Annual Report 2019
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World Health Organization LIBYA ANNUAL WHO Country Offce (Tripoli, Libya) REPORT Elizabeth Hoff, WHO Representative [email protected] 2019 WHO Country Offce (Tripoli, Libya) Yahya Bouzo, Communications Offcer [email protected] WHO Regional Offce for the Eastern Mediterranean (Cairo, Egypt) Inas Hamam, Communications Offcer [email protected] 3 TABLE OF CONTENTS Foreword 4 Situation in 2019 6 Overview 6 Status of health care services 7 Attacks on health care 9 Achievements in 2019 10 Support to hospitals and health care facilities 11 Delivering medicines and supplies 11 Deploying emergency medical teams 12 Training health care workers 13 Areas of focus 14 Primary health care 14 Secondary health care 15 Trauma care 15 Communicable diseases 16 Childhood vaccination 20 Disease surveillance and response 20 Tuberculosis 21 Leishmaniasis 21 Noncommunicable diseases 24 Mental health 25 Reproductive, maternal, newborn, child and adolescent health 25 Health information system 25 The humanitarian-development nexus 26 Coordination 27 Monitoring 28 Challenges 29 WHO’s presence in Libya 30 Looking ahead 31 Donors in 2019 35 Credit: WHO ANNEX 1: Main assessments conducted and technical guidelines and reports 36 published in 2019 2 3 5 FOREWORD Nine years after the fall of Muammar Gadhaf, gaps in coverage due to the uneven distribution of Libya remains riven by armed confict, economic general physicians, most of whom work in urban collapse and disintegrating public services. areas. Although Libya has traditionally depended Continued violence and insecurity coupled with heavily on foreign health care workers, the political stalemate have resulted in a governance overseas workforce has steadily dwindled since vacuum accompanied by signifcant insecurity 2011 when the confict began. and a breakdown of the rule of law. Thus far, the confict has defed national and international Some donors are understandably reluctant to efforts to fnd a political resolution. fund humanitarian activities in oil-rich Libya. However, Libyas needs will remain signifcant Of a total population of 6.7 million, almost 4 for the foreseeable future. The absence of a million people, mostly women and children, functioning government has made it impossible require humanitarian health assistance. According to unlock Libya’s abundant resources to support to the health sector severity scale, almost 1.7 the health system and meet critical health needs. million people are in extreme need and more than Oil production has slowed, USD 60 billion in 122 000 are in catastrophic need. Many people have Libyan assets have been frozen, and the country’s specifc vulnerabilities (gender, age, disabilities, economic collapse has led to a major liquidity ill health and nationality) that undermine or crisis. Short- and medium-term funding will be limit their ability to withstand the effects of essential to stave off the further disintegration the confict. Other groups such as refugees and of health care and other public services and halt migrants often face abuses by state and non-state Libya’s spiral into further violence and decay. entities. Given their irregular legal status and lack of domestic support networks, they encounter While the primary responsibility for providing racism, xenophobia and grave human rights assistance lies with the Libyan authorities, violations. At the end of 2019, more than 3200 the persistent political crisis and escalating refugees and migrants were being arbitrarily held confict require the international humanitarian in appalling conditions in overcrowded detention community to fll critical gaps. WHO will work centres, creating conditions ripe for the spread of to combine humanitarian and development diseases such as tuberculosis (TB). These unlawful approaches that will allow it to deliver essential detentions are serious human rights violations health care services while laying the foundation that exacerbate an already volatile situation. for universal health coverage and Libyans’ right to health. Regardless of whether its operations are Libya’s health system is close to collapse. Severe humanitarian or developmental, the Organization shortages of health staff, medicines, supplies will scrupulously adhere to the four humanitarian and equipment have been compounded by years principles of humanity, neutrality, impartiality of under-investment in the health system and a and independence. In a country where some chronic lack of transparency and accountability. political factions view the UN with deep suspicion, Around one quarter of public health care facilities adherence to these principles will be more are closed, around one quarter of public health important than ever. Credit: WHO care facilities are closed, and most of those that remain open do not provide any health care services for children under fve years of age. Only fve of 78 hospitals assessed by WHO offer all essential services. There are acute shortages of medical specialists, midwives and nurses and huge 4 5 7 SITUATION condemned this clear pattern of ruthless attacks of acute diarrhoea have been reported each against health workers and facilities in the week. The clear threat of outbreaks of vaccine- IN 2019 strongest terms. preventable and other diseases is compounded by poor surveillance. Only 84% of the country’s Outbreaks of measles and rubella and increasing 125 sentinel sites are sending regular surveillance rates of cutaneous leishmaniasis, tuberculosis, data to the disease early warning and response pertussis and acute jaundice syndrome system, which has very limited capacity to detect highlighted Libya’s vulnerability to large-scale and respond to disease alerts. Overview disease outbreaks. Between 1000 and 1500 cases In 2019, Libya remained locked in confict, confict, and almost half of them were living very violence and political instability. The situation was close to battle frontlines. compounded by the existence of two competing Status of health care services governments. A Government of National Accord hile the battle for Tripoli has dominated (GNA) in Tripoli was established in December 2015 international attention, the situation in the south Libya’s health system suffers from severe shortages uneven distribution of general internists, most with the support of the UN. A rival government in has been all too often overlooked. The region is of staff, a poorly functioning medical supply chain of whom are working in urban areas. In many the east (Benghazi) is backed by the Libyan National critical to the stability of Libya, but it has been and very weak disease surveillance and health remote and hard-to-reach locations, poor and Army (LNA) headed by Field Marshal Khalifa historically marginalized in the countrys politics information systems. The lack of detailed data on vulnerable communities have very limited access Belqasim Haftar. The UN-backed government in despite its ample natural resources. The United the main causes of mortality and morbidity has to health care. In areas affected by confict, health Tripoli has struggled to exert control over territory Nations upport Mission in Libya (UNMIL) has hampered efforts to analyse needs and deliver a care facilities were overwhelmed with patients. held by rival factions and intensifying geographical expressed its deep concern about reports coming targeted response. Around 22% of Libyans and 18% of migrants and and political divisions between the east, west and from the south on the mobilization of armed refugees faced diffculties accessing health care Approximately one ffth of Libyan hospitals services2. The most severe health needs were in south. Terrorist groups and armed militias have forces and the escalating cycle of statements and 1 exploited the turmoil and used the country as a counter-statements by warring factions, signalling and PHC facilities are closed. There are acute districts affected by violence (e.g., Murzuq, Sirt base for radicalization and organized crime. Libya the growing risks of imminent confict. shortages of medical specialists, midwives and and Tripoli) or that were hosting large numbers of is awash with weapons: arms from the Gaddaf nurses and huge gaps in coverage due to the IDPs (e.g., Benghazi, Ejdabia and Sebha). era are plentiful, and materials of war continue In August 2019, the dangers of working in Libya to be shipped to the country in breach of the UN- were illustrated when a bomb exploded under a imposed arms embargo. UN vehicle in Benghazi, instantly killing three UN staff and severely injuring several other staff and In April 2019, the LNA launched an offensive to bystanders. No one has claimed responsibility for capture Tripoli from the GNA. After initial advances, the incident investigations are under way by the it has been locked in stalemate with government- United Nations. The same month, approximately backed forces for several months. The continuing 100 people were killed, more than 200 were fghting in Tripoli has cut off access to hospitals injured and over 30 000 were displaced when A WHO Libya staff member and left thousands of people without health care. violence fared between rival tribes in Murzuq, assesses needs in a health At least 3000 people have been killed and injured south Libya. By the end of the year, the number care facility serving people and another 149 000 have been displaced. At of internally displaced people (IDs) in Libya had displaced by the violence in Tripoli. the beginning of July, Tajoura detention centre almost doubled to 343 000. in Tripoli holding more than 600 migrants and Credit: WHO refugees suffered a direct airstrike that killed 50 The number of attacks on health care rose sharply. people and injured 130 others. This prompted the In the summer of 2019, airstrikes on two feld international community to renew its calls for the hospitals and two ambulances in Tripoli killed at closure of detention centres across the country. As least four doctors and one paramedic and injured of 31 December 2019, around 250 000 civilians in several others. The pecial epresentative of Tripoli were living in areas directly affected by the the ecretary-General for Libya Ghassan alam 1 Figures taken from WHO’s Service Availability and Readiness Assessment of 2017.