How are we going to rebuild public health in Libya?

Little is known about how armed conflict attenu-ates established public healthcare systems. Politics aside, Libya has been justifiably feted as one of the world’s great success stories in public health. Its ability to deliver low cost healthcare with good outcomes is held as a model for other developing countries. The most cursory examination of the evi-dence from the UN’s Human Development Index strongly supports this. On life expectancy alone, Libya is ranked 53rd at 74.5 (compared to 59.8 in 1980). This is above Russia (65th) and Brazil (73rd) and well above their neighbours Algeria (84th) and Egypt (101st). Under-five infant mor-tality rates also illustrate the robustness of the system with a rate of 17 per 1000. In comparison, the under-five infant mortality rate for Egypt is 23, for the most prosperous African state Nigeria it is 186, and for the conflict-ridden state of DR Congo it is 199. The public gains by Libya are also particularly noteworthy when one considers that the Arab world, despite its resources, has under-achieved in public health terms. The reasons for this, outlined in the Arab Human Development Report of 2002, is that while some Arab countries have also achieved similar public health gains, e.g. Qatar, others such as Yemen with an under-five infant mortality rate of 66 per 1000, have not. But all this is changing. The conflict in Libya is already altering mortality and morbidity rates as well as degrading public healthcare systems. While research on healthcare systems in post-conflict countries is well developed, little is known on how armed conflict degrades estab-lished functioning systems. One of the problems of defining what the post-conflict needs will be in Libya is the paucity of empirical research in many of these areas, despite the work already conducted in countries such as Afghanistan,