|Hospitals are running low on supplies and foreign journalists are being kept under a near-total lockdown [Evan Hill]
As Libya watches Tripoli to gauge whether anti-regime protesters can regain momentum toward unseating longtime leader Muammar Gaddafi amid a frightening security crackdown, international aid groups say they are incapable of reaching the capital and other areas in the country’s west, where armed conflict continues.
Hospitals are running low on supplies, and foreign journalists are being kept under a near-total lockdowfn.
UN officials based in the liberated eastern city of Benghazi told Al Jazeera on Friday that several towns around Tripoli - including Misrata, Khums and Ghayran - remain in a state of "siege," incapable of communicating reliably with the outside world and cut off from the donations flowing into eastern ports and across the Egyptian border.
Journalists, international aid workers and Libyan citizens remain unable to travel freely between east and west, paralysed by violence both real and rumoured along the 600km of coastal road between Benghazi, the heart of the uprising, and Sirte, the hometown of Gaddafi.
Military forces loyal to Gaddafi have reportedly set up defences at Ras Lanuf, Libya’s largest oil refinery, which sits astride the road around 120km west of rebel front lines at Brega, another refinery town that has been the scene of deadly fighting over the past two days.
Ajdabiya, one hour east of Brega, is the last reliably peaceful stop on the road west.
“What [locals] told me is that after Ajdabiya, it’s death,” said Anne Chatelain, the local co-ordinator for Doctors Without Borders.
On Friday, journalists and armed opposition fighters had reportedly moved beyond Brega toward Ras Lanuf with little resistance, but the fear of travelling along the road remained.
On Wednesday, a Libyan air force jet bombed the road and other rebel positions near Brega.
Scores of fighters as well as journalists from Al Jazeera and CNN who had stopped on the road outside the town were dozens of metres away from one explosion.
Fighting in the area left at least 10 dead and 21 wounded, reportedly including two children.
Reporters and doctors who previously attempted to travel past Brega on the main road have been turned back by Gaddafi troops, and local sources reported numerous checkpoints on the approach to Sirte, Chatelain said.
Rumours have also circulated in Benghazi that a group of residents who attempted to travel that way recently were ambushed and killed, though that report could not be verified.
With Gaddafi forces guarding the east and restricting movement across the Tunisian border to the west, towns remain isolated in the middle.
One doctor in Zawya, around 50km west of Tripoli, and the site of ongoing fighting, has made repeated pleas for more medical supplies on Arabic-language satellite news programmes.
Journalist and aid workers have found it difficult to get reliable information from the west.
Mobile phones have been working sporadically for at least a week, but the network functions intermittently and Gaddafi’s regime apparently shut down most of the country’s internet access late on Thursday night.
Reports from the west have described a campaign of kidnappings and murder by armed Gaddafi supporters that has extended inside hospitals since demonstrations broke out more than two weeks ago.
Last Friday, Gaddafi’s security forces surrounded hospitals and mosques in the west to pre-empt protesters who hoped to mass after the end of midday prayers, said Hunter Price, a representative in Libya for the International Relief and Development Agency.
Clinics in the region are also running low on supplies to deal with traumatic injuries, he said.
Hospitals in the west, like those in the east, were ill-prepared to deal with the combat-related injuries that have flooded emergency rooms in recent weeks.
But the arrival of foreign aid organisations in the east means clinics there have at least received training and supplies to help them cope. Endangered towns such as Misrata and Zawya have had to respond on their own.
This week, Doctors Without Borders sent a three-person team to Ajdabiya Hospital to train staff to deal with mass casualties, Chatelain said. The team included an anaesthetist, a nurse and a surgeon who has practiced reconstructive surgery for victims of Iraq’s violence at a special clinic in Jordan.
At the hospital, doctors said that previously three-victim car crashes were the worst incidents their emergency room had seen. During the uprising, residents rushed in 10 or 15 victims at a time.
Foreign nurses, the backbone of many Libyan hospitals, have fled since the uprising began on February 15. At some hospitals in the east, up to 70 per cent of the nursing staff have left, Chatelain said.
Mohammad al-Ammary, a 25-year-old Benghazi resident, had only recently graduated from medical school and started work at Benghazi’s Hawari Hospital when fighting between protesters and security forces began. Most of the Ukrainian nurses had fled, he said, though Filipino staff remained.
After staying in the safety of his home for a few days, while gunfire and explosions echoed on the streets of Benghazi, Ammary visited the hospital and found that civilians who had protested outside the main security headquarters had been shot in the head and chest by high-calibre weapons.
"Even the doctors were shocked," he said, and the hospital was in a "panic situation".
Sometimes, three ambulances bearing casualties would arrive at once. Ammary, who had trained in pediatric medicine, found himself pressed into emergency service. Victims with gunshot wounds to their arms were left to triage while life-or-death cases received attention.
With few orthopedic surgeons on staff, some of the injured waited days to have bullets removed and wounds repaired.
Others who had been hit by gunfire went into hiding rather than seek treatment at the hospital, because they had heard stories that Gaddafi troops were kidnapping and executing injured protesters.
Jelaa Hospital received the brunt of Benghazi’s casualties. The day the city's military garrison fell to a combined assault of protesters and defected special forces troops, Jelaa was receiving five or six gunshot victims every few minutes, Ammary said.
Since Jelaa lacked the space to deal with the hundreds of injured, doctors there sent patients to Hawari Hospital and Benghazi Medical Centre.
Ammary’s sister, a second-year pharmacy student, volunteered at Hawari; other residents with no medical training - boy scouts, barber shop workers, as well as engineering and economics students - lent their help.
Hawari ran short of gauze, needles and plasma fluid, Ammary said. To ease the crisis, local pharmacies donated drugs, grocers gave their food away to the hospital for free, and residents brought blankets and pillows.
Since rebels secured Benghazi and much of east Libya, life here has returned to a kind of normalcy.
Shops are open and food is available. But while the UN workers who arrived in Libya on Tuesday said there is no humanitarian crisis in the east, they warned of less-visible problems on the rise.
“We feel that basic humanitarian needs are catered for, however we need to be prepared for longer- term support in case this crisis continues,” said Abdul Haq Amiri, the head of the regional branch of the UN’s Office for the Co-ordination of Humanitarian Affairs.
Foreign donors have supplied the east with equipment to deal with trauma cases, but since the region has split with the central authority in Tripoli, it now has limited stockpiles of drugs to treat non-combat cases: cancer, heart disease, diabetes and mental disorders.
"They don’t receive the same media attention as gunshot wounds," said Naeema al-Gasseer, the assistant regional director for the World Health Organisation (WHO).
“Usually, we want to see the blood, the fracture,” she said.
While WHO workers were able to buy serum in Egypt to treat tetanus cases and bring it over the border, acquiring specialty drugs like those to treat cancer or epilepsy takes time, she said.
Anesthesia drugs, already in comparatively low supply in Libya, are also in greater shortage now.
Money might also become an issue. The end of the fiscal year for Libya’s public hospitals comes this month, Chatelain said, so they are waiting to see if they will receive any funds from the embattled leadership in Tripoli.
One public sector worker told Chatelain he had not received his usual salary payment at the end of February.
Wealthy Gulf countries have already sent supplies directly to the east, and Kuwait has donated $100,000 to the WHO, Gasseer said, but the UN has asked nations such as Qatar and the United Arab Emirates to give more and will make a formal appeal to regional neighbours on Sunday.
The UN headquarters in New York City has also released $5m to its team in Libya to make emergency purchases of medical and humanitarian relief supplies, Amiri said.
The region is also well-stocked with food, but those stockpiles may be threatened, said Price, the International Relief and Development worker.
Baby food and formula are in critically low supply across the country, he said.
Staples such as tomato paste, pasta, rice, sunflower oil and flour are available currently but have traditionally been subsidised by the government, so how their availability and price fluctuates during the uprising remains to be seen.
Witnesses in Tripoli have already reported being forced to wait in two-and-a-half hour bread lines, Price said.
Meanwhile, the UN is "extremely concerned" about the situation in the west, especially on the Tunisian border, where thousands of migrant workers wait in squalid camps to leave the country, Amiri said.
Teams from the UN and Doctors Without Borders have also been stalled there by regime restrictions and the dangerous environment in the vicinity of Tripoli.
The UN team would enter Libya "as soon as the situation permits," he said. Chatelain, of Doctors Without Borders, said their 17-member team on the border was waiting as well.
For now, most residents of free east Libya have yet to feel a real squeeze.
But as the flow of medicine, on which people depend on to stay healthy and alive, slows to a trickle, the east-west split caused by Gaddafi’s tenuous and fanatical hold on power may begin to mean the difference between life and death.