When the eastern Libyan town of Ajdabiyah came under fire, its residents had just minutes to pack up their belongings and flee. They did not know when they would be able to return and if there would be anything to come back to. Many could not seek refuge with family, as their homes were also caught in the crossfire, and instead were forced to live in half-built, abandoned buildings with other displaced people.
What happened in Ajdabiyah was repeated in cities and towns across Libya. On top of this, many lost loved ones and were separated from family members. Some still face displacement while livelihoods and a sense of normalcy have been lost.
“In the context of conflicts and crises, most people experience distress such as anxiety, fear, or sadness,” says Dr. Inka Weissbecker, International Medical Corps Mental Health and Psychosocial Technical Advisor. “These are considered normal reactions to stressful events, but it does not mean that people are mentally ill or need clinical interventions.”
According to the World Health Organization (WHO), the number of people with common mental disorders, such as depression or Post Traumatic Stress Disorder (PTSD), can double following conflicts or crisis from an initial 10-15 percent to approximately 20 percent. In these contexts, it is important to take a comprehensive approach, providing general psychosocial support to the population as well as more specialized mental health interventions for those who need it.
Prior to the conflict, mental health services in Libya were highly concentrated in urban centers and hospitals. Today, with mental health problems on the rise, the few facilities that do provide care are stretched to the limit. In Tripoli, the local psychiatric hospital is describing the current situation as a “crisis” with medications, staffing, and space all in short supply. The hospital is the only one that provides mental health care to the approximately four million people in western Libya. As a result, many are walking great distances to seek care only to be turned away due to a lack of capacity.
To reverse this trend, it is critical that mental health care is more accessible at the community level. One of the best ways to approach this is by integrating mental health services into primary health care, an approach that International Medical Corps takes in its interventions worldwide and which is consistent with recommendations by the WHO and Libyan national policies and plans.
“We expect that primary health clinics will have a major role to play in effectively addressing mental health issues resulting from the conflict,” says Dr. Weissbecker. “Training and capacity-building for clinic staff will be critical in ensuring mental health issues are accurately identified and handled appropriately.”
Integrating mental health into primary health clinics not only makes care more readily available, but it also lowers the stigma associated with seeking psychological support. “Libya is composed of very close-knit families and communities, so people do not readily seek out mental health care providers due to fear of stigma and shame,” says Colleen Fitzgerald, International Medical Corps Mental Health and Psychosocial Program Manager in Libya.
Therefore, people often only seek mental health support in very severe cases at one of the few psychiatric hospitals in the country. To avoid social stigma, some families may even go to the opposite side of the country for care. “Still, there are far fewer cases for women than men in psychiatric hospitals because having mental health problems diminishes their chance for marriage,” says Fitzgerald.
In addition to centralization and social stigma, there is also a lack of psychologists and psychiatrists in Libya and those few are often in need of further education. To begin addressing emerging psychosocial support and mental health issues in Libya, International Medical Corps is providing training in Psychological First Aid (PFA) to general health care providers and volunteers. “Psychological First Aid is recommended as a first line response by international guidelines and is a non-intrusive way of providing basic support to people who have been subject to very distressing events,” says Dr. Weissbecker. “This includes listening skills, positive coping mechanisms, and referrals to local services.”
International Medical Corps has trained more than 140 hospital staff in PFA, as well as teachers and refugee camp staff. In August, International Medical Corps held three two-day workshops in PFA on the Tunisian border and in Dehibat, Zintan, and the Nafusa Mountains in western Libya. Twenty-six people participated, both men and women. “After the Psychological First Aid training by International Medical Corps, many were grateful for the skills they acquired,” says Ardeshir Baiki, International Medical Corps mental health and psychosocial consultant for Libya. “It was the first time they had come across the topics we covered in the course.”
“Before the training, I was just at the burnout level and when I came back after the training I felt fresh,” says Hussein, a workshop participant.
As Libya’s conflict evolves, International Medical Corps will continue to strengthen the national health system through training and education. Today, this is largely focused on PFA, but in the future, these educational opportunities could include more specialized training such as capacity building of general health care providers to identify and manage mental disorders. “Libya could also benefit from a recognized accredited mental health curriculum, possibly through a partnership with an international university, for a formal mental health degree,” says Baiki.
International Medical Corps continues to provide PFA workshops to help ensure that more people in Libya are able to provide basic and compassionate psychosocial support. “As we have done in conflicts and disasters throughout the world, International Medical Corps is committed to not only providing immediate support during emergencies, but to also helping communities rebuild and start anew after the crisis subsides,” says Dr. Weissbecker. “Our approach to the mental health needs in Libya will be no different.”