International Activity Report 2004
Helping immigrants at Europe's door
By Carlos Ugarte Head of Mission for MSF's projects in Spain

" We were about to go to bed when we heard screaming and shouting.... We thought it must be loads of people drowning at the point! We ran over there and they were clinging onto a large rock. There were about seven or eight of them. In the time it took us to get to our boat and return, several of them had already fallen off.... We managed to save five of those still on the rock. The sea swept the others away. The ones we pulled out were almost dead with exhaustion. The rest we found with the lantern by their shouting. It sounded like a turkey farm, with all the screaming. The howling and wailing was pitiful. Some others came barefoot... their feet shattered and dripping with blood. They were crawling to the huts. We gave them some clothing and hot milk and biscuits and they were so grateful, hugging us, asking us for our address to write to us some day. I gave one of them my shirt, I felt so sorry. And my friend gave his to another. It was a terrible night. A young boy from Kenya told me that there were 29 of them. The next day I passed by there and they were recovering 11 bodies from the bottom of the sea. Only 18 survived." – Juan Rodríguez, a fisherman from the island of Fuerteventura (Spain) recalling the night a small ship wrecked near Gran Tarajal. Testimony published in La Vanguardia Magacine (Spain), 13 June 2004.

This dreadful episode is only one of the many stories that can be heard along the southern coastline of Europe these days. While the setting may change, the human drama is always the same. In 2003, 19,500 north African, sub-Saharan and Asian immigrants arrived in such appalling conditions in Spain alone. Hundreds more died before reaching its shores. Some European governments do not officially recognize the problem and offer little or no assistance to these immigrants. Help only appears in the form of spontaneous aid given by sympathetic local residents like Spanish fisherman Juan Rodríguez.

A lack of political response

In the past few years, MSF teams working on the beaches or in immigrant reception centers have seen more and more undocumented immigrants arrive at the edges of Europe. This desperate group is part of a growing wave of economic and political immigration to Europe which shows no signs of slowing. Countries such as Morocco, are a common transit point for refugees from Africa, while Spain and Italy receive thousands of immigrants along their beaches each year. The path continues into France, Belgium, Switzerland, Holland and the United Kingdom where immigrants ultimately try to settle and work. All of these countries and more play a part in the current immigration drama and each has a large number of undocumented immigrants and asylum seekers trying to survive within its borders. MSF's work with this vulnerable group aims to ensure that immigrants obtain quality medical care and information at a time when they most need it.

MSF assists immigrants and asylum seekers in places where authorities refuse to shoulder their responsibilities for them. Our objective is to alleviate the suffering of populations in vulnerable situations. For this reason, our work is not only limited to giving people the medical attention they need. MSF is also denouncing the inhumane manner in which many undocumented immigrants are treated. By speaking out on the conditions we witness for immigrants arriving in France or in Tarifa, Ceuta and Fuerteventura, Spain, to name but a few, MSF hopes to help provoke needed political action and legislative change to improve the situation for new arrivals.

Aiding a vulnerable group

Immigrants do not only face problems at points of entry into EU territory. If able to slip through this initial net, an immigrant lacking identification papers will join the growing ranks of the illegal immigrant workforce, and may be subjected to exploitation in the underground economy. These individuals are extremely vulnerable, given their lack of recognition as citizens. They are prime targets for economic and physical abuse and have no legal protection. Many of them also lack medical care.

MSF's experience in Belgium demonstrates this troubling trend. After conducting 10,000 medical consultations in MSF clinics based in three Belgian cities during 2003, our teams concluded that the national health care system does little for undocumented immigrants and is hampered by complexity, incoherence and compounded by a lack of will to reform. While the Belgian health care system proports to provide care for everyone in the country, undocumented or otherwise, the reality is that red tape, hidden costs and incoherent policies keep thousands of people outside of it. Many of them are undocumented immigrants and asylum seekers who have few other options for medical care. To help curb these effects, MSF's three Belgian clinics offer free care to those who need it. MSF staff also try to arrange care for people through the official health care system. To date, 70 percent of the Belgian clinics' patients come from outside the European Union.

The team in Belgium also assists immigrants whose serious illness would make it dangerous for them to return to their country of origin. With the help of its field missions, staff in the Belgian health centers can provide documentation on the quality of care available in specific home countries. This can help immigrants avoid being repatriated to a country where their illness cannot be treated adequately.

Promoting a humanitarian approach

There have been some humanitarian successes along the way. MSF closed its project in Fuerteventura after the Spanish government finally committed (after an intense denunciation and lobbying campaign) to take responsibility for providing medical attention to the immigrants arriving on its coast. Similar commitments have enabled MSF to end projects in the Spanish port of Tarifa, in Andalusia, and Ceuta, on the coast of northern Africa.

However, these small victories are the exception. Outrageous treatment and rights violations happen every day. For example, in June 2004, a group of people arriving by boat on the Sicilian island of Lampedusa, were detained for three days in a reception center. They were then transferred to another location, where they were forced to sign expulsion orders without understanding what they were signing. Among them was an 18-year-old student, Haysam, who was fleeing the violence of his home region, northern Darfur, Sudan. Haysam told MSF how he had f led to save his life in November after his village was attacked and his father and two brothers were murdered before his eyes. After traveling for six months to get to Europe, he planned to seek asylum and start a new life. However, after being detained for three days in Lampedusa without access to information, translation, legal advice or medical attention, he signed his own expulsion order. Authorities may now decide to return him to the horror he tried to leave behind. At the gateways to Europe, MSF will continue to provide emergency care to immigrants. From a medical and humanitarian perspective, MSF will keep on fighting so that these immigrants and asylum seekers become informed about their rights and can easily access required medical care. MSF believes all immigrants deserve to be treated in a decent and humane way.