Provide Emergency Medical Care for Libyan Refugees

International Medical Corps was one of the first organizations to arrive in Benghazi, Libya following the February 2011 outbreak of violence, and has since expanded throughout the country to Misurata, Sirte, Tripoli, Sabha and the Western Mountains region. During the conflict, International Medical Corps’ emergency response teams provided critical supplies and medical personnel to support health facilities; conducted medical consultations and lifesaving surgeries; provided emergency care for patients requiring medical evacuation; delivered essential supplies for people displaced by conflict; and trained local health care professionals. 

Today, though the conflict has largely ended, International Medical Corps is still active throughout Libya and working in collaboration with key local stakeholders to help rebuild the health infrastructure through a variety of critical programs. Funds received through Global Giving were used along with government grants and other private donations to deliver these life-saving services to the people of Libya.

International Medical Corps’ Initial Emergency Response:

Nursing Support: During the conflict, in response to critical shortages of skilled nurses, International Medical Corps provided nursing staff to address acute gaps at hospitals in Sirte, Misurata, Zintan, Jadu, Gharyan, Tripoli and Sabha. True to our mission to return devastated communities to self-reliance, International Medical Corps’ specialized personnel simultaneously conducted on-the-job trainings to strengthen the capacity of Libyan nurses. Because the shortages for skilled nursing staff extend to the primary health care level, trainings were also being undertaken at International Medical Corps-supported clinics in the Western Mountains and Sirte.

Rehabilitation: International Medical Corps’ rehabilitation program focused on those affected by the conflict, and provided physiotherapy and psychosocial support services through facilities in Benghazi, Misurata, and Sirte. To strengthen local capacity, trainings of local staff were also being conducted by physiotherapists trained in rehabilitative physiotherapy best practices and by rehabilitation staff trained in providing psychological first aid.

Gender-Based Violence Prevention and Response: International Medical Corps trained social workers, psychologists and Libyan non-government organizations (NGOs) in guiding principles of gender-based violence (GBV) response; in addition, International Medical Corps also trained medical professionals on the clinical management of sexual assault survivors. Awareness campaigns to aid the prevention of GBV continue in four cities, and community awareness sessions took place within cities of operations, as well as internally displaced person (IDP) camps and towns outside of these cities. International Medical Corps continues to support women’s centers and clinics in Zintan and Misrata, to provide a safe space for women recovering from GBV.

Primary Health Care Support: Throughout the conflict, mobile medical teams supported primary health care clinics across Libya. In areas around Tripoli, Misrata, and Sirte, International Medical Corps provided medical care for internally displaced persons (IDPs) at clinics located in settlement areas. International Medical Corps also provided support in the Western Mountains, with mobile teams supporting community clinics and complementing these services with health education sessions for patients diagnosed with, or at risk of developing chronic diseases. Teams also distributed urgently needed items to clinics. International Medical Corps primary health care support also reached beyond the Libya, and on the Libyan/Tunisian border, International Medical Corps operated a health post at the Shousha camp to provide services to third country nationals and refugees who fled Libya during the conflict.

Current International Medical Corps Programming in Libya: 

Nursing Support: The departure of foreign nurses during the conflict left a large service gap for nursing care at a time when service capacity had been outstripped. Today, International Medical Corps is engaging the Ministry of Health, the Ministry of Higher Education, universities and training institutes in Libya to address longer-term development challenges that includes strengthening the nursing sector. As part of this strategy, International Medical Corps provides theoretical and on-the-job training to Libyan nurses and is working on developing a longer-term nurse sector strengthening strategy, that includes developing pre-service and in-service nursing curricula, forming nursing counsels, and encouraging the promotion of Libyan nurses into key leadership positions. To date, over 400 nurses have been provided with clinical lectures and on-the-job training, with over 30,000 patients receiving treatment from International Medical Corps-trained personnel.

In addition, International Medical Corps is working with Johns Hopkins University to develop guidelines for nursing core competencies. These guidelines will be shared with relevant stakeholders to implement in nursing schools and training institutes throughout the country.

Rehabilitation Services: The conflict in Libya resulted in large numbers of casualties often with severe, life-altering wounds including amputations and head wounds, in addition to psychological trauma. Post-conflict, International Medical Corps is building on its emergency rehabilitation work to develop holistic rehabilitation services for those with physical disabilities. The program is focused on ensuring access to appropriate physical rehabilitation services while also promoting access for persons with disabilities to other measures that promote their full participation and inclusion in society.

To date, over 5,000 client rehabilitation consultations have taken place with doctors, physiotherapists, and prosthetics and orthopedic technicians. The program, which operates in Tripoli, Benghazi, Sirte, and Misrata, has also conducted upgraded trainings for 142 center staff members, including physiotherapists, occupational therapists, social workers, and prosthetic/orthotic technicians. International Medical Corps also engages local disabled person’s organizations to strengthen pre-service training efforts. The program also has a staff mentoring module in place to provide on-the-job support.

Prevention/Response to Gender-Based Violence: International Medical Corps is working to strengthen the ability of local health staff to identify, manage and treat GBV survivors through capacity building trainings; improved awareness of GBV; and improved reporting of GBV cases. In order to achieve these goals, International Medical Corps is working with all sectors of the Libyan population, from government ministries to schools, and through medical staff working with local community based organizations (CBOs).

To date, International Medical Corps has trained 1,134 key stakeholders, including teachers, ministry staff, hospital and clinic staff, and social workers on the prevention of sexual exploitation and abuse and the principles of GBV. International Medical Corps is also working with local CBOs to establish safe spaces and recreational centers for women. These centers will provide life skills classes and information sessions for women who go to these safe spaces. To date, one safe space has opened and another two have been identified for support. In addition, International Medical Corps is providing awareness session to community leaders and community focal points on the program, as well as GBV in general, to ensure public buy-in of these values and principles. 

Primary Health Care Support: Support to the primary health care sector has been a key feature of International Medical Corps’ work in Libya. International Medical Corps has used mobile medical teams to address staffing and supply gaps as well as training needs in facilities in rural areas and in communities with high levels of displacement. Today, International Medical Corps works with persons of concern detained in holding facilities, located in Gharyan, Al Khoms, Tripoli, Sorman, Sabratha, Sabha, where undocumented migrants, asylum seekers and refugees have been brought. This population is extremely vulnerable and lacks access to much needed basic health care. To illustrate this point, in just a four month period, International Medical Corps provided over 6,000 health consultations. International Medical Corps has been supporting these detention centers and these populations for over 13 months and will begin providing support to a community development center that provide basic services for urban refugees in Libya.

Conclusion:

In the months following the conflict’s end, International Medical Corps has transitioned programming from emergency response to development programming. Nearly all of International Medical Corps’ programs today focus on helping ensure that the health sector in Libya is rebuilt in a strategic, thoughtful manner. International Medical Corps is continually engaged with ministry officials, local CBOs, and the community to ensure that program goals and design continue to have buy-in from these key stakeholders, moving Libya from relief to self-reliance.

The program we originally set out to deliver with Global Giving support has been completed and our project is fully funded! We are still supporting the health and well-being of the Libyan people, however, we have shifted our main focus to training nurses in the country in order to help meet the demand for well-trained medical professionals that are in very short supply in Libya. The continuation of our mission will be supported by the Ministry of Health, the Ministry of Higher Education, universities, training institutes and other private funding sources. International Medical Corps is very grateful for all of your support in our mission to provide relief to the Libyan people. 

Links:

• International Medical Corps work in Libya

International Medical Corps in Libya:

Following the outbreak of conflict in February 2011, International Medical Corps immediately deployed teams in Libya to provide emergency medical services, train local health workers and deliver vital medicines and supplies.  

International Medical Corps remained in Libya as the conflict ended, shifting initiatives from emergency services to longer-term projects aimed at supporting efforts to eliminate major gaps in health care and restore the necessary infrastructure. To do this, International Medical Corps is working with the Libyan health sector to address the primary health, mental health and rehabilitation needs of a country emerging from war.

In addition to the physical wounds of war, many Libyans are also facing long-term psychological distress related to the conflict in a region plagued by a cultural stigma towards mental health needs. To address this stigma and the lack of access to mental health services, International Medical Corps is training local health workers throughout Libya in Psychological First Aid. Mental health services have also been integrated into all of International Medical Corps’ programs delivering primary health care.

Attitudes Towards People with Mental Illness:

In Libya, as in much of the Middle East, disabled people are often marginalized and discriminated against. Within existing rehabilitative care services, there is a lack of psychosocial support and psychological counseling services. The majority of the rehabilitation centers in Libya lack social workers and psychologists trained specifically in methods to provide psychosocial support and psychological counseling to persons with disabilities and their families.  There continue to be major challenges, but International Medical Corps is working with local partners to advocate rights for the disabled, including the right to education, the right to employment, and the right to take part in everyday activities. Our work aims to increase the quality of life for people living with disabilities in Libya.

In Misurata, International Medical Corps has been working to reduce the stigma associated with disability in conjunction with physical rehabilitation services and psychosocial support. Since our initiative at the Al Tadamoon Centre, the psychosocial department dealing with psychological affairs has been revitalized and is now active. The program has formed a self-help support group for women, provided literacy classes for women with disabilities, and has created a photographic exhibition where women, working together, were empowered through learning camera skills and taking photos to illustrate their theme “dreams and challenges”. The exhibition allowed them to show and explore their daily experiences, hopes and dreams.  They also developed their own newsletter and have led training sessions for staff members about disability issues. Mr. Meshbah Mansoor, a father of three participants in the program said:

 “There wasn’t much for my daughters to do. They were just staying at home, bored and with little meaning in life. I am grateful for this project and impressed by the way my daughters have been treated by the staff in the project. They have a feeling of being community members deserving respect and opportunities like everyone else now.”

International Medical Corps’ work in Libya continues in conjunction with both the Government of Libya, and Disabled Peoples Organization to change attitudes towards people with disabilities. Prior to International Medical Corps' involvement in the rehabilitation centers in Misrata, initial assessments showed a lack of psychosocial activities, documentation systems, an internal and external referral network, and staff knowledge of disability issues.

However, a recent re-assessment has shown improvements in these areas, especially for group activities, referral networks, and change in staff knowledge and attitudes towards persons with disabilities; much of this shift is a direct result of trainings and on-the-job activity mentoring by International Medical Corps.

International Medical Corps continues to work with those affected by both physical and mental disabilities, many as a result of the war, by providing a holistic approach to rehabilitating vulnerable people and raising awareness of the disabled population in Libya.

Hannah is 22 years old and finds meaning in her life from family, friends and her faith. She grew up in the Libyan city of Misurata and visits the International Medical Corps-supported physiotherapy center each week to help her enjoy those important parts of her life, despite her disability. Hannah has spastic paraparesi, a condition that causes weakness in her legs and makes walking difficult.

At age 14, Hannah left school because of the way her teachers treated her, keeping her inside at lunchtime and assuming she could not do anything for herself. She also felt excluded by the other students and thought they were always staring at her.

When International Medical Corps first began working in the Tadamon Centre in Misurata, Hannah was very shy and would just come in for physiotherapy and then leave without speaking to anyone. She would often miss appointments and was not making much progress.

Our team of physiotherapists and psychosocial experts spoke to Hannah, her doctors and her family. It soon became clear that Hannah had been told that her condition would quickly get worse and worse, with no chance of preventing it. It is hardly surprising that Hannah had responded to this advice by giving up hope.

According to Leticia Pokorny, an International Medical Corps Physiotherapist in Misurata:

“I explained to Hannah that we could not cure her condition, but Hannah had the power to control if and when it would get worse through hard work at her physiotherapy. Simply introducing the idea that she has control over her own destiny made a huge difference to Hannah and her whole approach to treatment.”

At the same time, our team of psychosocial specialists began introducing Hannah to group activities that had never been available at the Center before our involvement. Very quickly, Hannah began to open up and make friends. Hannah explained,

“...this was the first time I have ever met other people with disabilities and it makes me feel less alone and ‘different’.”

Hannah joined several others from the Tadamon Centre in preparing a photo exhibition that showed their plans and dreams for the future. As she discussed her photos, the group helped Hannah realize that no matter what happens to her in the future, the things that are most important to her – family, friends and faith – will always be there to support her.

In March 2013, International Medical Corps supported a group of persons with disabilities to produce a short play about living with a disability in Libya. Hannah was very keen to participate, but her family was reluctant to let her take part. Our team met with Hannah’s family to explain the benefit of the activity and Hannah’s sister came along to one group session. It was immediately obvious how the interaction with other people and the challenge of standing in front of an audience was helping Hannah’s self confidence and her family became happy for her to carry on. Today, Hannah is planning with the rest of the group to perform the play in schools around Misurata and even considering taking it on tour to Tripoli.

Julie Currie, International Medical Corps Rehabilitation Coordinator, observes:

“Hannah faces more challenges and uncertainty than most 22-year-olds anywhere else in the world. But, with the support of those around her, she hopefully now has the confidence and the strength to face whatever comes her way. I doubt that would have been the case if International Medical Corps had never come to Misurata.”

 With International Medical Corps’ help, Libya continues the transition from conflict to rebuilding. International Medical Corps has shifted attention from Emergency Medical Care to rehabilitation services for the injured and disabled (or those born with disabilities).

In addition to providing support to hospitals and clinics, International Medical Corps also worked with local groups for the disabled to strengthen the capacity of leadership, host community events, and provide vital information on health care and well-being.

One such group, The Blue Eye, was established in April 2012 in Jadu, Libya, to address the needs for people with disabilities in the Western Mountains.

“We said to ourselves that the situation has changed, and now we have a free Libya. Disabled persons need their rights, but before they get their rights, they need to know them and demand them,” says Anwar, one of the Founders of The Blue Eye. In addition to the capacity-building activities, International Medical Corps also trained senior members of The Blue Eye and provided the organization with tool kits and training to manage home modifications and home assessments for construction of ramps and accessible entrances.

“Our aim was to empower these organizations in the Western Mountains by providing them with the tools and knowledge about standard measurements for building ramps and modifying home entrances as part of their field work with the disabled persons in the Western Mountains,” said Fadi Daccache, International Medical Corps’ occupational therapy specialist.

This is just one example of International Medical Corps’ work in Libya. In 2013, International Medical Corps will continue to provide support to Libyan health facilities for rehabilitation and related medical and community activities. We thank you for your generosity, and hope you will continue to support our efforts in Libya.

Four-year-old Mohamed* is the first child with Cerebral Palsy that International Medical Corps worked with in the Libyan city of Sirte. With bright, intelligent eyes, Mohamed was always smiling and laughing. He came to an International Medical Corps-supported rehabilitation center carried by his doting father, but was unable to sit independently and had very little controlled movement in his arms and legs. His parents were doing all they could for him—traveling to the center regularly from his home an hour outside of the desert city—but they needed professional help.

As Libya has moved from conflict to rebuilding, International Medical Corps has transitioned from emergency activities to longer-term programming, such as building the capacity of Libya's rehabilitation sector by training physiotherapists.

For Mohamed, we worked with physiotherapists to identify what he was and wasn’t able to do, and to plan how we could realistically help him most. After realizing that physiotherapy in isolation wasn’t going to be enough for him, we made arrangements with Mohamed's family to visit him at home. There, we showed Mohamed’s family how to stand him using a simple piece of wood and cloth, and how to stretch his limbs comfortably. We built a wedge from pillows so that he could use his hands to play freely and develop neck strength, and showed his family how to adapt a chair so he could sit with his hands free and start to feed himself. Mohamed’s smile and laughter only grew as he learned to grab his toys with both hands.

It’s thanks to your generosity that we were able to help Mohamed—and there are many other children like him that we want to reach. With your support, International Medical Corps has plans for more specialized training with physiotherapists across Libya. We will soon be introducing outreach teams to identify and work with more children in their communities.

So thank you for helping make Mohamed smile!

*Name has been changed to protect the identity of patient under the age of 18.