Tunisian Border Camp Report
Here is their report on the situation :
Objectives of the visit:
-To assess the gravity of the situation
-To assess medical needs for the Libyan Refugees
-To set up some routine medical care for women, children and primary care in collaboration with local healthcare providers under the umbrella of Tunisian Red Crescent (TRC)
Visiting Team:
Dr Tareq, UK, Paediatrics (On behalf of Libyan Doctors Relief)
Dr Jamal, UK, Chest Medicine (On behalf of Libyan Doctors Relief)
Dr Abdulfattah, Internal Medicine, Zawia, Libya
Dr AbdulRahman, Canada, Internal Medicine (on behalf of WAFA Relief)
Dr Abdurrazag, Haematology (on behalf of Global Relief Libya)
Overview:
There are over 250,000 inhabitants in Jabil Nafus area distributed as follows:
Zentan 30,000 Nalut 25,000
Yefrin/Galaa 25,000 Jadu 20,000
Rojban 15,000 Kabao 10,000
Hawmid 4,000 Rahabat 3,000 anti-Kaddafi
Many of the people exiled in Tunisia are scattered geographically. Tataouine, Remada, Dheba, Medenine (620 families), Zarzis, Sfax, Tunis, Ghanous (62 families), Gabes etc
Assessment:
The group was divided into 3 teams, Tataouine, Remada & Dheba.
Tataouine:
Dr Abdulfattah, Dr Abdurrazag
There are around 30,000 refugees in Tataouine, mostly women and children distributed as follows
| Organisation | Number of families | Accommodation | Funding |
| Al-Ehssan Charity | 1200 | Private | Charity Libyan businessmen in Tunis Others |
| WAFA-relief | 700 | Private | UK |
| Ragba | 30 | Private | Local charity Dr Moustfa |
| Dr Fathi | 150 | Camp | Local charity |
| Outskirts of town | 500 | Private | Local charity |
| Total | 2580 |
Access to local help is available but disorganised and not coordinated. Local Healthcare Resources (local population 150,000) Tataouine General Hospital, Private clinics, two Private Laboratory
1 private imaging centre
2 Obstetrician/both are males (very relevant)
Charities including TRC, Women and Children charity organisation
Tunisian Women’s Health Society (TWHS) and Tunisian Children Care Society
(TCCS) Chaired by Dr Mohammed ((Dr MTT )(1 of 2 obstetricians in Tatowwen) and Mr Bashir respectively
2. Tataouine Tunisian Red Cross (TTRC), headed by Dr Salaheddine, Senior
Pharmacist
The following services were agreed:
A) MATERNITY CLINIC (from a limited sample in Dheba clinics, out of 225 women seen, 65 were pregnant (29%)).
Routine 2 daily clinics will start on Wednesday 04/05/11 except on Sundays. A morning clinic 9-12 and afternoon clinic between 3-7 pm.
The clinics are manned by 2 midwifes and two nurses
A Tunisian female obstetrician is recruited
Further senior obstetric support by Dr Mohammed will be available when needed
Dr Mohammed will provide an US machine for Libyan Obstetrics specialists till we source one.
Libyan doctors role (support and commitments):
1. Help to fund the facility to acceptable standard including furniture, consumables and US machine in due course
2. Provide Medical cover of the service when possible
B) CHILDCARE (out of 632 patients seen, 217 were children (34%)
In the same premises, there will be a clinic to
1. To see children with acute and chronic problems
2. Provides vaccination services (will be based on Tunisian regimen including HIB and Hep B)
3. To ensure continuity of care for children with chronic illnesses like DM, asthma etc
4. Supported by GP type female doctor
5. Will be supported by Libyan Paediatricians from UK/USA/Libya
GENERAL MEDICAL/GP SERVICES
1. To cover all other medical referrals (excluding pregnancy and paediatrics)
2. Will be based in the TRC in the same street.
3. A daily service
4. Will be manned by Libyan Doctors on 2-weekly basis
5. Specialist referrals will be made as clinical needs dictate to Ibn Nafis clinic in Sfax.
D) PHARMACY
A wide-range of medications is being sourced in UK as well as a sizeable load from Benghazi.
1. Will be based in the TRC
2. Medicines will be dispended by the physician directly to the patient (to avoid delay and overcome English/French drug names issues)
3. Will endeavour to provide a Libyan pharmacist to set it up
4. Will be the reference pharmacy for all Libyan refuges in the area
5. Specialist medicines including chemotherapy, Hep C anti-viral, other expensive medications will be discussed individually
Hospital Care:
Any patient needs hospital care should follow this pathway:
a) Emergency admission: should be referred to Tataouine General Hospital for initial assessment, stabilisation and treatment. If patient condition allows, transfer to Ibn-Nafis clinic (Private clinic in Sfax) should be arranged (Dr AbdulRahman is the coordinator)
b) Elective admission: direct admission or assessment should be done in Ibn-Nafis clinic
Diagnostic support:
A) Blood tests:
All blood tests needed, will be referred to a specialist private laboratory as defined by TRC colleagues as they are familiar with the settings and they use them for their own practice. This is for basic routine blood tests including:
1. Haematology (especially antenatal serology, FBC, ESR, Haematinics etc)
2. Chemistry (Us & Es, LFT’S, TFT’S, CRP, Glucose, HBA1C, Lipid profile etc)
3. Microbiology (Unine C/S, sputum for AFB, throat swabs etc)
4. Immunology
B) Imaging:
Likewise any radiology or other imaging needed, will be organised in a similar manner
The investigations will be vetted by one of the TRC colleagues to minimise wastage. These include:
1. Chest X-ray, Abdominal X-ray, KUB, musculoskeletal X-ray
2. Abdominal US
Remada camp:
Dr Tareq & Dr Jamal
This is some 40 kilometres from Dheba.
There is a UNCHR camp of about 2000 refugees mostly women and children. is UNCHR sponsored and run by ALTAWAN charity, with 250 people working on campus (information from one of ALTAWAN employees)
The overall condition is very poor with insecure tents. We arrived on a windy day and significant number of tents is falling. 2 days later, there was a much worse sandy storm, and a lot of tents were displaced and collapsed.
Sanitary facilities are insecure and unsuitable for use and most women and children are not using them due to lack of privacy. Women are showering in their own tents.
Similarly, toilets are weak and insecure.
I was not allowed to take photographs.
A businesswoman from Tunis donated 2 units with 3 showers each for women and children, these were transported from Tunis, unloaded by crane but could not be installed as they thought to create problems as they are luxurious units. Further negotiation with UNCHR, we were promised that they would be connected.
Medical Care:
Provided by
1. Saudi doctors group
A team of female and male doctors
Pharmacy supplies
2. Women society had a half tent with an Algerian physician (Ex-Nalut Hospital employee)-This has closed 4 days ago.
Further 3 portakabins were erected and one of them was taken over by Libyan Doctors to start a clinic there. The necessary equipments were bought.
The camp is crowded with ill-fitted tents, over all state is poor and the feeling was if the standards cannot be improved, the refugees should be moved elsewhere. The UAE are looking to provide a camp in Tataouine.
UAE Red Crescent exploring the possibility of opening a new camp in Tataouine with up to 3000 in capacity, which should be able to accommodate the Remada camp.
Dheba Camp
Dr AbdulRahman supported by Dr Jamal, UK, Chest Medicine & Dr Tareq, UK
The camp is located about 2-4 kilometres from the crossing point.
In contrast to Remada, this is a much more comfortable facility. Generously size tents, much better private toilets and showering facilities. This is run (99%) by UAE with a medical facility and well stocked pharmacy.
Other organisations include MSF and Tunisian Red Crescent. There are around 1000 refugees
Some refugees wished to leave due to recent shillings inside Dheba. Some people left to Tataouine only to return next day, as they found no place.
The Libyan doctors have started a clinic and two Canadian physicians already joined in.
There is a small hospital next to the camp, which has been taken over by the Tunisian army.
Cost Implications:
This is very much a partnership and joint venture between UK Libyan doctors and TRC, Tunsian Women’s Health Society (TWHS), Tunisian Children Care Society (TCCS) and the project cost will be shared as follows:
1) The premises for all the clinics are for free, both TRC and TWHS/TCCS are committed to this.
2) Capital cost:
i. Furniture
UK Libyan medical doctors will provide the cost of furnishing the Maternity/Children clinics which has been paid for and this will be completed on 05/05/11
UK Libyan doctors will provide the necessary infrastructure for the Dheba, and Remada clinics
The total cost of this is around 4,000 Tunisian Dinars (around £ 2,000).
ii. Medical equipments
US machine will be needed (cost around 10000 Tunisian Dinar, £ 5,000)
Sphygmomanometer
Pulse oximeters
Peak flow meters
iii Clinical consumables
The Maternity/Children clinic needs some consumables to bring the standards and this will cost: 20,000 Tunisian Dinars (£ 9,000)
3) Overheads:
The monthly cost of providing the above service is about 5,000 Tunisian Dinars (£ 2,500) which covers:
1. 2 midwifes
2. 2 nurses
3. A manager/coordinator
4. Sanitary staff
5. A female obstetrician
6. A female general medical doctor (Paediatrics)
7. Telephone, stationary etc
Conclusion:
We believe that the visiting medical team has achieved their objectives during this relatively short visit.
We feel now the foundation and infrastructure is being laid for a reasonable healthcare programme, which should address the needs of our beloved sisters, children and brothers.
We found the Tunisian colleagues are committed, extremely helpful and unconditionally supportive.
We are sure, that everyone would like to join us in extending special thanks and our appreciation and gratitude to them.
It is upon us, the Libyan doctors from all over the world to honour the agreement and meet the requirements; we would like to ask for your support and commitments both in person and financially.
