Libya: “We were able to make their time in that horrible place at least slightly better.”

20 Mar 2019

Australian nurse Jai Defranciscis, recently returned from an assignment as Nursing Activity Manager in Misrata, Libya, where Médecins Sans Frontières (MSF) is providing care for migrants, refugees and asylum seekers facing arbitrary detention and extreme suffering. She recalls her experience. 


Australian nurse Jai in Libya. © MSF

“It was completely heartbreaking to see people caged up in the detention centres, standing behind bars. Their eyes were empty. Yet when I spoke to them, every single person had a story. There were child soldiers escaping a horrific life for a new beginning; people longing for an education or more opportunity for their family. They would say to me, “I’ve done nothing wrong – why am I in a prison?”

In Libya, MSF is providing emergency assistance and medical care to migrants, refugees and asylum seekers who are caught in a cycle of violence and exploitation. We have two mobile teams working across four detention centres in Misrata, Khoms and Zliten, located to the east of Tripoli, to deliver basic healthcare to people held in centres under the authority of the Directorate for Combatting Illegal Migration.

They would say to me, “I’ve done nothing wrong – why am I in a prison?”

We also have an outpatient clinic in Misrata. In Bani Walid, a region where the kidnapping of migrants and refugees and the use of torture for ransom are widespread, we regularly provide medical consultations in a compound for people who are released or escape from the illegal prisons run by traffickers. The patients there have often endured horrific torture and require ongoing care. We organise medical referrals to clinics and hospitals for the most severe cases.

The living conditions I saw in the official detention centres are shocking. We mainly treat skin conditions like scabies, respiratory tract infections and gastrointestinal problems, linked to unhygienic living conditions, overcrowding and an exceptionally poor diet. We also have patients with old injuries from torture and wounds that have worsened due to a lack of treatment.


A mother with her two children in a Libyan detention centre. “People are afraid here. There is no freedom for us. My boy was born in prison,” she says. © Sara Creta/MSF

Many people are mentally broken and traumatised by what they have experienced, and by being held in detention indefinitely. You might assume that people arrive in Libya quite sick from fleeing their home countries but in reality, most of the physical health issues affecting people are directly caused by the horrific abuse and living conditions they are subjected to in Libya.


Endless cycle of suffering

On several occasions during my time working in Libya, our team was able to access disembarkation points, where we met people who were brought back by the Libyan coastguard after attempting to escape Libya by boat. We assessed their needs and handed out hygiene kits, which contain shoes, underwear, towels, washing detergent, toiletries, and feminine hygiene products for women.

"I became aware of the devastating cycle within which migrants, refugees and asylum seekers became endlessly trapped between the sea and detention"

We provided emergency medical care, which often included treating chemical fuel burns, generalised body pain, respiratory tract infections, dehydration, nausea and vomiting (from sea sickness), hypothermia and inhalation of water. We then referred serious or complicated cases to the hospital. The remainder of the people were taken to detention centres by the authorities.

In Libya, I became aware of the devastating cycle within which migrants, refugees and asylum seekers became endlessly trapped between the sea and detention. I started to see the same people turning up in the boats at disembarkations. As soon as they were brought ashore, people were trying to organise the next boat out.


A survivor of a shipwreck off the coast of Libya is treated by medical staff after being transferred to a detention centre. © Sara Creta/MSF

“They had disappeared in the night”

There was one patient, a little girl of around eight years old, who was among a group of people I met at a disembarkation point. I told her that when I visited the detention centre her family would be assigned to, I’d bring her some shoes that were her size. When I arrived, she came skipping through the yard to meet me – when I noticed her mother standing behind her with their belongings.

I looked around and there were 20 people, all grabbing belongings and walking to waiting cars. The girl said, “We’re going to live in a house in Tripoli!” I had no clue where they were going - possibly to be better off than held indefinitely in a detention centre. I clung to that idea even though there is also a risk of forced labour and human trafficking. This was a common occurrence, and it was happening to everyone – men, pregnant women and babies.

"We would attend a detention centre one day, and the next day people were missing. They had disappeared in the night."

I knew their names and I knew their faces; I’d built up a relationship with these people as we had cared for them over time. We would attend a detention centre one day, and the next day people were missing. They had disappeared in the night. Some people would say, “Please send me to a hospital, because I don’t think I’ll be here tomorrow if you don’t.”

It is an ongoing challenge for us to reach people who need our care in Libya; there are so many blind spots. We need to constantly negotiate with the authorities to maintain access to the detention centres. Sometimes, the guards have concealed patients by only bringing certain people to the consultation rooms for us to treat. The follow-up of patients is extremely difficult when we can’t trace where they have been moved. 

If MSF wasn’t in Libya providing care, many of these people would likely have no access to medical treatment. We can’t free people from detention. But being there and treating someone for a severe wound or a chest infection, and listening to their story, I could see that we’d at least done something to help that individual in this awful situation. It’s also our responsibility to share these stories, to expose this terrible cycle of violence that the European countries are deliberately feeding in the name of managing migration.”