UNHCR – Insecurity and COVID-19 fuel mental health concerns for refugees in Libya

By Ziyad Alhammadi in Tripoli, Libya | October 14

Ibrahim* sits in the waiting room of a UNHCR community center in Tripoli to see psychiatrist Dr. Ibrahim. Hanan Al-Shremi. © UNHCR/Mohamed Alalem

These days, Dr. Hanan Al-Shremi’s work schedule is very busy. As a psychiatrist working in the Libyan capital Tripoli, she helps refugees and asylum seekers deal with mental health challenges such as anxiety and depression, both of which she says have increased significantly since COVID-19 and since last year’s security measures repression in the city.

Security checks in Gergaresh and other neighborhoods have created a heightened sense of fear among asylum seekers and refugees, who are considered by Libyan authorities to be illegal migrants subject to arrest and detention. Many saw their shelters destroyed during the operations, leaving them homeless and concerned for their safety and well-being, while thousands were detained.

“On average, I get 10-12 cases a day. Before, it was five to seven cases,” said Dr Al-Shremi, who works for the International Rescue Committee (IRC) in public health clinics and a community center in the city run by UNHCR, the UN refugee agency.

“Many come in with anxiety and panic attacks. Some cannot go out to work. Physically they can, but they are afraid. They feel that no one will help them. When they come here, they feel comfortable.

“Most of them tell me, ‘We… just want safety, we want to live with dignity, our ambition is not Europe.’ No one leaves their country voluntarily. The hardest thing for a person is not to have a home,” she says.

According to the World Health Organization, the COVID-19 pandemic has created a global mental health crisis, with a 25% increase in cases of anxiety and depression in the first year of the pandemic.

At the same time, mental health services have been severely disrupted due to restrictions on movement, making it difficult for people to get the help and treatment they need. In Libya, many asylum seekers and refugees rely on casual labor to support themselves and their families — work that has dried up since strict curfews came into effect, especially in the first year of the pandemic.

“Anxiety has increased,” explains Dr. Al-Shremi. “The lockdown had a huge [negative] impact. Some days we were working but people couldn’t get to us.”

Continuing to treat her existing patients was difficult, but accepting new cases was even more difficult. She needed to meet them face-to-face so she could assess their condition and provide a diagnosis and treatment plan.

Libya.  There is no health without mental health

Dr. Hanan Al-Shremi consults with a pharmacist about medications prescribed to a patient. © UNHCR/Mohamed Alalem

There are other challenges facing those in need of emergency aid in Libya these days, says Dr Al-Shremi. State psychiatric hospitals will not accept refugees and asylum seekers, while admission to private clinics is extremely expensive. There is also a shortage of medicines.

Another issue is the stigma surrounding mental health. Some patients wrongly fear this will affect their chances of being considered for resettlement or evacuation flights and want their files closed. Some stop treatment when they get a little better, she adds.

Despite the challenges, Dr Al-Shremi says there are also many success stories.

“I myself have doubts about some cases, given their circumstances. But then I’m surprised when they tell me they’ve improved,” she says. She mentions the case of a divorced refugee mother and her son who came for help with serious health and mental health problems.

“Little by little their conditions improved. She came to see me about a week ago… She told me it was [being resettled] in Canada,” Ph.D. Al-Shremi says.

“There is no health without mental health.”

Another patient is Ibrahim*, a 22-year-old who is starting to lose his sight, which is having a huge impact on his mental health. He has been seeing Dr Al-Shremi for treatment for the past seven months and said the help he has received has given him hope to continue living.

“I couldn’t sleep before the treatment, I was thinking about my situation, I felt insecure and I couldn’t see. I feel better now,” he said.

Being able to talk more openly about mental health and getting help for those struggling is crucial, says Dr Al-Shremi.

“It is so important. Distress, depression and psychological trauma can cause destructive thoughts. “Mental illness can make a person desperate and they can lose hope,” she says.

“There is no health without mental health.”

*Name has been changed for security reasons.

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