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WHO IS WHERE, WHEN, DOINGWHAT (4WS) IN MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT 2017LIBYA

This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents of the presentation are the responsibility of MHPSS.net and do not necessarily reflect the views of USAID or the United States Government.

WHO IS WHERE, WHEN, DOINGWHAT (4WS) IN MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT 2017LIBYA

This report was prepared by MHPSS.net in partnership with WHO Libya and The Delegation of the European Union to Libya. The purpose of the report is to facilitate the exchange of knowledge and information on available services information among MHPSS actors and their partners in Libya.

We are thankful for the collaboration with many Mental Health and Psychosocial Support (MHPSS) actors, their efforts and contributions. We are especially thankful to the Libyan colleagues involved in data collection across the country.

We would like to acknowledge the Libyans colleagues participating in this study, who welcomed this initiative and shared valuable information.

Coordination: Marcio Gagliato (MHPSS.net).

Project Team: Dr. Sara Zarti (WHO Libya); Renata Reali (MHPSS.net); Marcio Gagliato.

Libya Advisory & Data Collection Team (in alphabetical order): Ali Abdusamad (Psychiatrist – Tripoli NCDC); Anwar Naser Farjah Allah (Psychologist – Tripoli MoH); Asiddiq Alhajali Shwehdi (Psychiatrist – Misrata Central Hospital); Khaled Hamidi (MHPSS – Tripoli Psychosocial Support Team); Khaled Adris Alhasi (Psychologist – Head of Social and Psychological Office of Education, East Libya); Nidhal Mohammed Ali Shaeban (Psychiatrist – Sabha Psychiatric Clinic); Ramadhan Salim Almusrati (Psychiatrist – Director General of Benghazi Mental Health Hospital); Saleh Mohamed Ali Elwelwal (Board member of Libyan Society for Psychological Sciences).

Report written by: Renata Reali and Marcio Gagliato.

Reviewers (in alphabetical order): Ananda Galappatti (MHPSS.net), Edda Costarelli (Delegation of the European Union to Libya), Dr. Ghassan Karem (PHC Director, Libya Ministry of Health), Malak Ben Giaber (Libyan Clinical Psychologist), Margriet Blaauw (MHPSS.net), Dr. Sara Zarti (WHO Libya).

Tripoli Psychosocial Support Team1 generously provided the image on the front cover and section pages

The Mental Health & Psychosocial Support Network (MHPSS.net) is a growing global platform for connecting people, networks and organizations, for sharing resources and for building knowledge related to mental health and psychosocial support both in emergency settings and in situations of chronic hardship.

For further information, please contact Marcio Gagliato at [email protected], and Sara Zarti at [email protected]

Acknowledgements

1Libyan Non-Governmental Organization

Who is Where, When, doing What (4Ws) in Mental Health and Psychosocial Support (MHPSS) in Libya4

Acknowledgements 4

Contents 5

List of Abbreviations 6

Executive Summary 7

1. Introduction 11

1.1. MHPSS Coordination and Mapping 13

2. Contextual Information and MHPSS Background in Libya 15

2.1. Libya Country Statistics 16

2.2. Socio-political context 17

2.3. Libya Mental Health System 18

2.4. Prevalence of Mental Health Disorders in Libya 19

2.5. Migrants, Refugees and people on the move in Libya 20

2.6. Earlier MHPSS Assessments and Mapping Activities 20

3. The 4Ws MHPSS Mapping Exercise 23

3.1. Methods and the 4Ws Mapping Process 25

3.2. Findings 27

3.3. Challenges 33

3.4. Recommendations 33

References 34

Annex A - Detailed MHPSS activities provided in Libya 36

Annex B - Data collection - Excel Form 37

Annex C - List of resources available at Libya MHPSS Response - 2017 Group 38

Annex D - Organizations operating MHPSS programs/activities per governorate 47

Annex E - Organizations providing MHPSS services by IASC MHPSS Layers 48

Annex F - Actors currently active in MHPSS 50

Contents

MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT (MHPSS) 5

List of Abbreviations


CBO Community-Based Organization

EU European Union

GNC General National Congress

IASC Inter-Agency Standing Committee

IMC International Medical Corps

INGO International Non-Governmental Organization

IOM International Organization for Migration

MH Mental Health

MHPSS Mental Health and Psychosocial Support

MHPSS WG Mental Health and Psychosocial Support Working Group

MoH Ministry of Health

NCDC National Center for Diseases Control

NGO Non-Governmental Organization

NTC National Transitional Council

OCHA United Nations Office for the Coordination of Humanitarian

OFDA US Office of Foreign Disaster Assistance

OFDA PSS

US Office of Foreign Disaster AssistancePsychosocial Support

PHC Primary Health Care

PTSD Post-Traumatic Stress Disorder

SWOT Strengths, Weaknesses, Opportunities and Threats

UN United Nations

UNSMIL United Nations Support Mission in Libya

WHO World Health Organization

Executive Summary


This Who is Where, When, doing What (4Ws) in Mental Health and Psychosocial Support (MHPSS) in Libya exercise was carried out by MHPSS.net in partnership with the World Health Organization (WHO) Libya and the Delegation of European Union to Libya, and with the generous financial support of the US Office of Foreign Disaster Assistance (OFDA).

It also marked the first use of an online 4Ws tool, developed by MHPSS.net, that organizations can use to provide their own information on ‘Where they are doing What and When’ in emergency settings and generate a real-time analysis and display of data related to the MHPSS services available in Libya.

This 4Ws mapping seeks to:a) Enhance coordination, collaboration, referral systems and accountability for all involved agencies

b) Identify gaps in service provision, geographic, and target group coverage, human resources and technical expertise

c) Provide data on patterns to inform recommendations, agency plans/proposals and lessons learned for future responses, and

d) Improve the transparency and legitimacy of MHPSS services through structured documentation

This mapping provides an overview of services currently available in Libya. It does not provide information on the quality of these services, the number of interventions or the number of beneficiaries served. The findings are based on the data collected between July and October 2017. According to the findings there are diverse MHPSS services available in all regions of Libya, targeting different populations:

Number of organizations: This exercise identified a total of 190 organizations that deliver MHPSS services, programs, and activities across Libya, including 178 national actors and 12 international actors.

Location: Despite MHPSS services being mapped as present in all regions of Libya, there is a concentration of reported services in the Tripoli area (58% of all activities).

Target groups: The majority of the reported MHPSS activities target children, adolescents, local communities, and persons with disabilities.

Activities targeting women, men, elders, caregivers, refugees, migrants, and IDPs were also reported, but in lower numbers.

Most reported activities: The most frequently reported MHPSS activities in Libya are linked to strengthening communities and family through recreational activities; psychological support in education settings; and in lower numbers, services linked to clinical management of mental health (MH) disorders.

Reported MHPSS Human Resources: There is a relatively high number of health staff, social workers and psychologists2 providing MHPSS services compared to other actors. Other categories such as volunteers or case managers appear to be reported less frequently.

IASC intervention pyramid: 5,9% of the reported MHPSS activities in Libya are under “Social considerations in basic service and security”


layer; 52,8% are under “Community and family support”; 18,5% are under “Focused non-specialized support”; and 22,7% are under “Specialized services”.

In addition, 30 organizations reported general activities in support of MHPSS, such as trainings, clinical supervision etc. “

Recommendations• Exploration of possibilities to expand MHPSS services to regions where people have limited access to them

• Support coordination mechanisms and initiatives

• Build on this exercise with a further detailed assessment of MHPSS needs, capacities and resources

• Enhance the capacity and quality of services in other regions, depending on the results of the detailed needs assessment proposed above

2 In Libya, psychology graduates are often not trained in providing any counseling or psychotherapeutic interventions


1. IntroductionThis mapping is based on the Inter Agency Standing Committee (IASC) MHPSS 4Ws (IASC, 2012) tool and aims to enhance coordination, collaboration, referral systems and accountability for all involved agencies; identify gaps in service provision, geographic, and target group coverage, human resources and technical expertise; provide data on patterns to inform recommendations, agency plans/proposals and lessons learned for

future responses, and to improve the transparency and legitimacy of MHPSS services through structured documentation. Furthermore, the mapping is available as a ‘living’ online 4Ws tool provided by MHPSS.net, to which organizations can provide their own information and generate a real-time analysis and display of data on MHPSS services available in Libya.

Screenshot of MHPSS.net 4Ws online tool

https://app.mhpss.net/4ws-mapping/%EB%BA%AD


The first MHPSS Working Group (WG) in Libya was established in 2012 in Tripoli. With the support of WHO the WG was chaired by the National Center for Diseases Control (NCDC) Mental Health department, established under the Ministry of Health (MoH). Most members were International Non-Governmental Organizations (INGOs) and United Nations (UN) Agencies. The MHPSS WG used to meet on a regular basis to exchange updates on activities.

During 2012-2014, the MHPSS WG group contributed to the identification of mental health and psychosocial needs as a public health priority, especially with key Libyan policy makers officially acknowledging this as a key priority area.

The MHPSS coordination mechanism was active until 2014 when the country was impacted by a new wave of violence, political instability and an economic crisis. Most of the United Nations Support Mission in Libya (UNSMIL), and INGOs were relocated to Tunis.

By end of 2015, the Libyan Authorities, with the support of WHO, initiated the development of a MHPSS strategy outline for 2016-2018, which had been proposed through a workshop on “Mental Health planning and response for Libya3”. This included an exercise of Strengths, Weaknesses, Opportunities and Threats (SWOT) Analyses of MH services in Libya followed by the identification of short and intermediate term plans.

Since end of 2016, the Libyan authorities have taken efforts to reactivate the MHPSS WG which had become relatively inactive. However, MHPSS coordination remains fragmented. It is geographically split between Tunis (where most of the INGOs are operating from) and Tripoli, the capital city. In addition, at present “psychosocial” services are largely coordinated through the Protection Cluster, while “mental health” activities are mostly coordinated through the Health Cluster.

In 2017, a partnership between the Ministry of Health, WHO Libya, European Union (EU) and MHPSS.net4, launched a mapping exercise of Who is Where, When, doing What (4Ws) in mental health and psychosocial support (MHPSS) in Libya (IASC, 2012).

This mapping was carried out during June to September 2017 with the following main objectives:

a) Enhance coordination, collaboration, referral systems and accountability for all involved agencies

b) Identify gaps in service provision, geographic, and target group coverage, human resources and technical expertise

c) Provide data on patters to inform recommendations, agency plans/proposals and lessons learned for future responses, and

d) To improve the transparency and legitimacy of MHPSS services through structured documentation

1.1. MHPSS Coordination and Mapping

3Held in Tunis 28th-30th December 2015 4The MHPSS.net online platform seeks to improve mental health and psychosocial wellbeing in humanitarian settings by improving access to people, resources, and knowledge.

https://app.mhpss.net


2. Contextual Information and MHPSS Background in Libya


2.1. Libya Country Statistics5

Libya map6

5 Libya Statistics data were extracted from UNdata (2015)6 United Nations Map of Libya with cities, roads, and the current twenty-two Districts or Shabiyah of Libya. United Nations Cartographic Section Department of Peace-Keeping Operation.


2.2. Socio-political context9

Country statistics

Population 6,330,000

Capital Tripoli

Urban population 78.6%

Refugees, IDPs and others of concern7 to UNHCR 471,721

Life Expectancy at birth (female, male/years) 74.4/68.8

Religion8 96 % Muslim Sunni

Libya is located in the north of Africa, bordered by the Mediterranean Sea, Egypt, Sudan, Chad, Niger, Algeria and Tunis. After becoming independent as a kingdom in 1951, a military coup in 1969 overthrew King Idris I. The coup leader was Muammar Gaddafi, who ruled the country for 42 years.

On 17th February 2011, days after the resignation of former president of Egypt, Hosni Mubarak, violent protests erupted in Benghazi, Eastern Libya, against the regime of Muammar Gaddafi. The Libyan leader and his supporters responded violently to the demonstrations, as clashes spread throughout the country. On 20th February 2011, after several days of fighting, anti-Gaddafi fighters seized control of Benghazi and other cities. In March, the UN Security Council voted to impose a no-fly zone over Libya in order to protect civilians, and NATO forces continue with flights surveillance throughout the country.

In August 2011, anti-government forces advanced into cities close to Tripoli, seizing

control of important ports and towns. After several months of fighting, on October 20th 2011, Muammar Gaddafi was captured and killed in Sirte. A National Transitional Council (NTC) was established and announced plans to hold elections within months.

In August 2012, the NTC handed over the power to an elected General National Congress (GNC) in order to select a new interim Head of State. In 2014, new conflicts erupted leaving two governments claiming legitimacy over the country’s control, leading to a power vacuum and instability. Amid the chaos, Islamic State extremist militias took advantage of the conflicts and gained control of several coastal cities.

The long-lasting conflicts have had an impact on the general and public health infrastructure, and social network of the Libyan society, resulting in an estimated 1.3 million people requiring humanitarian assistance to date (United Nations Office for the Coordination of Humanitarian Affairs [OCHA], 2017).

7 Others of Concern: IDP’s and groups that do not fall under any specific legal criteria8 Libyan religion data was extracted from Encyclopedia Brittanica (2017).9 Libyan socio-political context information is based on Amnesty International (2016) and International Medical Corps (2011).


2.3. Libya Mental Health System

Mental Health is a chronically neglected field in the country with many longstanding problems (El-Badri, 2015) that predate the conflict that started in 2011, including underdeveloped community and specialized services, shortage of qualified workforce, lack of facilities, social stigma towards people with mental illness and funding marginalization (World Health Organization [WHO], 2003, 2014). In addition, the current and long-lasting violence in the country is believed to further increase the proportion of the population in need of mental health and psychosocial support, requiring a combination of immediate and longer-term interventions.

Libya has two main psychiatric public hospitals with in-patient services, located in Tripoli and Benghazi. The country has no mental health policy (WHO Regional Office for the Eastern Mediterranean [WHO EMRO], 2015) or updated mental health legislation10. Violations are often referred to occur in psychiatric institutions through inadequate, degrading and harmful care and treatment (Abuazza, 2013).

In 2012, an Inter-ministerial mental health meeting was conducted with various representatives, proposing to develop a coherent and comprehensive mental health policy focused on six core components: organization of services by developing community mental health services; capacity development of human resources; involvement of users and families; human rights protection of users; equity of access to mental health services across different groups; and quality of services (WHO, 2015).

Public financing of mental health services is limited. In 2012 the Ministry of Health’s annual budget provided 13 million Libyan Dinar for the two mental hospitals in Tripoli and Benghazi, accounting for 0.45% of total public health budget11.

A MHPSS Needs Assessment conducted by International Medical Corps (IMC) (2011) shows that severe social stigma exists towards psychiatric patients. The stigma prevents individuals with mental illness, especially people who have been treated in psychiatric hospitals, from integrating into the community. People prefer private clinics, if they can afford these, to reduce or avoid the stigma.

Some informants have noticed an increase of local traditional healers dealing with MHPSS issues in recent years, especially in the city of Misrata, Libya’s third largest city.

The Ministry of Health (MoH) and other stakeholders identified MHPSS as a priority area in Libya (WHO EMRO, 2015). A new mental health program based within Libya’s National Center for Disease Control (NCDC) was set to transform the institution-based approach to a community-based approach to mental health care, to be made available in all areas of the country. In 2013, a 4-year (2015-2019) mental health strategy to improve the services was launched.

10 The Health Law 106 of 1973 briefly refers to mental health and the 1975 Implementation Report has 9 articles dedicated to mental health.11 Information based on WHO meeting in 2015 om the subject of Mental Health Planning and Response for Libya


2.4. Prevalence of Mental Health Disorders in Libya

There are no published data of the prevalence of mental health disorders in Libya prior to the conflict. The World Health Organization (WHO) estimates that rates of common mental disorders such as anxiety disorders and depression double in the context of humanitarian emergencies from a baseline of about 10% to 20% while people with severe mental disorders (2-3%) are especially vulnerable in such contexts and need access to care (WHO, 2012).

According to Charleston et. al (2012) predictions on mental health impacts after the 2011 conflict in Libya, the estimated prevalence of depression and Post Traumatic Stress Disorder (PTSD) varies according to levels of population-level political terror, trauma exposure and recurrence of conflict. The study suggests12 that the prevalence of depression is higher than the prevalence of Post-Traumatic Stress Disorder (PTSD) and may be as high as 30-40% of the population in areas that are severely affected by conflict. Despite the authors’ estimates, there is no study revealing the actual mental health impacts related to Libya since 2011 conflicts.

In 2013, a survey amongst 2,692 households conducted by the Danish Institute against Torture and the Benghazi University, revealed that 29% of individuals reported anxiety and 30% depression and 6% reported Post Traumatic Stress Disorder. Stress levels showed a preoccupation with political instability (63.6%) followed by the collapse of the country (61.2%), insecurity about “life right now” (56.6%) and insecurity about the future (46.4%). Nearly 30% reported being exposed to violence during demonstrations (Danish Institute Against Torture, 2015).

A wave of drug use has been on rise since the beginning of the conflict, including amongst women (JUSOOR Center for Studies and Development, 2017). Unsafe opioid injections have led to HIV infections among drug users (Hanna, 2017). Accounts from outreach workers, doctors and the media13 reveal Libya’s drug problems with painkillers, especially Tramadol, and increased use of alcohol abuse.

12 According to the research, the post-conflict prevalence estimates were derived from models based on a previously conducted systematic review and meta-regression analysis of mental health among populations living in conflict.13 Media as IRIN News, 2013 and Voa News (Dettmer, 2013) revealed Libya´s drug problems.

An MHPSS assessment (International Medical Corps [IMC], 2011) and an MHPSS 4Ws exercise (IMC, 2011a) conducted and reported by International Medical Corps in 2011 demonstrate the services and reality of Libya at that time.

The assessment was done in conflict affected areas including Benghazi, Misrata, Tripoli, and the Nafusa Mountains. It was based on site visits, key informants’ interviews, focus groups discussions, and other sources of information (i.e. medical professionals, humanitarian workers, school teachers, coordination meetings participants, etc.). According to IMC, at that time, the most vulnerable groups were children, women (especially mothers), families who lost loved ones in the conflict, freedom fighters, released prisoners, and medical first responders. In addition, five groups (Tawergha, Gwalish, Mushashaya, Siaan, and Taminah) who were facing protection threats in relation to their association with the former Gadaffi regime were identified as vulnerable.

Regarding the mental health system in Libya, the assessment found that mental health service provision was highly centralized, difficult to access and of limited quality. The national psychiatric hospitals in Tripoli (Al Razy Psychiatric Hospital) and in Benghazi (Benghazi Psychiatric Hospital) were reported to have a shortage of qualified Mental Health staff (psychiatrics, psychologists, and nurses).

MHPSS services were also offered by local Non-Governmental Organizations (NGOs) and at schools. Since the beginning of the conflict, more than 500 NGOs were established in Libya, and some of them were aiming to provide psychosocial support to vulnerable groups. The assessment suggests that in schools, social workers were under-utilized and under-appreciated, besides being poorly prepared for their roles.

Furthermore, training opportunities in mental health and psychosocial support areas were reported to be limited. The education level of


2.6. Earlier MHPSS Assessments and Mapping Activities

2.5. Migrants, Refugees and people on the move in Libya

The situation of non-Libyans in the country (migrants, refugees, people on the move) is of great concern. Several reports such as ´Migration Trends in Libya: Changing Dynamics and Protection Challenges´ (United Nations High Commissioner for Refugees [UNHCR], 2017) and ´Kidnapped, Trafficked, Detained? The Implications of Non-State Actor Involvement in Immigration Detention´ (Flynn 2017) mention how refugees and migrants face kidnapping, slavery, torture and organized violence, and sexual violence in Libya before crossing the Mediterranean Sea. In August 2017, OXFAM International (2017) collected 158 testimonies

from 31 women and 127 men who arrived in Sicily. • All but one woman said they had suffered from sexual violence• 74% of the refugees and other migrants said they had witnessed the murder and /or torture of a travelling companion• 84% said they had suffered inhuman or degrading treatment, extreme violence or torture in Libya• 80% said they had been regularly denied food and water during their stay in Libya• 70% said they had been tied up


psychologists was reported to be limited to BA level degrees which usually focused on general or educational psychology, but not in clinical training. According to Rhouma et al. (2016), there was no psychiatric training scheme for clinicians; and general practitioners commonly work as specialists, without having a formal training program. Qualified doctors usually work as GPs and specialists at the same time, without having to go through a formal psychiatric training program (Rhouma, Husain, Gire & Chaudhry, 2016).

The 2011 4Ws mapping exercise was conducted by IMC in 4 different areas in Libya (Benghazi, Misrata, Tripoli, and Nafusa Mountains). At that time, 27 actors were reported to be providing MHPSS activities, among them national NGOs, INGOs, governmental bodies, and independent/private actors.

The services were reported to be centralized in Benghazi, Tripoli, and Misrata. The most common activities provided were general services to support MHPSS, psychological intervention, and specialized clinical management of mental disorders. However, some activities linked to information dissemination, community mobilization, community support, safe spaces, psychosocial support in education, inclusion of psychosocial support (PSS) in other sectors, case focused psychosocial work, and non-specialized management of mental disorders were also reported.

Handicap International conducted an assessment of the availability, the capacity and the range of services of Health Structures in Western Libya in 2016. The assessment focused on the availability and capacity of psychosocial and mental health services, the organization of health and rehabilitation centers since mid-2014; and access to adequate health services for conflict-affected people and persons with disabilities.

The findings of the Handicap International assessment stress that the MHPSS Sector is undeveloped: there is no systematic system for the diagnosis and referral of patients in need of mental health and psychosocial support; there is a lack of trained and experienced MHPSS human resources; an over-medicalization of psychological distress; only few Civil Society Organizations (CSOs) are active in the field of psychosocial support; and there is a lack of capacity to advocate efficiently for the cause of MHPSS. Moreover, the assessment reported a lack of an integrated rehabilitation system, integrating physical and psychosocial rehabilitation, as well as including health structure department, coordination, and referral system.

A multi-sector data collection (REACH, 2017) was also conducted and reported by REACH in June and August 2017 to provide information on the needs and vulnerabilities of affected populations. A total of 2,978 household surveys were conducted across 8 areas and found that 36,2% of households reported that at least one member was experiencing two or more signs of psychological distress.


In order to facilitate a better understanding of the MHPSS actors and their activities in Libya, the current 4Ws MHPSS mapping was planned through a partnership between MHPSS.net and WHO Libya, with the financial support of the EU Office and OFDA.

3. The 4Ws MHPSS Mapping Exercise

Time-frame and actors The mapping was conducted from June to October 2017 by a team of 10 national collaborators with MHPSS background, with technical support and supervision by MHPSS.net staff.

Mapping of Libya MHPSS Resources14

In order to facilitate the mapping coordination as well as to improve the access to resources, people, and knowledge of the area, MHPSS.net created a Libya group (Libya MHPSS Response – 2017). The group is divided in 4 sub-groups: Libya Group – General Resources; Libya Group – MHPSS Resources; Libya Group – Resources in Arabic; and Libya – MHPSS Working Group space. The Working Group space is a restricted area only for members directly involved in the Libya response. The group contains more than 70 curated resources - articles, needs assessments, country profile, Sit Reps, news - and can be updated by any member of the group.


3.1. Methods and the 4Ws Mapping Process IASC MHPSS 4Ws Data collection toolIn 2012, the Inter Agency Standing Committee (IASC) Reference Group on mental health and psychosocial support developed the “Who is Where, When, doing What in Mental Health and Psychosocial Support”, aiming to map supports by government and non-governmental agencies, including pre-emergency services and support in humanitarian settings across sectors.

An online 4Ws tool based on IASC 4Ws tool has been created by MHPSS.net and used as a tool to collect data, allowing each organization to provide their own information and generate real-time analysis and display of available data. Because many organizations within Libya do not have a reliable internet connection and/or few hours of access to electric power, an Arabic Excel template was also used to collect data. The collected data was translated from Arabic to English. The tools focused on MHPSS activities and sub-activities, and additional features such as for example the number and type of MHPSS workers; a specified list of target groups; specified list of governorates15.

14 The list of resources can be found in Annex C - MHPSS Documents about LibyaAnnex C - MHPSS Documents about Libya15 The governorates had been organized according to WHO Libya recommendation.

https://app.mhpss.net/groups/current-mhpss-emergency-responses/mhpss-libya-2011/https://app.mhpss.net/groups/current-mhpss-emergency-responses/mhpss-libya-2011/libya-group-_-general-resources/https://app.mhpss.net/groups/current-mhpss-emergency-responses/mhpss-libya-2011/libya-group-_-general-resources/https://app.mhpss.net/groups/current-mhpss-emergency-responses/mhpss-libya-2011/libya-group-_-mhpss-resources/https://app.mhpss.net/groups/current-mhpss-emergency-responses/mhpss-libya-2011/libya-group-_-mhpss-resources/https://app.mhpss.net/groups/current-mhpss-emergency-responses/mhpss-libya-2011/libya-group-_-resources-in-arabic/https://app.mhpss.net/groups/current-mhpss-emergency-responses/mhpss-libya-2011/libya-group_working-group/


A team of ten national contributors was selected according to their MHPSS background and their geographical presence within the country. In July 2017 they received a training on the MHPSS 4Ws and on data collection. They were responsible to identify and meet organizations providing MHPSS activities in their areas, collect all data from government and local organizations in an Excel sheet, and insert these data in the online 4Ws mapping tool.

A multi-sector data collection (REACH, 2017) was also conducted and reported by REACH in June and August 2017 to provide information on the needs and vulnerabilities of affected populations. A total of 2,978 household surveys were conducted across 8 areas and found that 36,2% of households reported that at least one member was experiencing two or more signs of psychological distress.

MHPSS.net staff was responsible for supporting the collection of data from international organizations. International organizations with good internet access received instructions how to insert their data directly in the mapping tool. Organizations with difficulties accessing the online mapping tool could provide their data via an Excel spreadsheet. The data were collected both in Arabic and English. All data in Arabic were translated to English.

All collected data were recorded in the online mapping tool and also exported to an excel spreadsheet to enable further analysis of the mapping data. The final stage involved analysis and reporting of the findings for dissemination.

Exercise limitationsLimitations to this mapping exercise are presented below:

• Due to the security situation, access to Libya is limited. Travel for Libyans within Libya and from Libya to Tunisia can be challenging as well. MHPSS.net staff were not able to access Libya and were only able to provide training on data collection in Tunis. Other support to the data collectors was only possible remotely.

• The mapping of reported MHPSS services did not include an assessment of the quality of these services, or the number of interventions and number of beneficiaries.

• The purpose of the mapping was explained to the participating organizations. There remains, however, a possibility that some responses on activities on services and MHPSS workers may not be reliable – considering that there may be factors causing organizations to report higher numbers than actually present.

• Human resources are reported per MHPSS activity and do not provide the total number of people working in the field of MHPSS in Libya. For example, the same professional might work on multiple activities and in multiple health facilities or organizations; over-representing the actual number of human resources available.

• Despite the care that was taken with the translation from English to Arabic and vice versa, certain nuances may have been ‘lost in translation’. Translation of MHPSS terminology can be especially challenging, and participants may have different definitions of some of the terms.


Type of organization Number of organization

Community Based Organization 33

Governmental 5

Health facility 29

Int. NGO 9

Local NGO 36

Private (for profit) 34

UN Agency 3

University 1

Other 40

3.2. Findings

Number and type of organizations

Number and type of organizations This mapping identified a total of 190 organizations16 that deliver MHPSS services, programs, and activities for communities across Libya. A total of 314 activities were reported. The profile of the participating organizations was diverse, varying from the type of activities

delivered, type of organization, location and target population served. Activities were provided to adolescents, caregivers, children, elders, displaced population, local community, men, migrants/refugees, persons with disabilities, women, and others in different Libyan regions.

Among the participating organizations 178 were national organizations17 while 12 were international organizations18 offering MHPSS services in Libya (Table 1). The majority of governmental organizations were centers linked to the

government, such as the National Center Disease Control19; the health facilities can be understood as including both clinics and hospitals; and the “other” organizations were mainly schools.

16 A list of contributing organizations and its contact details can be found in Annex F - Actors currently active in MHPSS17 National organizations are understood as Community-based organizations, Local NGOs, Governmental organizations, Private, Health Facilities, University, and Schools.18 International organizations include both International NGOs and UN agencies. 19 The National Center for Disease Control is a specialized center which makes a significant contribution to the promotion of public health and protection of citizens, particularly in the area of disease control by enhancing the ability to find scientific methods for the prevention and control of diseases, in collaboration with specialized counterparts around the world. The Centre aims to establish a research unit to guide and advise health care delivery institutions, especially the Ministry of Health, academic institutions, health development partners, health researchers and policy-makers, on different health research matters, which govern the planning, review, conduct, evaluation and translation of outcomes of health research in Libya to promote high quality health research, and foster evidence-based health policy-making.

Concentration of organizations and activities per region20

The reported organizations and their services were highly centralized in Tripoli area (Figure 1; Figure 2). Tripoli is the country’s capital and the most populated city in the country. The city also has a psychiatric hospital (Al-Razi Hospital), which provides specialized MHPSS services.

A high number of organizations does not necessarily mean a high number of activities. For example, in the South area, while there are more organizations reported than in the West, in the West area there are more MHPSS activities reported than in the South.

20 See Annex D - Organizations operating MHPSS programs/activities per governorate for organizations operating MHPSS programs/activities per governorate


Number of Organiza0on by region

Na0onal Organiza0onInterna0onal Organiza0onTotalBenghazi 10 2 12Central 31 2 33East 22 0 22South 18 1 19Tripoli 86 7 93West 11 0 11Total 177 12 189

10

31 22 18

86

11

177

2 2 0 1 7

0 12 12

33 22 19

93

11

189

0

20

40

60

80

100

120

140

160

180

200

Benghazi Central East South Tripoli West Total

Na0onal Organiza0on Interna0onal Organiza0on Total

Number of organizations by region

178190


0 10 20 30 40 50 60

Benghazi

South

West

East

Central

Tripoli

4%

6%

7%

11%

15%

58%

Community-Focused

51%

Case-Focused

39%

General

10%

Concentration of activities by region

Concentration of organizations and activities per area of focusThe mapping demonstrated that 51% of the reported services provided represents “community-focused” interventions, such as safe spaces, community mobilization, information dissemination, inclusion of psychosocial considerations in other areas, as well as psychological support in education (Figure 2).

Furthermore, 39% of the services provided are “Case-focused” activities, which can be case-focused psychosocial work, psychological intervention, clinical management of mental health by specialized and/or non-specialized health care providers. Only 10% of the activities provided are considered “General activities to support MHPSS”, including trainings, assessments, clinical supervision, research, and psychosocial support for staff.

For a detailed overview of reported activities please see Annex A.

Concentration ofactivities per areaof focus

Most common activities in LibyaAccording to this mapping, the most frequently reported MHPSS services in Libya are linked to strengthening communities and family, especially group activities (43 activities); strengthening parenting (41 activities); as well as (un)structured recreational activities (42 activities). These activities occur in all regions of Libya.

A total of 56 MHPSS services linked to psychological support in education, most specifically psychosocial support to classes or groups of children at school/learning places, have

been recorded. While these services are reported in all regions, 85% of these activities were reported in the Tripoli region.

Services linked to clinical management of mental health disorders by specialists (e.g. psychiatrists, psychiatric nurses, and psychologists working at primary health care/ general/ mental health facilities) are mainly provided at health facilities or private clinics. In total, 46 activities were reported across Libya. These activities include pharmacological treatment of mental disorders.


0 5 10 15 20

Strengthening of community and family support

Psychological support in Education

Psychological Intervention

Clinical management of mental disorders by specialized health care providers

General activities to support MHPSS

(Case-focused) psychosocial work

Information dissemination to the community at large

Safe Spaces

Facilitation of conditions for community mobilization, community organization,ownership or community control over emergency relief in general

Supporting the inclusion of social/ psychosocial considerations in other sectors

Clinical management of mental disorders by non-specialized health care providers 0.3%

1.2%

2.2%

3.5%

7.0%

8.9%

9.5%

14.6%

15.6%

17.8%

19.1%

Concentration of services by activity type

Where activities are providedMHPSS services in Libya are provided in a variety of locations. The majority of services are offered in community centers (38%), followed by clinics (21%), schools (18%), hospitals (9%), home visits

(4%), informal shelters (1%), and camps (1%). The remaining 7% of MHPSS activities mapped are provided at other sites, including detention centers.


Considerations in basicservices and security

5.9%

Community andFamily supports

52.8%

Focused-nonSpecialized services

18.5%

Specialized Services

22.7%

Concentration of activities and organizations on the IASC MHPSS intervention pyramid

IASC intervention pyramid

5,9% of the reported MHPSS activities in Libya are under “Social considerations in basic service and security” layer; 52,8% are under “Community and family support”; 18,5% are under “Focused non-specialized support”; and 22,7% are under “Specialized services”. (Figure 5).

In addition, 30 organizations reported general activities in support of MHPSS, such as trainings, clinical supervision etc. “ it is possible that there may activities of ensuring social considerations in basic services and security that were not reported, as these services may be provided by other general services, which were not captured by this 4Ws mapping.

Activities by target groupThe target groups that were most commonly served by reported activities were children, local communities, adolescents, and persons with disabilities, in order of frequency. Migrants, refugees, men, caregivers, and elders were the target population who received the least number of reported instances of MHPSS support from the organizations mapped.

Case

3%

CommunityHealth

1%

Education

14%

Health

14%

Psychiatrist

14%Psychologist

19%

Social

23%

Volunteer

8%

Others

3%

Human resources for MHPSSThis exercise is not able to identify the total number of qualified trained MHPSS professionals, as it only counts the professionals reported as associated with each listed activity. It is widely recognized that MHPSS delivery has been hampered by a shortage of trained mental health professionals in Libya. There are fewer than 30 psychiatrists in the country, and the mapping results indicate that they have been providing services in multiple places, including their own private clinics. The mapping exercise could not identify the level of engagement of professionals with specific activities.

The information collected shows that there is a relatively high concentration of health staff, social workers and psychologists involved in providing MHPSS services compared to other actors, followed by education staff. Volunteers, case managers, community health workers are relatively under reported (Figure 7).

Concentration of activities per target group

Concentrationof HumanResources


Adolescents

16%

Women

7%Persons withDisabilities

15%Caregiver

3%

Children

21%

Elders

2%IDPs7%

LocalCommunity

18%

Men

5%

Migrant/Refugees

5%

Others

1%

3.3. Challenges

3.4. Recommendations


ToolIn general, there were few difficulties using the tool. However, challenges emerged especially regarding the inconsistency of the number and type of MHPSS workers enrolled in each activity. Several organizations provided a total number of MHPSS workers in their team instead of specifying them by activities. Also, there were inconsistencies regarding the terminology used for psychosocial worker, psychosocial counsellor, psychologists, a point already raised in previous assessments exercises.

The majority of the reported activities are currently being implemented. Only one activity has been reported as funded but not yet implemented. Local organizations had difficulties to report the start and end date of their activities. The lack of input in this regard precluded a deeper analysis of implementation status and timing.

Partners Collaboration While there is a high number of participating organizations in this mapping, there were some challenges in contacting and collecting data from international organizations.

Due to the challenging context in Libya, the majority of INGOs and UN agencies are based in Tunisia, working remotely. Not all focal points were able to participate in Health and Protection Cluster meetings where the MHPSS 4Ws mapping was announced. In order to approach all organizations, e-mails containing instructions on how to fill the online form were sent during July and August. Considering the context, an e-mail with the excel file was also sent out. Despite this, only 9 out of the 12 identified international agencies participated in the exercise to date.

This mapping is a relatively comprehensive overview of services currently available in Libya and should be updated every year. For more detailed information on how to do this on an ongoing basis, refer to the online 4Ws tool at MHPSS.net.

This mapping does not provide information on the quality of these services, the number of interventions, the number of beneficiaries served or key needs of the affected population. Therefore, this mapping exercise would be complemented by development of a robust MHPSS Needs and Resources Assessment exercise. This would

provide further, more detailed information regarding MHPSS needs, gaps in services provision, the target population and vulnerabilities. This exercise should also include a capacity and needs assessment of organizations and implementing staff.

Well-coordinated programs to address identified gaps and needs must follow such an exercise.

This report also calls for efforts to strengthen and better link the existing fragmented coordination mechanisms, to enhance technical guidance, referral systems and information management.

Abuazza, A. (2013). The Arab Spring Movement: A Catalyst for reform at the psychiatric hospital in Tripoli, Libya. International Psychiatric. 10(3). Retrieved from https://app.mhpss.net/resource/the-arab-spring-movement-a-catalyst-for-reform-at-the-psychiatric-hospital-in-tripoli-libya/ Amini, M. (2017, April 28). War-torn Libya has become a ‘torture archipelago’ for migrants sold into slavery. CNBC News. Retrieved from https://www.cnbc.com/2017/04/28/libya-has-become-a-torture-archipelago-for-migrants-sold-into-slavery.html

Amnesty International. (2016).Retrieved from https://www.amnesty.org/en/countries/middle-east-and-north-africa/libya/

Charlson, F.J., Steel, Z., Degenhardt, L., Chey, T., Silove, D., Whiteford, H.A. (2012). Predicting the Impact of the 2011 Conflict in Libya on Population Mental Health: PTSD and Depression Prevalence and Mental Health Service Requirements. PLOS ONE 7(7): e40593. Retrieved from https://app.mhpss.net/resource/predicting-the-impact-of-the-2011-conflict-in-libya-on-population-mental-health-ptsd-and-depression-prevalence-and-mental-health-service-requirements/

Danish Institute Against Torture. (2014). Consequences of Torture and Organized Violence | Libya Needs Assessment Survey. Retrieved fromhttps://app.mhpss.net/resource/consequences-of-torture-and-organized-violence-libya-needs-assessment-survey-2014/

Dettmer, J. (2013, March 06). Drug Use, Smuggling Increasing in Libya. VOA News.Retrieved from https://www.voanews.com/a/drug_use_smuggling_are_increasing_in_libya/1616257.html

Encyclopedia Brittanica. (2017). Retrieved from https://www.britannica.com/place/Libya

El-Badri, S. M. (2015). Mental Health Delivery in Libya.

Flynn, M. (2017). Kidnapped, Trafficked, Detained? The Implications of Non-State Actor Involvement in Immigration Detention. Journal on Migration and Human Security. 5(3), 593-613.). https://doi.org/10.14240/jmhs.v5i3.100

Hanna, F.B. (2017). Alcohol and substance use in humanitarian and post-conflict situations. Eastern Mediterranean Health Journal. 23(3).Retrieved from https://app.mhpss.net/resource/alcohol-and-substance-use-in-humanitarian-and-post-conflict-situations/

Handicap International. (2016). Rapid Assessment of Health Structures in Western Libya. Retrieved from https://app.mhpss.net/resource/rapid-assessment-of-health-structures-in-western-libya-2016/

IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings. (2012). Who is Where, When, doing What (4Ws) in Mental Health and Psychosocial Support: Manual with Activity Codes (field test-version). Geneva. Retrieved from https://app.mhpss.net/resource/who-is-where-when-doing-what-4ws-in-mental-health-and-psychosocial-support/

IRIN News.(2013, 17 June). Libya’s “growing” drugs/HIV problem. IRIN News. Retrieved from http://www.irinnews.org/report/98239/libya’s-“growing”-drugshiv-problem

Inter-Agency Standing Committee (IASC). (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva: IASC. Retrieved from https://app.mhpss.net/resource/iasc-mhpss-guidelines-in-english/

References



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United Nations Office for the Coordination of Humanitarian Affairs (OCHA). (2017). Humanitarian Dashboard as of 30 September 2017. Retrieved from https://app.mhpss.net/resource/country-profile-mental-health-services-in-libya/

OXFAM. (2017). OXFAM Media Briefing | 9 August 2017. Retrieved from https://app.mhpss.net/resource/oxfam-media-briefing-as-of-9-august-2017/

Reach. (2017). Libya Inter-Sector Coordinator Group - Multi-Sector Needs Assessment: Sector Factsheets | Libya, September 2017. Retrieved from: https://app.mhpss.net/resource/libya-inter-sector-coordinator-group-multi-sector-needs-assessment-sector-factsheets-libya-september-2017/

Rhouma, H.A.; Husain, N.; Gire, N.; Chaudhry, I.B. (2016). Mental Health Services in Libya. BJPSYCH International 13(3). Retrieved from https://mhpss.net/resource/country-profile-mental-health-services-in-libya

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United High Commissioner for Refugees (UNHCR). (2017). Migration Trends in Libya: Changing Dynamics and Protection Challenges. Retrieved from http://www.unhcr.org/publications/operations/595a02b44/mixed-migration-trends-libya-changing-dynamics-protection-challenges.html

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Activity # of Services reported Organization/institution Location(s)

Activity 1: Information dissemination to the community at largeThese services focus on informing (on?) the current situation, relief efforts or available services; provide messages on positive coping; and/or other information linked to MHPSS to Libyan community.

22

Local NGOs, private organizations, INGOs, Health facilities, and governmental

organizations also offer these kind of activities, usually in community centers, as well

as in clinics, hospital, schools, camps, and home visits.

Benghazi, Central, South, Tripoli, and West areas of Libya.

Activity 2: Facilitation of conditions for community mobilization, community organization, ownership or community control over emergency relief in generalThe main focus of these services is on support for emergency relief that is initiated by the community; support for communal spaces/meetings to discuss, problem-solve and organize community members to respond to the emergency. The main target population is the local community.

7

A total of 4 NGOs, 1 INGO, 1 governmental organization,

and 1 community-based organization offer these

services across Libya

Mainly in Tripoli and Central area, however there are

activities also in East and South of Libya.

Activity 3: Strengthening of community and family supportThe activities offered are focused on: structuring social activities; strengthening parents/family supports; structuring recreational or creative activities; facilitating of community supports to vulnerable persons; supporting social support? activities initiated by the community; early childhood development activities; facilitating conditions for traditional, spiritual, or religious supports.

60

30 community-based organizations, 12 private

organizations, 11 local NGOs, 4 health facilities, 1 governmental organization, 1 UN agency, and

1 INGO.

Mainly in Tripoli (39%), however, are also present in Central (28%), East (23%),

West (5%), Benghazi (3%), and South (2%).

Activity 4: Safe SpacesThe services are focused mainly on offering child friendly spaces to children and adolescents, mainly in community centers

114 private organizations, 3 local

NGOs, 2 community-based organizations, and 2 INGOs.

In Tripoli, central area, east, south, and Benghazi area.

Annex A - Detailed MHPSS activities provided in Libya


Activity 5: Psychological support in EducationActivities linked to psychological support in education, especially focused on psychosocial support to classes/group of children at schools and/or learning places (87%), psychosocial support to teachers and/or other personnel at schools/learning spaces (9%), and others (4%). The main target population are children, adolescents, and persons with disabilities. This is the second most common activity provided in Libya.

56

The services are provided in 40 are schools, 5 are private

organizations, 3 local NGOs, 3 health facilities, 3 community-

based organizations, 2 governmental organizations.

They are highly centralized in Tripoli (84%), but are also provided in other regions of

Libya, such as West (7%), Central (5%), East (2%), and

South (2%).

Activity 6: Supporting the inclusion of social/ psychosocial considerations in other sectorsThe main focus of these activities are on orientation of or advocacy with aid workers/ aid agencies on including social/ psychosocial considerations in programming,

4

This activity is provided by 4 organizations (2 local NGOs, 1 INGO, and 1 governmental

organization.

In Tripoli and Central area of Libya.

Activity 7: (Case-focused) psychosocial workThe services are mainly focused on linking vulnerable individuals/ families to resources and follow up, and providing Psychological First Aid (PFA). These activities are offered mainly in community centers (53%), clinics (11%), hospitals (9%), home visits (6%), informal shelters (3%), schools (3%), and other places (i.e. detention centers) (15%).

28

9 are local NGOs, 5 are private organizations, 4 health

facilities, 3 community-based organizations, 3 INGOs, 2 governmental, and 2 UN

agencies.

The provision of these activities is mainly centralized in Tripoli area (52%), followed by South

(24%), Central (14%), West (7%), and Benghazi area (3%).

Activity 8: Psychological InterventionThe services are focused on basic counseling for individuals (27%), psychotherapy (30%), basic counseling for groups or families (19%), individual or group psychological debriefing (15%), intervention for alcohol/substance abuse (9%), and others (6%).

49

These organizations are community-based

organizations (30%), local NGOs (26%), private (18%),

health facilities (16%), INGOs (5%), and UN agencies (5%).

They are mainly based in Tripoli, however also present

in East, Central, Benghazi, and West areas of Libya.


Activity 9: Clinical management of mental disorders by non-specialized health care providersService focused on non-pharmacological management of mental disorder, targeting especially children, adolescents, persons with disabilities, and migrants/refugees

11 community-based

organization.In Tripoli.

Activity 10: Clinical management of mental disorders by specialized health care providersThe services available are focused mainly on pharmacological management of mental disorders by specialized mental health care providers (50%), non-pharmacological management of mental disorder by specialized mental health care providers (23%), in-patient mental health care (16%), and others (11%). These activities are offered usually in clinics, however are also provided in hospitals and through home visits. The main target groups benefitting from this this service are: local community, persons with disabilities, IDPs, migrants/refugees, children, women, men, adolescents, and elders.

4621 health facilities, 20 private, 1 CBO, 1 local NGO, 1 INGO, and 1

governmental body.

The majority of these services are offered in Tripoli (48%), yet in South (16%), Central (13%), East (9%), Benghazi (7%), and

West (7%).

Activity 11: General activities to support MHPSSThe services are mainly focused on training/ orientating, followed by situational analysis/assessment, psychosocial support for staff/volunteers, research, technical and/or clinical supervision, and others.

30

CBOs (21%), private (21%), health facilities (17%), local NGOs (17%), INGOs (12%),

governmental (4%), UN agencies (4%), and universities

(4%).

This activity is mostly offered in Tripoli (72%), Central (12%),

West (12%), and Benghazi (4%) areas.


Annex B - Data collection - Excel Form

Date Information on Organization

Num Date of entering or updating this information

Name of organization (full name and acronym)

Type of Organization

UN Agency: 1Intl NGO: 2Local NGO: 3 Community Based Oorganization: 4Health Facility (clinic/hospital): 5Private (for profit): 6University: 7Other: 8

Address of organization

Name of the MHPSS focal point at the organization

(Person Managing or Coordinating the agency’s overall MHPSS programming and activities)

Phone number of focal point

Email address of focal point

1

2

3

4

5

6

7

8

9

10

Area of Intervention & Target Group

Governorate: where activity occurs (enter number as per below. To select more than one option, separate by comma)South: 1East: 2West: 3Central: 4Benghazi: 5Tripoli: 6Mobile/roving: 7

City/village/town (or camp) where the activity occurs (Specify exact area or neighborhood)

Target group(s) for this activity (specify age group(s) where relevant)

(select from list below. To select more than one option, separate by comma)

Refugees: 1Internally Displaced Persons: 2Local Community: 3Children: 4Adoloscents: 5Men: 6Women: 7Caregivers: 8Elderly: 9Persons with Disability: 10Other (please especify): 11

Where is MHPSS service provided? (select from list below. To select more than one option, separate by comma)Clinic: 1Community Center: 2Home Visits/Outreach: 3School: 4Hospital: 5Informal Shelter: 6Camp: 7Other: 8

MHPSS Activity Code, Layer of Intervention and Sub Codes

MHPSS activity code (Click here to see the codes)Acivity Code 1-6= Communtiy Focused MHPSSActivity Code 7-10 = Case-Focused MHPSSActivity Code 11 = General MHPSS

MHPSS activity subcode(s) (Click here to see the subcodes)

IASC MHPSS Layer (Click here to see the codes)Layer 4= Specialized ServicesLayer 3= Focused non-specialized supportLayer 2= Community & Family supportsLayer 1= Social Considerations in basic services & security

Implementation & Funding Status

Partnership with any International agency? If yes, which?

Funding Source (Donor) Implementation Status (please select from list below)

Start date for implementing the activity (for current activities, provide actual start date and not the originally proposed start date)

End date (specify on what date committed funding to implement the activity ends)

MHPSS Capacity

Number of MHPSS workers per activity “Type of MHPSS workers who do this activity (select from list below. To select more than one option, separate by comma)-psychiatrist: 1-psychologist: 2-social worker: 3-case manager: 4-community health worker: 5-health staff (e.g. doctors, nurses): 6-Education staff (e.g. teachers, school counselors): 7-volunteer: 8-other: 9”


Annex C - List of resources available at Libya MHPSS Response - 2017 Group21

Title Author(s) Organization / Publisher Published Date Access available at

“Hell on Earth”: Abuses against refugees and

migrants trying to reach Europe from Libya

Izza Leghtas Refugees International Jun-17

https://mhpss.net/resource/hell-on-earth-

abuses-against-refugees-and-migrants-trying-to-

reach-europe-from-libya/

2017 Libya Humanitarian Needs Overview

OCHA 2016

https://mhpss.net/resource/libya-

humanitarian-needs-overview-2017/

Advocacy Package: IASC Guidelines on Mental

Health and Psychosocial Support in Emergency

Settings

IASC 2011

https://mhpss.net/resource/advocacy-

package-iasc-guidelines-on-mental-health-and-

psychosocial-support-in-emergency-settings/

Alcohol and substance use in humanitarian and post-conflict situations

HANNA, F.B. EMRJ 2017

https://app.mhpss.net/resource/alcohol-and-substance-use-in-

humanitarian-and-post-conflict-situations/

Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Major Humanitarian

Settings

WHO/ UNHCR 2012

https://app.mhpss.net/resource/assessing-mental-

health-and-psychosocial-needs-and-resources-

toolkit-for-humanitarian-settings-2/

Checklist for field use of IASC Guidelines

on Mental Health and Psychosocial Support in

Emergency Settings

IASC 2008

https://mhpss.net/resource/iasc-mhpss-

guidelines-checklist-for-field-use/

Consequences of Torture and Organized Violence | Libya Needs Assessment

Survey.

Danish Institute Against

Torture2016

https://app.mhpss.net/resource/consequences-of-torture-and-organized-

violence-libya-needs-assessment-survey-2014/

Country Profile: Mental Health Services in Libya

Abdul Rhouma; Nusrat Husain; Nadeem Gire; Imran

ChaudhryBjpsych International 2016

https://mhpss.net/resource/country-profile-

mental-health-services-in-libya/

Displacement Event Tracker – Biweekly

Update, 1 – 18 July 2017 IOM Jul-17

https://mhpss.net/resource/displacement-event-tracker-biweekly-update-1-18-july-2017/

Drug Use, Smuggling Increasing in Libya

Voa News 2013

https://app.mhpss.net/resource/drug-use-

smuggling-increasing-in-libya-2013/

DTM LIBYA REPORT ROUND 9 Libya | IDP &

Returnee Report IOM Mar-17

https://mhpss.net/resource/displacement-

tracking-matrix-libya-report-round-9-libya-idp-

returnee-report/

EU steps up humanitarian assistance in Libya

ECHO Jul-17

https://mhpss.net/resource/eu-steps-up-

humanitarian-assistance-in-libya/

21 Note that this list of resources is constantly updated.


Expanded Response in Libya 2017

UNHCR UNHCR May-17https://mhpss.net/resource/expanded-

response-in-libya-2017/

Health Sector - Libya Coordination meeting

minutesSara Boujnah WHO Libya 04-Oct-16

https://mhpss.net/resource/health-sector-

libya-coordination-meeting-minutes-oct2016/

Help Seeking and Referral Pathway For the Ras Jdir

Tunisia-Libya Border Area – MHPSS

https://mhpss.net/resource/help-seeking-and-

referral-pathway-for-the-ras-jdir-tunisia-libya-border-

area-mhpss/

Human Rights Watch: World Report - Libya 2017

(AR) Human Rights Watch Jan-17

https://mhpss.net/resource/human-rights-

watch-world-report-libya-2017-ar/)

Human Rights Watch: World Report - Libya 2017

(EN) Human Rights Watch Jan-17

https://mhpss.net/resource/human-rights-

watch-world-report-libya-2017-en/

Humanitarian Action for Children – Libya

UNICEF 2016https://mhpss.net/

resource/humanitarian-action-for-children-libya/

Humanitarian Dashboard as of 30 September 2017

OCHA 2017

https://app.mhpss.net/resource/country-profile-

mental-health-services-in-libya/

IASC Guidelines on Mental Health and

Psychosocial Support in Emergency Settings

(ENGLISH)

IASC Jun-07https://mhpss.net/

resource/iasc-mhpss-guidelines-in-english/

IASC: Who is Where, When, doing What in Mental Health and

Psychosocial Support

IASC 2012

https://mhpss.net/resource/who-is-where-

when-doing-what-mapping-services-for-mental-health-and-psychosocial-support-

in-emergencies/

IDP Child Protection Assesment in Tripoli and

Bani Walid (2016) Cesvi Libya, Unicef 2016

https://mhpss.net/resource/idp-child-

protection-assesment-in-tripoli-and-bani-walid-2016/

IMC Libya - 4Ws Mapping of MHPSS Services and

Support

Amera Elkaied; Colleen Fitzgerald

IMC Dec-11

https://mhpss.net/resource/imc-libya-

4ws-mapping-of-mhpss-services-and-support-2011/

IMC Libya - MHPSS Assessment Report

Dr. Inka Weissbecker; Colleen Fitzgerald

IMC Nov-11https://mhpss.net/

resource/imc-libya-mhpss-assessment-report-2011/

Inside Libya’s Migrant Detention Centers

MSF 2017https://app.mhpss.net/resource/inside-libyas-

migrant-detention-centers/

Invisible Wounds: Libya’s Battle for Mental Health

Courtney Subramanian Time 01-Nov-11

https://mhpss.net/resource/invisible-wounds-

libyas-battle-for-mental-health-01nov2011/


Judicial expertise center outlines reasons behind

suicides in Al-BaydaThe Libya Observer The Libya Observer 27-Apr-17

https://mhpss.net/resource/judicial-expertise-

center-outlines-reasons-behind-suicides-in-al-

bayda-27apr2017/

Kidnapped, Traf cked, Detained? The

Implications of Non-state Actor Involvement in

Immigration Detention

Michael Flynn - Global Detention Project

Journal on Migration and Human Security

2017

https://mhpss.net/resource/kidnapped-

trafficked-detained-the-implications-of-non-state-

actor-involvement-in-immigration-detention/

LEAVING LIBYA - Rapid Assessment of Municipalities of

Departures of Migrants in Libya

Altai Consulting 2017

https://mhpss.net/resource/leaving-libya-

rapid-assessment-of-municipalities-of-

departures-of-migrants-in-libya/

Libya Fact Sheet UNHCR Apr-17https://mhpss.net/

resource/libya-fact-sheet-april-2017/

Libya Humanitarian Response Plan 2017

OCHA 2016

https://mhpss.net/resource/libya-

humanitarian-response-plan-2017/

Libya Humanitarian Situation Report _ 2017

Mid Year UNICEF 2017

https://mhpss.net/resource/unicef-libya-

humanitarian-situation-report-_-2017-mid-year/

Libya Inter-Sector Coordinator Group - Multi-Sector Needs Assessment: Sector Factsheets | Libya, September 2017.

REACH 2017

https://app.mhpss.net/resource/libya-inter-sector-

coordinator-group-multi-sector-needs-assessment-

sector-factsheets-libya-september-2017/

LIBYA OPERATION: UNHCR EXTERNAL

UPDATE UNHCR May-17

https://mhpss.net/resource/libya-operation-

unhcr-external-update-may-2017/

Libya Sectoral Quarterly Reporting Summary:

Health WHO Apr-17

https://mhpss.net/resource/libya-sectoral-

quarterly-reporting-summary-health/

Libya: Arbitrary detention of refugees, asylum-

seekers and migrants must stop

MSF 2017

https://app.mhpss.net/resource/libya-arbitrary-

detention-of-refugees-asylum-seekers-and-migrants-must-stop/

Libya: Emergency Dashboard, July 2017

WFP Jul-17https://mhpss.net/

resource/libya-emergency-dashboard-july-2017/

Libya: Health Profile 2015 WHO WHO 2015https://app.mhpss.net/resource/libya-health-

profile-2015/

Libya: Health Statistical Profile

WHO WHO 2015https://app.mhpss.net/resource/libya-health-

statistical-profile/

Libya: Humanitarian Bulletins

OCHA 2016-2017

https://app.mhpss.net/groups/current-mhpss-emergency-responses/

mhpss-libya-2011/hierarchy/


Libya: Ongoing Conflict Severely Impacting

Medical Care MSF USA 2016

https://app.mhpss.net/resource/libya-ongoing-

conflict-severely-impacting-medical-care/

Libya: Red Crescent scales-up psycho social support to vulnerable

populations

Libyan Red Cross 2017

https://app.mhpss.net/resource/libya-red-crescent-scales-up-

psycho-social-support-to-vulnerable-populations/

Libya: Who does What and Where

OCHA Mar-17

https://mhpss.net/resource/libya-who-does-

what-and-where-as-of-march-2017/

Libya: Who does What Where (as of March 2017)

OCHA Mar-17

https://mhpss.net/resource/libya-who-

does-what-where-as-of-march-2017/

Libya’s “growing” drugs/HIV problem

Irin News 2013

https://app.mhpss.net/resource/libyas-growing-drugshiv-problem-2013-

june-17/

Mapping of mental health and psychosocial support

in post conflict Libya

Colleen Fitzgerald, Amera Elkaied & Inka Weissbecker

Intervention Journal 2012

https://mhpss.net/resource/mapping-of-

mental-health-and-psychosocial-support-in-

post-conflict-libya/

Maritime Update Libyan Coast, 6 July - 20 July

IOM Jul-17https://mhpss.net/

resource/maritime-update-libyan-coast-6-july-20-july/

Mediterranean Migrant Arrivals Reach 69,574 in

2017; Deaths: 1,569 IOM May-17

https://mhpss.net/resource/mediterranean-

migrant-arrivals-reach-69574-in-2017-

deaths-1569/

Mental Health and Psychosocial Support

in Emergency Settings, What should Camp

Coordinators and Camp Manager Actors Know?

IASC 2011

https://mhpss.net/resource/


emergency-settings-what-should-camp-coordination-

and-camp-management-actors-know-2/


in Emergency Settings: What should Protection Programme Managers

Know?

IASC 2010

https://mhpss.net/resource/mental-health-

and-psychosocial-support-in-humanitarian-

emergencies-what-should-protection-programme-

managers-know-2/


in humanitarian emergencies

M. van Ommeren; F. Hanna; Weissbecker and P.

VentevogelEMHJ 2015


and-psychosocial-support-in-humanitarian-

emergencies-2/


in Humanitarian Emergencies: What

should Health Actors Know?

IASC 2010

https://mhpss.net/resource/


humanitarian-emergencies-what-should-humanitarian-

health-actors-know/


Mental Health Atlas 2014 WHO 2014https://app.mhpss.net/resource/mental-health-

atlas-2014-2/

Mental Health Delivery in Libya

Dr Selim El-Badri WHO Apr-15https://mhpss.net/

resource/mental-health-delivery-in-libya/

Mental Health Financing WHO 2003https://app.mhpss.net/resource/mental-health-

financing/

Mental Health Planning and Response for Libya


planning-and-response-for-libya/

Mental Health services in new Libya: The way

forwardSelim M. El-Badri Lybian J Med 2013


services-in-new-libya-the-way-forward/

mhGAP Humanitarian Intervention Guide

(mhGAP-HIG): Clinical management of mental,

neurological and substance use conditions

in humanitarian emergencies

WHO WHO

https://mhpss.net/resource/mhgap-

humanitarian-intervention-guide-mhgap-hig-

clinical-management-of-mentalneurological-

and-substance-use-conditions-in-humanitarian-

emergencies/

Migrants Caught in Crisis: The IOM Experience in

LibyaOlga Sheean IOM 2012

https://mhpss.net/resource/migrants-

caught-in-crisis-the-iom-experience-in-libya-3/

Migrants in Libya - Key Findings, May 2017

IOM May-17https://mhpss.net/

resource/migrants-in-libya-key-findings-may-2017/

Migration Trends in Libya: Changing Dynamics and Protection Challenges

UNHCR 2017

https://app.mhpss.net/resource/migration-trends-in-libya-changing-dynamics-and-protection-challenges/

MoH/WHO Activities updated until end of June

2012 MOH/WHO 2012

https://mhpss.net/resource/mohwho-

activities-updated-until-end-of-june-2012/

OXFAM Media Briefing (as of 9 August 2017)

OXFAM 2017

https://app.mhpss.net/resource/oxfam-

media-briefing-as-of-9-august-2017/

Predicting the Impact of the 2011 Conflict in Libya on Population

Mental Health: PTSD and Depression Prevalence

and Mental Health Service Requirements.

Charlson FJ, Steel Z,

Degenhardt L, Chey T, Silove D, et al

2017

https://app.mhpss.net/resource/predicting-the-

impact-of-the-2011-conflict-in-libya-on-population-

mental-health-ptsd-and-depression-prevalence-

and-mental-health-service-requirements/

Proposal for Mental Health Policy Framework

in Libya 2012 -2025

Prof. Marina Erhola, Dr. Simo Kokko, Prof. Timo Tuori, Dr.

Marja Anttila

National Institute for Health and Welfare (THL)

Aug-12

https://mhpss.net/resource/proposal-for-mental-healthpolicy-

framework-in-libya-2012-2025/


Protection Assessment in Libya

Handicap International,

Save the Children International

2016https://mhpss.net/

resource/protection-assessment-in-libya/

Psychological first aid: Guide for field workers

(ARABIC)

WHO, War Trauma Foundation and World Vision

InternationalWHO 2011

https://mhpss.net/resource/arabic-version-of-psychological-first-aid-

guide/

Psychological first aid: Guide for field workers

(ENGLISH)

WHO, War Trauma Foundation and World Vision

InternationalWHO 2011

https://mhpss.net/resource/psychological-first-aid-guide-for-field-

workers-2/

Rapid assessment of health structures in

Western LibyaHandicap International Handicap International 2016

https://mhpss.net/resource/rapid-assessment-

of-health-structures-in-western-libya-2016/

Report on Psychosocial Activities “Humanitarian

Response to the Libya Crisis” March 2012

Anne Schaefer IOM Mar-12

http://mhpss.net/resource/report-on-psychosocial-activities-humanitarian-

response-to-the-libya-crisis-march-2012/

Save the Children: Psychological First Aid

Training Manual for Child Practitioners (ENGLISH)

Dybdal, Anne-SophieMelin, MieTerlonge, Pernille

Save the Children Denmark 2013

https://mhpss.net/resource/save-the-children-

psychological-first-aid-training-manual-for-child-

practitioners-english/

Save the Children: Psychological First Aid

Training Manual for Child Practitioners (ARABIC)

Dybdal, Anne-SophieMelin, MieTerlonge, Pernille

Save the Children Denmark 2013

https://mhpss.net/resource/save-the-children-

psychological-first-aid-training-manual-for-child-

practitioners-arabic/

Self-Help Booklet for Men facing crisis and

displacement IOM 2014

https://mhpss.net/resource/self-help-booklet-for-men-facing-crisis-and-

displacement/

Suicide incidents are sweeping Bayda city in

east LibyaThe Libya Observer The Libya Observer 19-Apr-17

https://mhpss.net/resource/suicide-incidents-are-sweeping-bayda-city-in-

east-libya-19apr2017/

The Arab Spring Movement: A Catalyst for reform at the psychiatric hospital in Tripoli, Libya

Abuazza, A. 2013

https://app.mhpss.net/resource/the-arab-spring-movement-a-catalyst-for-reform-at-the-psychiatric-

hospital-in-tripoli-libya/

The situation of women in Libya

JUSOOR Center for Studies

and Development2017

https://app.mhpss.net/resource/the-situation-of-

women-in-libya/

UN HUMANITARIAN COORDINATOR IN LIBYA CALLS FOR PROTECTION

OF INTERNALLY DISPLACED PERSONS

UNSMIL Jun-17

https://mhpss.net/resource/un-humanitarian-coordinator-in-libya-calls-

for-protection-of-internally-displaced-persons/

UNHCR IDP Protection Monitoring Assessment:

Libya REACH Feb-16

https://mhpss.net/resource/unhcr-idp-

protection-monitoring-assessment-libya/

UNHCR Libya Emergency Response in 2017

UNHCR May-17

https://mhpss.net/resource/unhcr-libya-

emergency-response-in-2017-may-2017/


UNHCR, IOM pledge increased support for

Libya IOM, UNHCR May-17

https://mhpss.net/resource/unhcr-iom-pledge-increased-support-for-libya/

University student commits suicide in Bayda

The Libya Observer Apr-17

https://mhpss.net/resource/university-

student-commits-suicide-in-bayda-22apr2017/

War-torn Libya has become a ‘torture

archipelago’ for migrants sold into slavery

CNBC News 2017

https://app.mhpss.net/resource/war-torn-libya-has-become-a-torture-

archipelago-for-migrants-sold-into-slavery-2017/

We Will Stay Here: IDP Vulnerability Assessment

Mercy Corps, UNHCR 2016

https://mhpss.net/resource/we-will-stay-here-idp-vulnerability-

assessment/

WFP Libya Country Brief (Jul - Dec 2017)

WFP 2017https://mhpss.net/

resource/wfp-libya-country-brief-jul-dec-2017/

Women in Libya: The Ongoing Armed Conflict,

Political Instability and Radicalization - Up

Holding Gendered Peace at a Time of War

Asma Khalifa

https://mhpss.net/resource/women-in-libya-

the-ongoing-armed-conflict-political-instability-and-

radicalization-up-holding-gendered-peace-at-a-time-

of-war/

IOM, UNHCR 2017

https://mhpss.net/resource/we-will-stay-here-idp-vulnerability-

assessment/

IOM 2014


Annex D - Organizations operating MHPSSprograms/activities per governorate

Governorate Organizations

Benghazi

Alamel Clinic, Aljamia Clinic, Amazonat Libya, Enjaz for charity, Libyan Association of Psychology, Libyan organization for counseling and psychotherpy, Libyan Organization for Mental Health Support, Nataj organization for capacity development of women, Organization for the Amazons of Libya, “Premiere Urgence Internationale (PUI)”, Psychiatric Hospital of Benghazi, ACTED

Central

AbuJerida Psychiatric Clinic, Adel Organization for People with Special Needs, Al - Aswak Mental Health Center, Al Naseem for Community development, Al Rayyan Center for the rehabilitation of children with special needs and improvement of speech and speech defects, Al temena center for people with special needs, Al-Fosah Academy for training and rehabilitation of people with special needs and communication and development, Al-Hikma Specialized Hospital, Al-Naba’a alyaken Center for those with special needs, autistic children and educational consultations, Alemdad organization, Algad Al Mashreq Organization for People with Special Needs, Ashraqa Foundation for Child Care, Department of Psychiatry, Misrata Central Hospital, Department of Sociology Faculty of Arts, “Dr. Salem Al - Shukry Psychiatry Clinic”, Hun Society for Child Welfare, “International Federation for Human Development and Psychosocial Support IU.C”, “International Rescue Committee (IRC)”, Libya Heroes Organization for the Parties, Libyan association for psychology science, Libyan Organization for autism kids, Libyan Red Crescent, Mashafe Medical Center for Mental Health and Psychosocial Support, Ministry of Social Affairs Misrata Branch, Misrata Psychosocial support team, Model Team for Mental and Behavioral Disorders of Children and Adolescents, Noor Al Ghad Center for Training and Rehabilitation of People with Special Needs, Office of the Special Groups of Education Supervision Misrata, Pediatric Psychiatry Clinic in Al - Abrar Specialty Hospital, Psychiatry Clinic at Dar Al Hekma Clinic, Safaa Libya Center for People with Special Needs, Social Solidarity Fund - Comprehensive Care Complex, Wa’ed Al Khair Association for People with Special Needs

East

Al Amal School for Deaf and Hearing Impaired Education, Al Safa Clinic, “Al.Ishraqa school for developing mental abilities”, Allibia for social work, Alseraj Almoneer for the Blind and weak-sighted, Autism center - Darnah, Center for Autism-Alquba, Child Care House - Albeada, Deaf and dumb school - Albeada, Elderly Home - Mesa, House Boys - Albaeda, House of events in Soussa, Kufra Psychosocial Support Clinic, Libyan Women Union, Nour Al Mustaqbal Clinic - Darnah, Psychiatric clinic - Albeada, Psychiatric clinic - Derna, Red crescent - Tobrek, School For Deaf & Hearing Impaired - Darna, School of mental alertness Derna, School of mental development, Tobruk Autism Center

South

Aleradaa center for autism, Almalaeka alseghar kindergarten, Alousra clinic, Alwaha center for disability children, Azdjar, El Hakim clilnic, El Manar Clinic, Fazzan center for autism, Ghat general hospital, Libyan Association for Youth and Development, Om el Momeneen, Oubari hospital, Psychiatry and neurology center/ sabha, Psycho-social supportive team of libyan red crescent sabha, sabha mental capabilities school, Sabha Oncology center, Sabha psychosocial support team, Sarkht Aljonob association, STACO

Tripoli

Abdel Rahman Interior School, Al - Andalus Center for Multidisciplinary Rehabilitation, Al Ethad school, Al Ghad Al Mashreq School, Al rabea school, Al rashied school, Al sadeqa school, Al Safa for Mental Health Association for Children, Al Tahr