By Mel Plant
Libya’s battered healthcare system is ill-equipped to face the emerging coronavirus outbreak in the country as fighting continues to rage on, humanitarian, health and rights organisations have warned.
Both the United Nations and the Libya INGO Forum, a coalition of international non-governmental organisations operating in the country, have called for an urgent ceasefire to tackle the Covid-19 pandemic.
But some say the shortcomings of Libya’s healthcare system go beyond the conflict, and are rooted in deep-seated corruption.
Allegations that the first Libyan coronavirus patient is being housed in squalid conditions without access to oxygen cylinders have compounded fears that the country will be unable to tackle the highly contagious Covid-19 illness.
“My brother has been abandoned to wait for his death,” Salah al-Jamal told Libyan satellite television station Al-Ahrar, adding that his room lacks water and a toilet.
“The doctors don’t visit him. All of them fled except for [one] who visits from time to time,” Jamal claimed.
The allegations were later confirmed by the head of the National Center for Disease Control, the government agency tasked with handling the coronavirus pandemic.
“Everything that the patient’s brother said is true,” Badr al-Din al-Najjar told The New Arab’s Arabic-language sister site. “The reality of this country’s healthcare system is that there are limitations and lack of capabilities.”
Libya’s Tripoli-based Government of National Accord (GNA) has not yet prepared any special centres for the isolation or quarantine of confirmed or suspected coronavirus patients, Najjar said. Patients are currently expected to quarantine themselves at home, he added.
Najjar confirmed that healthcare workers had fled from the coronavirus patient’s room, a situation explained by a severe shortage of personal protective equipment (PPE).
“Doctors are terrified because they feel like they’re being sent to the front lines unarmed,” said Ahmed Gatnash, a Libyan-British author and co-founder of the Kawaakibi Foundation.
Najjar is not the only official to raise concerns over Libya’s preparedness for the coronavirus crisis so far.
“This is a health system that was close to collapse before you get the coronavirus,” Elizabeth Hoff, head of mission for the World Health Organization in Libya, told Reuters last week.
Libya has around 100 intensive-care unit (ICU) beds and fewer than 350 ventilators to care for coronavirus patients in severe respiratory distress, said Mohamed Eljarh, an independent Libyan affairs specialist.
Since former dictator Muammar Gaddafi’s overthrow in 2011, “successive Libyan governments have spent billions on the health sector with very little to show for it”, Eljarh told The New Arab.
Conflict and corruption stymie coronavirus response
Libya has so far reported eight confirmed Covid-19 cases, two in the capital Tripoli and six in the coastal city of Misrata.
Both cities are controlled by the internationally recognised GNA, which has been in conflict with forces loyal to rogue General Khalifa Haftar since April last year, when Haftar’s self-styled Libyan National Army (LNA) launched an offensive to capture the capital.
Hostilities continue despite international peace efforts earlier this year. Fighting between pro-GNA fighters and forces loyal to Haftar escalated on the outskirts of Tripoli last week.
“As a result of the ongoing conflict, Libya’s health system is severely challenged,” the Libya INGO Forum said last week in a joint statement calling for an urgent ceasefire.
“Lack of specialised medical staff, medical equipment, and the overall medical capacity to respond to the emergent health needs can lead to an unthinkable amount of lives lost if conflict does not end,” the statement read.
While the Tripoli-based government has promised a $350 million coronavirus response, its main source of funding remains under blockade by forces loyal to Haftar. Medics across the country have reportedly not received their salaries in recent months.
Tribal groups linked to Haftar seized key oil export terminals and fields in January. Oil is the country’s lifeline and the shutdown has caused losses of more than $3.5 billion, according to the National Oil Corporation (NOC).
While the oil blockade and war are “playing a role” in inhibiting the government’s response to the crisis, the real issue is “systemic” corruption on both sides, Gatnash told The New Arab.
“It is fairly widely believed that they are just funnelling money out of the country,” Gatnash said, calling the government’s multi-million dollar pledge a “PR move”.
“Hospitals in Tripoli are equipped with all kinds of equipment on paper but when you turn up in person, it doesn’t actually exist,” he said, adding that the issue of an “on-paper only” MRI machine is nothing new.
Widespread allegations of corruption and mismanagement of funds have fuelled distrust in the GNA and calls for resignations, he said.
“The two rival governments have taken some measures but they are nowhere near enough to handle a widespread [outbreak] of the virus,” Eljarh added.
“Progress is slow and impeded by in-fighting over control of the Covid-19 budget and the widespread corruption and mismanagement,” the analyst explained.
The situation is not dissimilar in Tobruk, where the Haftar-affiliated eastern government is based, said Gatnash.
The rival factions are both facing a “crisis of legitimacy” which they are seeking to use the coronavirus crisis to offset, he said.
The LNA has a “long-term strategy” to expand its influence outside the military realm into public life, Eljarh explained.
The LNA’s business and investment has donated money and equipment to hospitals in addition to curbs on movement imposed by both regimes, he said.
But the continuation of hostilities might be a better metric of either side’s dedication to tackling the pandemic.
“It is clear that both parties have little regard for the threat of Covid-19 given the fact that both sides continue with their military operations and ignore international calls for a humanitarian ceasefire,” Eljarh stated.
Grassroots initiatives provoke government response
Others are more optimistic about the Tripoli-based government’s response to the crisis.
Reem H Furjani, a Libyan heritage scholar who has chronicled state and civil society responses to the pandemic on her Twitter account, argues that the GNA mobilised early to address a potential outbreak despite the long-standing weaknesses of the healthcare system.
Indeed it is too soon to tell whether containment measures implemented before the detection of Libya’s first Covid-19 case will be successful in preventing a full-blown outbreak.
Furjani’s positive outlook is not misplaced. The scholar, whose mother is an infectious disease consultant, is well aware that “corruption for some has become the norm”.
Allegations of mismanagement of the Covid-19 funds come as no surprise, she said.
Popular anger and grassroots action is already forcing change in the government’s response, she said.
As documented on her Twitter account (@ReemHgs), local organisations and individual citizens have stepped in to respond to the crisis, whether it be through raising awareness of social distancing, doing charity work with Libya’s 350,000-strong displaced population or producing PPE.
One young engineer has successfully experimented with a method to place more than one patient on a single ventilator at a time, she said.
Other examples include direct donations towards hospital infrastructure and equipment by local businessmen. One philanthropist in Misrata even donated a “multi-story building… equipped with a 100 beds and a number of ventilators,” she said.
“There remain many shortages and concerns regarding PPE, but the speed and scale of official effort has increased since community and municipal pressure escalated over the past three days,” Furjani stated.
“Grassroots supervision, advocacy, and holding the government accountable [this is all] a very positive and crucial voice, one which I and fellow civil society activists have been longing to see since 2011.”
Mel Plant is a journalist at the New Arab.