The Libyan Dental Syndicate reported that they have voluntarily, in coordination with the National Dental Association, modified their delivery of care from clinic to telemedicine as well as through house calls and successfully completed thousands of visits on April 19, 2020 [16].

By the end of April, the Director of the National Centre for Disease Control stressed that continued social distancing and isolation measures are necessary to ensure that the number of COVID-19 cases remains low [17].

In light of school closures, few academic institutions have been able to provide an online alternative, a challenge since internet access is not readily available in the country and certainly not in the capacity it would be required to stream videos continuously.

In light of school closures, few academic institutions have been able to provide an online alternative, a challenge since internet access is not readily available in the country and certainly not in the capacity it would be required to stream videos continuously [18]. However, public high schools have coordinated with Libyan television networks to broadcast classroom sessions [19], schedules have been posted on social media for students to follow and post- secondary institutions are delivering final examinations to students online [20]. In June, all primary and secondary schools, both private and public, have closed until the end of the month and have since been extended to mid-July as part of yet another lockdown [21,22].

Media, civil society, and public institutions have also launched several public awareness and education campaigns to fight against COVID-19 [23].

After the governments’ initial declarations and varying implementation of measures taken to stop the spread of COVID-19, Libyan citizens have different levels of acceptance and understanding of the gravity of the situation and the importance of social distancing. Many have continued to go about their daily lives in shops, attending social events and travelling between cities [24]. There is also concern that varied implementation by municipalities is an indication of corruption where some businesses are given permission to stay open while others are forced to shut down and suffer the economic consequences. The country’s long history with liquidity issues means that long lines and crowding in banks have not let up and many struggle to afford basic needs since they cannot access their funds [25]. Occasions like the month of Ramadan (most of May) and Eid celebrations (at the end of May) put a stress on social distancing as it is a time of gathering and celebration.

Unfortunately, support for vulnerable persons in Libya including domestic abuse victims and less able bodied persons were hard to come by in pre-pandemic times. There have not been any official government responses put in place to assist vulnerable persons during lockdown.

Libyan women were found to already face challenges including gender based violence and insecurity has constrained their employment, livelihood and overall potential.

In fact, according to a UN Women study, measures like the lockdown disproportionately impact women in Libya [31]. UN Women’s Representative to Libya, Begoña Lasagabaster, expressed concerns about the challenges women face, “Libyan women were found to already face challenges including gender based violence and insecurity has constrained their employment, livelihood and overall potential”[31].

An open letter penned by fourteen Libyan civil society organizations including women’s rights groups Jusoor, Haaki, Tamazight Women Movement, called on the government to include gender-sensitive policies in their COVID response measures including: food supports for women in rural regions who are unable to access markets, psycho-social support as well as a hotline to report domestic violence complaints [32]. Unfortunately, none of these measures have been put in place yet. However, Libyan civil society have started an online social media campaign called COVID Diary to disseminate important information but also to serve as a platform where women can share their experiences during the pandemic [33]. A dedicated Facebook page has launched and a call for women who are experiencing challenges including those suffering from domestic violence are invited to reach out so that their reports can be officially documented by the group [34].

There have been no provisions made to support less able bodied persons to date.

Layoffs, stay home orders, and lockdown have made life much harder for low-income households and have presented new issues for refugees, internally displaced refugees as well as citizens stranded abroad while seeking medical treatment.

Job loss due to measures taken to prevent the spread of COVID-19 have made basic foodstuffs less affordable and puts pressures on breadwinners to find alternative work even if it means not abiding by government lockdown measures. The Libyan Worker’s Union reported that COVID-19 has put thousands of workers at risk because employers are failing to meet their commitments to their employees denying them their financial rights; forcing them to take unpaid vacation or outright dismissal [35]. In addition to this, inflation due to the ongoing conflict in Western Libya where prices have gone up 21.5% according to a REACH international study, also presents a challenge and could push people back into work, putting themselves and their families in jeopardy [36].

Because of Libya’s access to Europe through the Mediterranean Sea, it has always been a hub for migration and a destination for migrants from neighbouring countries to find work. Since 2011, the volume of migrants has drastically increased and the country currently has over 600,000 migrants from over 40 countries [37], putting undue pressure on Libya to provide a safe haven; an impossible task given the country’s economic, political, and security challenges. Detention centres across Libya have put migrants at increased risk to violence, poor health care and food shortage due to the ongoing conflict [38]. The International Organization for Migration as well as the UN High Commission for Refugees (UNHCR) have halted their resettlement operations in Libya due to the pandemic leaving migrants to face an even longer stay in a country largely unequipped to keep them [39]. In addition, over 3,000 migrants attempting to flee Libya have been forced to return. Migrants are returned to one of eleven detention centres in the country which face increasing challenges to provide basic needs as international humanitarian aid organizations are unable to operate continuously due to shortage of funds, ongoing conflict, and the pandemic [40].

Photo by Gerd Altmann, Pixabay.

A joint statement by several UN agencies reports that 400,000 people have been internally displaced in Libya since 2011, half of which were displaced in the last year during the ongoing conflict in Western Libya (including the capital Tripoli) [40]. Internally displaced people face additional challenges including securing safe housing and the costs incurred adjusting to living in temporary accommodations.

Libya’s health system is historically known for being fragile, citizens frequently travel to neighbouring countries to seek medical treatment at their own expense. At the start of the lockdown, 15,000 Libyans were stranded abroad in Tunisia, Egypt, Turkey, Jordan as well as in France, Spain, and Morocco [41]. This has put an additional cost and consideration for the Libyan government who have had to register, accommodate, test and monitor all Libyans and make arrangements to bring them back to Libya safely [41]. Those returned have been isolated in unoccupied hotels and residences until they can reunite with family [42]. The government’s ineffective implementation of such provisions have contributed to the rise in the number of cases since.[43].

Local community groups, civil society organizations as well as international humanitarian aid and development organizations in coordination with their local partners are responding to the pandemic by providing assistance and relief to fill in gaps in the governments’ measures, especially those pertaining to marginalized and vulnerable groups.

As the largest national humanitarian organization, the Libyan Red Crescent is the national partner of the International Red Cross and has over 8,000 volunteers that operate through a network of 36 branches across the country [44]. To date, they have distributed hundreds of thousands of dollars in support to health and rehabilitation facilities across the country to buy PPE supplies, funds for awareness and educational materials, training on infection prevention and how to disinfect homes and streets, and advising Ministries on appropriate responses to COVID-19 [45].

The UN Refugee Agency (UNHCR) in Libya has been able to deliver supports in an inter-agency effort that includes the UN Office for the Coordination of Humanitarian Affairs (OCHA), the International Organization for Migration (IOM), UNICEF, Doctors Without Borders (MSF) and the Danish Refugee Council (DRC) [37]. The UNHCR and local partner Libaid [46] distributed aid across the country; relief items to detention centres housing migrants and asylum seekers across Eastern Libya [47], in Tripoli [48], and in the desert [49], distributing bars of soap and providing hygiene training to displaced families [50], and providing supplies to support doctors and nurses as well as patients in quarantine in Misrata [51]. In coordination with ACTED, the UNHCR also distributed cash assistance to displaced families in Benghazi. Despite the challenges, aid is getting through [52]. In coordination with the Libyan Red Crescent, relief items were also distributed to vulnerable persons in Tripoli [53]. A psychological hotline [54] has been set in place to assist refugees and mental health supports for migrants have been put in place [55]. In coordination with Cesvi, women migrants and refugees who have faced physical and sexual abuse are receiving psychological and medial help [56].

The Benghazi Boy Scouts and Girl Guides Association, in coordination with the Libyan Authority for Relief and Humanitarian Aid, distributed 2,500 food baskets to families in need [57]. Local media have also taken it upon themselves to produce programs to educate and inform listeners on the corona virus and best practices to stay safe including Sama Libya, a radio station in Derna [58]. Women’s organization Al-Bayan volunteered to make 500 masks following WHO (World Health Organization) guidelines with the support of the UN Populations Fund (UNFPA) to be distributed to health workers and residents in Tripoli [59].

The Pharmacists Association in Benghazi responded to the pandemic by locally manufacturing affordable face masks. To date they have made 10,000 masks that are sold for 10 Libyan dinars each (just under $2 USD) [60]. The National Oil Corporation (NOC) has also stepped in to deliver supplies including protective masks, disinfectant spray materials, hand sanitizer in 12 municipalities. The NOC and its international partners have allocated a $3 million budget to distribute supplies across the country [61].

Heavy shelling in Tripoli and the surrounding areas over the past few months have not only resulted in casualties but at times also struck hospitals and medical facilities [65]. This has a two-fold impact: increasing the needs for medical services while simultaneously limiting capacities to not only treat those injured but to also test and treat potential COVID-19 cases. The conflict complicates Libyans’ ability to abide by social distancing efforts resulting in increased potential exposure to COVID-19 as they are either fleeing violence or fulfilling social duties to attend funerals and mourn the dead.

To date (June 29, 2020), according to the National Centre for Disease Control, Libya has conducted 26,339 tests and confirmed 763 cases of COVID-19, including 545 active cases, 196 recovered and 21 deaths [29]. The country has seen a slow increase of cases since the first case was detected in March with a spike at the end of May which has since been maintained until today [62]. This spike coincides with the repatriation of Libyans from abroad including some who are suspected to have failed to abide by quarantine measures, returning to their families or travelling within the country resulting in the spread of the virus to the south of the country to Sebha [63]. Health officials in Sebha have seen a rise in cases and struggle to contain them due to lack of facilities to hold patients and logistical challenges to receive new supplies and equipment from the government(s) [64]. Dr. Ramadan Osman from the Libya office of the WHO reports that of the four stages that the WHO has classified at the country level of covid spread (one: no cases reported, two: sporadic cases, three: cluster cases and four: community-wide spread) Libya is presently in stage three and without diligent testing, isolating and treating cases, Libya risks losing complete control and graduating into stage four which the health system is presently unequipped to manage [43]. Libya’s ongoing conflict presents serious challenges that continue to raise the threat of the pandemic. Heavy shelling in Tripoli and the surrounding areas over the past few months have not only resulted in casualties but at times also struck hospitals and medical facilities [65]. This has a two-fold impact: increasing the needs for medical services while simultaneously limiting capacities to not only treat those injured but to also test and treat potential COVID-19 cases. The conflict complicates Libyans’ ability to abide by social distancing efforts resulting in increased potential exposure to COVID-19 as they are either fleeing violence or fulfilling social duties to attend funerals and mourn the dead. A question has been raised about the entry and presence of foreign fighters in the country, including thousands of Syrian soldiers from Turkey, as contributing factors to the spread of the virus since testing, tracking or quarantining of foreign fighters is not enforced [66]. Signature electricity outages (and potential water shortages) that frequent Libya during the hot summer months have intensified in Western Libya as they have been politicized and exploited by the conflict [67]. Officials continue to grapple with the challenges of a disease that continues to spread, extending lockdowns and closures, costing millions of dollars-perhaps billions [iii] and yet, no clear breakthrough has been made.