The German government promised hundreds of war victims from Libya medical help, but many who were wounded are now struggling to get the care they need. Healthcare provider Almeda and Libyan authorities are entrenched in a deep conflict over costs, and patients are suffering as a result.
The rockets struck Afaf Gadhafi's car one day last August. The 38-year-old, a distant relative of former Libyan dictator Moammar Gadhafi, had sought to reach an airport with her family to flee the civil war. But rebels attacked, likely suspecting that the car may have contained Gadhafi or his allies.
Afaf's daughters, aged two and 19 months, were killed, along with her mother, sister and nephew. Afaf lost an eye and suffered serious injury to her nose and left arm. Her four-year-old son survived only because her sister protected his body with her own.
Afaf now lives in Munich with her son after rescuers brought them to Tunisia, where they received an offer of aid from Germany. The Foreign Ministry in Berlin had reached an agreement with the National Transitional Council to provide care for seriously wounded war victims. Hundreds of civilians and rebels were to be treated in German hospitals as the country's humanitarian contribution to the Arab Spring.
But the aid program now threatens to become an embarrassment. Just weeks after the first operations, the effort became bogged down with what the German Health Ministry called "administrative difficulties." A conflict has broken out between Germany and the Libyan organizers over treatment costs, billing and assistance for the traumatized patients -- a situation that has had terrible consequences for the patients.
Not only could they soon lose their accommodations, but desperately needed treatments could also be delayed or cancelled entirely. Workers inside government-run hospitals in Munich report a chaotic situation in which bills aren't being paid and helpless patients have been forced onto waiting lists for weeks at a time.
Initially, the program seemed to have gotten off to a promising start. After the German military brought the first patients to Germany in October, the Libyan financial authority signed a contract with medical services provider Almeda, a subsidiary of reinsurer Munich Re. Almeda was supposed to handle the transport and care of most of the victims, paying them pocket money and providing clothing, family housing and interpreters. Almeda was also to provide medical care, receiving some $60 million for 600 injured patients.
But already in November, workers at Munich's Klinikum rechts der Isar hospital began contacting Almeda, complaining that some patients coming from Libya didn't even have underwear or proper clothing. Many were also reportedly waiting in vain for their 60 ($75) in monthly pocket money. Doctors and nurses also had to step in as interpreters.
Meanwhile, there was no answer at the telephone number set up to handle patients' emergencies. Almeda didn't answer complaints, and officials at the company were arguing with Libyan authorities over money. The Libyans accused the Munich company of concealing documents and raising prices beyond those that ordinary German patients would normally pay.
Almeda denied the allegations, saying that the costs were regularly revealed through the submission of bills, and that only the most severely injured victims were subject to higher billing rates. But no agreement was reached, despite efforts by the Foreign Ministry and the German Health Ministry to arbitrate. Even a trip by Health Minister Daniel Bahr to Tripoli in April, during which he agreed to set up a special commission to resolve the matter, didn't help. The Libyan finance authority refused to extend its contract with Almeda and stopped payments to Germany the same month.
Both sides are now pointing the blame at each other. The German Health Ministry says it deeply regrets the failure of mediation attempts, but adds that all victims received the necessary treatment. Patients, however, have reported problems. In late May the Libyan Embassy took over management of their care. "We are having difficulties reorganizing accommodations for people, but at least the money has been made available again," says Ali Kuthani, the embassy's chargé d'affaires, who has sent workers to lodgings around Germany to make assurances that costs will be covered. Though patients will be allowed to remain where they are for now, he doesn't know how long that will continue to be the case.
Afaf Gadhafi currently resides at a guest house in Munich's city center with her son, and has also since been joined by her husband. Relatives are providing money for food and clothing. She is supposed to get an artificial eye, while metal shrapnel still needs to be removed from her face and arm. But she says she doesn't know whether the medical costs will be paid, or if she can honor her next appointment at the hospital.
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