Women’s Health Care in Libya: Strengthening a Health System Destabilized by Conflict

In June 2016, Doctors Without Borders/Médecins Sans Frontières (MSF) OBGYN Dr. Tane Luna traveled to northeasetern Libya to work in the maternity department of Al Marj General Hospital, near Benghazi. Here she describes a hospital system seriously affected by the conflict and political crisis that has engulfed the country for three years and forced hundreds of foreign health workers to flee.

"Since the Libyan revolution in 2011 the country has been experiencing great instability, and hundreds of foreign health workers who contributed a large part of the care and upkeep of Libyan hospitals have fled, leaving the health system in crisis,” says Dr. Luna. “It is hard to imagine what it was like before [with] the buildings intact and a certain level of equipment available. Now we are facing a really destabilized health system."

The Al Marj hospital where she worked serves a population of 400,000 in an area that has so far been spared from the fighting between different armed factions that continues in Benghazi. Up to 2011, partnerships with international organizations guaranteed the hospital a full complement of staff, support for training, and medical equipment. But with the loss of that external assistance the situation has become very difficult.

A Willing Staff with Limited Access

With a fluctuating workforce, insufficient trained personnel, inoperable medical equipment—due to the lack of spare parts or technicians to repair them—and significant problems with hygiene and upkeep, Al Marj Hospital struggles to provide a high level of quality care to thousands of Libyan women. Nonetheless, each month the medical team assists nearly 900 deliveries, including about 150 Caesarean sections. This considerable proportion of Caesareans is common in hospitals in major cities across Libya, but poses a problem when women have multiple births. This is because repeated Caesareans increase the risk of uterine rupture in the subsequent pregnancy, a risk that can only be managed with quality medical care.

“The Al Marj staff are dedicated and willing,” says Dr. Luna. “I had a very good relationship with the young doctors and the nurses,but for years they have had no training or supervision. They have also had little or no access to specific modules of training in obstetrics, and their workflow is generally not well-organized. There is no established patient circuit, for example.  They are also missing spare parts for their equipment. So the autoclave [a steam sterilizer machine] can only be used for sterilization when it is full to limit its usage. Meanwhile, the entry doors to the surgical ward broke, but were not repaired. This makes it difficult to control access by family and other people to an area that should be off limits due to the risk of contamination."

The MSF team—seven international staff, five of them medical—has worked alongside their Libyan colleagues since 2015, supporting the hospital with training and donations of equipment and medical supplies, in addition to MSF’s financial support for running the hospital. Each hospital department is being addressed one by one.

"We give training on hygiene [and] facility maintenance; on cleaning, from staff uniforms to bedding to surgical areas,” says Dr. Luna. “I was able to share my obstetric skills with the young staff and perform complex surgical operations, and ensure they would be followed through with the placement of another obstetrician-gynecologist for three months. But it is a very demanding program for MSF, involving change management, and we particularly need to bolster the team to be able to support the full breadth of our work there, while also up-skilling the young Libyan professionals to be able to replace the international staff. This is the first time I have experienced such a project, very demanding, in a complex environment, and undertaking European-level obstetrics. But it was also a great experience, although I would have liked to chat with more patients, but few of them spoke English and I don’t speak Arabic.”