Almost ten years after the fall of Muammar Gadhafi, Libya remains one of the most unstable countries in the region. Armed conflict continues unabated and foreign armed groups, drug and human traffickers, uncontrolled borders, and rampant corruption continue to disrupt normal life. There are two power centres — an elected parliament in the country's east, supported by the Libyan National Army (LNA) led by Field Marshal Belqasim Khalifa Haftar, and the UN-backed Libyan Government of National Accord (GNA) in the west, headed by Prime Minister Fayez Sarraj. Despite intensive international efforts, the two parties have found it difficult to agree on a lasting political solution and path to peace. Recently, they took a significant step towards negotiating a political solution to the decade-long conflict. On 23 October 2020, military officers from the GNA and LNA signed a countrywide, permanent ceasefire agreement in Geneva under the auspices of the United Nations Support Mission in Libya (UNSMIL). The agreement calls for the withdrawal of all military units and armed troops from conflict frontlines and the departure of all mercenaries and foreign fighters within 90 days.
The conflict has had a devastating impact on the lives of ordinary civilians. Almost 900 000 people need humanitarian assistance. Close to 400 000 Libyans − about 6% of the population − have been displaced since the start of the conflict, half of whom have been displaced since the LNA’s assault on Tripoli in April 2019. In the summer of 2020, when temperatures sometimes reached 50°C, continued fighting cut off water and electricity supplies to over two million people in the west.
Years of conflict and acute shortages of qualified medical professionals have led to the near-collapse of the health system. Sexual and reproductive health care is scarce and inadequate. Obstetrical services are available mainly in the private sector. Although families and communities face increased economic hardship and stress, mental health services are practically non-existent. Approximately one fifth of Libyan hospitals and primary health care (PHC) centres are closed; those that remain open face severe shortages of staff, supplies and equipment. The lack of basic medicines is a major challenge (70% of functioning PHC facilities do not have any of the top 20 essential medicines). Most health care staff are paid only sporadically and have to wait months to receive back-pay. Frequent power cuts, exacerbated by the lack of fuel to run back-up generators, routinely force health care facilities to suspend their services. Repeated stockouts of critical vaccines have disrupted children’s immunization services and put them at risk of disease and death.
The situation has been compounded by continuing attacks on health care. Currently, Libya accounts for the second-highest number of attacks on health care globally, second only to Afghanistan. In the nine months ending in October 2020, there were more than 200 confirmed attacks on medical facilities, ambulances and medical personnel, killing eight people and injuring 23. Earlier in the spring, military activity around Tripoli disrupted hospitals’ electricity supplies and damaged the only factory producing oxygen tanks.
Libya reported its first confirmed case of COVID-19 on 24 March 2020. Since then, almost 60 000 infections have been reported. The pandemic has laid bare the country’s inequalities and placed a huge strain on its severely disrupted health system. Soon after the start of the pandemic, reports indicated that in some areas up to 90% of PHC centres had closed and several hospitals had been forced to suspend services because staff were unwilling to report for duty without personal protection equipment (PPE).
COVID-19 has plunged many Libyan households into poverty. Border closures, movement restrictions and curfews imposed to reduce the spread of the virus have driven up the cost of food and essential items by 20%. Many of the country’s more than half million migrants and refugees no longer have access to the informal work opportunities they once had. By virtue of their displacement or legal status, they have limited access to health care services. Migrants who try to return home find they can no longer do so because their sources of income have disappeared and travel is extremely difficult.