The Front-lines of Libya: Health Care in the Crossfire

Providing bipartisan health care among hand grenades in a war zone can be tricky to master. One must first find the best means possible of serving any individual in distress, regardless of their affiliation within the politics of the conflict. And second, one must find the balance between keeping patients at a safe distance from the rocket launchers, yet remain accessible to those injured by the explosion.

For International Medical Corps, that meant supporting a field hospital on the outskirts of Sirte along a main route leading away from the front-lines of Libya’s civil war. In partnership with Libyan Volunteer Doctors (LVDs), we provided care at the hospital for both casualties and internally displaced persons (IDPs) seeking medical attention for health issues directly and indirectly related to the combat.

When rebel forces shifted their focus to the streets of Sirte in an effort to bring down one of Qaddafi’s last strongholds, most women and children were able to escape, and some sooner than others. Many were pregnant and came through the doors of our field hospital needing immediate medical attention. As violence escalated and the number of fleeing families grew significantly, our patient intake increased in an equally drastic fashion.

In addition to the surgeons and emergency care specialists who were caring for war casualties 24 hours a day, we hired a midwife and a female general practitioner with OBGYN experience. We immediately set up a full delivery center where doctors could help safely bring new and innocent life into the world only a few miles from a fight that was simultaneously causing so much death.

According to Helema, our midwife, some women had miscarriages due largely to the stress of attempting to not only deliver a child, but to do so in the midst of war. Many were anemic, a result of the lack of food and basic nutrients to be found in a city directly under siege. Others suffered from heavy bleeding, after attempting delivery at-home to the soundtrack of constant neighborhood gunfire punctuated by mortar shelling. The women Helema treated would share many stories of the mothers inside Sirte who tragically did not survive attempted deliveries at home in the absence of properly trained and skilled doctors.

For the expectant mothers who were able to escape the conflict, a gauntlet of high-rise-dwelling snipers awaited them, while rumors circulated of imminent rape of all women who attempted to flee. At as much as $250 per gallon, fuel prices were outrageous in a place where all business was at a standstill and finding anything of monetary value was nearly impossible without exuberant cash on-hand. Refuge seekers resorted to pooling their limited resources to find any means of escape.

Many times I arrived at the Sirte 50km field hospital to find a line of cars, all stuffed with those lucky enough to have the means of leaving and quite often with more than one passenger in grave need of the medical attention. Some of the passengers were pregnant and unable to reach the field hospital in time and were left with no option but to deliver in packed cars. I know of two women who gave birth inside vehicles en route to anywhere outside of Sirte. Only one of them had a child who survived.

She was forced to leave her other small children alone and hiding inside the city

One expectant mother managed to flee Sirte and arrived at the field hospital with very heavy bleeding. She was just four months pregnant. At first, our team wanted to transfer her to a fully equipped hospital in Misurata by helicopter, but she refused. As we came to find out, she was forced to leave her other small children alone and hiding inside the city and would not go to Misurata without them. While she rested uneasy in our field hospital, she was tormented by the mystery of whether her children were safe.  Still bleeding, she left the field hospital and made her way back inside Sirte to be with her children. Our team has not heard from the family since.

On October 12th, we were finally granted security clearance to approach the front-line inside the city of Sirte to assess the needs of the Ibn Sina Hospital. The journey from our base in Misurata would soon become my 90-minute early morning daily commute. It was the only route into town approved by the military council for transit and I could plainly see why our pleas for access in the weeks prior were so swiftly rejected. Overturned vehicles, artillery shells, miscellaneous debris, and charred rubble littered what remained of the street.

The 2.5 kilometers leading up to the hospital offered a much more thorough and recent account of full-fledged combat in the days prior. Bullets, empty shell casings, grad rockets, RPGs, mortars, katyusha rockets, tank shells, and the fragments of shot-up cement walls and collapsing demi-structures carpeted the streets. Along the approach to the south side of the hospital lay a number of high-rise buildings. As I was informed in daily security updates, these skyline structures offered cover for Qaddafi snipers to pick off anyone bold enough to walk the streets or stand exposed by a window, rebel soldier or civilian.

And many times, the focus would fall on those both utilizing the hospitals services and the staff providing the care. From the outside, the building’s parking lot remained peacefully clear of signs of artillery while the second and third floors suggested the contrary. The walls were standing but heavily destroyed, displaying the scars from explosions around the perimeter and from the snipers taking aim at its occupants. The staff had no choice but to seek refuge on the first floor accommodating patients in the halls and windowless common areas with hopes of staying out of a keen gunman’s scope view. One of the first things I noticed when I walked through the door was the unique sight of ceiling panels accumulated on the floors around the patients after being shaken down by heavy artillery hitting the exterior walls and rocking the foundation.

While my own foundation was equally shaken, we were there to serve a purpose and I could not let the grave aesthetics of war slow me down. My assessment showed a great deal of needs as the hospital did not have access to water, and doctors and nurses were limited. While fighting ensued in surrounding neighborhoods and the thunder of mortar shells filled the air and shook the floor, we continued to work on the needs of Ibn Sina hospital where more than 50 patients rested each day, most commonly with artillery wounds and often in need of amputation.

However, there was one case that stood alone.

The treated patients were almost exclusively those caught in some form of crossfire. However, there was one case that stood alone. Just four days prior to our entry, an extremely premature child was delivered.  She was born into a Qaddafi-controlled hospital and toughed out the combat that quickly led to rebel occupancy of the area during her first few days of life. Amid the destruction, she was battling for her life, having been born prematurely and with severe respiratory distress.  Laying in an incubator on oxygen, her best chance to survive was to be transferred to a better equipped hospital in Tripoli. Much like the mother who came to our field hospital bleeding profusely, her own mother was also afraid to leave the rest of her family in Sirte. After some discussion, the mother’s uncle volunteered to accompany the newborn to Tripoli and they were airlifted immediately. The mother returned to the epicenter of the combat to care for her other children, alone.

Whether the needs were for birthing mothers or wounded soldiers, we continued to visit Sirte each day to monitor the situation and drop off supplies. I was just outside Sirte on my regular commute when I learned of Qaddafi’s capture. I watched a convoy  of more than 30 vehicles whiz by: pick-ups with gunmen manning artillery built into the trucks’ beds; cars painted in Libya’s red, black, and green. The excitement of the passengers was pulsating, as they let out screams and celebratory gunfire.

They were chanting: “Libya is free! Sirte is free! We got Qaddafi!”

We heard this before around other battle sites in Libya, but this time, the authentic roars of excitement convinced me that it may be the truth. At the next military checkpoint, the rumors were confirmed: After nearly 42 years in power, Muammar Qaddafi was captured, and Libya was free.

During the battle for Sirte, the unpredictability of the shelling in the city center made it impossible for us to visit with anything close to a security clearance. For the days leading up to Qaddafi’s capture, we had heard rumors of a semi-functional clinic struggling to treat a large number of injured civilians with few resources. The day Sirte fell, when the only gunfire was in celebration, we were finally cleared to enter. The streets were filled with fighters singing and dancing, while firing their remaining ammunition into the sky. But while the atmosphere was jubilant, the extreme devastation was impossible to ignore.

I sat awestruck by the incongruity around me: the purest joy of victory against a backdrop of such demolition.

The reality may not have made perfect sense yet, but it did begin to settle in as I approached the city center’s clinic. Prior to our arrival, our security advisor reminded me to watch where I stepped: booby traps and trip wires were possibly set up throughout Sirte in buildings and sidewalks where they still remain armed and waiting in the aftermath of war. The fight for Sirte may have been over, but the wrong step could have very easily killed me and my colleagues.

As people return to a post-war Sirte, as with the rest of Libya, the danger of war’s weaponry is far from absent. A few days ago, I met an eight-year-old boy who had been playing with an intact hand grenade that he may have thought resembled a toy. His tampering set it off before he had a chance let go. The sounds of the young boy’s voice remains with me as he exclaimed over and over again, “My hands, my hands!”

He said nothing else.

Just outside Sirte, there are well over 20,000 IDPs and counting who have no home to return to, their city shattered to pieces by war. International Medical Corps is helping these communities by running mobile clinics and supporting existing medical facilities with medicines and supplies. We are doing similar work in towns and cities throughout Libya and are committed to being here during the long haul to help pick up the pieces and help the Libyan people build an even stronger health care system than they once had.

The war for Libya may be over, but this only marks the beginning of a long and grueling period of recovery. My only hope is that, once the action-packed and explosive news coverage fades away, the future wellbeing of Libya is not a forgotten cause. The long-term process of rebuilding the country’s health care system may not remain on the international stage, but it will be headline news for the Libyan people for many years to come. Unless the international community continues to take the necessary steps, it will be a long time before the remaining women and children find full access to the general health care they need to survive.

This remains collectively in the hands of both you and me.

Help us save lives.