporting patients.

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MSF in Libya

In the eastern city of Benghazi, MSF teams are providing medicine and medical supplies to health facilities, including anaesthetics and surgical materials for wounded patients, in coordination with the Libyan Medical Committee. So far, 44 tons of supplies have arrived in the country, with more on the way. MSF teams on the ground are being reinforced with additional medical personnel who will provide nursing care training. On 21 March, MSF sent a shipment of surgical kits for 300 wounded patients to the hospital in Misrata.

In Ras Ajdir, Tunisia, at the border with Libya, MSF teams have been providing psychological support to people fleeing the conflict. They are also working in the transit camp at Choucha, where people are awaiting repatriation or resettlement. From the onset of violence in Libya, MSF’s priority has been to access areas with the largest needs.