By Bridget Joyce – When a bloody revolution erupted in Libya in February 2011, the crisis had a significant impact on Tunisia’s economy. Along with tackling short-term economic obstacles resulting from the interruption in trade with Libya and the conflict’s spillover across the border, Tunisia now has the opportunity to assist Libya’s transition and reap economic benefits. Ultimately, the two states can create strong bilateral ties that may eventually lead to the larger regional economic integration of the Maghreb.
Just before the uprisings, Tunisia and Libya had agreed to a number of joint projects that would increase bilateral trade. However, Libya’s short but brutal civil war derailed most of these arrangements and the institutions that supported them. As Libya looks to rebuild, it has focused much attention on its health care system, which is severely underdeveloped.
For many years Libyans have had little confidence in their own health care system, instead seeking services outside their borders. Many citizens saw Tunisia as a desirable destination. In 2009 more than 100,000 Libyans visited Tunisia to receive medical care. Tunisian facilities provide staff and equipment comparable to that of their European counterparts, but are more accessible for Libyans and relatively inexpensive. Greater cultural similarities and a common language also facilitate ties.
In the thick of revolution, some Libyans in need of medical care continued to escape for services abroad. As Libyan money was spent elsewhere, the system at home further deteriorated. At the same time, Libyan medical centers experienced a massive influx of patients injured during the eight-month conflict.
The interim government recognized that its health care services could not adequately accommodate this influx, and began to implement policies that sent Libyans wounded during the revolution abroad for treatment – policies that many exploited. According to the BBC, Libyan Deputy Prime Minister Mustafa Abushagur stated that the government spent a staggering $800 million to send 40,000 people abroad for treatment. Yet just 10 to 15 percent of those treated abroad at the expense of the Libyan government had the war-related injuries that the program intended to address.
This policy has not only proven frustrating but has also created regional tensions for the post-revolution government. Both Tunisia and Jordan have threatened to stop serving Libyan patients unless the Libyan government pays its multimillion-dollar health bills in these countries. While Tunisians benefit from the increased activity in their economic sphere thanks to the spending of “medical tourists,” many are concerned that this unprecedented proportion of Libyans in Tunisian facilities has pushed their system over its capacity.
A recent article in The New York Times reported that the country’s private clinics are 100 percent full. While Tunisia has always been a destination for Libyans seeking health care, now almost half of clinic beds in Tunis are occupied by Libyans. With limited beds, the additional stress on the Tunisian system has proven crippling to the operation of the health care industry.
While this situation could ostensibly lead to escalated tensions between the two states, it also presents an opportunity: the Libyan health care system can be rebuilt while strengthening the bilateral economic relationship. Tunisians welcomed more than 300,000 Libyan refugees during Libya’s revolution by opening their homes and providing numerous services, further endearing Tunisia to the Libyan people. Deepening bilateral trade ties could serve to anchor broader integration in the future.
While it is clear that Tunisia currently serves Libyans’ medical needs, by focusing attention on rebuilding Libya’s health care industry Tunisia can diversify its bilateral economic ties and alleviate some of the pressure on its health care industry at home. Currently, Libya is looking to Europe to help heal its failing health care system. Through a project with the UK to create the Virtual Interactive Surgical Training Academy, an online training platform for UK surgeons to assist Libyan surgeons, Libya is addressing its lack of education in the health services.
But why should Libya outsource to Europe when it already has a mentor in Tunisia next door? In May 2011 it was reported that the unemployment rate among Tunisians with higher education was 29.2 percent. Cooperation between the two states would create more jobs for Tunisians and improve Libyan health education, creating a solid bilateral foundation and framework for increased cooperation in the future.
Libya and Tunisia share a common goal: development. While historically each of the Maghreb nations has maintained robust bilateral relationships with the European Union and its member states, it is time to create stronger South-South economic ties.
Certain policy adjustments are critical to pushing this process forward. It is vital that Libyans mend the tensions caused by its postwar policies on regional relationships. Breaking down barriers to inter-Maghreb trade and forming a sustainable trade network will put Maghreb nations on a path toward their developmental goals. Before comprehensive regional economic integration can be realized, Tunisia and Libya need to lead their partners in the Maghreb by establishing bonds in bilateral cooperation. Trade and investment in the medical sphere may be the best place to start.
Bridget Joyce is an intern in Stimson’s Middle East/Southwest Asia Program.