What is the situation like right now?

What we’re dealing with at the moment are health facilities in Tripoli that were already stretched even before the clashes erupted this week. Hospitals had shortages of personnel, due to the fact that many foreign medical staff who worked in the health system had already fled Libya. And hospitals had shortages of medical supplies because of the sanctions imposed on the country. The health system was already struggling to deal with the wounded coming from the frontline outside of Tripoli.

For the last three weeks, medical staff have been focusing almost exclusively on emergency cases and just haven’t been able to deal with any other medical problem the population has faced such as chronic diseases, emergency C-sections, and other medical conditions. The care really just hasn’t been available. When you add this to the clashes and fighting that’s broken out this week in Tripoli — and it has been extremely intense in some parts of the city — then you have a situation where already overstretched hospitals are trying to cope with the influx of wounded, and they just don’t have the support they need in terms of personnel or supplies.

What is the situation like in the hospitals you have been able to assess?

Almost all of the hospitals around the city are receiving wounded, but some of the hospitals have not been accessible due to the fighting, which means that other hospitals have an added burden. Now that the city is beginning to calm down a little bit, the hospitals are beginning to deal with the patients who weren’t able to reach them before. That’s not only the recently wounded, but it’s also the injured who have been too afraid to travel by road, along with other emergency cases.

The hospitals that I’ve visited since the clashes started are often quite chaotic scenes with many doctors and nurses unable to reach the hospital because either they live in areas that are still not secure or they can’t travel through the city from one side to another. There’s a shortage of health workers inside the facilities, but there is a huge number of people who are responding as volunteers and who are going to the hospitals to try and support and assist where they can. But this is creating quite a chaotic environment.

The hospitals that I’ve been to have been full of wounded – gunshot wounded – in the emergency departments as well as the other wards. In one health facility that I visited, they had converted some houses next to the clinic into an inpatient department. For example, in the one house I went into, patients were lying on the floor, lying on the desks that were left inside the house and had been converted into a makeshift ward for patients to stay. But because of the shortage of staff, there was no nursing staff and the patients were essentially caring for themselves. In another facility, I saw wounded people waiting outside the hospital to get into the emergency room.

Are there other obstacles to providing aid beyond the fighting?

The problem that’s facing ambulances is that there’s a massive fuel shortage in Tripoli. The fuel is not able to come in yet across from Tunisia. This is a big concern because electricity is very sporadic, so generators are being used to run hospitals, but hospitals have quite limited reserves of fuel.

How is MSF responding to the situation?

The medical situation requires a very quick response, which is why we’re bringing in additional teams and supplies. More staff arrived with supplies and more will come tomorrow. We will start supporting health facilities immediately. There are still clashes happening in parts of the city today and this will definitely have an impact on the medical needs.

The health facilities are stretched, but by no means are they completely collapsed or not functioning at all. Health workers are treating the injured, they are responding to the needs of their community, but they are, of course, facing massive challenges. It’s not a matter of competence or willingness. It’s a matter of needing the support to be able to better address the very urgent and overwhelming needs they’re faced with.

Has there been any let up in the intensity of the fighting?

Now it’s quieter. Three days ago I wouldn’t have been able to talk to you on the phone because of the constant gunfire and shelling outside. Today the fact that I can speak to you without hiding behind a wall is progress.

But it’s such a fluid situation, such a rapidly evolving situation. It’s been four days now and I can’t begin to explain the changes I’ve seen in Tripoli. It’s been extremely quick, the way in which the violence erupted within Tripoli and the way in which the city is now changing. We have to remain extremely vigilant in how things develop in the coming days.

In one of the hospitals that we haven’t been able to access because of ongoing fighting, we’ve heard of a critical situation with patients who are unable to be seen by medical staff because they can’t reach the hospital, because of fighting happening in the areas around it. It is absolutely essential in the coming days that all hospitals need to be accessible to patients. Health workers must be allowed to reach medical facilities and the sanctity of these structures must be respected by combatants on all sides of the fighting.