I worked onboard the Aquarius search and rescue ship earlier this year.
These are the unbelievably real stories of the people I met.
By Dr. Dan Schnorr
Two rescuers pull people from the boat up the ladder and onto the main deck, where many of them immediately fall to the ground in a mixture of relief and exhaustion. Our team helps them to their feet, takes off their life jackets, and encourages them onward to make room for those that follow. One of the medics from Doctors Without Borders/Médecins Sans Frontières (MSF) triages them, looking them up and down in search of urgent medical conditions.
MSF then hands them a rescue kit containing clean clothes, a blanket, a bottle of water, and food, and says, “Welcome on board. You are safe.”
I finished training in emergency medicine in Oakland, California, in 2015. Shortly after graduating, I did my first assignment with Doctors Without Borders/Médecins Sans Frontières (MSF) for six months in South Sudan. After that, I moved to Los Angeles with my wife, where I currently work in a combination of community and academic practice settings.
My second assignment with MSF was for three months on the search and rescue vessel Aquarius.
This blog was inspired by the migrants that I met while working on board.
When I first sat down in the ship’s medical clinic to listen to these people recount the circumstances that brought them there, I could not believe what I was hearing. I wanted to relay some of the stories that stood out to me in as straightforward a manner as possible, while still preserving the patients’ privacy.
Everyone is entitled to their own opinion on how they think the world should respond to the migration crisis centered in Libya, but I think their opinions should be informed by the reality of the people that live it.
The Aquarius
The search and rescue vessel Aquarius has a crew of 30 people. There is the marine crew, which includes the captain, officers, engineers, and cooks. There is the search and rescue team, run by a European NGO called SOS Mediterranee. And then there is MSF. All responsibilities are shared, but mostly SOS performs the rescues, and MSF cares for the rescued people once they are aboard.
One of my responsibilities is to ensure the health of the entire crew. I take confidential medical histories on my colleagues and do my best to balance the duality in that relationship. I am also responsible for planning a helicopter medevac for any of them should the need arise. I want everyone to be healthy; because that’s my job, because that’s the only way that we can be successful at our mission, and because these are my friends.
With the support of the rest of the medical team, I train the entire crew in basic life support and mass casualty scenarios. There are many interesting considerations in preparing for these types of situations at sea, like how to move patients on stretchers through steep and narrow staircases, and how to prepare people with no medical background to assist in patient care and resuscitations should resources become overwhelmed.
Lastly, I am responsible for the health of the rescued people once they are on board. The main emergencies we are prepared to handle are hypothermia/exposure and drowning. We even have a ventilator (breathing machine) on board. We see patients in our two tiny cabin clinics. If a sick patient requires respiratory isolation or admission for observation, we are down to only one cabin.
There have been few true medical emergencies since I took over this job two months ago. But even still, once we have rescued people aboard, the medical team works non-stop. Virtually everyone we rescue has at least one medical complaint, and with good reason. They have been traveling for months from various countries in Africa and the Middle East, most recently fleeing horrific conditions in Libya by piling into severely overcrowded boats and risking their lives at sea. Most have not seen a doctor in years, if ever.
The Aquarius can safely transit the Mediterranean with 300 rescued people during the winter and 500 during the summer. They might be aboard for as little as 24 hours before arriving in Europe, which leaves time to treat only the most serious medical cases. We also have to screen everyone for infectious diseases like tuberculosis and scabies, which are naturally of particular concern to Italian public health authorities.
The task would be wholly impossible without the participation of the entire crew. Each crew member has his or her unique experience and responsibilities, though our duties always overlap, and we can only function when we work as a team.
The ship has seen an average of two mass casualty events per year since commencing operations in 2016. The last occurred a month before I arrived when many people were pulled from the water after being found floating face-down and lifeless. Resuscitation efforts began on our two fast rescue boats and continued uninterrupted until the patients arrived to our floating micro-hospital on the Aquarius.
Nine resuscitations were performed during that single rescue and six of them survived: a remarkable percentage. It’s not a miracle, but rather a testament to the foresight of those who planned this mission and the training and preparedness of the entire crew on board. I hope that nothing like this happens again, but if it does, I hope our team is ready to handle it. As much as anybody can be prepared for such a situation, I think we are.
First Transfer
The first transfer of rescued people onboard the Aquarius, was something I will never forget. Here’s the back story:
A merchant vessel had been working the oil fields off the Libyan coast when it suddenly found itself in the middle of two desperate situations. First, a wooden boat carrying 51 people started to break apart during the night and 21 people drowned. The merchant vessel happened upon the remaining 30 people the next day and took them aboard.
Later, they came across an overcrowded rubber boat carrying about 120 people, but the Libyan Coast Guard arrived on scene at about the same time. Determined not to be intercepted and returned to Libya against their will, 42 of these people swam for and were rescued by the merchant vessel. Those who remained on the rubber boat were picked up by the Libyan Coast Guard and brought back to a detention center in Libya, resulting in the separation of many people from their families.
Many feared that they would be taken back to Libya, and possibly punished for having fled.
Enter the Aquarius, the ship where I work as the doctor on-board. The Aquarius was tasked by Italian authorities with taking the rescued people on board and bringing them to a port of safety in Europe.
We met up with the merchant vessel in the middle of the night and launched two rescue boats to dock with them. The first boat contained the search a rescue coordinator, his deputy, an Arabic translator, and me. I was brought along to triage the rescued people so that if anyone was critically ill he or she could be transferred first.
I boarded the ship and found the 72 migrants sitting in single file, deathly quiet, waiting to find out what their fate would be. The crew of the merchant vessel had not told them anything about what was going on. Many feared that they would be taken back to Libya, and possibly punished for having fled. These were the people who saw others drown the day before and others captured and brought back to Libya.
I looked them all over and asked a few questions to see if anyone was ill. They all seemed fine. Then the deputy search and rescue coordinator announced that we were from a humanitarian organization and that we would be taking them aboard our ship and then onward to Italy. “Don’t worry. You are all safe now,” he said, and then it was translated to Arabic. The outpouring of emotion and relief was completely overwhelming.
People fell to the ground crying and shouted prayers of thanks into the sky at the top of their lungs.
There wasn’t a dry eye on the ship.
Once the rescued people were aboard the Aquarius, where they felt safe and their basic needs were attending to, many of the awful consequences of their ordeal began to bubble to the surface. One man from the shipwrecked boat told me that he saw his brother fall off the boat and disappear into the sea during the previous night. Another informed us that he had been separated from his 10 year-old son when the Libyan Coast Guard intercepted half of the people on his boat.
Through contacts in Libya, an MSF team member was able to arrange an emotional conversation from the Aquarius between this man and his son, once the latter had arrived at a detention center in Libya. We also traced another child, 7 years old, who was separated from her uncle in the sea wreck and brought to the same detention center. However she later disappeared, and to this day we don’t know where she is.
Pulled from the Sea
The people we rescue are amazing individuals.
They come from dozens of countries throughout Africa, the Middle East, and Asia. Many are fleeing war-torn and lawless lands in places such as Syria, Yemen, Afghanistan, Eritrea, Somalia, Sudan, and the Occupied Palestinian Territories.
They frequently start their journeys having been tricked into abusive contracts.
Many have been the victims of religious persecution and extortion by extremists and thugs. Their family members have been killed. They carry the financial hopes for entire communities on their shoulders, often traveling alone as young as 14 years old.
They frequently start their journeys having been tricked into abusive contracts. They might pay a few thousand Euros with the expectation of delivery to a place of safety or financial security, but once in a smuggler’s hands find that they have surrendered all control over their destiny. On the road many are sold as commodities and forced to work for free. Many are raped or forced to pay for passage or freedom with sex. They are held captive by the smuggling and trafficking networks, tortured by beatings, burning, and electrocution until they can convince a loved one back home to send more money.
I know this because the victims of these atrocities have told me so directly.
Untold numbers die en route. Those who make it to Libya are often detained arbitrarily. Many are held for months without adequate sanitation or food. Torture and rape become a part of daily life. Scabies eats at their skin. Infectious diseases like tuberculosis spread easily. Pregnant women give birth unattended in these unsanitary conditions.
Having survived all this, many refugees and migrants feel they have no choice but to risk their lives by piling into a unseaworthy and overcrowded boat to cross the Mediterranean. Their smugglers wait for good weather, and then send the boats out at night so that they have a chance of reaching international waters at 12 nautical miles from shore by daybreak. Most of the time they have no food and very little water.
Many become seasick.
An increasingly large proportion of them are intercepted by the Libyan Coast Guard and returned to Libya.
But if we find them first, they are given a life jacket and pulled into our fast rescue boats, which ferry them to the Aquarius.
Two rescuers pull people up the ladder of the boat landing and onto the main deck, where many of them immediately fall to the ground in a mixture of relief and exhaustion. Our team helps them to their feet, takes off their life jackets, and encourages them onward to make room for those that follow.
One of the MSF medics triages them, looking them up and down in search of urgent medical conditions. MSF then hands them a rescue kit containing clean clothes, a blanket, a bottle of water, and food, and says, “Welcome on board. You are safe.”
Some are concerned that we will return them to Libya, but once they are satisfied with our trustworthiness, many start to celebrate.
They get a welcome speech: “You may be here a few days. The bathrooms are over there. That area is for women only. This is when food is served. That is where you can refill your water bottles. Also there is a doctor on board. If you are sick, come find one of us or wait on the white bench to be seen.”
One of the MSF medics triages all medical complaints on the deck. Many are dizzy or nauseous or complain of general body pain. Low-risk complaints can be treated on the spot on the deck with oral rehydration, Tylenol, or sea sickness medications. Those with more serious complaints eventually make it back to the clinic, away from the commotion and noise. The door is shut behind them and they have a private space, likely for the first time since they started their journey many months ago. Someone is paying attention to them, taking their vital signs. I sit across from him or her wearing a white vest and a stethoscope around my neck.
I shake their hand and ask how I can help.
Medical Ship’s Log
For many of the medical conditions I encounter among the rescued people on the Aquarius, we have a ready treatment available. For instance, a bacterial skin infection can be treated with oral antibiotics. Hypothermia in winter months may require only a change of clothes, but we also have heat packs and warmed intravenous fluids should we need them. Seasickness can be treated with oral or intramuscular medications.
Some conditions are unique to the Aquarius, such as fuel burns. These occur due to a chemical reaction between salt water and engine fuel. When the unseaworthy rubber boats inevitably take on water, some fuel spills out and burns the skin of those crowded into the bottom of the boat. These burns can be deep and are always very painful.
The most extensive burn I saw involved deep blistering over 13 percent of the woman’s body surface area. She told me that she had been burned so badly because she had positioned herself to protect the pregnant women on board from the fuel. Her pain was so intense that she had to be sedated into a light coma in order to change her dressings.
We screen for fuel burns as soon as rescued people board the Aquarius. If there is one, there are likely to be many, and if we can act fast to wash off the fuel before it eats away the skin, we can avoid progression of the injury. Thanks to the logistical ingenuity of our predecessors on board, we have a deck shower system that can be started within a minute or so via a clever pulley system.
We also see a lot of infected scabies. I see uncomplicated scabies very frequently in my work in emergency rooms in the United States, usually among homeless populations. This is an infestation involving mites that burrow under the skin to lay eggs. It is benign and easily cured but causes intense itching.
A feared consequence of untreated scabies is “bacterial superinfection” or simply “infected scabies.” The mite’s burrowing and the patient’s scratching cause breakdown in the skin, allowing bacteria to enter and form abscesses. This can be disfiguring and in some instances can lead to life-threatening infections if the bacteria enters the bloodstream.
For men, the most common site for infected scabies is the genitals.
I see this most frequently among East African migrants, such as those from Eritrea or Somalia, because they generally endure the longest detentions in Libya. When I try to put myself in these patients’ shoes, I find that I can’t imagine sitting in a detention center day after day for months or a year as this type of infection is allowed to progress untreated. Certainly some die and others are permanently scarred from the bacteria. All suffer immensely. I am thankful to be a part of the team that can finally offer treatment to these people. For infected scabies, all that is needed is a shower, oral antibiotics, and local wound care.
Our diagnostic capabilities on the ship are limited. We see patients with unexplained bleeding, fevers, or weight loss, and I hope that by referring them for further evaluation in Europe, they may find a diagnosis and eventually a treatment. But even when the diagnosis is clear, there are many conditions that we can not treat. Often these are the result of violence endured along the migration route or in Libya.
There are broken bones that have already healed incorrectly.
There are hernias resulting from forced labor that will require surgery.
There are lacerations that are too old or infected to repair.
There are traumatic brain injuries, skeletal injuries, and scars from burns and electric shocks that will never fully heal.
We provide whatever psychological support we can. Often there is no proper space to do this, and it has to be done on a corner of the deck or sitting down on the floor in the storeroom.
One woman had been pregnant when she arrived in Libya, but her captors wanted her to work as a sex worker, which she refused. She was beaten and coerced into having an unsafe abortion, which involved forcing her to sit in scalding water, leaving deep, disfiguring scars throughout her legs and pelvis. She had also developed an internal infection in the abdomen that had eroded through the skin. This infection had been allowed to fester for seven months, and the woman was nothing but skin and bones when she arrived on board.
With intravenous antibiotics and supplemental nutrition, she started to improve in just the three days we had her in our care, but she would likely require multiple complicated surgeries before the wounds could heal. And she would likely never be able to conceive again.
Seeing this woman’s condition and trying to understand the circumstances that had allowed this to happen took an emotional toll on the entire medical team. I wondered how many women had undergone similar ordeals but did not survive.
There are many victims of sexual violence. We generally get to them too late to administer emergency contraception or medication to prevent HIV infection, both of which should be given within 72 hours of the assault. But we can treat them presumptively for other sexually transmitted diseases and refer them for further testing and treatment in Europe.
We provide whatever psychological support we can. Often there is no proper space to do this, and it has to be done on a corner of the deck, or sitting down on the floor in the storeroom. And often we have just a few minutes free before other responsibilities and other patients call. But we do still try to provide psychological first aid, as we are told that it can make a big difference. It is part of our mission on the Mediterranean to restore human dignity.
Medic on the RHIB
For my third three-week rotation on the Aquarius, it was my turn to be the “medic on the RHIB’s.” RHIB stands for Rigid Hulled Inflatable Boat. Built for speed, maneuverability, and buoyancy, these are the vehicles of choice for maritime search and rescue teams worldwide. I was excited to venture out of the clinic to provide the first-line medical assessment at sea. In this role I would assist with rescue operations where needed, but my main responsibility was to perform the initial medical assessment and triage of the people aboard a boat in distress. I would also resuscitate any critically ill patients while transporting them to the Aquarius.
The word “triage” is derived from “trier,” the French word for “to sort.” There are many tested strategies available to aid medical first responders in sorting the sick from the non-sick, so that time-sensitive interventions and preferential transport can be directed toward the most ill. All strategies involve assessment of some combination of the mechanism of injury, exam findings, vital signs, and patient characteristics, such as age and underlying medical conditions.
I pondered which strategy I would use, but soon learned that these types of methodical assessments are impossible when approaching an overcrowded rubber boat. These are meant to hold 40 people but are typically packed with 110–130. The hull is a flimsy inflatable rubber tube, and the floor is a slab of rubber with a few wooden beams laid across. Lucky people get seats straddling the tube, and the rest, including women and children, are made to stand in the middle.
Once at sea, the floor very quickly sags under their weight, so that the heads of those standing in the middle only reach the height of the feet of the people sitting on the inflatable hulls. The two sides of the boat are pulled towards one another and the people in the middle are squeezed together. Water enters to varying degrees, reaching anywhere from the knees to the necks of those inside. Mothers may need to hold their children above their heads to keep them out of the water. This mass of rubber and flesh is pushed along by a 40 horsepower engine, generally reaching a speed of no more than two nautical miles per hour.
Thousands of people have died trying to cross the Mediterranean in these types of boats. Some boats succumb to the weight of the passengers and sink. Those in the middle of the boat may be crushed or drown where they stand. Again and again though, rescued people tell us that they would rather risk dying this way than stay in Libya.
If the boat does not collapse, it is only by some miracle of coordinated weight distribution. If anything were to throw off this balance, say by the shifting of people provoked by an approaching rescue boat, the homeostasis is disturbed which could spell disaster. That is why we are taught that the first approach to a rescued boat is the most dangerous period of the rescue.
A cultural mediator stands at the bow of the RHIB and does his or her best, with words, body language, and tone of voice, to convey a sense of calm. Once that message is conveyed, we start distributing life jackets, and that’s when I am supposed to perform my assessment.
The first time I did this, I thought, “My job is pointless. These people are dehydrated, crammed together, soaked, vomiting. They all need evacuation as soon as possible. The order doesn’t matter.” But I tried to do my job as best I could, because for some sick person, a few minutes’ delay to medical care could make a huge difference. Of the many parameters typically taken into account in triage protocols, the only ones that I could see as applying here were:
- general appearance (who looks sick or weak on a snap first impression)
- age (extremes of age are more vulnerable and likely to get sick quicker)
- self-reporting (just ask the people, “Is anyone sick?”)
The last one is the most reliable
In the case of my first rescue, they informed me that yes, one man is very sick. Then from the bowels of the boat, from underneath a mass of people where I could not even see, they produced a young man who seemed lifeless and handed him over their heads toward the RHIB. Two rescuers hauled him in and lowered him to the deck where he collapsed limply. He appeared very sick, so we made immediately for the Aquarius. I called over the radio that we would need a stretcher to meet us at the boat landing.
As we sped over the waves, I found thankfully that the man was breathing and had a faint pulse. With some vigorous shaking, I got him to produce an audible mumble. He wasn’t dead. He was just severely dehydrated from sea sickness, sun exposure, and lack of water. Once on board the Aquarius, he made a full recovery. But after seeing the condition of the rubber boat, I was surprised that we didn’t have many more patients presenting similarly.
Passengers waved at us to help, but we were ordered by European maritime authorities to stand by and not rescue.
The Human Toll of Being Caught in the Political Crossfire
As the migration crisis in the Central Mediterranean becomes more an issue of political concern to Europe, governments have started mounting barriers for Non-Governmental Agencies (NGOs) providing humanitarian assistance at sea. It is frustrating when government agencies stand between medical professionals and their patients, or between a search and rescue ship and a boat in distress. MSF’s charter states that that our organization “observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions.”
At times during my assignment the medical team has been called upon to speak up when political barriers prevented the Aquarius from helping those in need of care. The first such instance occurred when we spotted a rubber boat in distress. Its passengers waved at us to help, but we were ordered by European maritime authorities to stand by and not rescue. Control of the rescue was given to the Libyan coastguard, so that the people could be taken back to Libya instead of onward to a port of safety. However the Libyan coastguard was nowhere in sight.
It was only once our nurse on the RHIB (Rigid Hard Inflatable Boat) spotted a 16-day-old baby on board the rubber boat, and the medical team advocated that the newborn be evacuated immediately, that the authorities gave us the go-ahead to disembark the baby, along with her family, and any other medical cases. One could argue for all passengers on such a boat to be classified as “medical cases” since they are trapped in a position that is unquestionably hazardous to their health. But in this instance we were allowed to take only the most vulnerable and obviously ill, which ended up being young children, pregnant women, people with chronic medical conditions, and their families.
After we had evacuated the medical cases, we were instructed to leave the scene. At which point the Libyan coastguard arrived and took the remaining people back to Libya.
This was a morally wrenching situation for everyone involved.
We tried our best to keep families together, but one woman was separated from her husband. It was difficult for our cultural mediator to keep everyone on the rubber boat calm, knowing himself that most of them would be returned to Libya after we left. I questioned that by rescuing only some people from the boat, had we actually done harm? Would the correct response have been to leave a newborn in that situation? The newborn’s mother had given birth unattended in a detention facility. Once on board the Aquarius we found that she had bled so severely during delivery that she would require a blood transfusion. What would have happened to her if we did not evacuate her?
Another notable event occurred after a small search and rescue NGO performed a rescue of 105 people. Due to the size of their ship, they were unable to transit the Mediterranean with rescued people on board, and the Aquarius met them at sea with the intention of transferring them to our ship. However the maritime officials refused to authorize the transfer, saying that they had not authorized the rescue in the first place. The other NGO followed us for a full day as we continued search and rescue operations and waited for authorization to make the transfer.
Finally in the evening, the ship called with a report that a child on board had begun vomiting blood. They requested that I visit their vessel to assist their doctor with this potentially life-threatening situation.
I arrived to find a crowded small boat and, as the weather deteriorated, many rescued people becoming sick. Their doctor had done a remarkable job of treating everyone in the helm room that doubled as her clinic, but her capacities were quickly becoming overwhelmed. And indeed, one child had been seasick for three days and was now vomiting blood, likely the result of a tear in the lining of his gastrointestinal tract resulting from sustained retching.
I described the situation to our project coordinator via radio, and eventually the authorities relented to the sustained pleas of both the Aquarius and the smaller NGO, and allowed us to transfer all rescued people aboard the Aquarius. We were happy with the result but frustrated that it required a child to deteriorate into a potentially life threatening situation in order to reach it. Once he was aboard the more stable Aquarius, and treated with sea-sickness medications, the child stopped vomiting, his blood levels stabilized, and he recovered completely.
A TB Patient at Sea
We had a few critically ill patients on the Aquarius in my three months there. One patient I first noticed as we disembarked him from a wooden boat. He was very thin, so much so that the muscles on the side of his forehead had atrophied, a finding that we medical people call “temporal wasting.” There are many conditions that cause this. In Africa the two most important are AIDS and tuberculosis. Unfortunately, in the context of search and rescue of persons fleeing Libya, we must also consider forced starvation imposed by human traffickers and kidnappers as a possibility.
I was amazed that someone in his condition could make the journey.
However, in the next few days, as we got to know the predominantly Eritrean population from this wooden boat, it started to make sense. This group had been detained together for nine months. Their community was strong. They looked out for each other. Some of the wiser or more educated among them had assumed de facto leadership roles. One had training as a paramedic and had cared as best he could for the sick among them during those months, earning the nickname “Doc.” He helped me to identify people needing care who otherwise might have fallen through the cracks when we had more than 500 people on board.
When the rescue of this wooden boat was nearly completed, I boarded an RHIB heading back to the Aquarius along with 12 rescued people. As we approached the ship, the rescued men I rode with could see the hundreds of other rescued people onboard, smiling and cheering. They knew then that they would be safe. One of them suggested to the others that they offer a prayer of thanks, and they sang a beautiful hymn as we approached the boat landing. The next day was Sunday, and these Eritreans held a Mass on the deck. There was one leader and everyone else sat packed side by side and sang song after song in perfect unison. I imagine that this type of community and faith must have been a great comfort and sustaining force for them throughout the months of captivity in Libya.
I am convinced that it is only because of this strong community that the patient I described above was able to survive. This ill man is technically a boy; he gave his age as less than 18 years old. He had been traveling with one other boy his age. He told me that in the detention center in Libya he started to cough, and eventually developed nighttime fevers and sweats and weight loss: classic signs of tuberculosis. When he got to the Aquarius he could barely support his own weight and needed help to walk. As soon as he hit the deck, our nurses recognized that he was in critical condition, and diverted him from the other rescued people to our “pit-stop” area where they could take vital signs and a blood sugar level to make sure he was not in imminent risk of death. A day under the sun on a packed wooden boat without food or water could be enough to push someone in this condition over the edge.
We gave the boy oral rehydration salts and admitted him as an inpatient in order to watch him closely. Every night his temperature spiked and his heart raced and he appeared so weak. When he became febrile he could barely muster the strength to speak. We started antibiotics in case there was a bacterial infection underlying this syndrome, but predictably his fevers continued. We gave him special food designed for malnourished people, but he had little appetite, which is an ominous sign. When his blood pressure dropped, I became very worried. We had to start intravenous fluids, which is very risky for a malnourished individual.
On the night prior to our arrival in Sicily, I prepared a disembarkation report to hand over our medical referrals to the Italian public health authorities. I alerted them that among the more than 45 individuals whom we were referring for medical follow-up on land, we had one emergency case that would require an ambulance to meet us at the port for immediate transfer to a hospital. I also informed them that in addition to this one critically ill patient, we had three others who required respiratory isolation for suspected pulmonary tuberculosis.
When we arrived at port, as always, the doctor from the ministry of health was the first to board, along with four medical assistants, all donning full personal protective equipment including face masks and jumpsuits. I led them to our back clinic, where we had our respiratory isolation room.
The doctor immediately recognized the patient as a critical case and agreed to take him directly to a hospital. He asked if we needed a stretcher, and I was inclined to say yes, but when I asked the patient, he said no. He got out of the bed on his own, and then, supported by the other patients in the clinic, with whom he had been detained and grown ill in Libya, he walked down the long corridor to emerge into the sunlight on the main deck. Here he got his first glimpse of Europe. He was helped down the gangway as the cameras of the press that had gathered on shore swarmed in his face. And then his friends helped him into an ambulance and he was taken away.
I was moved by this scene. Having arrived in Italy, this boy would receive good medical care and would likely improve and survive his illness. It was fitting that those countrymen of his, with whom he had suffered for so long, and through whose support (quite literally) he managed to cross the Mediterranean, were the ones to finally deliver him to safety.
Thoughts After Coming Home
While at sea, the MSF team does our best to identify those needing medical care or those qualifying for special humanitarian protection. We know that once they are disembarked in a port of safety and we have handed them over to the Ministry of Health and other NGOs, we will no longer be able to follow their cases.
On shore their fate rests with various European security agencies, Italian health and human affairs authorities, and a smattering of NGOs that try to advocate for this population and fill some of the gaps left by an overstretched infrastructure for processing refugees and asylum-seekers.
It has been a pleasure to work with the Italian health workers who met us in port during my period on board. Despite the politicization of the migrant crisis, these individuals value the standing of medical professionals as non-partisan caregivers. They do their best to perform their own triage of the hundreds of rescued people, including dozens of medical referrals, we bring to them with each port call. They too have to decide how best to marshal scarce resources to benefit the sickest and most vulnerable. And I know that the decisions are not always easy.
Some rescued people will be granted asylum or protection to stay in Europe. Depending on their home country and individual circumstances, others will quickly be instructed to leave Italy, or may be deported. Many more will spend months or years in limbo in processing centers and reception centers, neither expelled nor granted the legal standing in Europe to start building a new life.
But the mission of the Aquarius ends with the delivery of people in distress to a port of safety. Our objectives are to prevent the loss of life at sea, provide medical care, and to restore human dignity. Within that narrow mandate, I think that we have been successful. We had no deaths in my three months on the boat, neither during rescues nor during transit to Europe. 1,359 people were pulled from the sea, and 1,359 people were delivered safely to port. We were very lucky, but also well-prepared.
One rubber boat that we approached was taking on water very fast, and looked about to collapse. The MSF team aboard the Aquarius prepared for a mass casualty event, by converting the shelter that usually serves as the sleeping quarters for rescued women into a makeshift trauma hospital. We were prepared to receive many drowning and trauma victims, however the SOS MEDITERRANEE search and rescue team was able to quickly and calmly offload the distressed passengers onto rescue rafts before anyone was injured. The only sick patient from that rescue had moderate hypothermia and recovered quickly.
Another time, the Aquarius transited the Mediterranean in rough weather with almost 300 people on board. At around midnight on the night prior to arrival in Sicily, I was finally finished treating patients and was going to sit down at the desk in our clinic to type up the disembarkation report detailing the medical conditions of the people on board. Just as I placed my coffee on the desk, the ship lurched violently to port, and everything in the room went crashing to the floor. Cabinets full of medical supplies were thrown open. I cursed, and wiped up the spilled coffee, but left everything else on the floor where it had fallen.
The waves outside had reached six meters. I had to type my report while standing because the only way I could keep myself steady over the keyboard was by constantly shifting my weight from side to side. This paled in comparison to the difficulties faced by those working outside. It was impossible to move on the deck without being knocked over. The logistician had fixed tight ropes running horizontally a few feet off the deck, so that rescued people could make their way to and from the bathroom. Large waves came crashing down on the rescued people, completely soaking them. The deck team had distributed survival bags to keep them dry.
No one slept until the weather subsided. But the next morning the sun rose over clear skies, and everyone made it to port in one piece. We can’t end the wars, conflict, instability, or oppressive circumstances that drive these people from their homes. And there is no easy counter to the trafficking networks that abuse them in this most vulnerable state. All we can do is try to treat people humanely within our capacity, and regardless of the political currents of the time. I think it is the right thing to do.
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