Part I: This is the first installment in a series of NCUSLR Founding President Dr. Hani Shennib's personal reflections while delivering medical assistance in Libya.
At the enormous three-tower Benghazi Medical Center, I took off my stethoscope to examine what I expected to be the last of 52 patients I saw that day. I looked out the window and then at my watch. It was getting darker, minutes closer to 8 o’clock at night, and patients are still being brought into the examination area. Many had been in line since 7 o’clock in the morning hoping to get an expert opinion. Adults and children with cardiovascular diseases awaiting critical treatment not available to them in Libya came after hearing about our Surgical Team’s Medical Mission to eastern Libya.
Cyrenaica, the eastern region of Libya that is the size of France, Spain and Italy together, is under the control of Marshal Haftar’s Libyan National Army and supposedly a temporary government by decree of Libya’s House of Representatives in 2014. The problem with this authority is that the UN and the international community have chose not to accept it, and alternatively they recognize a governmental authority in Tripoli. To complicate things further, Libyans from all walks of life, including its parliament, refuse to recognize UN-appointed Prime Minister Fayez Serraj or his internationally-supported government body in the West, the Government of National Accord. All of the East and many parts of the West and South of Libya who refuse to accept Serraj are punished by interruptions in their salary schedules and state funding distribution for public services - including funds that support vital programs such as health care.
Benghazi sustained enormous infrastructure damage during the war and will need international assistance to recover.
To make things worse, war broke out between Haftar’s Libyan National Army and Benghazi Shura Council forces devastating the infrastructure of Benghazi and forcibly displacing nearly 60,000 residents. Hospitals like the one I visited receive very little public funding and existing funding comes at a trickle in the form of loans from banks to the East’s temporary government.
After the introductory ritual of welcomes to our team, split in between the Benghazi Medical Center and the Hawari Heart Center, I went to visit the cardiovascular unit on the Heart Center’s second floor. It had two cath labs and an intensive care unit. The majority of heart patients were, however, not treated there but rather rerouted to a privately-run office owned by the treating cardiologists. The excuse offered was lack of devices and experienced staff at the hospital. Ironically, it was the same staff working at the public center who took care of the private office, but they received pay more generously in the latter.
When I stepped into the heart surgery unit at the Benghazi Medical Center, now locked for the last 6 months, I was astonished by how well it was equipped. It was what any cardiac surgeon would consider a dreamland, stocked to the teeth with the latest and greatest medical technology. Why was it deserted and its doors locked? I was told lack of liquidity was the primary reason by Cardiac Surgery Director Dr. Omar Al Mangoush. As I sifted through containers and boxes of disposable heart surgery material I came to the sad conclusion that as much as 6 million dollars worth of supply had expired, a result of ignorance, negligence, inventory mismanagement and most importantly corruption. It seemed customary for supply purchasers to over-order and for recipients to underperform and use much less. This mismanagement alludes to tragic consequences for Libyans with acute health problems.
Healthcare is clearly at the heart of stabilization in any conflict ridden state. Cardiovascular medicine is only a small portion of the health crisis in Libya. The return of communicable diseases, most of which were eradicated more than forty years ago, pose major threats to Libya and the greater region.
Libya’s health system is extremely ill. Efforts should be made to disengage the business of looking after the medical needs of different regions based on priorities set by the political wrangling of an ongoing transitional democratic process. Elections or not, constitutional debates and resolutions or not, there must be international action to stabilize the health and human security of Libyans at once. Means for equitable allocation of healthcare funding by the transitional government must be guaranteed. Centralism should be actively discouraged by the international agents invested in Libya and the UN. These will be critical first steps in the strategy for designing a safe and stable Libya.
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