Three months into the conflict, the frontlines and areas of control around Tripoli City have remained largely the same for the last 10 weeks, although there is still consistent and heavy fighting in the city. A political breakthrough between the conflict parties in the next month appears to be highly unlikely.
Casualties and displacement: Since clashes erupted, the World Health Organization had reported 910 deaths, including 50 civilians, on 2 July. With approximately 60 dead and 70 wounded, the airstrike on the Tajoura detention centre at midnight the same day more than doubled the civilian death toll, putting it at over 100 dead in 3 months of conflict. More than 104,875 people have been forced to flee from their homes in the conflict-affected area, according to the International Organization for Migration. Most displaced households are staying with family and in private accommodation in Tripoli and surrounding areas.
Health Workers & Facilities Targeted:
Since the onset of the Tripoli conflict, 19 ambulances have been struck, six health workers have been killed and 12 others have been wounded. Four health facilities have been hit by airstrikes or shelling and two of them had to be fully evacuated (WHO).
(Source IOM – Last updated 27 June 2019)
Refugees and Migrants
Other Relevant Data
In the Crossfire: many detention centres in Tripoli continue to be located in or near the conflict area. Some DCs are in militarized areas or near military compounds, meaning there's an even higher likelihood they will be targeted or hit, killing or severely wounding the refugees and migrants who are trapped within. Despite numerous calls for an immediate evacuation of migrants caught in the crossfire, on July 3, an airstrike on Tajoura detention centre housing almost 600 people, has killed an estimated 60 vulnerable refugees and migrants trapped inside and injured approximately 70.
- 26 June: despite MSF calls to evacuate them from Gharyan, a heavily militarized town located 90km south of Tripoli, dozens of refugees in fragile health status had remained detained when fighting (including air strikes) took place as GNA forces recaptured the town from LNA forces. Detainees were terrified for their lives, with nowhere to go in the middle of the battle. One week after (4 July), they were all eventually relocated to Tripoli: 8 referred to hospital by MSF and 21 referred to an NGO-run shelters program.
- 23 May: airstrikes continue to consistently target areas near Sabaa detention centre.
- 7 May: airstrikes directly hit the Tajoura detention centre compound in Tripoli, a mere 80 metres from where refugee and migrant women were trapped. Shrapnel from the blast tore through the roof of the women’s hanger and nearly hit an infant. See ‘MSF Response’ section for more details.
- 23 April: reports surfaced of a violent incident in the Qasr Bin Gashir DC, where over 700 unarmed men, women and children were trapped. An analysis of existing photographic and video evidence by MSF medical doctors concluded that injuries shown are consistent with gunshot wounds. (See 26 April PR).
- 16 April: shelling hit areas near the Abu Salim detention centre.
- Ain Zara and Qasr Bin Ghashir detention centres were on the front lines of the fighting during the first month of the conflict but have subsequently closed. Several other detention centres remain dangerously close to the front lines.
Dependent on Assistance: People in detention remain completely dependent on the limited basic services such as food, water, and medical services provided by authorities or the humanitarian actors that manage to reach them.
Access Challenges: The fighting has exacerbated the significant challenges for medical and humanitarian actors seeking to provide much-needed assistance in detention centres. For more than two weeks in early April for example, MSF was unable to reach over 700 people trapped in the Qasr Bin Ghashir DC located on the other side of the frontlines. It wasn’t until after a violent shooting at this centre that people were relocated away from the immediate vicinity of the fighting.
Food and water are major concerns in detention centres throughout the city. MSF has seen that the provision of food for refugees and migrants in detention has been significantly disrupted during the fighting. Some report not having eaten for several days.
Mental Health: The fighting and the surge in the numbers of people disembarked in Libya after being intercepted at sea has had a further detrimental impact on the mental health of people in detention. MSF teams are observing a heightened sense of anxiety, fear and desperation among many patients in detention. Interceptions at sea are resulting in physical and psychological traumas which are creating overwhelming demands for psychological first aid. This is made all the more severe by the fact that their future is uncertain, more expressions of despair and even suicidal ideation is becoming more commonplace.
Escape Attempts (Misrata + Tripoli DCs): The level of despair and protracted detention conditions is so unbearable that people in detention resort to desperate acts, including by attempting to escape at any cost. An attempted break out reportedly occurred on 7 May in Misrata DC, involving shootings to prevent it. Dozens of people managed to escape and others were injured as a result. On June 16 in Sabaa detention centre, there was a large-scale breakout of detainees that recently had been intercepted and returned to Libya by the Libyan Coast Guard. External sources reported another shooting occurring on 24 June to prevent a group of over 100 migrants and refugees intercepted at sea and disembarked to Khoms to escape during their transfer from disembarkation point to a detention centre.
DCs Reopening due to Influx of New Arrivals: In Khoms area, a detention centre that was shut down just four months ago by Libyan authorities (Directorate for Combatting Illegal Migration – DCIM) due to severe protection concerns were reopened beginning of May. On May 6th, there were 266 people detained in this facility. On May 19, only 36. While some people are possibly better off outside than held indefinitely in a detention centre, the risk that people disappearing with no trace from detention centres are subjected to trafficking, forced labour and sexual exploitation is also very real and documented. On June 30, the remaining 19 people in the facility were relocated by UNHCR to its GDF centre in Tripoli. Another DC in Khoms (referred to as Khoms Souq Al Khamis) remains in activity and officially under the authority of the DCIM.
Transfers between detention centres:
- Ain Zara & Sabaa: The refugees and migrants in the Ain Zara DC were relocated after over a week of being near or in the immediate conflict area. Following relocation by UNHCR and an additional transfer to Sabaa DC, Ain Zara detention centre is now believed to be empty. With the new arrivals, the population size in Sabaa has surged to nearly 500 people, exacerbating already poor conditions and services.
- Qasr Bin Ghashir: In the days after the incident in QBG DC, the population remaining in the DC were transferred to Zawiyah detention centre, just to the West of Tripoli.
- Zintan DC: Many refugees in Zintan DC, where MSF started to intervene end of May, were previously held in Tripoli DCs and got transferred there due to fighting in the capital in August 2018. They were further from the frontline, but left out of sight, with virtually no assistance. Between September 2018 and May 2019, at least 22 people died in detention in Zintan and Gharyan, mostly from tuberculosis.
- Relocation or transfer from one DC to another further from the fighting is an absolute last resort, but it is clearly not a solution. The only solution is to evacuate people trapped in detention out of Libya.
Since the onset of the fighting, MSF teams have remained on the ground responding to medical needs for refugees and migrants trapped in DCs as well as the displaced population. We are monitoring the larger context and humanitarian needs and are standing by to provide additional support to the conflict-affected population if and when needed.
- In Tripoli DCs: We are providing primary healthcare consultations, mental health support, and emergency food, water, and medical referral services for refugees and migrants in detention. In 2018 we have treated 164 patients with drugs sensitive tuberculosis in detention centres in Tripoli and we recently started treatment for two patients with drug-resistant tuberculosis.
- Outside DCs: In Tripoli, MSF medical teams have also provided hygiene kits in several shelters for displaced families that had to flee their homes, as well as a donation of war wounded kits (sutures, dressings) and essential medication to three hospitals so far, two in Tripoli and another south of the city. In Bani Walid, MSF continues to provide medical care to survivors of trafficking and torture and maternal care for both Libyan and foreign women. In Misrata, outpatient consultations in town and support to MoH TB clinic continue as usual.
- Outside Tripoli: While we keep monitoring context, MSF activities continue in the rest of the country. Our teams are providing assistance to approximately 1,080 people arbitrarily detained in Khoms, Zliten, and Misrata, among the people with international protection needs who have spent up to a year stuck in a detention centre. MSF also continues to carry out medical consultations in Bani Walid.
- End of May, MSF got access to two DC (Zintan and Gharyan) located south of Tripoli in the Nafusa mountains. The medical situation found by our teams was catastrophic. At least 22 people died there from tuberculosis and other diseases since September 2018. We now have a team based in Zintan to provide assistance (medical consultations, referrals, WASH and food) to some 600 detainees. On July 4, the 29 refugees detained in Gharyan DC was transferred to Tripoli (healthcare facility or NGO-shelter program) and the DC is now empty (as of 5 July).
Tajoura – 7 May Airstrike
On the night of 7 May, airstrikes directly hit the Tajoura detention centre compound in Tripoli, a mere 80 metres from where refugee and migrant women were trapped. Shrapnel from the blast tore through the roof of the women’s hanger and nearly hit an infant. MSF visited the following day (8 May) to provide what mental health support we could to women and children present during the strike. Many were frightened of further attacks and unable to sleep.
- Tajoura – 3 July Airstrike
- Tajoura detention centre is one of the DCs in Tripoli where MSF has regular medical and mental health activities. On the day of the attack, it housed nearly 600 detained refugees and migrants, including women and children.
- On July 2, the date of the airstrike on Tajoura detention centre, MSF had just returned from an intervention in the centre when it received emergency calls. MSF immediately deployed ambulances and medical staff. Dozens of injured were initially transferred by Libyan Ministry of Health and the Libya Red Crescent to different hospitals and clinics in Tripoli. MSF medical teams have been following up with those hospitals that have been receiving the wounded with offers of support and we have referred some of those patients to private hospitals for further care.
- On Wednesday, July 3, the team went back to Tajoura detention centre where they provided food and water to a large group of the people who survived the attack but were obviously extremely distressed by the incident that happened there. The team provided medical consultations and psychological support to survivors.
- On Thursday, July 4, the teams returned to Tajoura to provide medical and psychological support. The survivors of the attack had spent the night in the open as they were afraid of another strike. The medical team provided 54 medical consultations mainly for musculoskeletal pains and wound dressing. The mental health team did 10 individual counselling sessions and gave psychological first aid to 35 people.
- UNHCR and IOM is in Tajoura registering people. The total population is now 359.