By Jamie Prentis.
Tunis, 15 July 2017:
Libya’s health system is in an “acute crisis” and deteriorating rapidly, with lives bring lost everyday from serious shortfalls, the World Health Organisation’s (WHO) country representative has warned.
Dr Syed Jaffar Hussain cited Libya’s precarious governance and security, a lack of competent healthcare professionals and a complete dearth of funding as the key causes.
Hussain also said in an interview with the Libya Herald that deadly diseases not seen in Libya for over a decade were at risk of returning or had already re-established themselves, Migration from western Africa was just one vector. Malaria is now back after nearly ten years and polio is at serious risk re-emerging.
The WHO is doing all it can and dispatches life-saving medicine and equipment across the country he said. It has also set up teams at major migrant crossing points to vaccinate children and assess the health of those entering Libya.
Nonetheless, Hussain concedes there such is the severity of the country’s health problems, there is a limit to what the WHO can do.
“The health system is in acute crisis” he said, “The degree of unpredictably in the country with political disagreements and conflict will only intensify these issues and make the health system more broken.”
A recent extensive nine-month survey by the WHO found serious problems across Libya’s 98 hospitals and its 1,600 primary healthcare centres and other medical facilities. Physical infrastructure, equipment, availability of drugs, electricity, security and water cleanliness along with the limited numbers and competence of health workers were just some of markers used.
“Most importantly we assessed the readiness and functionality of staff and where they work” said Hussain, “We found a major breakdown in the health system, with only four of the 98 hospitals performing at 75 percent of their capacity.”
Conflict has closed 17 hospitals and 25 are below quarter capacity. Even Tripoli Medical Centre, the capital’s largest hospital, only working at half capacity. Hussain said a lack of trained junior doctors and specialist nurses is behind this. He also mentions an uneven concentration of health professionals in Libya. For instance Tripoli has a doctor/population density better than the WHO standard. Yet in places like Zawia, Zliten and Sirte there was a “major deficiency” of skilled health workers.
“In Libya there are very well-qualified health professionals but a work force who were trained for normative mode,” he explained.
The ability to provide quality care is clearly limited so the WHO is sponsoring training. Around 35 mid-level health workers have just arrived in Leeds, UK for supply-chain management training in an effort to improve human capacity.
The EU has recently given a €4 million grant to reform the health data system so managers can better plan. Nonetheless, Libya has a number of challenges that prevent the improvement of institutional capacity.
“There are major reasons for the problems faced in Libya’s health system” said Hussain, “A key factor is the non-availability of funds – money is just not flowing from government to the health care system. You couldn’t even run one hospital with the money provided. There is simply no money for service delivery and investment is only very limited.”
He described a “gross disconnect” and “major vacuum” between policy and the medical frontline that the WHO was struggling very hard to narrow.
Financing and transparency are clearly issues. Hussain said the WHO and UN member states last year started to unfreeze Libyan assets, worth potentially billions of dollars, that could be used to fund health. Even a fraction of this amount would go a long way to solving many of the health issues faced.
This paper has obtained a letter from the former German ambassador Christian Much to Presidency Council head Faiez Serraj last June. Much tells Serraj the German government is prepared to help unfreeze roughly $50 million of Libyan assets held by Deutsche Bank that would then be transferred to the WHO.
One condition that Serraj had to meet was to certify “your government is legally entitled to dispose of the LAFICO (Libyan Arab Foreign Investment Company) funds”. Beida health minister Reida El-Oakley has argued that, because Serraj’s government has not been accepted by the House of Representatives, he fears claiming the Presidency Council is the legal government.
Hussain believes that Libya cannot be compared to somewhere like Somalia, Yemen or Afghanistan, countries he describes as genuinely poor. “Libya has resources, but they are frozen”.
Even the richest of Libyans cannot pay for private sector treatment because of the lack of liquidity and instead have to rely on the “shambolic” public health service.
Hussain said he has held discussions with the Central Bank of Libya (CBL), who understood Libya’s health needs but believed the financial mechanism within the health ministry and sector is not transparent. Hussain has nevertheless urged them to realise that Libyans are dying and that the CBL should do more to allow finances to flow through.
Hussain says with clear frustration that health should not be politicised. He says he will not get involved in arguments between the CBL and Libya’s various governments, because this is outside his remit. But he is clearly exasperated by the crisis caused by such disagreements.
“It is not like having a lack of electricity. Fine I am hot, my child is upset. Health is not like that. If you do not give insulin to a patient or an operation to someone seriously ill, they will die” he said.
“My appeal to the donors and policy makers is to please keep health at the centre of your policy. If your population is not healthy, forget about economic recovery, forget about sending children to school. If you do not help, in the weeks and months to come we will be collectively responsible for losing lives in Libya”.
Hussain insists the WHO will do all it can to improve the situation across the country, regardless of governmental disagreements. The real limiting factor is money.
“Health has been identified as a key priority – with 1.3 million the most vulnerable and needing urgent assistance” he says, “Sadly the money is less than we need. We are struggling very hard to make the best use of the limited resources we have from donors or from the WHO core budget. The needs are just so high.”
The WHO has stationed teams across all parts of the country. Hussain is particularly pleased with their efforts in the south – though he concedes much has to be done because it has been neglected for so long.
He also notes how the WHO immediately deployed mobile clinics and trauma kits to Sirte last year as fighting raged. It is also stocking up on vital medicines in Tripoli, Beida and Sebha. Furthermore, the WHO is working to improve the capacity of Benghazi Medical Centre, because it is quicker than rebuilding the city’s devastated hospitals – though he says this will happen in time.
“The WHO is often requested to recruit foreign doctors and nurses, something it can do very quickly. However the money is just not there and potential applicants struggle to accept the security issues they may face and the fact that they will find it difficult to withdraw money – that is if they are even paid. The ‘brain-drain’ of foreign and talented Libyan health workers is just another reason the system is crumbling,” said Hussain.
However, despite it not being “easy but instead challenging” working with rival governments, there is a good level of cooperation he believes. He admits that everything must start in Tripoli as the capital, but intensive efforts are underway to help the east and south of the country. He cites the example of the WHO being the only group allowed into Derna to provide assistance.
Ideally, a unified Medical Service Organisation (MSO) would be good, but Hussain says that despite there being separate MSOs in Beida and Tripoli, they still work fairly well.
He cites the example of goods intended for the MSO in Beida landing in Tripoli and still being allowed to head to the east by road.
However, he clearly sees this as a small glimmer of hope in an already dire crisis.
“Human beings are the centre of Libya. A healthy human being needs to be the priority for everyone and I appeal to everyone to help. We have a moral, humanitarian and ethical need to respond to the country’s acute health issues. It needs to be a collective effort”.
