Australian psychologist Dr Trudy Rosenwald spent six months working with refugees and migrants in Libya. In a country where some of the world’s most vulnerable people are subjected to horrific violence and abuse, Médecins Sans Frontières/Doctors Without Borders (MSF) sees mental healthcare as an essential part of our work.
On arrival to Libya, I quickly gained insight into the mental health team’s daily work by joining them on visits to five detention centres and three private health clinics in and around the capital, Tripoli.
In each of the detention centres, I saw vulnerable people kept in overcrowded and unhygienic caged facilities. They were separated from their families and loved ones, and told us stories of unspeakable abuse and trauma.
I was quickly struck by the similarities between what I observed in these centres and what I had witnessed while working with another organisation from 2015 to 2016 in Australia’s offshore processing centres, in Nauru and on Manus Island. In Libya, like in the Pacific, I saw vulnerable people contained indefinitely and deprived of the basic means to live a safe, healthy and meaningful life.
“The artworks and notes included heartbreaking pleas for freedom and a safe place, messages of hope and despair, and goodbye letters to family.”
“I was held underground for a long time"
During my time in Libya I heard many people’s stories.
One patient recounted: “I was held in an underground cell for a long time and regularly beaten all over my body with a metal bar. I was given a mobile to call my family and tell them to send money to accounts in Egypt. When there was no more money coming in, I was sold to another gang.”
Another patient recalled abuse: “I was locked in a dark cell and electrocuted on my genitals and under my feet. I gave them all my money and begged them to stop, but they continued to torture me to get money from my family.”
Psychological support is an important part of our medical and humanitarian assistance for people like these patients. Through mental healthcare, we aim to support those who have suffered horrific experiences either in their home country, along their journey, or on arrival in Libya.
My colleagues and I found that many people who had already suffered so much continued to be traumatised while held in detention centres and clandestine prisons and warehouses in Libya. Some people had attempted to escape the country by boat, only to be sent back and trapped in an endless cycle of violence and horrendous living conditions.
We ran daily psychotherapeutic sessions for individuals and small groups in the detention centres and clinics. In these sessions, patients expressed growing feelings of helplessness, hopelessness and desperation. We often saw people with post-traumatic stress symptoms, as well as suicidal ideation and attempted suicides.
A lifeline of notebooks and pens
In addition to the appalling living conditions, one of the most destructive features of the detention system I witnessed was the absence of any meaningful activities for the detainees. Our teams ran psychosocial activities – including physical exercise and health and hygiene promotion talks – to provide people with some temporary relief from their environment.
We also delivered items such as books, dictionaries and educational material in various languages, for adults and children in the centres. Learning English was high on the list for many people. But notebooks and pens were the most sought-after materials.
Something that really affected me emotionally was seeing the hundreds of messages and drawings people made and posted on the inside of the cell walls in one detention centre. The artworks and notes included heartbreaking pleas for freedom and a safe place, messages of hope and despair, and goodbye letters to family. They also spoke of their appreciation for MSF and our staff for our support each week
“We continued to work via remote electronic communication with a skeleton team of Libyan staff, who did a fantastic job despite the risks to themselves and their families.”
The conflict in Tripoli that escalated in April 2019 is still ongoing, meaning refugees and migrants remain in danger of the indiscriminate shelling, gunfire and airstrikes that regularly hit the city and its surrounds. More than 200 civilians have been killed in Libya since April 2019, and last July, an airstrike on the Tajoura detention centre in Tripoli killed 53 people trapped inside.
While I was in Libya, in September 2018 MSF’s international staff had to be evacuated from Tripoli due to the outbreak of conflict. For a few weeks we continued to work via remote electronic communication with a skeleton team of Libyan staff, who did a fantastic job despite the risks to themselves and their families. They continued to provide medical and mental healthcare, water and sanitation and other support services for our patients.
The international staff could return to Tripoli soon after, where MSF has been operating uninterruptedly, providing medical and humanitarian assistance to the most vulnerable.
Looking back on my assignment in Libya, it was extremely challenging to see firsthand the unimaginable suffering of so many men, women and children. My principal way of coping each day was to do my best to support my patients.
Now, in 2020, our teams continue to witness the desperate situation of thousands of people who have been left with little hope. MSF reiterates its call for an immediate end to the arbitrary detention of migrants and refugees in Libya.
In Libya, there are between 3,000 and 5,000 migrants and refugees held in ‘official’ detention centres, nominally under the authority of the Libyan Ministry of the Interior based in Tripoli and its agency in charge of combating illegal immigration, the DCIM. The majority are registered with UNHCR and are seeking asylum. An unknown number of people are being held captive across the country in clandestine prisons and warehouses by smugglers and traffickers, who use torture and abuse to extort money from them.
MSF has been providing healthcare for migrants and refugees in Libya since 2017.