Migrant Crisis in the Mediterranean: "They See No Other Way"

Ikram N'gadi

Heading for waters off the Libyan coast aboard the rescue ship MY Phoenix, on which Doctors Without Borders/Médecins Sans Frontières (MSF) is working in partnership with MOAS, doctor Erna Rijnierse describes her work caring for migrants and refugees rescued in the Mediterranean Sea.

"On the very first rescue we carried out, the water in the migrants’ boat was already up to their ankles when we arrived. If it had been just a few hours later, the boat would have sunk and everyone would have drowned. That’s the big difference between this mission and my previous work with MSF in South Sudan or Eastern Congo: you know that if you don’t save those in need right now, they will surely die.

Distress Message

Rescue operations are coordinated by the Italian coastguard. They get the distress message, put the call out, and the nearest rescue ship gets into gear. In this case, it was us. We went to the location of the boat in distress. A team, including one medical person, headed [out] on a smaller boat to the people in need.

We found a wooden fishing boat with 369 people on board, without life jackets and all crammed together in a terribly small space. People were packed together so tightly that most had severe cramps in their legs and arms, a result of standing in the same position for hours and hours. There was simply no room to sit.

We gave everyone a life jacket and, using a rubber dinghy, brought them in smaller groups aboard our rescue ship, the MY Phoenix.

Rescue kits

Firstly, everyone has their temperature checked. Vulnerable people—including the elderly, the sick, women, and children—go to the lower deck. Healthy, strong men remain on the upper deck. Everyone is given a rescue kit with a towel, a coverall to keep them warm, two bottles of water, and a pack of nutritious biscuits. We give dry clothes to those who need them. And, of course, we have well-equipped toilets with running water and washing points on board.

Pregnant Women

We see a lot of people with hypothermia. Fortunately, we have seen few people so far in terrible health. But we are prepared for anything. We can do CPR, we have a mechanical ventilator and monitors, and we can delivery babies safely. On that first rescue, there were eight pregnant women on board. One was eight months pregnant and felt the baby stirring during the night. I was all ready to go. The baby, however, wasn’t. Perhaps that was for the best.


It is not just young men who risk this dangerous crossing. The refugees at sea are of ​​all ages and come from many parts of the world. There are pregnant women, elderly people, even families with small children. That says something about the state of mind that drives many people on board.

If you're a parent with two small children, and you consciously step aboard a shabby wooden boat—if you are willing to take that risk—then you are truly desperate. And they are. They see no other way to find safe refuge or a better life.

Terrible Stories

I have seen people with old fractures and people whose teeth were beaten out of their mouths. Everyone has a story—as do all the people I've helped in South Sudan or Central African Republic. But perhaps the stories of the people on the boats are even more terrible. In their countries, they have known war, violence, or a complete lack of freedom and social justice.

I spoke with a family from Syria. With a group of teenagers from Somalia. With two young brothers from Nigeria. With a young man from Eritrea who was given one choice: a lifetime in military service or prison. All they knew was that staying was not an option. They would rather die than stay.

Leaving Everything Behind

People talk about these refugees as if they are nothing but opportunistic fortune-hunters. But these refugees do not think idly of crossing the Mediterranean. There is nothing opportunistic about leaving everyone and everything behind.

Can we just stand idly by and watch while they drown on their way to freedom? We simply can’t. Should we be out at sea, searching and rescuing? Some people say we shouldn’t. And maybe they are right. But as long as people are suffering at sea we have a very good reason to be here. As a doctor and aid worker, this is my duty.

Many of the 369 people from our first rescue operation told me that this was the first time in a long time that they had felt safe enough to sleep at night. For many it was also the first time in months—maybe years—that they had seen a doctor.

An Uncertain Future

Following our first rescue, we took the people we’d rescued to Pozzallo, on the coast of Sicily, to be cared for and processed by the Italian authorities.

As soon as the refugees set foot on the land, they face an uncertain future. When they are saved from the sea, they are extremely happy and grateful. People shake your hand or want to kiss you on the cheek. But once we come closer to shore, they fall quiet. They have been through an awful lot. And their journey is far from over.

And me? I used to love the sea. But I think I will never look at it the same way again."

Learn More About MSF's Work in the Mediterranean

Dr Erna Rijnierse heads towards a vessel carrying 96 people from sub-saharan Africa to do an initial health assessment before the rescue can begin.
Ikram N'gadi