Public Health Indicators in Libya Higher than Expected, but Revolt Disrupts Services

Doctors Without Borders/Médecins Sans Frontières (MSF) finally has an eight-person team inside Libya, and reached three medical in facilities Benghazi. MSF issued a press release on their website indicating that the original team of six, along with medical and surgical supplies, was blocked at the Tunisian – Libyan border.

While it is currently unclear what the long-term health care needs in Libya will be after the revolt, there is an immediate crisis caused by a shortage of medical supplies and a large number of individuals wounded during protests. Revolution and war clearly disrupt health services, and the aftermath can leave the health care system of a country shattered and overwhelmed. Especially in failed states such as Afghanistan and Somalia where services are poor, conflict takes a bad situation and worsens it. Discounting loss of facilities, personnel and supplies, intervening public health workers are likely to find the post-revolt situation somewhat better in Libya than one might expect.

The World Health Organization (WHO) classifies Libyan Arab Jamahiriya is classified as being in the Eastern Mediterranean region. This is a particularly volatile area notably containing but not limited to Palestine, Pakistan, Afghanistan, Lebanon, Iraq, The Islamic Republic of Iran, Somalia and Sudan. This is a region where polio eradication is still a challenge. Wealth from oil deposits in conjunction with renewed commercial ties to the Unites States at the end of 2003 (President Bush offered to reinstate ties with Libya after the latter ceased work on its nuclear, chemical and biological weapons programs allowed Libya to develop a relatively strong health care infrastructure.

By most available measures, the average citizen in Libya in 2008 was in a much better social and economic condition than those in other Eastern Mediterranean countries. The average Libyan earned approximately four times the regional average per year, had a greater life expectancy at birth, a lesser chance of dying prior to the age of five and reduced risk of death due to communicable diseases. There was significantly more medical staff per capita, especially nurses. The government provides free health care for citizens, and immunization rates are high. While one often thinks government-provided health care means total government control, there has recently been an increased emphasis on supporting private clinics and hospitals. Primary care is emphasized over specialty practices.

The country is also on the developed side of the epidemiological shift: people are at greater risk from noncommunicable diseases such as cardiovascular disease, diabetes, and cancer than communicable diseases. As is often the case with lifestyle diseases, there has been a concomitant rise in risk factors such as obesity and smoking. Even traffic accidents represent a major burden of disease, with four – five deaths daily among a population of 5.5 million.

Surprisingly, slightly less than 3% of the Libyan Gross Domestic Product is spent on national health care. In contrast, the United States federal government spent approximately 17.6% of Gross Domestic Product on health care. That is just over $8000 per person and the rate of spending is only predicted to increase.

Photo credit:  CIA World Factbook