From Libya to Spain, Care is Critical for People on the Frontline

In our November 15th panel in the project Global Family Systems and Psychosocial Resilience #RapidResponse to Covid-19, our guest experts Dr. Nadia Ben Younis and Dr. Arancha Garcia del Soto discussed their experiences addressing family and community systemic response to the pandemic, in Libya and Spain respectively. Dr. Ben Younis, a psychiatrist in Libya with postgraduate international diplomas in mental health, human rights and law, and clinical psychotherapeutic interventions, currently provides mental health and psychosocial support for the National Center for Disease Control (NCDC) in Libya as well as INGOs and local NGOs. Dr. Garcia del Soto holds a PhD in Sociology and is currently based in Spain. She has taught and practiced human rights work in Africa, Europe, Colombia, and Sri Lanka, and has worked with migrants and refugees across the globe. Last year she worked for the Colombian Truth Commission in its exile chapter, and she continues her work in Colombia through EQUITAS (forensic anthropology and psychosocial support to the families of the missing).

Dr. Ben Younis shared some demographic information about Libya that is especially relevant during the pandemic. In Libya, thirty percent of the population is under the age of 15, and 3.9% is over age 65. Life expectancy is 72 for men and 77 for women. Fifty percent of the population lives in the three main cities in the north, where the all mental health services are concentrated, with neglect of the south cities and other remote areas. Libya, technically an UMIC, ie an upper middle income country, does not necessarily seem characteristic of such on the ground. In this country of roughly seven million, where 78% live in urban areas, the ratio of psychiatrists to patients is less than one psychiatrist for every 100,000 population; it is the same ratio for psychologists and social workers. Additionally, the impact from the civil war is significant, especially the impact on the general and public health infrastructures, and social network of the Libyan society. Till now, mass graves and dead bodies are discovered often, and water and electricity cuts are frequent. The lack of access to MHPSS services and differences in socioeconomic status (SES) across the country highlight the importance of understanding the Social Determinants of Health (SDOH), which explain how environmental factors impact mental health status for individuals, families, and communities.

As of the time of the panel, there were more than 76,000 confirmed cases of Covid-19 in Libya, with deaths over 1,000. Residents are afraid to seek healthcare due to coronavirus concerns, and also due to limited access to quality health services, especially MHPSS services. Similar to other countries, the rates of unemployment and domestic violence have increased. In Libya (and many other countries), families without access to the internet cannot engage in virtual learning thus education is at a standstill for many. A global concern for all healthcare workers during this pandemic, including in Libya, is taking on tasks that end up compromising the healthcare workers' wellbeing, as well as those of their families.

Dr. Garcia del Soto reported on the toll on families in Europe who had missing family members and their experiences on grieving, and on those in exile who were forced to leave their countries for various reasons and how they become “experts” when dealing with uncertainty. Both situations have parallels in the current pandemic times. She described the Mediterranean Sea as “a non-intended burial place,” now the largest mass grave in Europe. On the day she spoke to us, rescue boats recently discovered 480 deaths, of which 100 were drownings that had occurred in the previous 72 hours. She discussed the concept of double grief, hurting for the sudden loss of a loved one and hurting for one self. Some families may have to decide to give up search of the person and many start to feel guilty for giving up on the search, which may feel like a second death. When family members do not agree to the decision, tension results. In this time of Covid-19, Froma Walsh (2020) discusses the multiple losses experienced by families, and the importance of paying close attention to each family member as well as the family unit’s functioning in such times.

Dr. Garcia del Soto summarized four key lessons learned from working with the families in exile or with missing family members that can be applied to the current Covid19 times: 1) Many of us can always survive with less material possessions. 2) During these critical times it is important to value what we truly care for, such as kindness, education, generosity. 3) More family situations are filled with grief and sadness. Sadness is a part of our lives. 4) Past and future become more far apart. Thinking back to our lives one year ago, the uncertainty of today forces us to become more present. She talked about the importance of the ethics of care for others and ourselves, as providers and practitioners. Ways to improve care may include holding workshops and identifying support strategies for caregivers. Care is critical for people in the frontline.