In 2015 alone, 140,000 people have made the perilous journey in what is known as the Central Mediterranean route, a stretch of sea that lies between Libya and Sicily. Many of them had written the phone numbers of relatives back home on their clothes, forearms or life vests, in case their boat capsized and their bodies were recovered.
John is an Eritrean boy rescued off a small wooden boat packed with 323 Eritreans at the beginning of September 2015. He risked his life at sea along with his mother and little brother, having fled persecution by an oppressive regime back home. John speaks very good English and is mature beyond his years. He has seen too much for his age. He is terrified. He is just 9 years old.
Grace is from the Democratic Republic of Congo. She was rescued in August from a rubber dinghy packed with 112 sub-Saharan Africans. She left her country after enduring years of conflict which affected her village in the province of North Kivu. She had been sexually assaulted by armed militias. Before getting on the boat she had crossed the Republic of Congo (Brazzaville), Cameroon, Nigeria, Burkina Faso, Niger and Libya. Along her journey she was raped again while in the hands of smugglers. She is 28 years old and travelling alone.
Ahmed and Amira are a young couple from Damascus in Syria. They were rescued in May from a wooden boat packed with 563 people of many different nationalities. They were holding their two young children in their arms, as tightly as they could. The family has been through four years of war, from the barrel bombs of the regime to the brutality of the jihadist group that moved in to control the neighbourhood. They travelled to Jordan first, then to Egypt. Neither of those countries offered them opportunities for survival. So they decided to rely on smugglers to take them into Libya and attempt the sea crossing to Europe.
Between May and September 2015, and only in that area of the Mediterranean, Médecins Sans Frontières (MSF) vessels rescued and provided assistance to over 16,000 people from 20 different countries. John, Grace, Ahmed and Amira were among them.
MSF has long-standing programmes in most of the countries that people are fleeing from, and is often first-hand witness to the conditions that people report as reasons forcing them to flee their homes. While much of the European public debate hinges on a distinction between ‘refugees’ and ‘economic migrants’ the distinction is very difficult to sustain in reality. Whatever their backgrounds and places of origin, all of them share one motivation: the hope for a safer and more prosperous future. The motivations that people cite are varied and often multifaceted, from conflict, oppression and political persecution to widespread and crippling poverty. These reasons are often combined together, and are powerful enough to push people to gamble their lives on journeys managed by criminal smuggling networks.
The stories we hear from people from Syria, Afghanistan, Eritrea, Somalia, Yemen, Sudan, Iraq and Pakistan are of having fled violence, armed conflict, persecution, oppressive regimes, fear of forced recruitment, or arbitrary imprisonment. Then there are also large numbers of people from Sub-Saharan and West African countries like Nigeria or Mali, who, having been immigrants in Libya, are now fleeing from there because of harassment, violent assault, rape, forced labour, detention and kidnapping for ransom by armed groups and smugglers alike.
The boat trip
Although people are aware of the risks of the sea crossing, nothing can prepare them for the experience. Transported to the Libyan coast in trucks, people are loaded into boats in the dead of night, sometimes at gunpoint. Boats are systematically overloaded to maximise profit for the smugglers, often taking ten times more than their actual capacity. For most, there is no lifejacket and they cannot swim. People packed under the deck sometimes do not realise how dangerously overcrowded the boat is until the light of morning. This is when the precariousness of the situation becomes clear, and fear and panic set in.
Once on board, people face several risks. The first and most deadly threat is of capsizing. A large wave or a movement of people from one side to another in a boat so overladen can provoke sudden capsizing and inevitable mass drowning within minutes. When people are packed under the deck, they are exposed to exhaust fumes from the engine and we have seen cases of death by asphyxiation. The majority of deaths, of which over 2,800 have occurred to date in 2015 in the central Mediterranean, are related to these factors.
MSF boats work in coordination with the Maritime Rescue Coordination Centre in Rome to rescue and assist people. Those who are rescued are often found to be suffering from exhaustion, mild to moderate dehydration, general aches and pains, infections, chemical burns from fuel contamination on clothing, scabies and small injuries. Injuries typically relate to violence sustained in Libya and range from gunshot wounds or lacerations to broken bones. Mostly the injuries are weeks old but can also be newly inflicted, requiring more urgent treatment, and many need referral to medical facilities in Italy. There are always women and children, pregnant women and unaccompanied minors who make incredibly dangerous journeys on their own. We try to provide particular care and support for them and for survivors of sexual violence.
A common issue is the psychological distress that people have developed over a period of time. This is a roller-coaster of emotions, from leaving their home and family, the land journey to Libya, the abuse and turmoil of Libya, the exposure to smuggling gangs, being moved around like traded animals. When people are brought to the safety of the rescue boat there is often an emotional outburst of relief. People can be totally overcome and overwhelmed. Our immediate focus is to ensure people have their basic needs met: water, food, medical care, dry clothes and reassurance that they are safe and they will be taken to an Italian port.
The political narrative across many European countries has been about reinforcing policies that are known to exacerbate the crisis rather than about assisting and preventing people from putting themselves through much suffering and risk. For the central Mediterranean, the focus of the response remains only the symptoms – targeting the smuggling networks and the boats – rather than removing the restrictions on asylum and migration which put people into the hands of smugglers in the first place. Provision for safe and legal alternatives for people fleeing to seek safety and protection and more progressive migration regimes have been proposed. Meanwhile a proactive and preventative approach to search and rescue at sea is essential. The longer people are exposed to the terrible conditions on board, the sooner people’s health will deteriorate and the higher the risk of death at sea.
Hernan del Valle Hernan.del.Valle@amsterdam.msf.org
Head of Advocacy & Operational Communications
Rabia Ben Ali firstname.lastname@example.org
Humanitarian Affairs Officer
Will Turner email@example.com
Médecins Sans Frontières www.msf.org
Names of individuals mentioned in this article have been changed.
 See report by the Special Rapporteur on the human rights of migrants, François Crépeau, to the UN General Assembly, 8th May 2015 Banking on mobility over a generation: follow-up to the regional study on the management of the external borders of the European Union and its impact on the human rights of migrants www.un.org/ga/search/view_doc.asp?symbol=A/HRC/29/36