Yet Again

31 August 2015

Photo: Gabriele François Casini / MSF

 

We’re now motoring back to the rescue zone off Libya, after disembarking well over 400 people in southern Italy. This was our longest and most difficult voyage so far. One intense rescue day, then a long and eventful grind north, but that’s another story. Some of us were pretty much shattered by the end of it I think, but it’s not about us and we’re getting over it.

On the morning of August 25th the Swedish Coast Guard were using two small but powerful rescue craft to stabilize a wooden boat carrying over 450 people against the side of their large vessel, the Poseidon. The Swedes accepted our offer of medical assistance; it was an ugly scene with some people reportedly seriously ill and others deceased.

People die in these wooden migrant boats due to the toxic fumes of leaked fuel, oil, and engine exhaust, perhaps in combination with heatstroke, dehydration, and physical crushing as people and the boat move in a swell. Others drown, trapped inside a leaky or capsized boat, or unable to swim when only that could save them, without assistance.

Video of the early rescue. The Guardian News.

Mary Jo (MSF nurse) and I sped over from the Phoenix by rhib (rigid-hull inflatable boat), and boarded the still-crowded wooden boat. From there we jostled our way onto a narrow gangway leading to the deck of the Poseidon, where we found a medic attending to three or four conscious, recovering persons. They’d initially needed carrying on board, but clearly didn’t require us now.

My thoughts immediately turned to anybody still below deck on the wooden boat. I proceeded there directly, clambering down through a small hatch at the rear. There was enough light from the small hatches, and my headlamp, to make out a tragic tangle of bodies. At that point training cut in and emotions took a back seat, though the adrenaline flowed. Moving forward I quickly checked each person still above the incoming water, sloshing around in the bottom of the boat, for signs of life. All were dead.

Near the front a high-pressure air hose, run in through another hatch to clear fumes, hissed and flailed about like something possessed. A small backpack of two tanks of compressed air with a mouthpiece lay in the bilge below. Some rescuer must have already been there. Mary Jo dropped down to join me through the forward opening. We promptly finished checking that area, to no avail, and climbed back into the daylight.

Almost everybody had proceeded up the gangway to the Poseidon, but four people lay motionless around that hatch opening. For three of them it was clearly too late, but the very last one I checked was still breathing! He made no response as I inserted an oral airway. We got some oxygen going and established communication with our team on the Phoenix.

I tersely questioned a helpful Swedish medic about the available medical resources and personnel on the Poseidon, and learned by radio about those on a nearby Italian Navy frigate, the Grecale. Our patient remained breathing but profoundly unconscious, unresponsive to any stimulus. With his obviously injured lungs and poisoned system his condition threatened to deteriorate even further; it was decision and action time. We strapped him to a stretcher and transported him back to the Phoenix for intubation, in preparation for a helicopter evacuation to hospital on the small Italian island of Lampedusa.

Without needing to give him any medication, I inserted an endotracheal tube into his windpipe. We then suctioned out large quantities of thick secretions, and his breathing improved marginally. A fast rescue boat from the Grecale came alongside the Phoenix and we loaded and left.

One step followed another, even as my colleagues were busy transferring hundreds of people from yet another overloaded wooden boat that had incredibly appeared on the scene. A rubber dinghy too full of people was also soon to follow. What is this madness all about?

En route in the Grecale’s fast rescue boat I leaned closer and told the unconscious man that he wasn’t alone, that we were doing our best to help him. I believe that’s okay, when there’s nothing left to do at the time. I mean, I’d want somebody to talk to me in that situation, so far away. So I do it.

The sailors on the Grecale used a powerful crane to snatch the rescue boat with us all in it about ten meters up to deck level to unload. Crew were bustling about refueling and checking a most beautiful drab grey twin-engine Bell 212 helicopter on the rear heli-deck, for the long hop over water to Lampedusa. I carefully went over drugs and procedures with the Grecale’s physician, who would fly with the patient. (The next morning, to my immense relief and gratification, I learned they made it.)

Strange, but I still don’t remember much going through my mind on that first wooden boat besides having us responders stay safe, and wanting to quickly find anybody still alive. At first I counted bodies as I checked them, but soon gave that up as something that wouldn’t make any difference; the Swedes later cut the deck open with a chainsaw, recovering fifty-two corpses. Looking at a picture much later, I was surprised to see a small cabin-like structure on the wooden boat, very close to where we found the survivor. I had no recollection of it, whatsoever.

The rest of that day gave me no chance to mull over events either, until much later. After leaving our intubated patient in the capable hands of the Italian physician on the Grecale, I was called to another unconscious person on board the second wooden boatload of people that the Phoenix was unloading. That fellow did fine, though, and I left him talking. Then I returned to the Grecale, since their physician was away on the helivac, to assess people being rescued from a rubber dinghy nearby. All were in relatively good condition.

One day, two wooden boats, one rubber dinghy, one helivac, over a thousand people rescued by three ships, and fifty-two perfectly senseless deaths. The teamwork and effort involved were most impressive, but search and rescue isn’t any solution to this absurd and appalling Mediterranean mess. This crisis, this exodus, of refugees, migrants, people-in-flight, or whatever words we choose to use, that don’t make any difference. Safe ways for people to apply for asylum, just might. These death-trap boats are an abomination, for which many people and policies can be held responsible.

A journalist later asked me about the nationality of the deceased, noting that sub-Saharan Africans tend to end up below deck, on these boats. I felt a flash of quiet rage, at the question and the injustice. “They were all simply people”, I managed to reply, “whose nationality was of no consequence.”

May they rest in peace.

Listen to Simon on Everyday Emergency, the MSF podcast

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