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.