Intended for healthcare professionals


Stretched medical aid agencies race to disaster zones in Libya and Morocco

BMJ 2023; 382 doi: (Published 18 September 2023) Cite this as: BMJ 2023;382:p2131
  1. Luke Taylor
  1. Bogotá

International aid agencies have quickly reached areas affected by earthquakes in Morocco and flooding in Libya but the timing of the natural disasters is stretching their finances and capacities.

Morocco’s Atlas mountains were hit by a 6.8 magnitude earthquake on 8 September, killing at least 2900 and severely injuring many thousands more. Only three days later dams collapsed in eastern Libya, sending 30 million cubic metres of water through several cities, sweeping away entire neighbourhoods.

So far more than 11 300 people in the Libyan city of Derna have died, the Libyan Red Crescent said on 14 September. Another 10 000 are still missing, many having been dragged by the currents into the Mediterranean Sea.1

The immediate impacts of the two disasters are “death, injuries, fractures, shock, wounds, and mental health trauma,” according to international non-governmental organisation, MedGlobal.2 “However, the long term impact will be potentially worse, depriving patients with non-communicable diseases, children, and pregnant women of access to healthcare and drugs, interrupting the supply chain, and disrupting the already strained healthcare system.”

Despite the logistical challenges of sending personnel and supplies, international aid agencies have been able to reach the sites of both disasters in the crucial 72 hour window when most lives can be saved.

The most urgent humanitarian needs are “food, healthcare, psychosocial support, shelter, non-food items, and logistical support, as well as data assessment and specialised technical support,” according to the Libyan government.3

Emergency medical support

The World Health Organization has activated its network of emergency medical teams and eight countries and organisations have offered their assistance, WHO’s director general Tedros Adhanom Ghebreyesus said on 14 September.4 A team from France has already deployed a field hospital in the affected areas, he told the press briefing in Geneva.

“We are deploying contingency supplies that were already in the countries, and 28 metric tons of trauma, surgical, and emergency supplies are to arrive tomorrow from our logistics hub in Dubai,” Tedros said. WHO has allocated $2m in emergency funding to the response effort.4

The scale of the destruction has made the health response in a region already reeling from a decade of conflict more challenging.

Aerial photography over the city of Derma, home to 100 000 people, shows how the sudden barrage of water destroyed multistorey buildings and roads, and washed away cars, leaving only debris and mud.5 At least 715 buildings have been damaged, 7000 families have been stranded, and 30 000 people have been displaced, said a situation report by International Medical Corps on 14 September.6

“Conditions are challenging as Derna has been split into two parts, east and west, by the flooding,” said Doctors Without Borders, one of the international agencies supporting Libyan Red Crescent.7

A lack of communication has complicated the response as the floods wiped out local mobile networks.

Risk of waterborne disease

Nearly 300 000 children have been affected and are vulnerable to waterborne diseases, Unicef has said. “With compromised safe water supplies, the chance of diarrhoea and cholera outbreaks, as well as dehydration and malnutrition, increase significantly. Meanwhile, children who lose their parents or become separated from their families are more exposed to protection risks, including violence and exploitation,” the agency said.8

Field hospitals have become key for medical treatment as at least three hospitals are currently out of service, and at least 10 primary healthcare centres are flooded.

Michele Servadei, Unicef’s representative in Libya, who is visiting areas affected by the floods, said, “Our priority is to scale up life saving assistance, in particular providing health and water and sanitation supplies, psychosocial support, family tracing, and prevention of waterborne diseases. To prevent a catastrophe, we can’t afford to lose any time.”

He added, “We know from previous disasters that the aftermath of floods is often more deadly for children than the extreme weather event itself. Children are among the most vulnerable and are at high risk of disease outbreaks, lack of safe drinking water, malnutrition, disruption in learning, and violence.”

In Morocco, which was hit by the strongest earthquake in North Africa in the past 50 years on 8 September, significant progress in the recovery effort led by the Moroccan government has been made but the number of fatalities will continue to climb, Tedros said. “Our information is that most roads have now been cleared, and search and rescue teams have been able to access the majority of affected areas,” he said.4

The city of Rabat was worst affected but Agadir, Casablanca, Fes, and Meknes were also damaged.

Aid groups have been overstretched in 2023 by a series of severe disease outbreaks, political strife, and unprecedented natural disasters—including the recent earthquake in Turkey.

The World Food Programme warned in July that it may have to abandon 750 000 Haitians going hungry as the UN agency only funded 16% of its programme in the Caribbean country.9

The financial cost of responding to the two recent disasters is unclear though at least $6.5m is needed for urgent life saving intervention in Morocco, Unicef said. The immediate priorities are safe drinking water, medical supplies and mobile health teams, psychosocial support, and family tracing.

“We are stretched in the sense there are many competing priorities. The needs are massive,” Servadei told CNN.10

Calls for an inquiry are growing in Libya where local authorities have been accused of ignoring warnings that the disaster was imminent.11