IN A NUTSHELL Author's noteThe article reflects on the health consequences of Storm Daniel and the lessons Derna’s recovery holds for climate-informed planning, health services and people affected by displacement. Derna’s recovery will not be measured only by the speed of construction. It will be measured by whether residents and displaced people are safer, healthier and still able to get care when the next extreme event comes
By Meftah Lahwel
MD, Master in Sustainability in Health
Derna’s Flood Was a Climate and Health Warning for Libya
What a City Rebuilding After Storm Daniel Can Teach Us About Climate Risk, Displacement and Care
By the same Author on PEAH: HERE Meftah Lahwel is a medical doctor and public health professional with more than a decade of humanitarian experience, including work with UNHCR, MSF and International Medical Corps. He holds a Master in Sustainability in Health at the University of Turin. His interests include refugee and migrant health, health systems and climate-related health risks
In my humanitarian health work, I have learned to ask a practical question: when someone needs care, can they actually reach it? The answer depends on more than whether a clinic is open. It depends on safe roads, clean water, functioning referrals and whether treatment continues when a family has to move. Derna brought all these questions together.
Storm Daniel struck northeastern Libya on 10–11 September 2023. In Derna, the failure of two dams sent floodwater through the city, destroying homes and essential infrastructure. The disaster unfolded in a country with divided institutions and two competing administrations: the Government of National Unity (GNU), based in Tripoli, and another government based in Benghazi. In October 2023, the UN Support Mission in Libya warned that competing recovery initiatives risked undermining reconstruction and called for a unified approach.
Derna’s flood history matters. Wadi Derna is usually dry, but it can carry powerful floodwaters. Historical accounts describe damaging floods in 1941, 1956, 1959 and 1968. Two dams were built upstream between 1973 and 1977. Later floods in 1986 and 2011 showed that the wadi remained a threat. Those events did not make the 2023 catastrophe inevitable. They did make the hazard known.
The climate signal also needs to be stated carefully. In its study, “Interplay of climate change-exacerbated rainfall, exposure and vulnerability led to widespread impacts in the Mediterranean region” the World Weather Attribution group estimated that human-caused climate change had made rainfall as extreme as that observed in Libya up to 50 times more likely and up to 50% more intense than in a climate 1.2°C cooler. The researchers stressed that these estimates carry significant uncertainty. Their analysis also examined how exposure and vulnerability shaped the impact: climate change intensified the rainfall hazard, while dam conditions, preparedness and the ability to communicate and act on warnings influenced the scale of the catastrophe.
The water crisis after the flood was immediate. UNICEF reported that half of Derna’s 18 boreholes were shut down and that damage to the sewage system raised concerns about groundwater contamination. UNICEF and other responders supported water delivery and repairs to water points. The ICRC, together with the Libyan Red Crescent, provided emergency drinking water and water and sanitation equipment. These actions helped meet urgent needs, but they also showed how closely health depends on services outside the clinic.
When water systems fail, the consequences reach households, shelters and health facilities. Safe water, sanitation and proper shelter help prevent illness and protect dignity. When roads are damaged, a referral may fail. When a family is displaced, a course of treatment may be interrupted. These are not separate problems to be solved by separate sectors; they are connected parts of people’s health.
The flood also struck a health system already under strain. WHO assessed 240 health facilities in affected areas in October 2023: 73% were partly functional, 14% non-functional and 13% fully functional. WHO supported the restoration of facilities and the establishment of field hospitals. For patients, these figures meant disrupted access to routine care, medicines, referrals and follow-up at the very time when needs were increasing.
Residents of Derna and other affected locations were displaced, and not everyone faced the same barriers to finding shelter or care. IOM’s November 2023 assessment estimated that 1,715 migrants were also displaced by the floods, most in northeastern Libya. That figure counts people displaced by the flood; it does not mean they had migrated because of climate change.
For public health, this distinction matters. People move for different reasons and have different access to money, documents, language, family networks and services. Displacement can interrupt care for chronic illness, pregnancy, children and mental health. A climate and migration perspective asks who can reach services, who is left out, and how care follows people when they move. Derna’s recovery must include all affected people: local residents, displaced Libyans, refugees, asylum-seekers and migrants, as well as communities hosting them.
The psychological impact was just as real as the physical damage. People faced bereavement, loss of homes and livelihoods, displacement and uncertainty. Health workers and rescuers were exposed to distress as they cared for others and responded to loss.
There was a coordinated MHPSS (Mental Health and Psychosocial Support) response. The government Benghazi established a mental health and psychosocial support committee under the Ministry of Health. WHO worked with local health authorities to provide services from psychological first aid to specialist psychiatric care. By 7 November 2023, the committee had deployed 45 MHPSS professionals to seven flood-affected locations. ACAPS (Assessment Capacities Project) later reported ten health facilities offering MHPSS services in Derna, Al-Bayda and Al-Marj, supported by WHO and partner organisations.
This response showed the value of local professionals working with health authorities and international organisations. It also exposed a longer-term challenge: emergency teams cannot provide continuity if local services are not funded, staffed and supported after the emergency phase. ACAPS called for sustained capacity-building, training and supervision. MHPSS belongs within the health system, not only in the first weeks after a disaster.
The recovery needs were substantial. A joint World Bank, EU and UN assessment estimated US$1.8 billion for reconstruction and recovery and recorded nearly 44,800 people initially displaced. By 2026, rebuilding in Derna is highly visible. New homes, roads and bridges matter to people rebuilding their lives. But reconstruction is not proof that risk has been reduced. A 2026 study “Integrating socio-economic impact assessment into the reconstruction plan for Derna, Libya” raised concerns that parts of the reconstruction reproduced vulnerable spatial patterns without comprehensive flood management or alternative planning frameworks. The question is therefore not only what has been rebuilt, but whether people are safer in the places where they live.
New buildings alone cannot prevent another disaster. Derna needs land-use and reconstruction planning based on flood and climate risk, regular inspection and maintenance of dams, early warnings that people understand and can act on, and evacuation plans designed with communities. Health facilities, water and sanitation systems, roads and shelters need to be treated as one protection network. Clinics need backup water and power, medicines, referral routes and ways to continue care when people are displaced.
My work supporting health services in Libya has taught me that resilience is felt in ordinary moments: when a patient can reach a facility, find safe water, receive a referral and return for follow-up. It is also felt by people on the move, who can lose access to care each time a service or border interrupts their journey. Derna’s recovery will not be measured only by the speed of construction. It will be measured by whether residents and displaced people are safer, healthier and still able to get care when the next extreme event comes.