Libya conflict: A doctor's diary

Image caption A Libyan rebel fighter celebrates in the street in Tripoli, Libya

The conflict in Libya began with protests against Col Muammar Gaddafi's regime in February and has escalated into a bloody battle for territory between government and rebel forces.

On 21 August, rebels entered the Libyan capital of Tripoli and took control of large areas, while pockets of pro-Gaddafi resistance remain.

Moez is a junior doctor from Britain who has travelled to Tripoli to help provide medical aid. Here is his diary of recent events.

Sunday 28 August 05:00 - Tripoli Port, Libya

Yesterday evening several ships arrived and began to unload their stock.

There was a fishing vessel from Malta from the I Go Aid foundation which shipped several tonnes of food and medical supplies. And a ship run by the International Organisation for Migration - a UN subsidiary - also arrived with food and medical supplies donated by several NGOs from different countries.

We are getting some supplies now, but I feel that the greatest need is for logistical support.

We still see casualties arriving at the emergency departments of the Tripoli Medical Centre and the Tripoli Central Hospital, but there is no ambulance control centre in Tripoli and none of the ambulances have radios. There is also very little communication between hospitals.

I also hear that there are still pockets of resistance in some suburban areas of Tripoli - especially in the south of the city near the airport.

Saturday 27 August 23:00 - Tripoli, Libya

Image caption Security checkpoints have been established in Tripoli

Security checkpoints that have been established by local neighbourhoods are thankfully becoming more organised so moving around the city is becoming easier.

Local councils are merging with the aim of setting up one council to represent the whole of Tripoli, and there are signs that more shops are open for trade.

These are signs that life is returning to an acceptable level.

I say returning to an acceptable level because after what the country has been through, life will not go back to 'normal' again. Normal for your average civilian was oppression, fear and inequality.

Hospitals still require some much-needed assistance and as before, specific drugs, medical equipment and skilled staff are needed - especially skilled nursing staff.

Due to the nature of injuries suffered by fighters and civilians during the conflict, there is a dire need for orthopaedic equipment such as external fixators and orthopaedic drills which are used to stabilise fractures.

We have heard numerous accounts of execution-style massacres of detained civilians in various parts of the city, similar to the victims we saw on Wednesday.

We also hear from eyewitnesses and victims about the atrocities they have witnessed and suffered.

Friday 26 August 15:00 - Tripoli, Libya

Spending the last two days going around the main hospitals in Tripoli and assessing their healthcare needs, it is clear that much works needs to be done for the health service to be able to provide effective treatment for the population.

However, there were encouraging signs that despite all of the difficulties, many doctors from Tripoli and other cities such as Misrata, Zawiya and the Nafusa mountains had made their way down to Tripoli and in some hospitals accounted for up to 70% of the doctor staffing levels.

Due to security concerns, many local Libyan medical staff have been unable to get to work for a week or so - especially those who reside in regions where extremist regime loyalists still hold out.

I also noted that one of the private clinics had been damaged from a mortar shell.

And the main accident and emergency department of Al Khadra Hospital (one of the largest in Tripoli) was completely destroyed by a missile a few weeks ago, that had been fired by regime loyalists residing near the now infamous Rixos hotel.

There are specific requirements in all of the hospitals in terms of medical equipment, specific medications and specialists and there are a number of organisations and individuals trying to help out with this but I do not think we are at the stage of a humanitarian disaster of epic proportions as some commentators have been speculating.

This does not mean that the health service does not need help, especially in the post-conflict reconstruction phase.

I am of the opinion that mental health needs will be quite large due to the trauma experienced by nearly everyone during this conflict.

Wednesday 24 August 20:00 - Mitiga Air Base, Tripoli, Libya

As dusk set, a large trailer arrived at the hospital and I heard some crying and wailing.

As I walked to the truck, the stench was overwhelming and I found that there were (what we later counted as 17) bodies piled in the back of it.

A casualty arrived at the same time that was shot in the leg and hand. After he was treated, we spoke to him and found out that he was held captive alongside the 17 dead bodies in a school that was being used by regime forces as a prison.

As the regime loyalists retreated the day before, they entered the room and executed them - the lone survivor was the casualty we spoke to. He said he played dead so they wouldn't shoot him again.

He was able to identify at least 15 of the 17 bodies as he had spent a week with them in the cell and got to know them. The bodies looked like they were as old as 60 years old and the youngest looked like he was around 13 or 14.

It was obvious that these were the war crimes that Gaddafi is to be prosecuted for at the International Criminal Court and so my colleagues and I took it upon ourselves to try to document the types of injuries that these people had by taking clear pictures of them.

The demoralising task took a few hours to complete and amongst the stench and sweat from the stress of the situation, I almost passed out a few times.

That was nothing compared to the sorrow that was felt by the few family members that arrived to identify the bodies of their loved ones. One old man arrived to identify a relative and howled: "Gaddafi you monster", through his tears.

Wednesday 24 August 13:00 - Mitiga Air Base, Tripoli, Libya

I arrived at the airbase and found that the local volunteer doctors had already set up an operation at the base alongside support from the infamous Dafniya Field Hospital based out of Misrata that has been treating casualties on the front line near Zliten for the past few months.

They arrived in Tripoli on Tuesday night with a group from International Medical Corps.

There were many casualties at this hospital and I would say it was working near to full capacity. Most of the wards and the beds were full.

In one of the wards, some of the injured Gaddafi loyalists that were captured were being held. I counted at least 16 of them and they were being well looked after in spacious rooms and provided with good medical care.

However, at the entrance, there were at least three or four young men with loaded weapons who were keeping watch as much for the safety of the regime loyalists as for themselves.

Tuesday 23 August 19:00 - Bab al-Azizia, Tripoli, Libya

I noticed that many people were making their way to the rear of the compound and so I went to investigate.

They were all converging onto a large complex of buildings and it became apparent that these were very large weapons' stores or silos of some sort.

Everyone that was walking in the opposite direction to me had more guns in their hands than they could carry along with boxes of ammunition: Beretta pistols, Kalashnikovs, sniper rifles, submachine guns, rocket-propelled grenades, missile launchers - you name it.

But it was quite a sad sight to see a civilian population becoming armed in such a way - it can never be a good thing.

It will only mean that civil law and order may take some time to be established.

As dusk fell, some gunfire and even rockets were being fired over our heads. It was unclear who was firing and it became very dangerous and so we left the area very quickly to the safer suburbs.

Tuesday 23 August 18:00 - Bab al-Azizia, Tripoli, Libya

I made my way back to Bab al-Azizia and found that the revolutionaries had just entered Gaddafi's infamous compound.

There were three large perimeter reinforced concrete walls that we went through and into the inner compound.

Within it there were huge plains of lush green grass, palm trees and different buildings and condos. To one side there were the tents in which he was famous for receiving guests.

Right beside that was the iconic and symbolic building that was Gaddafi's house which was bombed in 1986 in response to the Berlin discotheque bombing where two American GIs were killed.

A civilian that went inside came out wearing the very hat that the colonel often wore when giving speeches.

Tuesday 23 August 14:30 - Mansoura, Tripoli, Libya

Image caption Hospitals have been swamped with people injured in the fighting

The pounding at Bab al-Azizia continued and we provided some first aid to some of the casualties before they were taken to a field hospital or larger hospital.

Around 13:00, a French journalist I was with was shot in the thigh, possibly by a sniper bullet. He was very shaken and we managed to provide some roadside first aid to stop the bleeding before whisking him away.

I was asked to go with them, but I didn't want to leave the battlefield as I felt that I could help people there, so we went to a place where the journalist could be assessed a little better.

Tuesday 23 August 10:00 - Mansoura, Tripoli, Libya

Early morning, we heard that there was a massive battle in Bab al-Azizia - Gaddafi's compound - so we made our way there.

As we got closer, the sound of heavy gunfire could be heard and black smoke was rising from the compound.

I joined the front-line soldiers and managed to get a front row seat to what was going on. There were at least 50 or 60 of these "technicals" or pick-up trucks that had been modified to carry heavy artillery, rocket launchers and anti-aircraft guns on the back of them.

The writing on the side of the trucks showed that they were from all over Libya: Misrata, Zintan, Jadu, Yefren, Rujban, Sorman, and Zawiya. They pounded away mercilessly for hour after hour.

Monday 22 August 21:00 - Siraaj, Tripoli, Libya

I was staying in a very organised neighbourhood, as it was difficult to get across to the other side of town due to safety concerns.

I say it was organised from a security point of view. Local civilians had set up checkpoints and lookouts on their streets to make sure that no weapons or anyone that could cause concern from a security point of view could enter.

One person I got to know on the day later gave me a call to come and take a look at his brother who got shot. He had a shotgun wound to his shoulder and had his wounds cleaned at the hospital earlier on.

But looking at his x-rays, I counted 29 pellets still embedded in his shoulder. The reason I was asked to see him was to administer intravenous antibiotics.

The hospital was so full that they could not keep him in and so he was told to administer antibiotics through a cannula at home by himself.

He was also not given any analgesia whatsoever so we arranged for this from the local pharmacy that was being used now as a field hospital.

Monday 22 August 14:00 - Suq Al Thalath, Tripoli, Libya

We went back along the same road as we were told that it was a lot safer.

We managed to get as far as a few minutes from the heart of Tripoli, Green Square (now restored to its original name of Martyr's Square).

There, we saw that a large battle was taking place in a large compound.

An organised group of revolutionaries that had descended into Tripoli from the mountains had surrounded a loyalist cell in this compound and ordered them to surrender, giving them the opportunity.

When the cell refused and started attacking the revolutionaries, they went in and secured the building by killing off the remaining pockets of resistance.

Monday 22 August 07:00 - Girgaarish, Tripoli, Libya

There was much more of the same scenes in the western suburbs of Tripoli, and roadblocks had been set up by some of the local neighbourhoods to monitor who was entering and leaving the area for security purposes.

As we got closer to the centre we noticed that all of a sudden it became very eerily quiet and there wasn't a single car or person on the roads. We became quite uneasy.

On the side of the road we noticed that someone was shot in the leg, then we were informed by another car that arrived next to us that there were snipers up ahead so we had to make a quick u-turn back - Tripoli wasn't quite done yet.

Monday 22 August 05:00 - Zawiya to Tripoli, Libya

Image caption Rebel fighters are facing resistance in the Libyan capital, Tripoli

Entering Zawiya, a place in the last few months I had only ever seen through the eyes of the world media, the destruction and devastation was plain to see.

Many burnt-out buildings lined both sides of the road and it was obvious that major battles had taken place here.

As we made our way to Tripoli, the number of cars around us increased and we found ourselves amongst a convoy of cars all making the same journey.

As we got closer to the suburbs of the capital, women and children lined the streets waving, singing and hugging each other. "We love you, revolutionaries of the mountains," some shouted.

Sunday 21 August 14:00 - Tatouine, Tunisia

I was in Tunisia when news came of the imminent "fall" of Tripoli. I made the mad scramble through the Western Mountains and we were on the road for 20 hours.

We stopped by a roadside café (the only one for along a 300km stretch of road) near to Rujban in the Western Mountains of Libya.

There, many Libyans were fixed to the television screens and the news of the capture of Gaddafi's son was aired.

People hugged each other and prostrated themselves on the ground in the middle of the café to thank God. We could hear celebratory gunfire from many different directions outside.

We were keen to make our way to Tripoli and so we hit the road again, making our way down the mountains and towards Bir Ghanam, then Zawiya.

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