Human rights’ violations suffered by migrants in Libya have been documented for years by international organizations and agencies, think tanks or journalists (5,8–10). The average stay of more than 6 months shows that the vast majority of people suffer from long imprisonment and confinement. As it has been stated in this study, violence is systematic and of a huge magnitude. In most of the cases (more than 80%), episodes of physical violence were suffered every day or almost every day and privation episodes were very long (sometimes for the whole journey) (data no shown). In addition, perpetrators are very difficult to identify (more than a half of the people interviewed could not identify their aggressors, and they simply called them “the Arabs”) (data no shown).
Physical violence occurs mainly in places of confinement and is closely linked to the exploitation of migrants, forced labour and extortion. Many NGOs have denounced the inhuman conditions of these places of confinement (5,11,12). Firearms are very common and often used for threat, but also including mass murders and shooting. A large number of reports mention that extortion is a common practice. However, NGOs note that migrants are often abducted by smugglers when they arrive in the country. They can be released if they pay, themselves or their families. They could also be sold to another smuggling group (5,11).
Women are particularly vulnerable to sexual violence. This result has also been documented by other studies pointing that sexual violence is a common practice during the detentions or before being released for the trip (4,13–15). In addition, 35% of the victims of sexual violence of the study stated that episodes were very common (daily or almost daily and by multiple perpetrators, -data no shown-). In addition, the results of the study show that men are also exposed to sexual violence. Nevertheless, data around sexual violence may be underestimated, especially for men, as the nature of the violence, which affects their privacy, sexuality and gender identity, makes it more difficult to testify or speak about.
As it has been stated in our results, access to health care in Libya is almost non-existent. Access to health care is generally provided by very few international organizations. Nevertheless, in our study no one had ever been treated by a doctor or had received medication during their stay. The health system in Libya is collapsed and it is facing serious problems due to infrastructure damage, lack of medicines, medical equipment and personnel (10). Access to medical care has become a problem for all people living in Libya, especially migrants, whether detained or not (16).
Most people asked for psychological support after the questionnaire, reflecting a real urgency. Publications documenting migrants' mental health disorders as a consequence of their journey are numerous. The main factors mentioned are traumatic events before migration, forced, unplanned, poorly planned or illegal migration, low level of acculturation, isolation or separation of the family in the host country, lack of support, perceived discrimination and length of residence of the host migrants (17–19).
Limits
This study has a number of limits. Firstly, the recruitment was hold in the Paris healthcare centre, which restricts the profile of participants and may affect the external validity of the study. In addition, the refusal and exclusion linked to risk of psychological decompensation could have avoided the most vulnerable patients from participating in the study, probably due to the difficulty of evoking traumatic experiences. Moreover, it is very possible that sexual violence was underestimated among men, as it was normally evoked as witnessed. Finally, the low proportion of women included could also limit the statistical power for this group.