MSF Responds to Emergency in Mediterranean

New York, N.Y.  Every year, thousands of people fleeing violence, insecurity, and privation at home attempt a  treacherous journey  via North Africa and across the Mediterranean Sea to Europe. And every year, countless lives are lost during the passage. In 2014 alone, more than 3,400 people are thought to have died during the crossing.

The number of migrants arriving to Europe by boat has already surpassed the 2014 total, with the United Nations Refugee Agency (UNHCR) reporting that 264,500 people have arrived so far this year. The majority have come via Greece (158,456), followed by Italy (104,000) with smaller numbers arriving in Spain (1,953) and Malta (94).

According to the International Organization for Migration, the majority of arrivals to Greece are from Syria, Afghanistan, and Iraq; while most arriving in Italy are from Eritrea, followed by Nigeria, Somalia, Sudan, Syria, Gambia, and Bangladesh.

Search and rescue resources must be adequately allocated as long as the need remains.   While search and rescue resources have been significantly increased, there have been periods where there were fewer boats available to carry out rescues. MSF’s rescue boats have subsequently been particularly needed as they are actively patrolling the international waters close to Libya where most incidents occur. MSF continues to call for member states to ensure adequate resources are allocated as long as necessary to search and rescue operations. We continue to stress the importance of active patrolling in the most at-risk zones as close as possible to the Libyan coast.

Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing assistance to migrants, refugees, and asylum seekers in Europe since 2002, and has long worked in many of the countries they flee from. In response to the urgent need for maritime search-and-rescue activities,  MSF has partnered with the Migrant Offshore Aid Station  (MOAS) to provide assistance to people fleeing crises and risking their lives to reach safe haven in Europe. The operation will take place between May and October 2015, when the number of desperate people attempting to cross the Mediterranean is expected to peak. A second ship, the  Bourbon Argos , was launched in early May.

MY  Phoenix

A six-person MSF team provides post-rescue care on board the Phoenix , a search and rescue vessel run by MOAS and funded 50 percent by MSF. The MY Phoenix launched on May 2, 2015. Medical care available ranges from primary care to resuscitation and advanced life support.

Bourbon Argos

MSF launched an additional ship on May 9 to carry out search and rescue operations in the Mediterranean Sea. The ship has 26 people on board (of which 14 are MSF staff), including an experienced search and rescue team as well as medical staff, water and sanitation experts, logisticians, and others. The Bourbon Argos has the capacity to carry up to 700 rescued people to land.

Dignity I

Launched on June 13, Dignity I has a crew of 18 people, including medical staff. The 50 meter-long vessel has the capacity to carry 300 people to land.

To date, the three boats have rescued 14,533 people. They have also assisted a further 1,166 more with safe passage to Italy (after they were rescued by other boats) bringing the total number of people assisted by MSF teams on the Mediterranean to 15,699 .

Click Here to Learn More about MSF's Work With Refugees

Push Factors

The biggest displacement of people since the Second World War is being fueled by considerable push factors that force people from their homes. From the increasingly brutal war in Syria to the difficulty of life under an oppressive dictatorship in Eritrea , everyone we meet has a very strong reason for fleeing their country. We see these considerable push factors firsthand in the countries in which we work. Many tell us that they didn't want to leave their homes, but did so because they had no other choice—they are fleeing for their lives. We hear that people know the risks they may face once they flee, but that this is still preferable to staying at home.

People Need Safe and Legal Ways to Seek Asylum and Migrate

There are very few safe, legal channels available to reach protection and safety. Many people resort to desperate measures to reach European soil. With Europe's land borders sealed, many are forced into the hands of smugglers and onto leaky, overcrowded boats. Many have contended with long, risky journeys over land and life-threatening conditions in countries such as Libya before even reaching the Mediterranean. Search and rescue is not in itself a solution—people will continue to risk their lives at the hands of smugglers as long as there are no safe alternatives.

Europe's restrictive policies put some of the world's most vulnerable people in even more danger as they try to bring themselves, and their families, to safety. European (and transit) countries have the responsibility to ensure that their policies guarantee the right to seek asylum and respect human dignity.

Most of the world's displaced people are displaced within their home countries, or in those that surround them. Relatively few are granted asylum elsewhere. For example, 12 million Syrians have been displaced by the ongoing conflict, eight million have fled to other parts of Syria, and four million live as refugees in the countries that surround Syria—many of which are now overwhelmed (about one in five people living in Lebanon are now Syrian refugees). Only a quarter of a million people have made it to Europe—that is less than 2 percent of the total number of displaced. Europe is not carrying its fair share of this tragedy—countries can and should do more to provide safe haven to those that need it.

A Need for Improved Reception Conditions

As there are no safe and legal routes for people to enter Europe, most have no choice but to use the maritime routes through Italy and Greece. Reception systems in these countries have many shortcomings and remain woefully under-prepared to treat the people arriving at their borders humanely. MSF calls for proper and humane reception to be urgently organized at arrival points in Greece and Italy, including shelter, food, water, sanitation, medical and mental health care, and access to asylum procedures. In Greece in particular, the situation is critical, with thousands of people scattered in different islands of the Aegean Sea, without any facilities to receive them.

Mikael Mangold/MSF.

European Countries are Only Accepting a Small Share of the Total Number of Displaced

Most of the world’s displaced people live elsewhere in their home countries or in those that surround it—relatively few are granted asylum abroad. For example, 12 million Syrians have been displaced by the ongoing conflict. Eight million have fled to other parts of Syria. Four million live as refugees in the countries that surround Syria—many of these countries are now overwhelmed (one in four people living in Lebanon are now Syrian refugees). Only a quarter of a million people have made it to Europe, less than two percent of the total number of those displaced. It is more than time for European countries to adopt more humane and asylum policies.

Christophe Stramba/MSF.

Q&A

Why is MSF scaling up its activities?

By committing to a more robust search and rescue capability, European powers have finally woken up to their responsibilities to stop people from drowning in the Mediterranean Sea. However, more needs to be done in terms of policy to save the lives of those desperate enough to flee across the Mediterranean. The Mediterranean search, rescue, and medical aid boats that MSF teams work on have rescued 6,000 people as of July 8, 2015. MSF aims to work where we are needed most, and we will continue to work in the Mediterranean until we are no longer needed. Typically, the busiest period for crossing is July and August, so all search and rescue operations on the Mediterranean are expected to be busy.

Doesn't the presence of search and rescue services just encourage people to risk their lives?

People attempt to cross the Mediterranean whether or not rescue operations are present. In the first half of this year, when there was no search and rescue capacity in the Mediterranean Sea following the end of Italy's Mare Nostrum operation, people still risked their lives crossing the sea. However, without the vital protection that search and rescue provides, more people died. Deaths in the Mediterranean exceeded 1,800 in the first five months of 2015, five times higher than the same time period last year when Mare Nostrum was running. We know that search and rescue is just a temporary solution to a more complex crisis, but it is essential—letting people drown is not an option.

What does MSF think is the real reason that so many people are trying to reach Europe?

It is the "push factors" that cause people to leave their homes, families, and lives—war, conflict, violence, persecution, poverty, and hunger. We see these push factors firsthand in the countries in which we work. People tell us that when they flee that they know that their journey will be long and dangerous, but that the risk it poses is still preferable to staying at home. We never hear that people were tempted to cross the Mediterranean because they expect to be rescued. They know they might die—this is worth the risk for them.

For MSF, the most striking point is the suffering and difficulties that the people have to endure: not only in their countries of origin under whatever conditions forced them to flee in the first place, but also in their journey to safety. It is important to remember that 86 percent of refugees are hosted in developing countries—only a minority are using irregular migration routes to places like the EU.

Aren't most of the people just economic migrants? Shouldn't they be sent back home?

Although some European politicians seek to characterize those coming across the Mediterranean as "economic migrants in search of a better life," the people we meet had very strong reasons for leaving their countries. We've assisted people fleeing war in Syria, and those trying to escape 20 years of conflict in Somalia—a country where even MSF is unable to safely work. We've also met many people who left Eritrea, where a brutal regime denies them their basic human rights and freedoms. We also see people who were employed in Libya and are now fleeing violence and fighting there—foreigners are at particular risk in Libya today.

Many people crossing the Mediterranean did not want to leave their home countries but are fleeing for their lives. Sending them back will not be an option. People deserve the right to assistance if they need it, no matter what reason initially drove them to flee their home countries.

What do you hear about the conditions in Libya?

The main departure point for people we meet on our search, rescue, and medical aid boats in the Mediterranean is Libya. The stories we hear are truly shocking. We repeatedly hear people say that a life in Libya is worthless without money. They talk of robberies, kidnap, rape, abduction, extortion, and even of having to watch their family or friends being killed. People who are held in detention centers tell us that they had limited access to food, sanitation, or medical care. We've given people on our search and rescue boats food, and they've told us that it is the first time that they have eaten in days. Some say it is the first time they have felt cared for in a long time.

Who is coming on these boats? What nationalities?

MSF teams in the Mediterranean have participated in the rescue of people from Eritrea, Syria, and Somalia, as well as people from a number of sub-Saharan African countries.

This year, Syrians (34 percent of arrivals according to the UNHCR) and Eritreans (12 percent) are the two main nationalities risking their lives to cross the Mediterranean. They are closely followed by Afghans (11 percent) and then Nigerians (5 percent) and Somalis (5 percent). Syrians and Afghans mainly arrive through the Greek islands, while Eritreans, Somalis, and Nigerians usually come through the route between Libya and Italy. The majority of people arriving by sea come from countries that produce refugees.

Our teams in Sicily report seeing fewer Syrians arriving this year. People fleeing the increasingly brutal war in Syria are instead taking the route through Turkey and across the water to Greece—60 percent of people arriving in Greece are now Syrian, which could be due to the upheaval in Libya and visa restrictions imposed in Lebanon, Egypt, and Algeria. Our teams see families with young children crossing, and our staff in Sicily have reported seeing more unaccompanied children making the crossing this year.

What are the medical needs related to the sea journey?

Our teams have treated dehydration, hypothermia, diarrhea, seasickness, scabies and other skin infections, diabetes, conditions related to pregnancy, and trauma injuries sustained either on their journey or in Libya. MSF medics working in the reception center in Pozzallo, Sicily, have also treated ulcers and chemical burns suffered from the fuel that floods the boats' holds.

People also arrive with mental wounds sustained after traumatic events at sea like shipwrecks, or the violence and brutality they have endured on their journey. Forty percent of our patients in the asylum centers in Sicily suffer from signs of post-traumatic stress disorder. In addition to providing mental health care in Pozzallo, MSF provides psychological first-aid through a standby team composed of cultural mediators and a psychologist who can be deployed to different landing ports in Sicily in 72 hours.

If MSF is apolitical, why is the organization entering into European politics?

We are aware that by working with migrants, asylum seekers, and refugees, and by speaking out about what we witness in the course of our work, we are entering a very hot political debate in Europe. We know there are different opinions in terms of policy choices that European governments could make. It is not up to MSF to determine EU migration policy—it is the job of politicians to find solutions to this crisis. We can only highlight the humanitarian consequences of political decisions that we witness firsthand.

Wouldn't money be better spent in countries of origin, addressing the reasons for which people are fleeing?

MSF works in more than 60 countries around the world, and we provide medical humanitarian assistance to refugees and internally displaced people in around 30 of them. We see no difference in working on land or at sea and our operations in all of these countries will continue.

It is up to governments to decide what their response will be—we are not trying to determine their foreign policy, or to tell them how to spend their money. What we are doing is speaking out about the humanitarian consequences of the political choices made by European countries.

Do you think European countries should accept more people?

It is the lack of safe and legal channels to reach Europe that pushes people to risk their lives and resort to using smugglers. The EU has put forward modest proposals to relocate 40,000 people in Italy and Greece and to relocate a further 20,000 refugees over the next two years. But it is not clear how this will happen, and it is clearly not enough to have a sufficient impact on the current situation at the EU's borders. More people have been forced from their homes than at any time since the Second World War—Europe could and should be doing more to carry its fair share of this humanitarian crisis. EU countries should not assume that spending money supporting refugees closer to their country of origin absolves them of their responsibility to take in more people.

What does MSF think of Australia's "Stop The Boats" policy? Could this be an option in Europe?

The so-called "Stop The Boats" policy is pushing human suffering offshore and the Australian government must stop advocating for the adoption of similar policies in Europe. While Australia's government has referred to its push back policy as "humanitarian," there is nothing humanitarian about leaving people to suffer or die out of sight.

Dragging back boats, closing borders, and putting a fence between safety and the population in need so that suffering and dying can take place elsewhere is not a "solution." It is the most harmful response one can imagine.

In addition to Australia's policy to "turn back boats," both parties in Australia support the interception of asylum seekers (and other irregular migrants) and their transfer offshore for mandatory detention and processing in countries including Nauru and Papua New Guinea. MSF does not in any way support policies of detention. Detaining people who are already traumatized, who have fled war and other humanitarian crises, causes further medical harm. We know this from our direct experience assisting those in detention centers around the world.  We strongly urge Europe to reject the Australian model and not to follow Australia's lead.

How does MSF work with Italian authorities? Where are rescued people taken?

MSF is involved in search and rescue operations on the Mediterranean on three ships: the MY Phoenix , the Bourbon Argos and the Dignity I (more information available here ). MSF works alongside the Maritime Rescue Coordination Center (MRCC) in Rome for rescues. On board we receive distress calls via the MRCC, which gives us the location of and information about the distressed vessel. Following the laws of the sea, they also direct us throughout the rescue. Once the rescue is complete the MRCC directs us to either disembark the people onto another boat which will take them to Italy, or instructs us to head to a specific port in Italy ourselves.

Does MSF have the expertise to do search and rescue operation?

The process is dangerous and trained crews are needed to ensure that a rescue goes as smoothly as possible. This is why MSF is partnering with Migrant Offshore Aid Station (MOAS) on the MY Phoenix and has recruited a well-trained rescue and navigation team onboard the Bourbon Argos and Dignity I . While MSF is well-versed in providing medical care to people with acute needs in very difficult circumstances, this search, rescue, and medical aid operation is a first for MSF and these experts working with us are invaluable to the success of the overall operation.

What does MSF think of the European Union's response to this crisis?

EU policymakers are failing to see that the majority of people have no choice but to come to Europe fleeing conflict, crisis, or chaos in Libya. Policies of containment and walls of deterrence are not the answer to this global humanitarian crisis. They will only continue to push people into long, dangerous journeys and into the hands of smugglers. Until we can offer safe and legal alternatives to leaky boats and life-threatening journeys in Libya, this extreme suffering will continue.

Even without compulsory relocation, reception capacities and services for people arriving in Greece and Italy will urgently need to be improved to deal with people humanely.

MSF is calling for a radical re-think of migration policy, with the needs of affected people front and center. The impacts of policy decisions should be measured to ensure that they are not contributing to the heavy toll of human suffering.

MSF is also concerned about plans to strengthen deterrence measures for people in transit countries, as MSF experience has shown the medical humanitarian impact of such policies in a number of different contexts.

One example is Morocco, where a 2013 MSF report showed that almost half of migrants' medical problems diagnosed were diseases closely related to poor living conditions, while 18 percent of consultations were related to physical and sexual violence. Between 2010 and 2012 MSF treated almost 700 survivors of sexual violence (both male and female) who had been attacked in their country of origin, en route to Morocco, and in Morocco itself. They suffered multiple episodes of rape and other forms of physical, psychological, and sexual violence. While migration along the western Mediterranean route has declined significantly, the sharp increases along the central and eastern Mediterranean routes show how such policies simply shuffle people around, pushing them into ever-more dangerous routes—and into Libya.

What does MSF think of the EU's proposals to use force to target smuggling vessels?

The plans to target smugglers' boats are now on hold pending the agreement of the Libyan authorities, but we have serious concerns about their feasibility and the dangers that they would pose to the people caught up in this crisis; a smuggler's boat is not easily recognized until it is full of people.

We are concerned that while Europe has been quick and unified to launch a war on smugglers, it has missed the point by showing no political willingness to offer immediate alternatives to these dangerous journeys. It is the lack of safe, legal routes to reach Europe that is fueling this humanitarian crisis, as well as the booming smuggling industry.

Launching attacks against the smuggling industry without giving people other options would also further trap people in Libya—a country where many face brutal conditions.

What exactly are safe and legal channels to apply for asylum or migrate to the EU?

By safe and legal routes we mean accessible ways for people to migrate and seek safety and protection in the EU. This might take the form of allowing people to take student visas, providing more resettlement schemes, or finding ways for families to be reunited.

People seeking protection and safety currently have little choice but to set foot in a European country where they can access a legal process that might allow them to stay. In an attempt to stop so many people from making this journey, governments have sealed Europe's land borders, pushing them to take dangerous journeys at sea. This is causing immense suffering to some of the world's most vulnerable people. We need a more realistic, humane migration and asylum policy that reflects the scale of the crisis we currently face.

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