Benghazi — Al Hawari hospital may be the most modern medical centre in the eastern Libyan city of Benghazi, but the large number of war wounded it has received in the last two months has stretched its limited resources.
"When the fighting began, most of the injured - both civilians and soldiers - were transferred here," said the hospital's senior medical officer Fabri El Jroshi. "We were missing a lot of important equipment to treat them, and we still are. We need material for fractures and fixtures and we badly need more nursing staff.
"Sometimes patients will find a doctor here, but no equipment for fixing a broken bone."
The 500-bed hospital has received 800-1,000 patients with war-related problems, El Jroshi told IRIN. "Providing physical therapy is also difficult. Again, we just don't have the equipment. Even before the conflict we had problems treating certain groups of patients, especially in the orthopaedic field."
Médecins Sans Frontières (MSF) emergency coordinator for Libya Simon Burroughs said: "All the doctors and medical staff that we've met in Benghazi, Brega and Ajdabya are incredibly skilled and dedicated. Although doctors are coping, many foreign nurses working in eastern Libya have now fled, leaving gaps in many health facilities. Medical students are doing their best to fill some of the gaps."
At one point, MSF left Benghazi after the security situation deteriorated. It is now back and has so far provided more than 30 tons of medical supplies to different hospitals, including surgical kits and equipment required for the treatment of gunshot wounds.
"On a more global level, we are struggling to get a clear picture of the needs as the security situation does not allow us to undertake even some basic assessments," Burroughs added. "When we tried to reach the town of Ras Lanuf - 300km west of Benghazi - we had to turn back twice because of fighting and insecurity."
Transferred to Qatar
The most severely war-wounded patients have been transferred from Benghazi's hospitals to medical facilities in Qatar. Benghazi doctors are also having to deal with cases which were rare previously, like rape and paralysis.
Twenty-six-year-old Abdusalam* was admitted to the hospital last week, after being hit by a NATO strike that unintentionally targeted a group of rebel fighters heading for the frontline near Ajdabiya. He fractured his thigh and sustained bullet wounds to the lower chest. His mother and sister were not aware he was a rebel fighter, he said.
"My mother is sick and I didn't want to worry her. My father and brothers are proud of me though... We saw NATO planes flying above us and then suddenly, for no reason, they started to strike us... Before the revolution began, I was sitting behind a desk. I was an employee in an office. Once my body heals, I hope to go back to the frontline," he told IRIN.
"I would like to go to the frontline too, but I have a job. And treating the injured is just as important," El Jroshi said.
Shortage of nurses
Nursing resources are stretched. According to the International Organization for Migration, several hundred Filipino nurses have left eastern Libya since the unrest began.
Jeanette Calo is one of those who decided to stay. A Filipino nurse who left Manila for Benghazi a year ago, she said there was a shortage of nurses. Seventy of her colleagues at the Al Hawiya hospital have returned to the Philippines.
"I decided to stay because it is my job to be here to care for the patients, especially the rebel fighters injured on the frontline. I had no experience treating gunshot wounds previously, so I had to learn quickly."
For two weeks, at the worst point, the nurses slept at the hospital. "We worked 24-hour shifts, waiting for the injured to arrive," she told IRIN. "Things are better now but we are still lacking some equipment, and we have to work extra hard to make up for the loss of so many nurses."
Calo added that some of her Filipino colleagues were visiting Tripoli when the unrest began. Unable to return home to Benghazi, they were instead recruited by a Tripoli hospital that paid higher wages, she said.
At the El Jalaa hospital on the other side of Benghazi, the situation is worse. Dr Nishal El Fayah said that although stocks of medicine are sufficient, there was a severe shortage of some medical supplies.
On one of the wards, which has 38 beds, there is only one stethoscope and one blood pressure monitor...Recently we received a patient who had hepatitis. In order to ensure that the equipment was not contaminated, we decided not to monitor his vital signs.
"On one of the wards, which has 38 beds, there is only one stethoscope and one blood pressure monitor," he said. "Recently we received a patient who had hepatitis. In order to ensure that the equipment was not contaminated, we decided not to monitor his vital signs."
Medical students, many of whom have been working unpaid at the hospital since the conflict began, have not been able to buy uniforms or appropriate footwear. "The shops are closed, so they have to go around in their old shoes," he said.
Occupying one bed was Younis Abdousalam Edbeshi who was shot by pro-Gaddafi forces while fighting at the beginning of March.
Another patient, Ed Beshi, who fractured his left thigh, was being treated for gunshot wounds, but could not be operated on due to a shortage of medical supplies.
"I was told to go home and return in a few weeks... The hospital didn't have the supplies to help me. I was hoping to be back on the frontline supporting the other rebels, but I'm still here, waiting for an operation... It is frustrating, but the hospitals here were just not ready for war casualties."
Although Benghazi's hospitals lack supplies, aid workers say needs are greater in the city of Misrata, where doctors at the polyclinic there have recorded 257 deaths since 19 February, mostly civilians killed by snipers or gunfire. The polyclinic said 949 people had been treated for wounds.
According to Human Rights Watch, Misrata's main hospital had been under construction for the last two years, meaning that the seriously injured have been treated at the polyclinic instead.
"All over Libya, hospitals close for construction, often for several years," Fouad El Mabrouk, a doctor at Benghazi's El Jawaa hospital, said. "Under the Gaddafi regime, construction would begin and then the funds would dry up. Libya has many hospitals that could have been excellent centres for medical treatment, if only construction had been completed."
Some of those injured at Misrata are being brought by ship to Benghazi.
"We never know who or what to expect," said paramedic Mohammed Nour. "So we have to be prepared for the worst. All we receive is a call saying that a vessel is about to dock at the port, and we get straight down there. Sometimes we have to deal with complicated injuries. Other times, fortunately, cases are much less serious."
*not a real name
This report does not necessarily reflect the views of the United Nations