There may be a "total collapse" of Libya's health care system if many of the Filipino and Indian staff on whom its hospitals depend go home, authorities have warned.
Fighting between rival militias in Tripoli over the past three weeks and bloody clashes between Islamists and army special forces in the eastern city of Benghazi have prompted several countries to evacuate their nationals and diplomatic staff.
Now, 3,000 health workers from the Philippines, making up 60 percent of Libya's hospital staff, could leave -- along with workers from India, who account for another 20 percent.
In Tripoli, at least 102 people have been killed and 452 wounded in the clashes that began on July 13, the health ministry said Wednesday.
It said 77 people have been killed and 289 wounded in Benghazi's violence.
Manila already urged its citizens in Libya to leave on July 20 after a kidnapped Filipino worker was found beheaded.
Of the estimated 13,000 Filipinos in Libya, only around 700 heeded the warning and left. The rest refused to abandon their jobs despite the dangers.
But Manila said Thursday it would charter ferries to evacuate its nationals, a day after a Filipina nurse was kidnapped and gang raped in Tripoli.
Hundreds of Filipino doctors and nurses in Tripoli's Medical Centre walked out in protest at the savage attack on their colleague, unleashing anarchy in the hospital.
Families were forced to transfer sick relatives to private clinics, a hospital official said.
"Hospitals could be paralysed" in the event of the mass-departure of Philippine nationals, health ministry spokesman Ammar Mohamed said, while authorities warned of a possible "total collapse" of the health care system.
A medical official said the ministry was trying to persuade the Filipinos to stay.
Complicating the situation further are the difficulties faced by Libyan staff as they struggle to keep work hours.
Mohamed said Libyan doctors and carers have been struggling to reach their workplace from home because of fighting around the capital and fuel shortages.
- Airport closed -
Faced with the deteriorating situation at home, Health Minister Nureddin Doghman has instructed Tripoli's missions in Egypt, Tunisia, Jordan, Turkey, Italy, Greece and Germany to organise the transport and care for Libyans needing treatment, to be paid for by Tripoli.
But the closure of Libya's airports in Tripoli and Benghazi because of the unrest has made medical transfers even more difficult.
"My brother spent several days in hospital after suffering a stroke. His health deteriorated day after day and the doctors told us he should be treated in Tunisia, but we could find no way to transfer him there," said Ahmed Drughi, a Tripoli resident.
"In the end we had to use contacts to find him a place on a medical plane flying out of Misrata," 200 kilometres (120 miles) east of the capital.
Even in peacetime, Libya's health services were understaffed and under-equipped, and tens of thousands of Libyans travelled abroad for treatment, mostly to neighbouring Tunisia and Egypt.
In Benghazi, two out of three of the city's main hospitals have shut.
Al-Jala hospital closed several weeks ago, as the army and an Islamist militia tussle to control it. Al-Houari hospital has been closed for months, after being flooded by sewage because of construction errors.
Only Benghazi Medical Centre remains operational, but its capacity has been limited to 300 beds, compared with 1,200 in normal times.
"The centre is hit by a lack of doctors and carers, particularly after the departure of the foreigners," said spokesman Moataz al-Majbari.
Many patients have had to be transferred elsewhere and have wound up in poorly-equipped clinics in neighbouring towns.