How is the overall situation in Derna now? 

We can still see that people are profoundly affected by the disaster. Many people have lost their homes or family members – often both. Almost everyone in the city is mourning and in pain at the moment. 

Two weeks after the floods, the retrieval of bodies under the rubble is not a priority anymore, while some bodies are still being recovered at sea. According to the search and rescue teams, the stream will continue to bring corpses in the coming weeks.

What was most striking when we arrived in Derna was the scale of the destruction. While the flooding was devastating, it was really the destruction of the two dams on the night of 10 September, while everyone was sleeping, that destroyed the centre of the city and took everything and everyone away within a few hours. 

As a consequence of this massive flooding, there were relatively few people with wounds or trauma, but sadly, a high number of deceased.

Now the authorities are focusing on rebuilding a bridge between the eastern and western part of Derna, as the city has been literally split in two. Their main priority is to make sure that everyone who has been traumatised or lost everything due to the floods is now receiving mental health support.

Has MSF been supporting health structures?

In terms of healthcare, the hospital system is not overwhelmed. There has only been a limited increase in the number of patients related to the disaster itself. The hospital system is coping well despite the situation and field hospitals set up by foreign governments were operational a few days after the storm.

Basic healthcare structures have been particularly impacted by the disaster: some general healthcare centres have been destroyed by the floods, and many medical and paramedical staff have either died in the flooding or are now mourning relatives or colleagues among the victims. Some basic healthcare centres are being supported by volunteers who have come from all over Libya to help. 

Two weeks in, we can see that a lot of health personnel are still missing or in the process of mourning, and the volunteers who came to help in the first days are starting to leave.

Since 20 September, our teams have been supporting two general healthcare centres. To date, our doctors have already conducted 537 consultations in Embokh and Salem Sassi Primary Health Care Centers, and Oum Al Qura school shelter. 

The consultations have mainly been for non-communicable diseases (diabetes, hypertension) for adults, and respiratory infections and diarrhoea for children. Many patients seen by our doctors were still in shock, some showing signs of psychological trauma. Some children refuse to drink water for fear of drowning. 

Patients complained of flashbacks and being unable to sleep between 2.30 am to 5 am – the precise time the deadly wave engulfed the city.

What kind of support can MSF bring to these invisible wounds? 

Our team of psychologists has been able to start providing mental health services to two priority groups among people in Derna: those who have lost everything and are now living in temporary shelters; and medical or paramedical staff and volunteers working in healthcare facilities. 

People in the latter group have sometimes lost relatives, colleagues, and friends, and on top of that, they are working on the frontlines, providing care to those who survived or even helping to evacuate dead bodies, which can be a traumatic experience. 

In that context, we have been putting all our efforts toward our mental health activities, including individual consultations and focus groups in shelters, and in the two general healthcare centres that we are supporting. We are planning to scale up our activities to offer mental health support to anyone who needs it.

Are the teams facing challenges? 

While our staff were only able to arrive in Derna three days after the disaster, flying from western Libya where we run regular projects, we remain limited by the issuance of visas for international staff. This can sometimes be a long process and could limit our capacity to scale up our activities. 

However, our collaboration with the authorities and with locally hired teams has been very good. We'll see in the coming days how medical structures are going to be organised and review our setup according to the needs and its added value.