Prior to the 2011 revolution, state-run healthcare facilities provided services free of charge in most areas of the country, and foreign workers composed approximately 60% of medical personnel. Non-communicable diseases, such as respiratory and cardiovascular illnesses, accounted for the majority of health-related mortality. Since 2014, staff have fled, infrastructure has been damaged, and supplies have run low, impacting the health system heavily. However, according to a 2016 assessment, the main hospitals in western Libya remain accessible free of cost for Libyan nationals. According to UN statistics, 1.3 million Libyans are currently lacking access healthcare services due to conflict.?
Collapse of health infrastructure: According to Libya’s Minister of Health, 60-70% of hospitals are closed or only partially functioning due to conflict.?The civil war has been marked by attacks on hospitals. In 2014 and 2015 the Tripoli Medical Centre and the Al-Zahraa hospital were attacked, and during the first half of 2016, the Benghazi Medical Centre came under shelling on multiple occasions.? Further attacks against ambulances marked with Red Crescent symbols have also been reported.?
The Misrata Medical Centre, which routinely receives wounded from armed confrontations, has reported lack of space and poor infrastructure as threats to the hospital’s ability to provide care. Some buildings remain unfinished since 2011, when construction companies left the country.?
Shortage of medical staff: Conflict, harassment and abductions by different armed groups have caused a widespread exodus of medical personnel, with 80% of foreign nurses being evacuated. As a result, shortages of qualified staff have been reported across the country. In addition, “ghost health personnel”, health workers receiving salaries but not working, further impact the availability of health professionals.?
Shortage of supplies: A severe lack of medicine and supplies has also been reported. This is largely due to the unavailability of funding as government revenues declined as well as the widespread looting of facilities. Moreover, importing and transporting medical commodities has become more difficult because of lack of liquidity and high prices.?
Obstacles to accessing existing health care: Access to available services is hampered by limited freedom of movement, particularly in areas with active conflict and those controlled by jihadist groups. Emergency transportation to hospitals has been adversely affected due to attacks on ambulances, fuel shortages, and poor communication.?
Health status of population: Morbidity and mortality is expected to increase as a result of lack of medicine and medical staff, reduced access to health facilities, and security constraints, however, there is no publicly available information on disease incidence and trends. Similarly, the overall casualty figures are yet to be confirmed. Estimates suggest there have been more than 15,000 weapon-wounded in Benghazi alone between May 2014 and May 2015. Ongoing clashes, especially in the eastern part of the country, along with movement constraints and limited availability of medical supplies is expected to result in a growing number of casualties.?
Maternal health: Despite the ongoing conflict having a negative impact on the health system, maternal mortality has significantly decreased since 1990. While the ratio was at 39 per 100,000 live births in 1990, in 2016 it dropped to 9 per 100,000. Similarly, neonatal mortality has also decreased, dropping from 21 to 7 per 1,000 live births between 1990 and 2015. The WHO still considers these risks in Libya to be high and moderate, respectively .?
According to 2016 estimates, crude birth rates in Libya are at 17.8 births per 1,000 people while fertility rates are at 2 children born per woman.?
Mental health: A large portion of the population has been affected by mental health conditions by the 2011 conflict. Distress is caused by continuing loss, trauma or uncertain social conditions. The insufficient number of health workers in this field in Libya combined with reduced access to care act as aggravating factors to the mental health status in the country.?
Vaccination: New waves of displacement and disruption of healthcare provisions have affected vaccination activities in some areas, increasing the possibility of outbreaks of diseases such as measles. Refugees and asylum seekers are particularly vulnerable, as reports indicate that unregistered children have no access to immunisation services. Concerns about storage of certain vaccines due to irregular electricity and supplies have also been reported since 2015.?
National immunisation days have been carried out on a yearly basis, including in coordination with other countries of the Arab Maghreb Union between 1995 and 2000. Routine immunisation against polio has been mandatory since 1970, with the last confirmed polio case reported in 1991. As of 21 April 2016, more than one million children were immunised against polio in a five day national campaign, the first held since 2014.?
HIV: There are no current statistics on the number of people living with HIV in Libya. However, 2015 rates highlight Libya as having the highest incidence of HIV/AIDS among intravenous drug users in the world at 87%.? A study by the Liverpool School of Tropical Medicine concluded that 87% of injecting drug users in Tripoli are HIV positive, based on data collected before the uprising. In Tunis and Cairo, these percentages are at 2.6% and 7.7%, respectively.?
Doctors at Benghazi’s Al Irada drug addiction clinic, the only treatment centre of its kind in Libya, report heroin as one of the two most common addictions treated. In 2013, doctors in the country reported a perceived growth in the number of patients with drug problems and a corresponding risk of HIV infection.?
Lack of HIV prevention as well as information regarding consequences of Sexual and Gender-based Violence (SGBV) are a concern across the country. HIV medicines are among urgently needed medical supplies in the country, especially in areas with a high influx of IDPs.?
Tuberculosis: According to the latest global TB report of 2012, incidence (number of new cases) of the illness in Libya for 2011 was at the lower end of high incidence countries, with 40 per 100,000, while prevalence (the number of people living with it) was 60 per 100,000. TB mortality rates were at 5.9 per 100,000.? Similarly to HIV, shortages of medicine to treat tuberculosis have been reported.?