This study aims to understand differences in access to diagnosis and treatment for people with multiple sclerosis (MS) receiving care in Libya. The study uses data from the Libyan Multiple Sclerosis Registry, which collects clinical and treatment information from patients at two tertiary neurology centres. The main focus is to examine how long it takes for patients to receive an MS diagnosis, who has access to high-efficacy disease-modifying therapies, and how these factors relate to disability levels. The results will help identify gaps in MS care within a conflict-affected health system and guide improvements in services for patients in Libya.

Inclusion Criteria:

• Adults aged 18 years or older
• Diagnosis of multiple sclerosis according to the 2017 McDonald criteria
• Receiving care at Tripoli University Hospital or Omar Askar Hospital
• Able to provide written informed consent
• Recorded EDSS score at registry entry
• Availability of core demographic and diagnostic information

Exclusion Criteria:

• Clinically isolated syndrome (CIS)
• Age younger than 18 years
• Absence of confirmed multiple sclerosis diagnosis
• Missing key clinical variables required for primary analysis (EDSS, phenotype, or DMT information)
• Declined or unable to provide informed consent

Adults with multiple sclerosis receiving neurological care at two tertiary centres in western Libya: Tripoli University Hospital in Tripoli and Omar Askar Hospital in Zliten. Patients are enrolled into the Libyan Multiple Sclerosis Registry during routine clinical visits, with disability assessments and treatment information recorded by trained neurologists. The study population reflects a broad range of MS phenotypes, socioeconomic backgrounds, and treatment exposures within a conflict-affected health system.