Libyan fighters flock to Tunisia for medical treatment

Amid escalation in civil strife, members of rival militias head to clinics across the border for better health care

SFAX, Tunisia — Business is going well for El Amen Co. The family-run business makes two or three lucrative corpse deliveries every day, always in one direction: from Tunisia to Libya. The recent eruption of full-scale fighting in Tripoli and beyond means even more patients are traveling across the border with Tunisia for treatment. For those who can't be saved, El Amen stands ready to take them home. Lately, it's been as many as five a day.

"We do whatever is necessary to get the body back to Libya," said Fouad Trabolsi, the firm's director. "We offer a same-day service."

Until 2012 he was an ambulance driver. His entrepreneurial streak emerged when he saw a newspaper advertisement placed by the Libyan consulate in Tunisia. It was looking for someone willing to transport an unusual cargo, the corpses of Libyans who died on Tunisian soil, back to their families.

His company has the contract for southern Tunisia, while another company deals with any deaths in the north. He employs six drivers, three men to carry out Islamic religious rites to prepare the bodies and four others to help with administration. The Libyan embassy confirmed the arrangement, saying Trabolsi charges a pretty penny for his services: $875 per repatriation.

El Amen is just one of dozens of companies that have popped up since 2011 as part of the blossoming ecosystem of Tunisian businesses catering to Libyan patients. With many hospitals and clinics in Libya suffering from staffing and supply shortages, hundreds of Libyans travel to their much more stable neighbor every week for all kinds of health care — whether in times of peace or war. There are more than half a dozen private clinics in Sfax alone. 

Mounir Ahmed al-Gori, who was injured in the battle for Tripoli’s international airport that began in mid-July, is one of hundreds of Libyan fighters in Tunisian hospitals.

Gori was part of the unfortunate brigade charged with guarding the airport, which has come under repeated attack since last month by Misrata forces and their allies, including the Abu Oubaida bin Jarrah militia. The group is linked to the Benghazi U.S. consulate attack and assassinations of leading Libyan security figures. The attackers include fighters from Abdelghani al-Kikli's notoriously brutal Tripoli-based militia, which sought revenge against the Zintan forces for whom Gori was fighting.

On July 23, stationed at a camp defending the airport, next to the Brega Oil Co. fuel depot, which a few days later would be dramatically set aflame, Gori took a bullet in his left upper arm and a second bullet through his forearm. He escaped the fighting and was sent to Zintan Public Hospital for emergency surgery. Immediately after that, he was evacuated by ambulance to Ibn Annafis Polyclinique in Sfax, where the ligaments in his forearm were reattached. Now he is waiting for a skin graft and physiotherapy.

Gori's roommate at the clinic, Osama El Ghoula, also from Zintan, was nervously waiting for surgery on deep shrapnel wounds in his right side. Other members of their brigade have already returned home in good health.

During his time at Annafis, Gori says he has noticed patients only from Zintan or allied militias, all working under the command of General Chief of Staff Gen. Khalifa Haftar.

"I did not see other wounded from the other brigades that are against us," Gori said.

During his time at the Ibn Annafis Polyclinique, Mounir Ahmed al-Gori says he has noticed patients only from Zintan or allied militias, all working under the command of General Chief of Staff Gen. Khalifa Haftar.

That doesn't mean Misrata forces are not receiving treatment in Tunisia. Multiple sources said that Tunisia does not discriminate and that victims on all sides are welcome for treatment.

"All Libyans come here from both conflicting sides, but they never speak about Libya fighting or politics," said Mohamed, a Libyan from Benghazi who recently moved to Sfax. "They just come for treatment, and I hope that all Libyans come here in order not to fight again. Tunisia is a country of law and order."

Some clinics follow a policy similar to Annafis’, accepting patients only from militias allied with one another. Their enemies are treated at different clinics. At least two clinics in Sfax are said to receive patients belonging mainly to Misrata forces and their allies.

Yet still other clinics take everyone. The head of one clinic in Sfax said his clinic has wards dedicated to rival militias, carefully separated and guarded by heavy security to prevent fighting breaking out. He said it was too sensitive for press to visit and asked that his clinic not be named because of the risk of revenge attacks.

Security is a growing problem in Tunisia, and Tunisian authorities say they keep tabs on every fighter receiving treatment. "We cooperate closely with the Interior Ministry," a doctor at Annafis said.

A patient at al-Sabah Hospital in the Libyan capital, Tripoli, in July 2014. After initial treatment, many Libyans complete their recovery across the border in Tunisia.
Mahmud Turkia / AFP / Getty Images

Libya is effectively outsourcing much of its health care to Tunisia. In Sfax, a business and industrial hub 170 miles southeast of Tunis, this increasingly well-organized, cross-border cooperation has quietly become a leading industry.

In late July, Tunisia's Foreign Minister Mongi Hmadi touted the possibility of closing the border entirely to Libyan nationals, citing the risk to Tunisian security. But even after Tunisia closed its border with Libya last week and with thousands of foreign workers desperate to escape the violence, Libyan fighters seeking urgent medical care were among the few still allowed in. 

"Libya is the biggest market for Sfax," says Hmaida, a Sfaxian man who works with Libyans visiting for medical treatment as a fixer — finding apartments, lending money and connecting people with the right treatment options. 

"The biggest beneficiaries are doctors. They are opportunists," he said with a laugh, adding that if the border were closed, then the health care sector would be badly affected.

Even in less violent times, Tunisia's private clinics are filled with Libyans, who are often charged double what Tunisian patients pay. 

Most Libyans pay for routine health care themselves, but Libyan authorities cover the bill for government-affiliated fighters and for the return of anyone who dies unaccompanied by loved ones.

Many of those interviewed stressed that the Tunisian-Libyan relationship is much more than an economic one. Solidarity dates to colonial times, when Tunisian political opponents of French rule could seek refuge across the border and vice versa for Libyans in trouble with their Italian rulers.

‘Libya is the biggest market for Sfax. The biggest beneficiaries are doctors. They are opportunists.’


fixer in Sfax

Aymen, a 29-year-old Libyan taxi driver and part-time fighter from Zawiya, was rushed to Sfax after he was shot through his jaw and cheek by a Misrata sniper near the airport on July 13.

The Libyan Health Ministry covered his treatment, and he has since returned to Tripoli. While he was in Sfax, he stayed in housing rented by the Libyan army. He will likely return to Sfax for false teeth, although he may need to cover that bill himself.

"The people of Sfax are very generous," he said, commending the quality of the treatment.

During the conflict in 2011 that overthrew Muammar Gaddafi, many Tunisians offered food and housing to their neighbors in their hour of need. Forces siding with Gaddafi were usually sent to the capital, Tunis, where hotels downtown were overflowing with young men, many in wheelchairs or on crutches, with stumps where their arms or legs used to be. Rebel fighters, meanwhile, opted for medical providers in Sfax, funded by the National Transitional Council. Other rebel fighters were sent to Qatar, Jordan or Turkey for treatment.

"At the time, we didn't even know whether they would pay us or not," says the Sfaxian doctor. "We even accepted patients without passports."

It was a gamble that didn't always work out. Many of the bills were never paid, a representative for Tunisia's Foreign Ministry said. This is an ongoing source of tension between Tunisia and its wealthier neighbor. Several clinics were forced to close.

But others did very well. New private clinics have opened since 2011, such as Al-Wafa in Zarzis. Often there are more Libyans than Tunisians receiving treatment.

"The clinics are all full. We are struggling to find space for everyone in our clinic," says the doctor from Annafis. "As long as we have spare beds, we accept patients."

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