HEALTH SECTOR BULLETIN March 2020 Libya Emergency type: complex emergency Reporting period: 01.03.2020 to 31.03.2020 Total population People affected People in need People in acute need 6.7 million 1.8 million 900,000 300,000 IDP Returnees Non-displaced Migrants Refugees 216,000 74,000 278,000 276,000 48,000 Target Health People in need Required Funded Coverage Sector Health Sector (US$ m) (US$ m) (%) 203,137 525,992 30 0 0 KEY ISSUES 2020 PMR (Periodic Monitoring Report) • Health sector does not have service delivery related indicators (February): coverage in the following districts: Nalut, Sirt, Number of medical procedures provided Tobruk, and Ubari. (including outpatient consultations, • There are only 40 PHC facilities which were referrals, mental health, trauma 18,845 assisted with no support in the following consultations, deliveries, physical districts: Al Jabal Al Akhdar, Aljufra, Almarj, rehabilitation) Azzawiya, Derna, Murzug, Nalut, Sebha, Sirt, Number of public health facilities Tobruk, Wadi Ashshati and Zwara. supported with health services and 53 • Situation with support of secondary health commodities Number of mobile medical teams/clinics facilities is of concern as only 13 hospitals 52 received assistance in Al Jabal Al Gharbi, (including EMT) Aljufra, Almargeb, Azzawiya, Ejdabia, Misrata, Number of health service providers and Wadia Ashshati and Zwara. CHW trained through capacity building 314 • Health sector does not reach any public health and refresher training facilities (PHC centers and hospitals) with Number of attacks on health care reported 1 Percentage of EWARN sentinel sites different types of support (services and 84% supplies) in Al Jabal Al Akhdar, Almarj, Derna, submitting reports in a timely manner Percentage of disease outbreaks responded Murzug, Nalut, Sebha, Sirt, and Tobruk). 80% • Most of health sector assistance was provided in to within 72 hours of identification 37 (37%) of 100 municipalities. Number of reporting organizations 10 • 14 (38%) of 29 reached municipalities were Percentage of reached districts 86% ranked as higher than 3 severity scale. Percentage of reached municipalities 37% Percentage of reached municipalities in • 8 confirmed cases of COVID-19 are reported in 38% Libya. Until present, a total of 120 cases were areas of severity scale higher than 3 tested for COVID-19 with 125 people on quarantine. • Absence of holistic response to COVID-19. • Limited funding of health sector. 1 HEALTH SECTOR BULLETIN March 2020 SITUATION OVERVIEW • 10 March, Bani Waleed General Hospital announced the suspension of the hospital's ambulance and emergency departments following the security incident related to the extensive use of gunfire inside the hospital by unidentified group of people. • 12 March, A doctor affiliated to the Tajoura field hospital was killed, as a result of shooting on his car at the Garabolli coastal road. His companion was injured. • 14 March, Mr Sarraj, the Chairman of the Presidential Council of Libya and prime minister of the Government of National Accord (GNA) announced a state of emergency in Libya. • 15 March, INGOs’ common principles on humanitarian operations in the context of COVID-19 pandemic in Libya. • 18 March, 2020 - WHO strongly endorses UNSMIL’s appeal for a ceasefire in Libya to allow national health authorities and health partners to respond to the potential spread of COVID-19 in the country http://www.emro.who.int/lby/libya-news/unsmil-appeals-for-ceasefire-to-strengthen-covid-response.html • 22 March, Humanitarian Coordinator for Libya, Yacoub El Hillo, welcomes positive responses by Libyan parties to calls for a humanitarian pause and appeals for full facilitation of COVID-19 prevention and response efforts in Libya https://reliefweb.int/report/libya/humanitarian-coordinator-libya-yacoub-el-hillo-welcomes-positive- responses-libyan • 25 March, first confirmed COVID-19 case reported in Libya. • 26 March, the Libya INGO Forum members commit to support the country to cope with the COVID-19 pandemic and call on the authorities for equal and fair access to medical services for all people in Libya. • Tripoli/Tunis, March 26th, 2020 • 27 March, An attack targeting of an ambulance point in the Abu Qurayn area near Sirte. The attack resulted in the injury of two paramedics and destroyed an ambulance. • 27 March, Statement by the WHO Regional Director Dr Ahmed Al-Mandhari on COVID-19 in the Eastern Mediterranean Region • 27 March, A public letter from the Ambassador of the United States to Libya, Richard Norland, to Libya’s political and military leadership and the people of Libya. • 28 March, additional set of precautionary COVID-19 measures is introduced, including increase of the curfew time to be from 2pm until 7am. • 30 March, 8 confirmed cases of COVID-19 are reported in Libya. Until present, a total of 120 cases were tested for COVID-19 with 125 people on quarantine. • 30 March, Ambassador Norland, joined by U.S. Department of the Treasury Deputy Assistant Secretary Eric Meyer, spoke with Finance Minister to underscore U.S. support as Libyan economic institutions and decision makers attempt to come together to COVID-19 pandemic. Ensuring the timely distribution of public sector wages and prompt allocation of funding for the National Center for Disease Control (NCDC), municipalities, and other Libyan stakeholders to prevent the spread of and respond to COVID-19, are vital to promote the health of all Libyans. PUBLIC HEALTH RISKS, PRIORITIES, NEEDS AND GAPS: Gaps and weaknesses of health sector response (based on 4W February analysis) Strategic objective 1: Increase access to life-saving and life-sustaining humanitarian health assistance, with an emphasis on the most vulnerable and on improving the early detection of and response to disease outbreaks. Provide a minimum package of integrated health services at primary and secondary levels (integrated services cover emergency and trauma care, management of Communicable and Non-Communicable Diseases, Maternal, Neonatal and Child Health (MNCH), Mental Health and Psychosocial Support (MHPSS) and clinical rehabilitation). PAGE 2 HEALTH SECTOR BULLETIN March 2020 • Health sector does not have service delivery coverage in the following districts: Nalut, Sirt, Tobruk, and Ubari. No service provision was registered in terms of support with outpatient consultations, referrals, trauma/injury related, mental health and disability related consultations, vaginal and caesarian support. • Number of outpatient support is at minimum in Al Jufra, Al Jabal Al Akhdar, Almarj, Derna, Murzug, and Wadi Ashshati. • No trauma response is provided in Al Jabal Al Akhdar, Almarj, Derna, Ejdabia, Ghat, Murzug, Nalut, Sirt, Tobruk, Ubari, Wadi Ashshati, Zwara. • Referral system should be enhanced in Al Jabal Al Akhdar, Al Jufra, Al Margeb, Almarj, Ejdabia, Ghat, Murzug, Nalut, Sebha, Sirt, Tobruk, Ubari and Wadi Ashati. No referral services are available in these districts. • Mental health consultations are not provided in most of districts (with the exception of Al Jabal Al Gharbi, Misrata, Sebha, and Tripoli). • No response on disability support. • Reproductive Health services are not being reported (support to vaginal deliveries and caesarian sections). Provide continuous and interrupted immunization services to children • There is no data available or shared by the authorities for coverage by Hexa and/or MMR. Expand the reporting capacity of the early warning system and support health authorities to carryout timely response to disease outbreaks • There is a need to scale up and increase not only the number of new sentinel in different districts but make sure the current ones (126) are all active while 84% provide regular reports. Strategic objective 2: Strengthen health system capacity to provide the minimum health service package and manage the health information system. Coordinate the humanitarian health response • There are no reported assessments by any organizations. Provide health facilities with essential medicines, medical supplies and equipment • There are only 40 PHC facilities which were assisted with no support in the following districts: Al Jabal Al Akhdar, Aljufra, Almarj, Azzawiya, Derna, Murzug, Nalut, Sebha, Sirt, Tobruk, Wadi Ashshati and Zwara. • Situation with support of secondary health facilities is of concern as only 13 hospitals received assistance in Al Jabal Al Gharbi, Aljufra, Almargeb, Azzawiya, Ejdabia, Misrata, Wadia Ashshati and Zwara. • Response with assistance with medical equipment is nonexistent or not being reported properly. Only 1 piece of medical equipment is being reported to be donated in Al Jabal Al Gharbi. • Standard health kits were only provided in Ejdabia, Misrata, Tripoli, Ubari, Wadi Ascshati and Zwara districts. Increase access to health services by establishing functional health facilities and mobile medical teams (including EMT) • Minimum response is in place with rehabilitation/refurbishment of health facilities as only 2 health facilities were supported (Aljafra and Almargeb). PAGE 3 HEALTH SECTOR BULLETIN March 2020 • It is essential to receive a standard list of camps and settlements in order to evaluate the impact and coverage of these locations by mobile medical teams and fixed health clinics. Health sector does not reach any public health facilities (PHC centers and hospitals) with different types of support (services and supplies) in Al Jabal Al Akhdar, Almarj, Derna, Murzug, Nalut, Sebha, Sirt, and Tobruk) Strategic objective 3: Strengthen health and community