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Photostory: Refugees facing disease and death in Libyan detention centres
Thousands of people seeking safety are being held without trial in dangerous conditions
In the capital Tripoli, a conflict has raged between the Libyan Government of National Accord (GNA) and the Libyan National Army (LNA) since the beginning of April - making the situation for those trapped in nearby detention centres even more perilous.
There is little prospect of reaching safety any time soon, despite repeated calls for protection and humanitarian evacuations.
"Most people held at Zintan have already been through dreadful experiences in Libya, often including being kidnapped by people traffickers who subjected them to rape and torture"
Away from the frontlines around Tripoli, hundreds more refugees and migrants remain locked up for indefinite periods at centres in the cities of Zintan and Gharyan.
South of Tripoli, in the Nafusa Mountains, people in need of international protection and registered as asylum seekers or refugees with UNHCR (The United Nation's refugee agency), have been left stranded in these detention centres for months - in some cases, years - with virtually no assistance.
Between September 2018 and May 2019, at least 22 people died, mostly from tuberculosis (TB), at the centres in Zintan and Gharyan. Among the dead were young men, women, and an eight-year-old child.
Until June 2019, some 700 people were locked in an overcrowded agricultural warehouse at Zintan, with another 200 detained in a series of smaller buildings.
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Poor sanitation in the warehouse at Zintan created a health risk.
The 700 refugees had access to four barely functioning toilets and buckets for urine. There was no shower and only sporadic access to water which was not suitable for drinking.
For several months, an outbreak of TB has also swept through the centre.
After the main warehouse was closed in June 2019, the remaining detainees were moved to other buildings in the compound.
Some are now sleeping in rooms of around 15 metres squared with up to 20 other people.
Earlier this year, around 50 of the detainees in the poorest health were transferred from Zintan to Gharyan detention centre. However, Gharyan then became a heavily militarised area when the LNA took control during its offensive on Tripoli in April.
Guards at the centre then reportedly deserted because of the insecurity and fears of TB contamination.
Following this, the detention centre management provided the refugees at the centre with a simple chain and padlock - so they could attempt to better protect themselves against incursions made by armed groups in the absence of guards.
On 26 June, when GNA forces finally recaptured Gharyan, they found 29 people still sheltering in the centre.
The detainees were terrified for their lives, with nowhere to go in the middle of the conflict zone.
A week after these events, they were all eventually relocated to Tripoli - eight were referred for hospital treatment with MSF and 21 to an NGO-run shelter programme.
At Zintan, most of the people detained are fleeing persecution and violence in Eritrea and Somalia.
Some have been held since March 2017, while the most recent arrivals were brought to the detention centre after being arrested at a checkpoint in May this year.
"Rather than being given a way out of this desperate situation, and the protections to which they are entitled, the refugees held at Zintan, Gharyan and across Libya are condemned to an indefinite cycle of violence and detention"
However, a large proportion of people at Zintan were transferred from various detention centres across Tripoli when the fighting first broke out in September 2018.
During more recent episodes of conflict in the capital, some refugees and migrants reportedly refused to be transferred, fearing that they would be forgotten in Zintan - out of sight and with little access to medical care.
Most people held at Zintan have already been through dreadful experiences in Libya, often including being kidnapped by people traffickers who subjected them to rape and torture.
Many suffer from both the physical and psychological consequences of this treatment.
Rather than being given a way out of this desperate situation, and the protections to which they are entitled, the refugees held at Zintan, Gharyan and across Libya are condemned to an indefinite cycle of violence and detention.
The level of trauma and desperation among people, exacerbated by their state of indefinite detention, is so overwhelming that several suicide attempts have been reported.
Detainees frequently have to restrain their distressed cellmates suffering from multiple mental health issues - stopping them from inflicting violence on themselves or others.
Responding to the critical situation in Libya, MSF has been able to negotiate access to detention centres such as Zintan - providing medical consultations and arranging hospital referrals since May.
During the first week of July alone, our teams made four referrals and conducted over 120 consultations at the centre. Since May, a total of 17 patients from Zintan and 11 from Gharyan have been referred for hospital care.
Unfortunately, what our medical teams can achieve to alleviate people’s suffering is inevitably limited by the fact that our patients remain held in the same protracted situation, with their need for international protection unanswered.
Bread and pasta are the main foods provided to people in detention, which, over a prolonged period of time, makes for a very poor diet. For people with an existing medical need, this can make their condition worse.
Undernutrition can also increase a person's susceptibility to TB, which in itself can cause malnutrition.
Our teams have undertaken several food distributions to enhance detainee's diets - providing tuna, sardines, dates and fruit juices, as well as powdered milk for infants and additional hygiene items.
On 3 June, UNHCR relocated 96 people from Zintan detention centre to a facility in Tripoli where they are awaiting evacuation from Libya. Currently, 585 people remain in Zintan detention centre.
We are calling for the evacuation and resettlement of refugees and asylum seekers from Libya to be scaled up urgently. For many people trapped in detention centres, it is a matter of life and death.