The flimsy boat of more than 100 people had been at sea for 12 hours when those on board put in a distress call to the Italian coastguard.
“Switch off the engine, we are coming,” an Italian accented-voice told them. But it was the Libyan coastguard who appeared instead.
For Sam, a 30-year-old Eritrean who fled his home country a year earlier to escape indefinite military service and a brutal dictatorship, the forced return to Libya, in February 2018, would have life-changing health consequences. Like thousands of other migrants rescued by the Libyan coastguard he ended up in a detention centre where conditions have been described by the United Nations as inhuman and squalid.
The European Union is currently pouring tens of millions of euros into the Libyan coastguard in a bid to prevent those crossing the Mediterranean ending up in Europe.
The money is being spent through the EU’s Trust Fund for Africa, created in 2015, which will see nearly €4 billion spent across 26 countries along the migration route to Europe. Critics say it overly focuses on security, with scant regard for the human implications of halting migration.
Since the deal was signed with the Libyan coastguard in February 2017 tens of thousands of refugees and migrants like Sam have been sent to Libya where they end up in detention centres.
Although the EU publicly says they want the centres closed, almost all refugees and migrants returned to Libya are locked up. Some languish for more than a year before they can be legally evacuated, escape, bribe their way out to try and cross the Mediterranean again, or are forcibly sold back to smuggling gangs.
Currently, the United Nations Refugee Agency says there are 5,700 people in detention centres run by Libya’s Department for Combating Illegal Migration (DCIM). Around 4,100 may qualify as refugees, who can’t return to the countries they’ve fled for fear of persecution.
The United Nations High Commissioner for Human Rights has described the conditions in the detention centres as “characterised by severe overcrowding, lack of ventilation and lighting, and insufficient washing facilities and latrines.” Many detainees are dying.
In the Tariq al Matar detention centre, where Sam and his fellow migrants were taken first, more than 1,000 people were herded together in one room. “The hangar was very dirty and hot,” Sam says in messages to the Telegraph on a hidden phone because communication with the outside world is banned.
Such a cramped and dirty environment provides an ideal breeding ground for a host of infectious diseases, but especially tuberculosis, which, if not treated, can run rampant through this vulnerable population.
Days after their arrival in the centre the detainees were medically screened and and some tested positive for TB, but Sam, whose name has been changed for security reasons, was given the all-clear.
However, over the coming weeks he’d help those who were infected: washing their clothes, feeding them and cutting their hair. He would even help them get to the toilet.
“After some months I was not okay,” he says. He was coughing and felt weak, with little energy even to walk around. “I went to check with the doctors and they said I had TB.”
The treatment for TB is usually a six-month course of four antibiotics - a regimen that is unimaginable for people in detention centres where those infected with the disease go weeks without medication. And even if detainees manage to get hold of the medicine, the treatment requires careful managing as the drugs have unpleasant side effects, such as itching and blurred vision.
“We think it’s not appropriate to provide a detainee an antibiotic while he’s hungry,” said Dr Prince Alfani, a medical coordinator for Médecins Sans Frontières in Libya. "We receive reports from detainees that they discontinue medication because they don’t have anything to eat,” he says.
Last week MSF reported that a quarter of the 300 detainees held in Sabaa detention centre in Tripoli are malnourished or underweight and found people forced to use buckets or plastic bottles for toilets.
In Triq al Sikka detention centre, in the Libyan capital Tripoli, detainees have been repeatedly left without medication. In their messages to the Telegraph detainees said hundreds were left locked up with infected people and no treatment. Last year, staff from the International Rescue Committee (IRC) tested positive for exposure to the disease and stopped entering the male detainees’ cell.
“The place is like a cave, there is no airway out and in,” said one man there.
In January at least 10 more detainees tested positive for TB.
“Here we die,” said one Eritrean man, who had been in the detention centre for nearly a year when the TB outbreak happened. “There are many cases of TB. No doctor. They’re playing games with us.”
Thomas Garofalo, the Libya head of IRC, says the organisation’s staff try to provide healthcare as best they can, but they are not comfortable working in a detention environment. Ethically, he said it poses challenges, because, by providing help they are legitimising the detention. And logistically, their access to detainees can be limited.
“Let’s face it, this population is very vulnerable, they’ve been rescued at sea, God knows what kind of hardships and challenges (they’ve been through). If you put them in an enclosed space like that it’s a very big public health danger, and a danger for them… Ultimately we need to get these people out of detention,” he said.
The UK has allocated up to £5 million on humanitarian assistance for migrants and refugees in Libya, including targeted healthcare provision. It has also contributed nearly £500 million to the EU Trust Fund for Africa, which aims to improve conditions in Libyan migrant detention centres. On the ground, though, refugees and migrants ask where the money is really going.
A refugee in a detention centre in Zintan, 180km south west of Tripoli, told the Telegraph at least 10 detainees have died since mid-September, partly because of a lack of proper sanitation and medical care.
The deaths included that of a young boy, who had appendicitis and couldn’t get medical treatment on time, according to fellow detainees and Unicef.
Using a hidden phone, a detainee told the Telegraph the number of sick people is increasing.
“The (building) the sick people stay in is full,” he said, which means others who need medical care are unable to get it.
The detainees only have water for half an hour in the morning and share eight toilets among roughly 650 people. “There is not enough food and not enough medication. You eat only two times a day and (it) never changes, it’s only pasta macaroni boiled with water and tomato paste, nothing else.”
The International Medical Corps, which works in the detention centre in Zintan, declined to comment.
In Triq al Sikka, which also serves as the unofficial DCIM headquarters, a detainee described shouting at medical staff from a cell to try and get treatment for a sick friend, who was later taken to hospital.
The guards decide who is allowed come out for medical screenings, three detainees said, and many of those who need it are never permitted to go.
“They don’t let you see the doctors easily, at least they have to see you faint or bleeding, or see you can’t breathe or walk,” one said.
Detainees said even when they see medical staff, the treatment isn’t enough.
“The doctors don’t have enough equipment, medicine, anything at all,” one said. “They don’t really care about the patients’ complaints. They take three minutes with you and give you Panadol, and give Panadol to every single (other) patient. That’s it.”
Even smugglers treated them better, the man claimed. “Two hundred percent. Because if you tell the smuggler you are sick, he’ll send you to hospital.”
“We didn’t know TB (with smugglers),” he claimed, “but here in detention we’ve seen a lot of diseases.
Aaron Oxley, the executive director of Results UK, an anti-poverty charity that campaigns on TB, said interrupting medical treatment can cause strains of tuberculosis to become drug resistant. After that, “of course it won’t stay in the detention centre. Anyone who breathes the air that’s anywhere near there will transport it around.”
Mr Oxley said that those helping others with TB were most likely to become ill themselves. “Those are the kind of people that really desperately need our support, people who are willing to put their lives on the line because they want to help their fellow human beings…
“People like that should absolutely be given the support and protection they need, because none of this is expensive… the cost of a dose of tuberculosis drugs is less than a beer in the pub.”
A Foreign Office spokesperson said the government was "deeply concerned over conditions in these centres in Libya" but said they were the responsibility of the Libyan authorities.
“We continue to pressure the authorities to pursue alternatives to detention, to improve conditions for migrants in country and to respect human rights.”
What Sam wants above all else is freedom.
"If we aren’t closed in one hangar with 1,500 people the disease would be stopped quicker, or may not be transferred to other people,” he says.
Until then, he says, the detainees want proper food and a separate area for those who are infected.
“The guards aren’t kind. They don’t care about you. If you ask for help they ignore you,” he said.
“In the detention centres there are many diseases, it’s not only TB, so the (main) solution is we want evacuation from Libya, and we want to look (after) our health by ourselves,” he adds.
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