Survivor assistance action points

• Develop a strategy and action planning to respond to the needs of survivors and other persons with similar needs.
• Increase financial resources for healthcare and physical rehabilitation as well as human resources in the health sector.
• Establish psychosocial service delivery for mine/explosive remnants of war (ERW) survivors.

Survivor assistance planning and coordination

Laws and policies

The 2011 Constitutional Declaration addresses the rights of persons with disabilities and requires the state to provide monetary and other types of social assistance but does not explicitly prohibit discrimination. In 2018, the government did not effectively enforce these provisions.[6] In Libya, persons with disabilities face “multiple barriers and discrimination.”[7] Article 1 of Law 4 of 2013, related to persons with disabilities “from the liberation battle,” created a new category of persons with disability for those who sustained permanent impairments while fighting in the 2011 uprising and against the previous regime and also for those persons who sustained injuries as civilians from attacks by that regime. This new category received more benefits as compared to other persons with disabilities. The NGO Lawyers for Justice in Libya noted that the disparity “highlights inequality in the treatment of people with disabilities as well as discriminating between them on the basis of political association.”[8]

The draft constitution of July 2017 includes a specific article (Article 60) on the rights of persons with disabilities. The article commits Libya to guaranteeing the health, social, educational, economic, political, sports, and entertainment rights of persons with disability on an equal basis with others and to make facilities accessible.[9] On 24 September 2018, the House of Representatives passed the constitution referendum law.[10]

Libya ratified the CRPD on 13 February 2018.

Major Developments

In 2018, violent clashes continued to take place and fighting escalated in the cities of Derna, Sabha, and Tripoli, which led to hundreds of people being injured or killed.[11] The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported that there was “a concerning lack of provision of specialized assistance to survivors of explosive hazards.”[12] Attacks on healthcare facilities and medical personnel continued across the country.[13] During 2018, health services and health infrastructure steadily deteriorated.[14]

The World Health Organisation (WHO) is working on a new District Health Information System, to disaggregate data at a district level from health facilities.[15]

In 2017–2018, there was an increase in psychosocial services provided by international and local NGOs. However, local capacities were not sufficient to meet the needs, and the shortage of medication to address severe mental health issues remained a significant constraint to the adequacy of services.[16]

HI established victim assistance activities in Benghazi in early 2019 and continued to intervene in Tripoli and Misrata throughout 2019.[17]

Needs assessment

In 2019, no needs assessment survey of survivors was conducted.[18]

Medical care and rehabilitation

Public healthcare services in Libya have been heavily impacted by the ongoing crisis, and the public health system remains dysfunctional. There were shortages of resources, qualified staff, equipment, and supplies.[19] Access to healthcare was not commensurate with the needs.[20] There was a lack of first-aid providers, as well as a lack of referral and coordination between ambulance services and medical centers. Libya also reported the absence of specific inter-sectoral and inter-regional referral system.[21] The already fragile health system came under increasing pressure, with hospitals struggling to absorb the number of patients and to cope with the shortage of staff, essential medicines, and supplies. All persons with disabilities had insufficient access to essential services, regardless of the cause of the impairment.[22] Healthcare services available for persons with disabilities, including mine/ERW survivors, were grossly insufficient to match their critical needs.[23] A number of injured Libyans, including soldiers, were sent abroad for medical treatment by the government; although, the number of patients treated abroad and supported financially by the government decreased significantly in 2018.[24]

In 2018, the ICRC continued to provide medical supplies to hospitals and other medical facilities as well as trained first-aiders and doctors in emergency care.[25] Eighteen hospitals received regular supplies from the ICRC, while another 21 received supplies on an ad hoc basis.[26] The ICRC and the National Society were not able to deploy mobile health units in 2018.[27]

The physical rehabilitation sector lacked raw material for prosthetics, qualified staff in rehabilitation centers, qualitative prosthetics and orthotics, qualitative mobility devices, and inpatient/outpatient capacity.[28] Persons with disabilities, who needed assistive devices and wheelchairs, were generally required to purchase them with private funds. Alternatively, individuals had to approach local charity organizations for support or become registered with the Social Solidarity Fund (SSF) under the Ministry of Social Affairs to be eligible for a device. However, eligibility criteria of the SSF remained unclear, and not all persons with the same impairments would qualify.[29] In 2018, Humanity & Inclusion (HI) donated assistive devices directly to persons with disabilities and injuries and to the SSF for their own distribution, as their stocks have been limited for a number of years.[30] The health system lacked capacity in physiotherapy, prosthetics, and orthotics. Mobility aids were of low quality, and many centers lacked the equipment and materials necessary to provide services. As of August 2017, the Swani rehabilitation center, located some 30 minutes from Tripoli, was no longer functioning. In 2018, another rehabilitation center closed in Misrata city.[31]

HI provided physical therapy services to persons with disabilities and patients with conflict-related injuries, including from landmines and ERW, in Tripoli and Misrata.[32] In 2018, HI was supporting five rehabilitation centers in Tripoli and four in Misrata, providing materials for prosthetics and orthotics (in Tripoli only), rehabilitation equipment, mobility aid devices, and technical training for staff.[33]

In 2018, the ICRC supported physical rehabilitation in three centers in Janzour, Misrata, and Benghazi.[34] It covered transportation cost for six persons with disabilities from Sabha to access these centers. The ICRC was unable to cover transportation costs for additional patients due to logistical constraints.[35] Fifty-three personnel received technical support from the ICRC to develop their capacity to provide rehabilitative care, and students from Benghazi, Misrata, and Tripoli received an ICRC scholarship to study prosthetics and orthotics.[36] In 2018, the ICRC-supported centers delivered 38 prostheses to mine/ERW survivors.[37]

Socio-economic and psychosocial inclusion

The psychological and psychosocial sector is a neglected sector in Libya. Psychosocial service providers were scarce.[38] There was no official budget for mental healthcare. Health professionals identified psychosocial support training as a priority for capacity building. Strong stigma toward psychosocial disabilities and their treatment prevented some war-injured persons from accessing psychosocial support and mental healthcare.[39] Mental health services were available in only eight districts across Libya.[40] With its NGO partner PSS Team, HI continued to provide home-based psychosocial support to persons with disabilities, people with injuries and caregivers, and referral to specialized mental health and psychosocial support services.[41]

Cross-cutting

HI trained Community Focal Points to identify internally displaced persons with disabilities or persons in need of psychosocial support.[42]

While there was a good safety net for vulnerable people in Libya, including persons with disabilities and mine/ERW survivors, it did not apply to foreigners, including migrants.[43]

Survivor assistance providers and activities