How to stop the rising tide of death in the Mediterranean

Doctors Without Borders
5 min readJan 18, 2017
January 13, 2017: 193 people aboard a rubber boat were rescued by the Aquarius. Two bodies were found at the bottom. They were crushed when panic broke out onboard after shooting started off the Libyan coastline. Photo: Anthony Jean/SOS MEDITERRANEE

Jens Pagotto heads the Doctors Without Borders/Médecins Sans Frontières (MSF) project in Libya, and its search and rescue operations in the Mediterranean Sea.

The number of people who died trying to reach Europe by crossing the Mediterranean has reached an all-time high and is becoming comparable to what MSF is used to seeing in war zones, with the UN Migration Agency recording at least 5,079 deaths last year.

The actual number of deaths is likely to be much higher.

We have no idea how many dinghies overloaded with terrified passengers set sail from Libya, headed in the direction of Italy. We don’t know how many of them sink without a trace before they reach busy shipping lanes in the Mediterranean and how many of them call for help.

Under international maritime law, all vessels in the area, whether commercial ships, military warships, or rescue boats operated by charities such as MSF, must provide assistance and take rescued people to a place of safety. But if they are not spotted in time, people sink to the bottom of the sea, along with their boats. Some of the bodies then wash up on the North African shore or get caught up in fishermen’s nets weeks later.

One of the most horrific things our teams on rescue boats in the Mediterranean do is recover the bodies of men, women, and sometimes very young children who have drowned.

Our doctors make absolutely sure that people are past the point of resuscitation, that there is no more that can be done. We bring the bodies on board, estimate the person’s age, and take photographs of every individual, then hand them over to the Italian authorities.

December 28, 2016: A boat in distress full of refugees and migrants off the northern coast of Libya. MSF and SOS Mediterannee search and rescue personnel transfer an infant child from the dinghy. Photo: Kevin McElvaney

Maritime regulations state that in the event of a death at sea, all possessions should be carefully kept with the deceased, but often there are no possessions at all, not even a pair of shoes. We check in case there is a name or phone number scribbled on their clothes, but, more often than not, the death certificates our doctors write are for persons unknown.

Many of these individuals will remain nameless forever, their families at home waiting anxiously for a phone call that will never come.

Of those who are pulled from the sea alive, many need treatment for hypothermia, dehydration, or chemical burns from petrol spills. The marks we see on people’s bodies are testimony to the alarming levels of violence and exploitation that the vast majority of refugees have experienced while in Libya and along their journeys.

I remember one woman whose front teeth had been knocked out, another with a perforated eardrum after she was beaten around the head. We see broken bones, malnourishment, scars from torture, survivors of sexual violence, infected gunshot wounds, and unwanted pregnancies.

Meanwhile, inside Libya, the political instability, economic collapse, and breakdown of law and order show no signs of improving. Fighting continues in several parts of the country.

Many migrants are unable to return home.

Refugees and asylum-seekers cannot receive protection due to the lack of a functioning asylum system, the limited role of the UN Refugee Agency, and the lack of strong legislation within Libya to provide protection to refugees. Many people see no other option but to try to cross the Mediterranean in an attempt to reach safety in Europe.

Efforts by the European Union to prevent loss of life at sea through strengthened border control, increasing militarization, and a focus on disrupting smuggling networks have only resulted in more people drowning — not fewer. Unscrupulous smuggling networks have been quick to adapt their ways of operating and the crossing by sea has become even deadlier.

Training the Libyan Coast Guard, in spite of their checkered human rights record, to intercept people at sea and return them to Libya isn’t the answer either.

People who are returned to Libya face arbitrary detention in unsanitary and inhumane conditions for prolonged periods of time with no way to challenge the lawfulness of their detention. They have virtually no access to the outside world and suffer ill treatment and a lack of access to medical care.

December 25–28, 2016: Rescue crews aboard the MSF- SOS Mediterranee rescue vessel, MV Aquarius, scour the horizon on Christmas Day, looking for migrant and refugee boats in distress (top left). In 2016, MSF teams on board of Dignity, Bourbon Argos and Aquarius (in partnership with SOS Mediterranee) have directly rescued 21,603 people and assisted 8969, a total of 30,572 in more than 200 different operations. Photos: Kevin McElvaney

Any solution to stop people from dying in the Mediterranean on such a huge scale must include offering people a feasible alternative.

The European Union needs to take urgent action to provide safe and legal channels for people to seek asylum and create legal migration pathways that make wider use of legal entry schemes; things such as family reunification, humanitarian visas, simplified visa requirements, resettlement, and relocation packages.

People looking for work or seeking safety in Europe would then be able to do so legally rather than having to turn to smugglers.

Those with legitimate asylum claims or opportunities to work should be able to simply board a plane rather than having to undertake long and dangerous journeys or risk their lives at sea.

Until a comprehensive solution is put in place, the mass drownings in the Mediterranean will continue.

December 30, 2016: A man and his young son pose for a photograph shortly before docking in Italy, after a harrowing crossing and rescue at night amid high seas and appalling conditions in the Mediterranean sea. Photo: Kevin McElvaney

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Doctors Without Borders

Medical aid org working globally to assist people whose survival is threatened by violence, neglect, or catastrophe. http://www.doctorswithoutborders.org