The impact of the COVID-19 pandemic on conflict and health system–related violent events in Libya: An interrupted time series analysis

As a response to the COVID-19 pandemic, the United Nations Security Council passed resolution S/RES2532 (2020), requesting the cessation of hostilities. Despite ceasefire initiatives, evidence suggests that both conflict and violent events remained unabated—and, in some cases, escalated during the first months of the pandemic. This study uses interrupted time series analyses to examine the impact of the pandemic on violent and non-violent political events—including health system-related violence—in Libya, which has been experiencing a protracted conflict since 2014. We find a reduction of approximately 21 battles (p < 0.001) only during the first month of the pandemic. However, overall, throughout the pandemic, there was an increase of roughly one battle per month (p < 0.001). The violence that affected healthcare workers decreased during the first year of the pandemic (p < 0.001); but by the second year the reduction in healthcare worker–related violence had dissipated. While the pandemic seems to have mitigated the level of violence experience by healthcare workers, the overall pattern of violence is a troubling one, particularly since they were observed while there is an international agreement for a ceasefire in place and a specific peace agreement occurring in Libya. The pattern suggests that policy to protect healthcare workers may need to be enhanced even more during crisis settings.