Medics attend to a militia member wounded in a mortar attack in a makeshift clinic on the Ain Zara frontline in Tripoli, Libya. (Lorenzo Tugnoli for The Washington Post)

Incessant attacks on health facilities and medical workers in a brutal battle for control of Tripoli could amount to war crimes, the United Nation’s top envoy to Libya said Thursday in a strong condemnation.

Ghassan Salame’s comments — describing the attacks on the Libyan capital as “merciless” and “ruthless” — came a day after two precision airstrikes targeted a field hospital in Tripoli’s Aziziya enclave, injuring at least four medical staff, the U.N. said.

The attacks came after a temporary truce over the three-day-long Eid al Adha holidays, one of Islam’s holiest periods, appeared to have ended Tuesday, with clashes and airstrikes resuming around the capital.

Since the latest surge in Libya’s violence began in early April, more than 37 attacks have targeted health workers and medical facilities, in violation of international humanitarian law, the U.N. said. At least 19 ambulances and 19 hospitals have been pummeled by shelling or airstrikes, killing 11 and injuring more than 33. The U.N. said the actual toll may be “significantly higher.”

“Intentionally targeting health workers and health facilities and ambulances is a war crime,” said Salame in a statement Thursday, adding that “when committed as part of a widespread or systematic attacks directed against any civilian population, may constitute a crime against humanity.”

It was not the first time he warned about attacks on health-care workers. On July 29, before the U.N. Security Council, Salame declared that both sides are “ignoring calls for de-escalation.” At the time, he also urged sanctions against anyone attacking civilians and humanitarian workers. “Impunity should not prevail especially for those who attack hospitals and ambulances,” he said.

Those comments came a day after an airstrike hit a field hospital in Tripoli’s Zawya district, killing five health workers. A week earlier, a field hospital in the Al Swani enclave was struck, injuring three personnel. It was the third attack on the facility since April.

“These health workers are risking their lives 24/7 to recover dead bodies and wounded cases without differentiating between civilians and military,” said Hussein Hassan, the emergency coordinator for Libya for the World Health Organization. “There is no respect for international humanitarian law or humanitarian principles.”

The increasing assaults on the health-care system come as the war pitting pro-government militias against an eastern commander Khalifa Hifter has expanded beyond the Libyan capital in recent weeks. Late last month, government carried out an air attack on Hifter’s main air base in central Libya. That prompted Hifter’s forces to launch airstrikes on the city of Misurata, 130 miles east of Tripoli, whose militias have long fought against him. Earlier this month, a Hifter drone strike on a southern town killed at least 43 people.

The Tripoli government, installed by the U.N. in 2016, blames Hifter’s forces for the attacks on medical infrastructure. Salame, on Thursday, also pointed the blame at Hifter’s self-described Libyan National Army for the two airstrikes last month — an extraordinary decision given the U.N.’s traditional tilt toward neutrality during conflicts.

Salame again vowed to hold those responsible for the attacks. “We will not stand idly by and watch doctors and paramedics targeted daily while risking their lives to save others,” he said. “We will spare no efforts to ensure that those responsible will face justice.”

Ahmed al-Mesmari, a Libyan National Army spokesman, did not respond to phone calls or text messages seeking comment.

U.N. and government health officials said all that the red and white painted ambulances are clearly marked and assist fighters on both sides as well as civilians. But dozens of disparate militias control front lines with little coordination.

“There are multiple fighters, competing interests and ideologies in each group, and I am not sure there’s a complete chain of command,” said Hassan, the WHO official. “Our calls are not being respected. This is part of a chronic problem in this country where armed groups, to show power, put their self- interests over civilian lives.”

It had been like this ever since Hifter, a dual Libyan-U.S. citizen who lived for years in northern Virginia, launched his offensive on Tripoli in early April. That plunged the capital into its worst episode of bloodshed since the 2011 Arab Spring uprisings and NATO intervention brought down dictator Moammar Gaddafi.


Medics attend to a militia member wounded in a mortar attack in a makeshift clinic on the Ain Zara frontline in Tripoli, Libya. (Lorenzo Tugnoli for The Washington Post)

Pro-government militias poured in to defend the capital, creating a military stalemate that exists today. But the theaters of war around the capital keep shifting and disgorging casualties, with more than 1,100 killed, including more than 100 civilians. 

Most of the injured, which now tallies more than 5,800, including 300 plus civilians, depend on a bare-bones network of field hospitals and ambulances for assistance. That includes as many as half million Tripoli residents who still live in or near front lines.

During a reporting trip in May, a Washington Post journalist and photographer visited the Al Swani field hospital, which at the time had already been attacked twice. There, medic Abduljabber remembered a trip in an ambulance two weeks earlier to retrieve some of the wounded.

As soon as they reached the front, clashes erupted, and the ambulance came under fire from both bullets and mortar shells, remembered Abduljabber.

The first mortar landed near their ambulance. Then, a second one did, too. That was when they realized their ambulance was under attack. The firing was coming from Hifter’s forces, said Abduljabber, who asked that his family name not be used for security reasons.

“Suddenly, there was an explosion,” he recalled. “We were hit as if we were a target.”

Miraculously, he and another medic endured only a few scrapes. But the blast tore apart the legs of Naseer Daw, the driver, cutting through the bone. Daw was later transferred to Turkey for surgery. In the days that followed, a medical student in his 20s, who had helped Daw would be killed in a strike on an ambulance.

Abduljabber’s days remain as precarious as ever.

“It keeps crossing my mind that we will be targeted again, but if I want to do my duty I need to forget about this,” he said.