“People living undocumented in Libya have no protection, either in law or from the country’s fragile institutions”—inhibiting access to health care.
“Your destiny can change at any moment in Libya, all it takes is one little thing and your life is turned upside down,” said Nelson, who lost is family in a shipwreck trying to reach Europe.
In Libya, migrants and refugees live in precarious conditions and are subjected to a range of violence and abuse, both inside and outside the country’s detention centers. While some of them have come to Libya in search of work, others aim to reach Europe by crossing the Mediterranean Sea from its coast. In addition to abductions, sexual assault, and other abuses, they face extortion and trafficking practices, with severely limited access to health care at a time when they desperately need it.
“I fainted under the blows, and when I woke up, they were still beating me,” said Ahmed*, a young Sudanese boy who was arrested and thrown into prison while trying to travel to Tunisia. “I was disfigured, I had no teeth, and my friend Saud told me they had hit my head with a brick.”
Ahmed was taken care of by Doctors Without Borders/Médecins Sans Frontières (MSF) teams in Zuwara, a coastal town around 60 miles from the capital, Tripoli. He was hospitalized for a month. Ahmed’s had an operation on his jaw, which was financed by MSF and carried out in a Tripoli hospital, as there was no alternative solution.
“People living undocumented in Libya have no protection, either in law or from the country’s fragile institutions, which prevents them from accessing health care,” said Steve Purbrick, MSF’s head of programs in Libya. “They are exposed to violence on a daily basis. We see people who have been trafficked, others who have been tortured, raped.”
No protection and no access to
health care
Libya is a country of departure for many people attempting to cross the Mediterranean Sea to Italy. Like Ahmed, undocumented migrants and refugees arriving there are exposed to violence throughout their journey. Once inside Libya, they often live in places that are overcrowded, dangerous, and unhealthy, including in shared rooms, abandoned sheds, or building sites where they are also at risk of contracting diseases.
“Their state of health reflects both their living conditions and the extreme violence they face,” said Issam Abdullah, a doctor and the deputy medical manager for MSF in Libya. “Without protection and access to care, their injuries and traumas are rapidly worsening.”
All it takes is one little thing and your life is turned upside down—you can die, you can end up in prison.
MSF teams provide medical support in the cities of Misrata, Tripoli, and Zuwara for primary health care, sexual and reproductive health, mental health, diagnosis and treatment of tuberculosis (TB), and sexual violence. The most serious medical cases requiring hospitalization are referred to the capital.
In 2024, MSF teams carried out over 15,000 consultations. The majority of those receiving mental health care were suffering from post-traumatic stress disorder (PTSD) linked to the violence they had endured.
“Your destiny can change at any moment in Libya, all it takes is one little thing and your life is turned upside down—you can die, you can end up in prison,” said Nelson, a man from Cameroon who has been under the care of an MSF psychologist since surviving a shipwreck that killed his wife and children as they were trying to reach Europe. “To go and see a doctor, for example, or to buy bread, you can take the wrong road and run into police. If it’s your lucky day, they don’t see you; if it’s not your lucky day, they arrest you.”
From left: X-ray of a patient with suspected tuberculosis in Zuwara; a patient at one of the health centers where MSF provides care.
Dangers of delayed care
Faced with the risk of abduction and arrest by the police or militias, people are forced underground to isolated places where their health is even more vulnerable. many only seek medical care as a last resort when their health has already seriously deteriorated.
In 2024, MSF teams diagnosed and treated more than 250 people with TB, of whom 16 died because they were not treated in time.
To go and see a doctor, for example, or to buy bread, you can take the wrong road and run into police. If it’s your lucky day, they don’t see you; if it’s not your lucky day, they arrest you.
“We receive people suffering from tuberculosis who seek treatment very late, which leads to high mortality and further spread of the disease,” said Dr. Abdullah. “Our teams are also seeing the negative impact of interrupted treatment.”
Salma*, a university professor who has diabetes, fled the war that broke out in Sudan in April 2023. “Diabetes requires regular meals and medication, and in Libya that’s not possible,” she said. “When I had to leave; my health deteriorated rapidly as the days went by. I became incapable of doing anything—not cooking, not even getting dressed … I became completely dependent on my daughters.” Ismail, MSF community health worker in Belgium
A survivor’s harrowing journey to Europe
“There’s no legal route from Sudan to Libya for someone in my situation. Near the border, I was held for a month by the people smugglers until I could pay. Conditions were barbaric. There were so many of us crammed into a windowless room that we slept on our sides, like sardines in a box. They fed us very little, as a tactic to make people pay.
I got sick. My head pounded. I couldn’t eat. People told me it was malaria. I was told there was no possibility of seeing a doctor. When we were finally driven toward Tripoli, I was too weak to stand and a guard hit beat me. When I couldn’t climb back in the truck, he threatened to shoot me. I said, ‘I’m dead anyway, go ahead.’ I really thought I was going to die. The guard was startled, and thankfully people pulled me inside the truck …
The evacuation corridor from Libya
In April 2023, the United Nations published a report concluding there were grounds to believe a wide array of crimes against humanity have been committed against migrants in Libya.
“People on the move are an integral part of an economic model set up by militias, with the complicity of the European Union and its member states, with the aim of extorting money from them,” said Purbrick. “They have to pay in exchange for their crossing, in exchange for their release, and for the continuation of their journey—but always with the risk of falling victim to criminal networks once again.”
[Migrants] have to pay in exchange for their crossing, in exchange for their release, and for the continuation of their journey—but always with the risk of falling victim to criminal networks once again.
Purbrick added, “This is why, in addition to providing access to health care in the country, we are also focusing our efforts on opening safe and legal pathways to evacuate people from Libya, in particular via the humanitarian corridor that exists between Libya and Italy. MSF participates in this corridor by identifying vulnerable people to be evacuated and taking charge of some of them in Italy. But these options need to be drastically increased.”
Since 2021, this corridor has already enabled the evacuation of more than 700 people, around 60 of whom were MSF patients in Libya. Fourteen people subsequently received care from MSF in Palermo, Sicily.
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