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Almost all of the roughly 40 female inmates had medical complaints. More than half complained about scabies, followed by general body pain, often associated with mental trauma.

April 2017 - The fighting continues in Libya, a country fragmented by a multitude of power centres. Since mid-2014, the humanitarian situation has deteriorated due to civil war and political instability. Millions of people across Libya are affected, including refugees, asylum-seekers and migrants. Doctor Tankred Stoebe spent the month of January in the country coordinating a medical assessment that took him from Misrata to Tripoli. He told us what he saw.

Misrata is steeped in history. Strategically located on the Mediterranean Sea, the city is known as much for its pride and independence as for its traders, smugglers, and pirates. Misrata is a sandy and dusty but bustling desert city that was subjected to heavy fighting between February and May 2011. Economically and militarily powerful, its hospitals are well-equipped and its health system better organised than those in the east. Compared to Benghazi and Tripoli, Misrata is for now relatively safe so, this was where we decided to set up base.

Every day we saw sub-Saharan Africans, each with their own agricultural or construction tools, brushes and drills, stationed at the citys crossroads looking for work as day labourers. Few are arrested, but some get caught at police checkpoints and interned in camps before being deported back to their home countries. There are around 10,000migrants in Misrata, mostly from Niger, Chad, and Sudan. Fearful of arrest and deportation, they usually go to pharmacies and buy the often high-priced drugs they are advised to take when they fall sick. For more serious problems, they prefer private medical facilities because, they are not required to report undocumented patients. But when they have a chronic illness, their only choice is to go home. When I asked them if they didnt want to get on a boat to Europe, they smiled and shook their heads: Its too dangerous. We dont want to die in the sea.

Between Misrata and Tripoli

Living conditions and hygiene are truly appalling in the detention centre in a small town halfway between Misrata and Tripoli, the Libyan capital. Intended for 400 refugees, there were only 43 detainees, 39 of them women from Egypt, Guinea, Niger or Nigeria whod been there for a month with no contact from the outside world. Most come from Nigeria, and told me their homes had been bombed. The Libyan coastguard intercepted their inflatable dinghy near the Mediterranean coast and they were sent to the detention centre.

Rooms were small, dirty and jam-packed with mattresses. As we entered the hall, there was a putrid stench. We walked through puddles of urine. There were no showers, the toilets didnt flush, and the women had to relieve themselves in buckets. They used a little of their drinking water to wash. They were utterly desperate and begged me to help them get back to Nigeria. When I told them I was a doctor, they didnt believe me to start with, but they accepted the treatment we offered them. More than half had scabies for which we prescribed medicines. Others suffered emotional trauma or at least, thats what we realised from the stories they told us about their journey and from their almost palpable fear. When I asked them if they thought they would try to get to Europe again, they replied, horrified, Never again!

Sanitation area in a detention centre west of Misrata, ankle-deep in urine and faeces, is the only place which inmates can use for washing and sanitation.

Close to the oil fields, Syrte is known for being the birthplace of Muammar Gaddafi. In spring 2015, Islamic State who controlled 300 kilometres of the countrys coastline made Syrte its stronghold in Libya. It was only in December 2016 that militias from Misrata succeeded in retaking the town with help from the US Air Force. The battle lasted seven months.

After being provided with a special permit and a police escort we managed to enter the coastal town. It was reduced to rubble; not one building has been left intact. A deathly silence hangs over the town.

We went to Ibn Sina hospital. Relatively unscathed by the bombs, it had been ransacked. Abandoned over a year ago, the hospital was once a modern, 350-bed facility equipped with several operating theatres, an intensive care unit, magnetic resonance imaging (MRI) scanner, a cardiac catheterisation laboratory, and 20 practically new dialysis machines. Its now completely destroyed, with flooded floors, smashed windows and sagging ceiling tiles*.

When we reached Tripoli I was stunned by the towering height of the ruins. MSF colleagues were in the capital providing assistance to people spread among seven detention centres.

Most of those wanting to cross the Mediterranean to Italy are from sub-Saharan Africa Nigeria, which is mired in conflict; Eritrea, governed by an authoritarian regime; and Somalia, a country embroiled in civil war. To reach the Libyan coast, people have to pass through Chad and Niger, both particularly poor countries. According to the International Organization for Migration, over 300,000people crossed through these countries last year. However, there are no precise figures on how many have died of hunger or thirst, or from falling off a truck along the way. According to most estimates, as many people have died crossing the desert as those who have drowned in the Mediterranean Sea. Survivors are insistent that the desert is by far the hardest part of the journey.

The many dead migrants also pose a problem. We went to hospital mortuaries full with unidentified corpses. Many have been there for months. As the authorities dont have the resources for DNA testing, its impossible to identify the dead and ship them back home, or bury them.

Dr Tankred Stoebe is the former President of MSF Germany and a current member of MSF's International Board. Testimony based on personal experience in January 2017. Please note that due to the volatile context, the situation changes quickly in Libya.

*As of April 21, 2017, the Ibn Sina hospital is expected to re-open by end of April.

Read more:
Libya: From Misrata to Tripoli, a first-hand account from Dr Tankred Stoebe - Mdecins Sans Frontires (MSF) International