11 October 2023 – In the wake of the devastating flood crisis that struck Libya, the World Health Organization (WHO) works with local health authorities in eastern Libya to establish a range of mental health services, from basic psychological first aid to specialized psychiatric care. WHO is supporting the setting up of mental health clinics staffed by specialists to respond to the immediate needs of affected people and help deeply traumatized survivors to deal with grief, anxiety, and loss.

Meet Dr Sumaya Shaftar, a 44-year-old mental health specialist, who is based at a primary health care centre in Derna, Libya. The city was left devastated by the deadly floods that followed Storm Daniel in September 2023. An estimated 30 million cubic metres of water came roaring through the city when 2 dams in the nearby mountains collapsed. The torrent of water levelled entire city blocks and swept away whole families.

Dr Sumaya, can you describe the current situation in the flood-affected areas and among the affected population?

When I first entered Derna, it had been 3 weeks since the floods, and I saw some people reopening their shops and starting to move around the city to secure their necessities. But I didn’t see ordinary people on the streets. Instead, I saw bodies moving around with expressions that didn’t convey sadness, anger, joy, or any emotions. Their faces were expressionless.

Even the children I saw every day on the way to my clinic didn’t seem like normal children playing and having fun. Instead, I saw small figures standing, looking at those around them, without giving any indication of what they were looking at or searching for.

Some neighbourhoods in Derna showed nothing but destruction, with streets burdened by the flooding’s remnants of household items, building debris and cars of unknown origin. I didn’t see the green trees, flowers and beautiful landscapes that Derna was known for. Everyone I met told me that they needed support, even those who hadn’t lost any family members or their homes. They repeated, “We have lost everything, life no longer has any taste.”

Most of my female patients – many of whom expressed joy that a fellow woman was here to help – talked about their needs, both material and emotional. They mentioned simple things that they longed for.

I cried when a friend from Derna sent me pictures of her home. In the first photo, she was drinking coffee in the beautiful courtyard filled with flowers, which is also where her father’s car used to be parked. The other picture showed what remained of their home, now just mud-coloured rubble, with no car in sight because the floods had washed it away. These pictures reflect the feelings of all of Derna’s residents, even those who didn’t lose their families in the floods.

What is WHO doing to help people address the mental health challenges caused by the crisis?

WHO is trying to assess the need for mental health services, provide more medical teams and necessary medications, allocate places for service delivery, and support the efforts of the Libyan Ministry of Health in providing mental health services to all those affected by the floods in Derna.

What are the challenges?

Several challenges face all mental health service providers in Derna during this period, including the fact that the Libyan people are not accustomed to seeking such services, even when they need them. Also, because of the floods, Derna has been divided into parts, which are difficult to move between owing to road and bridge damage. Many citizens’ cars were washed away, and many people contact me from inaccessible locations wanting mental health services. There is no public transportation in the city.

Citizens are not aware of the locations where mental health services are available these days. When I tell people that I am here to provide this service, they say they didn’t know about my presence.

Can you tell us the story of one survivor who came to you for mental health support?

A 25-year-old female patient came to me, silent and her face expressionless. She showed no signs of sadness, anger, joy or any other emotion. When she began to speak, she cried and complained of not sleeping for days and of chest tightness and a weary body, even though all her medical tests were normal. She felt that life no longer meant anything to her.

She had lost her aunts and their families, cousins and friends. Miraculously, she had survived, along with her mother, father and sister, even though the floods had washed them more than 3 km away from their home. She found herself sheltering in a house with people she didn’t know. She said, “The sound of women and children screaming never leaves my mind, and I heard it that night.” She wonders every day why she is alive and others are not. She no longer has an appetite for food and, when she does eat, she doesn’t taste anything.

The young woman mentioned that she no longer sat with her family, but instead constantly watched videos on her phone about that night and about the latest news about Derna and the missing people. She even considered ending her life and asked, “Is there anything painless that I can buy that won’t torture me for a moment in my death?”

She refused to go to a mental health specialist or to the specialized psychiatric hospital, which is over 200 km away in Benghazi. She also refused to let her mother or father attend my clinic. I started her on medication and therapy sessions with a mental health professional.

Unfortunately, she disappeared for 9 days, even though I had given her my phone number for contact. She didn’t respond to my messages and calls, and her phone was off. On the ninth day, she came back, wearing a smile I had not seen before. My heart leaped with joy when I realized it was her. I asked her where she had been, and she explained, “Didn’t you advise me to turn off my phone so I wouldn’t see more news?” She said, “Thank God, I can sleep better now, and I try to spend time with my family or in the kitchen. Some symptoms still linger, but I’m sleeping now, and that has made me feel better.”

I was overwhelmed with joy and told myself, “Thank God, I didn’t lose you.” I truly feel that what everyone is doing to support mental health in Derna during these days is indeed something great and worth the effort that it takes us.