Libya remains fragmented by conflict, with fighting ongoing in several parts of the country.
The insecurity, economic collapse and breakdown of law and order mean daily life for many Libyans is a struggle.
Additionally, the country is both a destination and place of transit for hundreds of thousands of refugees, asylum-seekers and migrants. Many are fleeing conflict, extreme poverty, or persecution.
Alarming levels of violence and exploitation
Inside Libya, many migrants are unable to return home.
Refugees and asylum-seekers cannot receive protection due to the lack of a functioning asylum system, the limited role of UNHCR and the fact that Libya is not a party to the Refugee Convention.
There is no way to challenge the lawfulness of their detention. They have virtually no access to the outside world, and experience ill-treatment and lack of access to medical care.
They are exposed to an alarming level of violence and exploitation at the hands of security forces, militias, smuggling networks, criminal gangs and private individuals.
Médecins Sans Frontières/Doctors Without Borders (MSF) teams in rescue ships on the Mediterranean sea have heard accounts and seen scars of over 50,000 men, women and increasingly unaccompanied children (as young as eight) who have transited Libya - and undertaken the treacherous journey to Europe.
Inhumane detention
Those intercepted at sea by the Libyan Coastguard or detained inside Libya are sent to migrant detention centres - often former factories or warehouses.
Here people face arbitrary detention for prolonged periods of time.
They are kept in unsanitary and inhumane conditions.
There is no way to challenge the lawfulness of their detention. They have virtually no access to the outside world, and experience ill-treatment and lack of access to medical care.
Providing healthcare in detention facilities
We are currently running mobile clinics in seven migrant detention centres in Libya, located in Tripoli and its surroundings.
These centres are under the administration of the Directorate for Combating Illegal Migration (DCIM), also known by the alternate translation Anti-Illegal Immigration Agency (AIIA).
Since activities started in July, we have been able to conduct 5,579 medical consultations. Currently, our medics carry out around 500 consultations each week.
Thirty-two pregnant women in detention received antenatal consultations, and 41 consultations were for children less than five-years-old.
Many hospitals in Tripoli do not want to admit sub-Saharan Africans.
Several of these children had been born in a detention facility. The youngest patient seen was only five hours old.
In the event of a medical emergency inside a detention facility, with the agreement of the DCIM, we attempt to arrange a referral to a hospital.
So far, there have been 113 urgent or complicated medical cases referred to a health facility for further treatment.
Each referral is complicated and time-consuming, as many hospitals in Tripoli do not want to admit sub-Saharan Africans.
Severe malnutrition
Our medics are treating respiratory tract infections, acute watery diarrhoea, skin disease, and urinary tract infections.
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These complaints are mostly related to conditions inside the detention centres. These places do not meet any national, regional or international standards.
They are dangerously overcrowded with a lack of natural light and ventilation. In some facilities, the amount of space per detainee is so limited (as little as 0.41m² per person), that people are unable to stretch out at night, resulting in many complaints of body aches.
There is a shortage of food in the detention centres, which makes people more susceptible to disease and acute illness.
Sometimes one food ration is shared between five or more detainees. At other times, food is served in communal bowls meaning that the weakest and most infirm receive nothing.
Significant numbers of detainees have suffered dramatic weight loss.
Many have an extremely emaciated appearance, and exhibit nutritional deficiencies due to small rations. Their diet averages at 600-800 calories per day, and has unbalanced nutritional content – food often consists of plain macaroni.
Sometimes one food ration is shared between five or more detainees. At other times, food is served in communal bowls meaning that the weakest and most infirm receive nothing.
The number of adult malnutrition cases we are seeing is increasing, with 41 people suffering from moderate to severe malnutrition screened in the first half of November. This represents around three percent of all detainees in facilities visited by us.
The number of adults suffering from malnutrition to this degree in a country not suffering from drought or natural disaster is of great concern.
Infections and infestations
Detainees do not have adequate access to safe drinking water: sometimes less than one litre per person per day. As a result, people suffer from headaches, constipation and dehydration.
Access to latrines or showers is severely limited, and sanitation facilities are inadequate. This is resulting in high rates of skin infections and infestations with lice, scabies and fleas.
We have provided hygiene kit distributions to detainees in the detention centres visited by our medical teams.
There have also been distributions of water jerry cans, buckets and cleaning materials at several detention centres.
In specific instances, when food supplies have run out and the situation became critical, we have had to bring in sacks of bread and boxes of processed cheese from local markets to feed detainees.
We continue to urge all relevant authorities to provide sufficient quality and quantities of food supplies.
Mental health support
Our psychological first aid team provides mental health support to detainees who have been involved in traumatic incidents at sea.
Support was provided to 29 survivors of a shipwreck on 27 October, where at least 100 people drowned.
It is a difficult choice for us to work in an environment where people are kept in conditions without human dignity, with no immediate prospect to improve their situation, and with no idea why or for how long they will be detained for.
Seven people with severe psychiatric disorders were referred to other hospitals.
The team is aiming to improve access to mental health services and psychosocial support not only for migrant populations, but also for Libyans in the Tripoli area.
Our impact and message
It is a difficult choice for us to work in an environment where people are kept in conditions without human dignity, with no immediate prospect to improve their situation, and with no idea why or for how long they will be detained for.
However, our hope is that by being present and providing medical care, we can ensure an immediate improvement in the living conditions of detainees.
Everyday our teams advocate for the humane treatment of those being held in detention, stress the importance of detainees receiving adequate food and water, and access to working latrines and washing facilities.
We push the authorities to release pregnant women, women with babies and young children, detainees under the age of 18, and those who are disabled or have serious health conditions.
We remain opposed to the indefinite arbitrary detention of migrants, refugees and asylum-seekers in Libya.
