The Libyan authorities and militias in control of southern cities and towns and international donors must ensure that those most marginalized are factored into their emergency public health response to the spread of COVID-19, Amnesty International said today.
Libya’s public health system has been undermined by years of armed conflict and insecurity including attacks on medical facilities, the exodus of qualified medical personnel and frequent militia interference in the provision of medical services. In addition to these general risks, pre-existing discrimination against ethnic minority groups such as the Tabu and Tuareg create additional barriers to their access to healthcare.
“Fears of the spread of COVID-19 in southern Libya expose the vulnerable circumstances of minority communities who have long struggled to enjoy equal access to health care. Owing to years of armed conflict, insecurity and neglect, the Libyan south as a whole is woefully unprepared for the pandemic, as it lacks adequate testing facilities, protective equipment and qualified health workers. The situation of minorities is of particular concern, as they face additional hurdles in accessing the two largest and best equipped hospitals in the area.” Said Diana Eltahawy, MENA Deputy Regional Director.
“We call on the Libyan authorities and militias in effective control to ensure that all people have equal access to health care regardless of race, nationality or ethnic origin. All parties to the conflict are obliged, under international humanitarian law, to treat the sick and wounded, without discrimination or distinction other than on medical grounds.”
The organisation spoke to medical professionals, activists and journalists across the Libyan south.
Since Libya reported its first COVID-19 case on 24 March, the figures have grown to 48 confirmed cases and one death. There are no testing facilities in the southern Libya, and samples from suspected cases so far would have to be collected in designated public hospitals and sent to either Tripoli or Benghazi for testing. According to medical sources and news reports in Sebha, promises by the Tripoli-based Ministry of Health to provide testing equipment in Sabha have yet to materialize.
Fears of violence limit access to healthcare
Many cities and towns in the south of Libya have been historically segregated on the basis of tribal affiliation and ethnicity. The sporadic flaring of hostilities between different tribal militia groups hinders the movement of people in this area, affecting people’s access to health care when hospitals are in areas controlled by rival groups.
For example, in Sabha, the largest city in southwestern Libya, Tabu residents told Amnesty International they avoid the main hospital, which is in a part of the city controlled predominantly by the rival Arab Awlad Sliman tribe. Credible sources told Amnesty International of incidents reported in previous years of Tabu men including patients at Sabha’s main hospital facing physical attacks, abductions and even killings. Sabha residents explained that fear of violence drives Tabu men in particular to go to a smaller underequipped hospital in Murzuq, a predominantly Tabu town 180 kms away, for treatment, instead of going to Sabha’s main hospital.
In Murzuq, two medical sources told Amnesty International that only four ventilators were available, with no one trained to use them, as well as a shortage of personal protective medical gear for health workers.
In the southeastern city of Kufra the main medical facilities, themselves inadequately equipped to deal with the COVID-19 pandemic, are in an area controlled by the Arab Zwai tribe. The clinics controlled by the Tabu are more poorly equipped and unprepared to deal with the virus outbreak. Tabu residents in the city told Amnesty International that they refrained from going to the main medical facilities located in areas controlled by the Zwai tribe as they fear violence and instead have to rely on a smaller clinic in the Tabu-controlled area of the city.
Lack of documentation
Some members of the Tabu and Touareg communities face additional barriers in accessing health care as they do not possess identity documents or family identity booklets to prove Libyan citizenship, necessary to access the free public health system. The lack of documentation has also had serious economic consequences, and many cannot afford to privately pay for medical expenses. Neither the internationally recognized Government of National Accord based in Tripoli, nor the self-styled Libyan National Army in control of eastern Libya and parts of the south have announced any measures to guarantee access to the public health care system for members of the Touareg and Tabu communities without identity documents.
Members of both communities are also potentially more vulnerable to adverse impacts in case there is an outbreak of COVID-19, as they live in impoverished and densely populated neighborhoods such as Taouiri in Sabha, where social distancing is essentially impossible.
Furthermore, Amnesty International calls upon the international community and donors providing assistance for Libyan public health services to take into account the specific obstacles faced by the Tabu and Tuareg communities, including those who lack Libyan identity documents, in accessing medical services in the south.
The Tabu are an ethnic minority who live in areas of Sudan, Niger, Chad and the south of Libya. Some Tabu people reported being denied documentation proving Libyan citizenship during Mu’ammar al-Gaddafi’s rule and have also been subjected to forced evictions, arbitrary arrest and detentions. Since 2012, localized armed conflicts have erupted between Tabus and Arab tribes in many southern cities.
The Tuareg are an ethnic minority group living in the southwest of Libya, as well as Mali, Niger, Chad and Algeria. Some report facing obstacles in proving Libyan citizenship, which has created barriers for them in accessing education, health and jobs.