Libya’s trachoma elimination reflects systemic healthcare access gaps and colonial health legacies in North Africa

Trachoma in North Africa was historically addressed through indigenous practices like the use of *kohl* (antimony-based eye treatments) and communal hygiene rituals. Berber and Arab medical traditions emphasized prevention via clean water and dietary interventions, which were disrupted by colonial public health policies. Modern trachoma elimination programs often dismiss these traditions in favor of mass drug administration, ignoring their cultural resonance and sustainability.

Libya’s healthcare system was dismantled post-2011 NATO intervention, which targeted medical infrastructure and displaced healthcare workers. Colonial-era public health systems in North Africa prioritized urban centers, leaving rural populations vulnerable to neglected diseases. Trachoma elimination in Libya mirrors similar successes in Tunisia and Morocco, but these are contingent on stable governance and foreign aid, not systemic health equity.

Trachoma elimination in Libya contrasts with persistent outbreaks in conflict zones like Gaza and Yemen, where healthcare systems are collapsed. Indigenous communities in the Sahel and Horn of Africa have used traditional eye care practices for centuries, yet these are rarely integrated into global health strategies. The WHO’s biomedical model risks erasing culturally grounded solutions that could address root causes like poverty and displacement.

Trachoma is caused by *Chlamydia trachomatis* and spreads via poor sanitation and flies, with children as primary vectors. The SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) has proven effective, but its implementation requires sustained investment in water infrastructure and education. WHO’s validation relies on trachomatous inflammation-follicular (TF) prevalence thresholds, which may not capture subclinical or recurrent cases in unstable regions.

In Libyan and broader North African culture, eye health is symbolically tied to protection and wisdom, with amulets and prayers used to ward off infections. Traditional healers often incorporate spiritual rituals alongside herbal treatments, reflecting a holistic approach to disease. Modern public health campaigns could benefit from integrating these cultural narratives to improve community engagement and trust.

Libya’s trachoma elimination may face reversal due to climate-induced water scarcity and ongoing political instability. Future scenarios must account for the intersection of conflict, climate change, and healthcare access, particularly in North Africa’s arid regions. Global health models should prioritize adaptive strategies that integrate indigenous knowledge and community-led monitoring to prevent resurgence.

Women and children in rural Libya bear the brunt of trachoma due to limited access to healthcare and sanitation facilities. Marginalized groups, including migrants and internally displaced persons, are often excluded from trachoma surveillance and treatment programs. The WHO’s validation overlooks how Libya’s healthcare system, post-2011, has failed to address the needs of these populations, exacerbating health inequities.