We are currently facing the greatest displacement crisis since World War Two
Every year, thousands of people flee violence, insecurity, and persecution
They attempt a treacherous journey via North Africa and Turkey, in an attempt to cross the Mediterranean to reach Europe.
And every year, countless lives are lost on these journeys.
In 2016 alone, 5,096 people are thought to have died or gone missing during the crossing.
"A mass grave is being created in the Mediterranean Sea. Faced with thousands of desperate people fleeing wars and crises, Europe has closed its borders, forcing people in search of protection to risk their lives and die at sea. There is no more time to think, these lives must be saved now."
Loris de filippipresident of Médecins Sans Frontières/Doctors Without Borders (MSF) Italy
MSF search and rescue: the facts
MSF search and rescue operations are coordinated by the Maritime Rescue Coordination Center (MRCC) in Rome and comply with the law at all times. In line with international maritime law, all rescue operations at sea happen under the coordination of an MRCC (in this case the Italian Coast Guard Centre for the Coordination of Rescue on Sea).
We patrol in international waters at around 25 nautical miles off the coast of Libya during the day, only moving closer to territorial waters if we have been instructed to do so by the MRCC or we become aware of a boat in distress. At night, we operate in international waters at 30 to 35 nautical miles from Libya.
If deemed necessary to save lives, MSF boats have approached the limit of international waters which are – by law – 12 nautical miles from the Libyan coast. Entering Libyan territorial waters is highly exceptional.
There were three occasions in 2016 when MSF – with the explicit authorisation of the relevant Libyan authorities – assisted in rescues 11.5 nautical miles from the coast.
We look out for boats in distress using binoculars and respond to directions from the MRCC in Rome in the event of an SOS call. Italian law states that not answering an SOS call from a boat in distress is an omission of rescue, subject to a penalty of one to five years of detention.
Non-governmental organisations account for a minority of search and rescue operations in the Central Mediterranean. EU assets, the Italian Coast Guard, commercial vessels and other actors are also involved in these operations, which are necessary to save lives.
International Maritime law states that all vessels have a legal obligation to assist boats in distress. If we weren’t there, other vessels, that do not specialise in search and rescue operations, would be asked to assist boats in distress.
Who is rescued?
Refugees, migrants and asylum seekers are not interchangeable terms. The following is a brief explanation of the very different legal definitions:
A refugee is a person who has fled his or her country and cannot return because of a well-founded fear of persecution due to their race, religion, nationality, or membership of a particular social group. Refugee status is assessed by the United Nations High Commission for Refugees or a sympathetic state.
An asylum-seeker is someone who says he or she is a refugee and is seeking asylum in another country, but whose claim has not yet been definitively evaluated.
A migrant is someone who chooses to move in order to improve the future prospects of themselves and their families.
As a humanitarian agency involved in search and rescue, MSF does not have a mandate or means to assess the immigration status of the people we assist.
We provide medical care without judgment and strongly believe that no human being should drown when the means exist to prevent it.
Where are the people rescued at sea taken?
Our primary aim was to prevent loss of life, not to provide transport.
When a situation arose in which we had to intervene, we did so under the direction of the Maritime Rescue Coordination Center in Rome.
They also decided where those we rescued should disembark, as dictated by the laws of the sea.
As a rule, those we rescued were taken either to reception centers in southern Italy (Sicily) or transferred from search and rescue boats to Italian coast guard vessels.
A compromise to MSF’s neutrality?
We felt compelled first and foremost to assist people who were dying in the Mediterranean. We had the means and, for us, ignoring the problem was not an option.
Of course, we are aware that by doing this we are entering a very contentious political debate in Europe. But we believe that inaction cannot be justified on ideological grounds and that, in fact, as a medical organisation that takes its cues from medical ethics, we must take action.
Ten things you need to know about the Mediterranean crisis
We look at the new and deadly tactics of smugglers and the terrors faced by people transiting through Libya.
TEN THINGS YOU NEED TO KNOW ABOUT THE MEDITERRANEAN CRISIS
KickerThis is a kicker.
**In 2016, Mdecins Sans Frontires/Doctors Without Borders \(MSF\) had teams on board three boats: the Dignity I, Bourbon Argos and the MV Aquarius \(run in partnership with SOS MEDITERRANEE\).** From the beginning of operations in April until 29 November, these three teams directly rescued 19,708 people from overcrowded boats and assisted a further 7,117 people with safe transfer to Italy and medical care. At least one in nine of those rescued on the Mediterranean were helped by our teams. This listicle provides, among other things, an overview of MSFs figures and a brief analysis on aspects such as the poorer quality of the boats seen this year, the new and deadly tactics of smugglers, the large number of unaccompanied children that have been rescued and the conclusions drawn from the testimonies gathered of the nightmarish transit through Libya.
1: 2016 is already the deadliest year on record and it's not even over yet
Since 1 January, at least 4,690 men, women and children have died while attempting to cross the Mediterranean Sea. Thats nearly 1,000 more than in all of 2015 and still with some weeks left to go. This is not due to a significant increase in overall arrivals but instead an increase in mortality in the deadly stretch of water between Libya and Italy. In 2016 around one in 41 people who attempted to flee Libya by boat, died trying.
Despite the shocking figures and the immense loss of life, the European response in the central Mediterranean has been to declare war on smugglers. The focus has been on deterrence measures, and the externalisation of borders, rather than on saving lives and enabling a safe passage into the EU. This has only served to force smugglers to adapt their tactics and operate in an even more dangerous way, in order to avoid border controls and in turn claimed lives.
2: Men, women and children are being packed into even poorer quality boats
In 2016, MSF teams rescued people from 134 extremely poor quality rubber boats, and 19 wooden boats. Our teams also recovered the bodies of those for whom rescue came too late.
The large wooden boats of 2014 and 2015 are all but gone and have been replaced by cheap, single\-use inflatables. The smugglers assume these will be intercepted at some point by the search and destroy operations launched by the international military in the high seas.
These shockingly low quality boats have led to tragedy after tragedy. Our teams have recovered the bodies of people who have asphyxiated, crushed by the weight of hundreds of others in the dinghy. There are also those who drowned in the bottom of a boat, in a toxic mix of sea water and gasoline.
3: Smugglers are more ruthless than ever
Our teams have seen boats capsize after spending hours or even days floating aimlessly without a motor. Usually, motors are snatched by smugglers or other criminals, well before rescue is possible. Those we rescued have told us told us they were kept in caves, ditches or holes in the ground for days or even weeks before being forced on a boat and sent out to sea.
> Weve heard stories of executions, horrific ill\-treatment and sexual abuse, which in some cases amounted to torture.
In contrast to last year, we have seen fewer people equipped with life jackets, food, water and other supplies for the journey. Sometimes there is not even a sufficient amount of fuel. Weve seen rescues come in waves, and at all hours of the day or night.
Smugglers are sending people out in large flotillas at odd hours, in the hope they will escape the mechanism of control, dissuasion and interception imposed by restrictive policies. The thought is if some are captured, the majority will get through and be rescued. Precarious night rescues have become more frequent, as have days where a single rescue vessel has had to respond more than 10 distress calls in a 24 hour period.
4: Large numbers of children are braving the sea alone
Sixteen percent of arrivals to Italy are children, 88 percent of whom are unaccompanied. One tiny family rescued by the Aquarius was headed by a 10\-year\-old boy, travelling alone with his siblings. All of them were young enough to still be in nappies.
5: Many women we rescue are pregnant, many pregnancies are the result of rape
Some babies born at sea are very much wanted, and come simply at a difficult time. Many others are the result of rape in Libya, on the road, or in the countries of origin. Many women we rescue, especially those travelling alone recount horrific stories of rape and sexual abuse in Libya. Others are too traumatised and terrified to disclose what they have been through to our staff, in the short amount of time we spend with them on board.
The threat of rape is so well known, that some women opt to have long term contraceptive implants put in their arm before they travel. This is to ensure they do not become pregnant. In 2016, four babies were born on MSFs rescue boats. The fact they were rescued in time is nothing short of miraculous. With skilled midwives on board, they were able to get the help they needed. If their labour had started earlier, or had they been rescued by merchant ships without proper medics, the outcome could have been disastrous for both mother and child.
6. MSF is not assisting people smugglers nor are we smugglers ourselves
Lets make this point clear, MSF are not people smugglers nor are we an anti\-smuggling operation! We're in the Mediterranean to save lives: pure and simple.
Smugglers are exploiting some of the most vulnerable people in the world for profit. Their business model exists in part due to the lack of any safe and legal alternatives for people to be able to reach Europe.
The instability and economic crisis in Libya is also a major factor in the proliferation of smuggling networks.
7. It's not only women and children who are vulnerable
Each and every person we rescue has a story of hardship. Whilst women and children have very specific vulnerabilities that need special care and attention, men too have weaknesses that are often more difficult to see. Some flee wars they want no part in. Others are escaping torture, forced conscription and mass human rights violations.
Many men face discrimination based on their sexuality, violence, persecution, extreme poverty and destitution. Their journey of suffering begins in countries that range from as far as Pakistan, to countries across sub\-Saharan Africa such as Nigeria or Gambia. Others originate from the horn of Africa, especially Eritrea, as well as the Middle East, ravaged by years of tension and instability.
8. Europe is far from the top destination for the world's refugees and other migrants
The vast majority of refugees and other migrants have sought refuge or employment in their own region of the world.
> According to UNHCR data, none of the top hosting countries for refugees: Turkey, Pakistan, Lebanon, Iran, Ethiopia, Jordan, Kenya, Uganda, Democratic Republic of Congo and Chad, are in Europe.
However, combined they provide refuge for more than half of the worlds refugees. Europe has only received a tiny percentage of the worlds refugees. Yet it continues to focus on creative ways to keep refugees and migrants away, rather than on taking in those in need.
9. Refugees and migrants endure horrific violence and abuse in Libya
Refugees and migrants in Libya suffer widespread violence and mistreatment, driving them out of the country and onto the boats. According to people interviewed by our teams, men, women and, increasingly unaccompanied children \(some as young as eight years old\) living or transiting through Libya are suffering abuse. This is at the hands of smugglers, armed groups and private individuals who exploit the desperation of those fleeing conflict, persecution or poverty.
The reported abuses which people have experienced include being subjected to violence \(including sexual violence\), kidnapping, arbitrary detention in inhumane conditions, and torture. There have also been reports of ill\-treatment, financial exploitation and forced labour.
10. Intercepting boats leaving Libya is not a solution
Preventing people from leaving Libya condemns them to further ill\-treatment and physical, sexual, financial and psychological abuse at the hands of smugglers. The Libyan Coast Guard is expected, according to the training plan initiated by the European Union, to play a key role in future policies of containment within Libyan territory. It will carry out interception, search, rescue and return operations in Libyan waters.
Our experience shows that intercepting overcrowded and unseaworthy boats can be extremely dangerous in this context, exacerbating the risks faced by those desperate to reach a place of safety. Those fleeing Libya must be rescued in a safe and calm manner and brought to a port of safety. There they can receive assistance, claim asylum and other forms of protection. The current situation in Libya means it cannot be considered a safe port of disembarkation.
In 2016, over three hundred thousand people fleeing wars, persecution, poverty and insecurity attempted to cross the Mediterranean in search of safety and refuge, according to UNHCR, the UN’s refugee agency.
It was the deadliest on record: 4,581 men, women and children died attempting to cross from North Africa to Europe.
Of the 181,436 people who arrived safely in Italy after being rescued at sea, the vast majority had embarked in Libya. None would have made it to safety without rescue.
During the year, our teams were on board three specially equipped SAR boats: Dignity I, a 50-metre vessel with the capacity to take 400 people on board, and a crew of 19 MSF staff; Bourbon Argos, a 68.8-metre vessel with the capacity for 700 people, and a crew of 11 MSF and 15 non-MSF staff; and Aquarius, a 77-metre vessel run in partnership with SOS MEDITERRANEE, with the capacity for 500 people.
All three boats actively searched for boats in distress in international waters north of Libya.
From 2015 to June 2017, MSF has assisted 67,898 people in 555 operations. This includes people who have been rescued as well as people who have been transferred onboard MSF vessels.
Medical teams onboard treated violence-related injuries linked to detention, torture and other ill-treatment, including sexual violence, in Libya.
Medics treated skin diseases, dehydration, hypothermia, scabies and serious injuries like chemical burns caused by fuel mixing with sea water in the boat.
Pregnant women were cared for by midwives onboard and several babies were born safely at sea. Lifesaving emergency care was also provided in emergency rooms on the ships or through medical evacuations, when needed.
People continued to try to cross the Mediterranean even as winter approached. From October onwards, MSF in collaboration with SOS MEDITERRANEE, ran the only NGO boat continuously carrying out search and rescue in this stretch of sea
Despite harsh weather conditions, in the first three months of 2016, 151,452 people made the eastern crossing from Turkey to the Greek islands, the largest number landing on Lesbos.
During the same period, 366 men, women and children lost their lives in the Aegean Sea.
We provided assistance to boats in distress off the coast of Lesbos until June, when the drop in arrivals meant that the team’s presence was no longer required.
Between December 2015 and June 2016, the MSF-Greenpeace rescue operation assisted more than 18,117 people in 361 interventions.
MSF medical teams also treated people on disembarkation and referred 30 individuals to hospital for further assistance, mainly for trauma-related injuries.
Abuse in Libya
The deplorable conditions in Libya and on the boats resulted in various medical and humanitarian needs. In addition to medical care, the teams provided food, water, clothing, protection against the elements, and information and reassurance to the people rescued at sea.
Common medical complaints included headaches, exhaustion, skin and upper respiratory tract infections, scabies, motion sickness and hypothermia. Some people were dehydrated or suffering from asphyxiation from being crowded together inside wooden boats.
Staff also treated chemical burns caused by fuel spills in the boats, and sexually transmitted infections as a result of sexual abuse, including rape.