After more than a week of violent confrontations, a ceasefire brokered by the United Nations (UN) was agreed upon between all armed groups in Libya’s capital, Tripoli, on 4 September 2018. The country has been in turmoil since the start of the civil war in 2011, and the violence has directly impacted the healthcare system, with 19% of medical facilities forced to close down for reasons of maintenance, serious damage, occupation or inaccessibility related to the conflict. The Office of the High Commissioner for Human Rights (OHCHR) and the UN Support Mission in Libya (UNSMIL) have recorded 36 attacks on medical facilities and personnel in Libya from just May 2017 to May 2018.

On 26 August 2018, violence severely escalated between two warring groups, the Seventh Brigade and the Tripoli Revolutionaries Battalion (TRB), and their allies in densely populated neighbourhoods of southern Tripoli. The militias started using indiscriminate fire and shelling in the capital, endangering the lives of civilians who have been trapped in the chaos. The UN Humanitarian Coordinator in Libya, Maria Ribeiro, disclosed the numbers of civilian casualties so far: over 100 wounded and 14 deaths, four of which were children. The toll includes the death of a volunteer paramedic that was killed on duty as he was helping families evacuate their homes during the crossfire.

As stated in the World Health Organization’s Service Availability Readiness Assessment (SARA) 2017 report on Libya, only 10 of 17 healthcare facilities offered emergency services in Tripoli. The capital got an “unacceptably low” score of 48% on its readiness for emergency response, which means it will face difficulty in managing urgent situations, especially traumatic injuries. The Libyan Ministry of Health and its Private Health Sector have been closely collaborating to facilitate the treatment of the wounded, giving them access to private hospitals and clinics in Tripoli and its suburbs since 27 August, partially alleviating the lack of functioning healthcare infrastructure. Nevertheless, the health system is not fully operational, as many Libyan health professionals face extreme obstacles to their work, from indiscriminate violence to targeted reprisals.

Various international organizations and state institutions, such as the UNSMIL, the Libyan Ministry of Health and its Private Sector have called on the warring parties to allow the safe passage of civilians and rescue teams after the militias failed to comply with ceasefires agreed to on 28 and 31 August. However, Osama Ali, spokesperson of the national Ambulance and Emergency Services, declared on 3 September that there were no safe corridors for the evacuation of families and that the armed groups’ military occupation of the capital obstructed roads and hindered the work of aid and relief crews, thus undermining the principle of non-interference of medical impartiality. The militias disregarded the safety of medical facilities and vehicles, as they shelled the Bedea Physiotherapy Centre in Souq al-Juma and allegedly stole three ambulances in Tripoli’s outskirts.

After the 4 September ceasefire, the Libyan government has created an Emergency and Crisis committee in order to implement the necessary measures to guarantee security and restore national stability. The cessation of hostilities between armed groups will allow the safe conduct of aid and relief crews’ work and the safe transportation of wounded civilians to hospitals. Defenders for Medical Impartiality calls upon the Seventh Brigade, the TRB and their allies to abide by rule 25 and 29 of customary humanitarian law, as codified by the International Committee of the Red Cross, which states that on-duty medical personnel and medical transportation must be respected and protected in all circumstances.