"The Libyan health care system was struggling before COVID-19," said Willem de Jonge, ICRC's head of operations for Libya. "Today, some medical professionals who need to be trained on COVID-19 infection prevention protocols keep being called back to the frontlines to treat the injured. Clinics and hospitals are overwhelmed caring for war-wounded and those with chronic illnesses, so their capacity to receive COVID-19 patients is limited. They need more support and resources to face this challenge."

Despite international calls for a ceasefire, fighting in Tripoli has escalated, forcing people to flee their homes and damaging civilian infrastructure. Some areas in Tripoli like Abu Salim have seen their patient-load quadruple in recent months, mostly due to the influx of displaced families, many of whom live in collective centres.

"Displaced Libyans, including some of our colleagues, have told us they have no choice but to return to their homes near the frontline, for fear they could bring the virus into the homes of their elderly parents or family members," said Maria Carolina, ICRC's deputy head of sub-delegation for Tripoli. "This highlights the unimaginable choices some people are now forced to make as they struggle to decide whether shelling and airstrikes pose a greater threat to their lives than COVID-19."

Special preventive measures must also be taken to ensure that COVID-19 does not enter prisons, as physical distancing is impossible. Migrants in Libya are also highly vulnerable to the disease, as many have only limited access to information, health care, or income.

At the same time, restrictions such as curfews and border closures, while important in curbing the spread of the disease, are creating new challenges to deliver humanitarian aid and keep the supply chains for food, medicine, and basic needs open. "Authorities must ensure that delivery of humanitarian aid is facilitated while maintaining preventive measures such as physical distancing, or those who depend on it will suffer tremendously," said Jonge.

"We are already seeing the cost of food and other essential supplies increase, putting an additional strain on some of Libya's most vulnerable families. COVID-19 comes on top of years of conflict in which families have seen their public services interrupted and job opportunities vanish."

About ICRC's operational response in Libya to conflict:

• ICRC continues to provide food and household items to internally displaced people, residents and returnees. In March, these efforts reached more than 8,200 people.
• ICRC's water and sanitation teams have been working with local water authorities to increase access to clean water in dozens of areas affected by the conflict. We are also working to improve sanitation by supporting sewage-processing facilities.
• We are also providing medical supplies to hospitals and primary health care facilities across Libya, including insulin and other medicines to diabetes centres. ICRC teams are also delivering trauma medical supplies and body bags to health workers on the frontline.

About ICRC's operational response in Libya to COVID-19:

• The ICRC is giving cash to health care facilities to help them buy equipment and medical consumables such as masks, soap and disinfectants. Three hospitals will also receive generators, so they can keep working through power cuts.
• We delivered hygiene items to 3,200 detainees living in two places of detention and are working with authorities on measures to be taken to prevent COVID-19, and manage suspected cases inside prisons.
• We are working with the Libyan Red Crescent and the International Federation of Red Cross and Red Crescent Societies (IFRC) to share information about how COVID-19 can be prevented in communities across the country.
• Teams are also providing hygiene materials and chlorine to displaced families in 17 collective centres. Staff in the centres are also being trained in how to carry out disinfection to prevent the spread of COVID-19 in shared living spaces
• We are also working with authorities to develop a plan for how bodies of those who die from COVID-19 will be managed safely and with dignity. This also includes equipment support such as body bags.