Jean-Guy Vataux, head of mission in Libya, explains how MSF is providing assistance to migrants, refugees and asylum seekers. Most of them have been robbed, taken under the control of criminal networks, abused, jailed, beaten up or tortured. Some have died.  Since July 2016, MSF has provided lifesaving and primary healthcare to refugees and migrants detained in Tripoli. A  new project opened in early 2017 to find ways to assist migrants, refugees and asylum-seekers in the Misrata area. These activities are now expanding.

MSF provides medical and humanitarian aid inside detention centres in Misrata.  How is it going?  What is the situation there?

In and around Misrata, the teams started activities few months ago in three detention centres, formally under the authority of the Directorate for Combatting Illegal Migration (DCIM).

The number of detainees varies from one week to the next. They have been stopped at sea by the Libyan coast guards or arrested in towns, at checkpoints, etc. Some arrive here after being transferred from other detention centres in Tripoli. We have also met people who have lived and worked in Libya for years. A migrant who moved to Libya with his family can be jailed simply because he tested positive for hepatitis C.

In the detention centres, the majority of health issues affecting the patients are directly linked to the conditions there and the violence that marked their journey: skin diseases, scabies, diarrhoea, respiratory infections, muscular pain, wounds, but also psychosomatic disorders. MSF provides referrals to secondary and specialised care for those who need it, such as patients with fractures, and distributions hygiene and relief items.

While it is possible to marginally improve detention conditions, let us not lose sight of the core issue: people are jailed, theoretically awaiting expulsion, following an opaque process that denies them their basic rights.

According to the International Organization for Migration (IOM), around 7,100 people are detained in the 27 detention centres officially operated by the DCIM, mostly in Tripoli. What about other migrants, refugees and asylum seekers in the country? Can you tell us more about them?

The IOM identified over 380,000 migrants currently in Libya. People held in detention centres under the authority of the DCIM only account for a relatively small proportion of the total migrant and refugee population in Libya.

Some came to work in Libya, which once was an economic Eldorado for nationals from neighbouring countries.  Others work to try secure funding for the Mediterranean crossing, working under conditions that fall within the scope of forced labour, and spending time in detention. Some  are just beginning their journey across Libya.

The journey through the Libyan desert and time spent in the “unofficial” centres – the connection houses and warehouses run by criminal networks – are described as excruciating experiences by those who survived. This remains a blind spot for us.

In 2016, around 5,000 people drowned in the Mediterranean, and in 2017 the toll is already estimated at 2,000 people as of June. But how many die before reaching the coast and embarking on boats?  

What is MSF trying to do to assist them?

This month, we opened an outpatient clinic in Misrata town to reach out to migrants and refugees who live and work here under various conditions. In addition to providing them with free and confidential healthcare, we want to better understand their challenges. The respect of medical confidentiality is key in such contexts, where developing certain diseases can be grounds for detention and expulsion.

Then there is the question of how to help people in the worst moments of their migration journey.  So far, we do not have an answer. We continue to attempt to negotiate access to people on the road to the coastal cities. We will see what kind of working space we are able to negotiate or not. The risk of failure is significant.  We certainly need to develop other operational methods. Our team regularly goes south of Misrata, where the corpses of those who are referred to as “migrants” are taken to the local morgue. There are reportedly around ten corpses a week.