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Omar Salem, a Libyan rebel fighter, has gotten treatment at a hospital in Amman. Jordanian surgeons saved his leg, which was hit with shrapnel during fighting in Tripoli.
Omar Salem, a Libyan rebel fighter, has gotten treatment at a hospital in Amman. Jordanian surgeons saved his leg, which was hit with shrapnel during fighting in Tripoli.

Libyans get tummy tucks with money meant to treat war wounded

"We had a tsunami of Libyans in Jordan," said Ali Bin Jlayel, head of the Libyan Medical Committee in Jordan.

AMMAN // A programme set up by Libya's new government to provide its fighters with medical care abroad has been so mismanaged that some Libyans have used it to pay for tummy tucks and lip enhancement.

The cost of the programme has more than doubled since September when Mahmoud Jibril, then the prime minister, announced that the National Transitional Council (NTC) would provide US$400 million (Dh1.5bn) to pay to treat the wounded.

By January, the new prime minister, Abdul Rahim Al Keib, said the cost had already reached $800m for Libyans receiving medical care in countries around the world. He acknowledged that Libyans had taken advantage of the programme and that some injured fighters had not received the help they needed because of the abuses.

In Jordan alone, the programme has run up $110m in bills through January, said Awni Bashir, head of the Private Hospital Association of Jordan.

Jordan is one of the most popular destination for Libyans seeking the subsidised medical treatment. In addition to covering the medical costs, Libya has been paying for the airline flights, hotel rooms and spending money for the wounded. It also pays for everything except the plane tickets for Libyans who were not injured in the fighting but travelling to Jordan for medical care they claim they can't get in Libya's dismal medical facilities.

In the past year, about 48,000 Libyans came to Jordan for treatment, said Ali Bin Jlayel, head of the Libyan Medical Committee in Jordan.

Almost half of them, about 20,000, arrived in January.

"We had a tsunami of Libyans in Jordan," Mr Bashir said.

Of the 48,000 who arrived, about 8,000 were wounded fighters, Mr Bashir said. Many more were in Jordan for cosmetic procedures.

"I have seen bills involving the removal of an eyebrow tattoo and others for hair removal [by laser], nose jobs and tummy tucks and I heard about other bills that involved surgeries such as breast implants," said Rajab Hassan, the general coordinator in Jordan for the Commission of the Injured Libyans. He is among a group of Libyan officials and Jordanian auditors who are trying to get the programme under control.

The avalanche of Libyans has hampered efforts to help actual wounded fighters. "I have seen many wounded who have been neglected," because the programme has been so chaotic, Mr Hassan said.

And the wounded have not been the only patients affected. In Jordan, so many Libyans have descended on Amman's hospitals that some Jordanians can't get appointments for treatment.

"There has been a negative impact on Jordanians in a country where, for the first time, they started having a waiting list in the private sector," Mr Bashir said. "People are not used to this."

At a press conference in Amman last week, Nael Adwan, head of the Jordan Hospital Society, announced that private hospital would curtail some of their services because they could not pay their bills. He said the decision would affect Jordanians as well as other patients, but not those "who pay in cash."

Libyans have not been the only ones to abuse the programme, officials say.

Hospitals and doctors in Jordan, Tunisia, Turkey have been accused of overcharging Libyans for treatment, ordering unnecessary tests and performing procedures that have nothing to do with war wounds, Libyan officials say.

"Bills were inflated," said Dr Sameh Lutfullah, head of the Libyan Commission of the Injured. "In some instances, patients underwent unplanned medical procedures. A patient who had a broken leg also gets treatment for nasal deviation. Some got braces. There should be honesty when it comes to treating patients."

In Turkey, Recep Tayyip Erdogan, the prime minister, said his government had been told that private hospitals in Turkey had written exaggerated bills. Authorities have asked the hospitals to provide documentation.

"We will do what is necessary," Mr Erdogan said after a meeting with the Libyan interim prime minister in Istanbul on February 25. "It is not worthy of this nation to turn human lives into a [business] opportunity."

On the other hand, some doctors and hospitals in the countries where Libyans have been treated are worried about not getting paid for legitimate work.

Mr Bashir, of Jordan's Private Hospital Association, said Libya so far has paid only about $30m of the $110m it owes 20 private hospitals in Jordan, a government hospital and an army hospital.

"The only guarantee, as far as getting paid is concerned, is based on good faith," he said.

Like many other countries around the world, Jordan initially offered free medical care to Libya's rebels as the uprising against Muammar Qaddafi erupted into civil war last year.

Tunisia, in particular, provided aid as more than one million people fled across the border from Libya.

At first, the Tunisian government and medical institutions had a policy of treating all refugees for free, said Dr Naoufel Somrani, director of Emergency Care for the Tunisian Health Ministry.

While the government would like to be reimbursed for care provided by public hospitals, "we haven't insisted on it because we know that this is a transitional period," Dr Somrani said.

But private hospitals now want to get paid, said Dr Khaled Nabli, president of Tunisia's National Chamber of Private Healthcare Facilities. Some can no longer can afford such benevolence, he said.

"Some clinics can't bear the burden anymore, and have stopped treating Libyans in this way," he said, referring to the practice of offering care while deferring fees. "The call has been made to Libyan authorities to pay the debts as quickly as possible."

Libya's NTC officials acknowledge the gross mismanagement and halted the programme for three weeks last month. The benefits were so generous and the monitoring so poor that some Libyans were using the programme just to take oversears holidays.

Libyan officials have now imposed criteria on who gets accepted to the programme, limits on the types injuries and ailments that are treated and required documentation from doctors and hospitals.

Libya has even cut the weekly expenses allocation for patients from $300 per week to $200 and will make the payments only to wounded fighters, said Abdullah Al Zanbouzi, a member the Media Committee for Injured Libyans.

But the reforms have slowed hospital reimbursement even more, Mr Hassan said. Auditors are demanding proof that work was done and the charges were appropriate.

"Now there are negotiations between the hospitals and auditors," Mr Hassan said. "Some hospitals unfortunately are unethical. The issue is not that of money because it is available. But the Libyan government wants to ensure that the money is paid appropriately."

NTC officials say they have ample money. Oil revenues are beginning to flow again and Qaddafi had assets estimated as high as $200bn scattered around the world when he was killed by rebels in October.

For some wounded rebels, such as Omar Salem, Jordan's medical system has been a godsend. A native of Tripoli, he was fighting Qaddafi loyalists near the city's airport in May when a shell sent metal slicing through his leg, he said. After months of poor treatment in Libya, the leg became infected. Jordanian surgeons saved it.

"I don't know what I would have done if I couldn't come here for help," Mr Salem, 33, said from his room in the Arab Medical Center's surgical ward. "I could never have had this done in Libya."

* With additional reporting by Foreign Correspondents Hugh Naylor, John Thorne and Thomas Seibert

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