War. Civil unrest. Persecution. Extreme poverty. Seasonal trade. People are driven from their homes for many reasons, but they share a common objective: a safe and dignified future. There are now more than 70 million people displaced worldwide—more than at any time in modern history—and thousands pass through the desert region of Agadez, in central Niger, on their journey.
From January to October 2019, migration flows across Niger doubled compared to the same period last year, from an estimated 266,590 people in 2018 to more than 540,000 this year, according to the international organization for migration (IOM). Doctors Without Borders/Médecins Sans Frontières (MSF) has provided medical and humanitarian assistance to women, men, and children along key migration routes in the area since August 2018. Our teams distribute relief items and provide general health care, psychosocial support, lifesaving medical evacuations, and search and rescue operations for migrants lost or abandoned in the desert.
Stranded in the middle of the desert
At least five hundred migrants, refugees, and asylum seekers are expelled from Algeria to Niger every week, on average. More than 25,000 people were sent from Algeria to Niger in 2018, including in official convoys, according to the European Council on Refugees and Exiles (ECRE). The trend is continuing, with more than 23,800 people expelled from January to October 2019—half of them forcibly—according to the International Organization of Migration (IOM).
They are usually picked up off the streets in Algeria, and sent to detention centers without minimum standards for living conditions or judicial guarantees or protections. They are later dropped at “Point Zero,” from which they must walk around 15 kilometers [about nine miles] to reach the village of Assamaka, in Niger.
“They just picked me up in the street; I had only the clothes on my back,” said Sandrine, a 32-year-old woman from Cameroon who was expelled from Algeria to Niger last July. “I spent five days in prison. They do not care; they do not want to know your condition. They put us in trucks carrying sand. We slept there. They threw food to us in the back, without knowing if there were babies in the truck or if there were pregnant women. And then they throw you out into the desert. You walk and walk, more than 20 kilometres [about 12 miles]. That's really not easy when you are seven months pregnant. I really went through hell.”
Stories like Sandrine’s are common. And displaced Nigeriens who decide to return voluntarily don’t fare much better. They are transported into the country in official convoys, reportedly subjected to violence—including sexual violence—during the deportation process.
The majority of people expelled from Algeria try to re-enter the country within 24 hours, often using smugglers operating in the area. However, some Syrians, Bangladeshis, and Yemenis are forcibly sent back to Algeria by Nigerien authorities. This has occurred on multiple occasions since the beginning of 2019, raising concerns about violations of international refugee laws, as some of these people are asylum seekers who should be granted protection.
First-hand accounts gathered by MSF teams in the Agadez region confirm that refugees, asylum seekers, and migrants suffer terrible ordeals during their journeys. Whether traveling north, expelled from Algeria, or returning from Libya, people experience violence, neglect, abuse, and exploitation. Some do not survive. Those who reach Niger find themselves with limited and often hazardous options to earn a living and continue their trip in search of safety.
Fleeing violence, abuse, and exploitation in Libya
In Libya, people live with war and the continuous threat of arbitrary detention, torture, rape, sexual exploitation, and other human rights violations. Many strive to leave the country. Some try to find their way out via the Mediterranean Sea, while others risk their lives going south overland into Niger. MSF teams in the Agadez region encounter many of these people, both stranded in the desert in northeastern Niger’s Ténéré region and in the medical facilities we support.
Mary*, from Nigeria, was offered the chance to go to Italy to work as a hairdresser. She had experience and “things were hard at home,” so she accepted. But the smuggler who was supposed to get her there never fulfilled his promise. Instead, he held her and other women in Libya against their will and forced them to engage in sex work.
“The house they kept us in was like a cage,” she said. “We would barely go outside. When we were going to Libya, he was nice. But when we got there, things changed.”
Rose* was also brought to Libya and exploited while believing she was going somewhere else. She says she was kept in a building with about 30 other girls, some of them “very, very young.” All of them were reportedly subjected to abuse and exploitation by human traffickers.
“I went to hell inside that house. If I didn’t have sex, they would beat me to death. One day he beat me so hard, my hand was swollen and broken. I would just sit on my own, crying.” Hygiene conditions inside the house were very poor. If someone was sick, Rose said, they would have to pay 80 dinars (about $56) for health care.
Rose and Mary are both currently in Niger. They managed to escape from their captors with men who helped pay for their “freedom,” and then moved to Niger using smugglers. MSF teams met them in a health facility where they sought medical assistance. We connected them with specialized protection agencies, as their past experiences and current situations put them at great risk.
Assisting vulnerable migrants and host communities
MSF helps both people on the move and vulnerable host communities in the Agadez region. We provide health care in existing medical facilities in Arlit, Tabelot, Séguédine, and Aney, and run mobile clinics in transit locations such as Dirkou, Fasso, Amzigan, Lataye, Guidan Daka, Kori Kantana, and La Dune. MSF also works in n Dirkou, in areas where people engage in sex work. Our teams also identify and refer people in need of specialized protection—like Rose and Mary—to organizations that can help them.
This year, our teams built showers and latrines, and distributed water, high-energy biscuits, and essential items such as hygiene kits, underwear, blankets, and clothes to nearly 7,000 people expelled from Algeria. MSF also offers people who have newly arrived basic medical check-ups to identify anyone that needs to be evacuated for immediate healthcare or mental health support.
Between January and October 2019, MSF provided more than 30,400 general consultations, 713 mental health consultations (for people diagnosed with anxiety, depression, or post-traumatic stress disorder), and 2,317 antenatal consultations. We also assisted in delivering 362 babies.
Search and rescue in the desert
People continue to attempt to cross the Ténéré desert’s dunes despite the dangers. Harsh weather conditions and limited supplies make people extremely vulnerable on this perilous route. The criminalization of migration forces hundreds of people to take this dangerous route, causing an unknown number of deaths. Piles of stones in the sand mark the graves of those who died, buried by those who survived.
Migrants, refugees, and asylum seekers usually travel across the dunes in vehicles packed with up to 30 people. They are sometimes also forced to walk very long distances.
MSF recently started search and rescue activities in the desert. The rescue teams consist of Ministry of Public Health staff, desert guides, and members of the local community. Since July 2019, we have rescued more than 40 people and provided urgent assistance to 30 others—half of whom were Nigerien migrants, while the other half were Nigerians and Chadians. Most were either in a car crash or were stranded due vehicle mechanical problems. Many had extreme dehydration from the high temperatures and no access to water.
People on the move usually carry water reserves, but these do not last long if people get lost or abandoned. Adults rarely survive longer than three days without water, and shorter in in extreme heat, meaning those who are stranded quickly die of dehydration. In October 2013, a group of rescuers found the bodies of 92 people near Arlit—mostly women and children. This continues to happen in 2019 along the routes to or from Libya and along the border with Algeria. In November this year, a person from MalI was expelled from Algeria and taken to “Point Zero.” He got lost on his way to Assamaka and died, just a few kilometers away.