Hell on the other side of the sea

When I look at the sea, it no longer has the same meaning for me. When the sea is rough, I hope that they won’t set out, and I worry for those who have already left, whose fate we may never know. When the sea is flat, I know they will set out.

When I look at the sea, it no longer has the same meaning for me. When the sea is rough, I hope that they won’t set out, and I worry for those who have already left, whose fate we may never know. When the sea is flat, I know they will set out. I know there will be many of them, carrying with them a whole raft of hopes and illusions. Some will reach their destination. We will greet them by searching them like criminals, although they have little to confiscate. They have already lost everything in the hell that is Libya – everything that wasn’t already taken from them in the Sahara or in their own countries.

I see the wounds on the dark skin of the Africans and on the paler skin of the Middle Easterners. Violence does not discriminate. I see the wounds on a human multitude that our borders have forced to become merchandise, to be bought and sold. Every effort we make on their behalf is so infinitesimally small compared to their plight. Standing on that dock, the toughest thing for us to witness is not the way they are welcomed, nor how cold they are, nor even their state of exhaustion. It’s the understanding that apparently outdated concepts such as slavery and racism still dominate our times. We live in a time of fear, ignorance and injustice.

The ‘new Lampedusa’

Our team has been working in Sicily since October 2013. Since then, the Syrian crisis has shown no signs of slowing. Nor have the conflicts in various parts of Africa, the brutality in Sinai’s prisons or Libya’s lethal anarchy. The successful survivors of this violence and of the Russian roulette journey across the sea have arrived. We are there on the dock, in Pozzallo, Ragusa province, and for five months in Augusta, Syracuse province. They call these ports the ‘new Lampedusa’.

Usually we are the first gazes they meet, the first hands they shake. Although when they land, our medical response is limited, we believe it is very important just to be there. We don’t like the idea that, after all they have been through, there are only armed men to greet them.

On the dock, as they disembark, we identify those in urgent need of medical care and send them to hospital. Then we begin our standard medical triage, identifying people with possible infectious diseases or other significant health issues. But most of the migrants who manage to reach Sicily are in a good condition in terms of health.

‘Where are you from? When did you leave?’

In the past year, more than 40,000 people have been through our triage tent. Usually you have less than two minutes for each one, sometimes a little more. During these minutes you exchange a few words. ‘Where are you from? When did you leave?’ you ask. It’s a strange phrase. Despite their exhaustion and fear, they have arrived, they are alive. They smile. Many also thank us. Some ask us how we are. Others ask us where they are.

I remember a paraplegic woman who arrived in a wheelchair after travelling all the way from Somalia. I remember whole Syrian families, their eyes filled with images that will never be erased. An old man repeating a single sentence, ’I saw death three times’. A baby girl, saved by the lifejacket that her parents had managed to put on her before they both drowned. I remember the words of a Senegalese girl: ’I don’t want to fall asleep because I’m afraid of dreaming about what happened. I don’t want to see the sea ever again. Never.’

Our doctors, our nurses and our cultural mediators are there on the frontline. They listen, they offer first aid: some medication, a sticking plaster, a pill to alleviate the pain. They carry out basic diagnostic tests, for glycaemia or malaria. Sometimes they merely listen and respond. No one in the team is ever the same after these encounters.

A never-ending journey

But the journey is not over yet. For the first few days, the new arrivals stay in reception centres, after which they are transferred to secondary reception centres. Most are asylum seekers, who are forced into inertia while they wait for their asylum applications to be dealt with and for admission to an ‘integration facility’. During this waiting period, many are haunted by images from the past, which is not helped by their forced inactivity and inability to work. MSF psychologists, supported by cultural mediators, identify those who are particularly in need of support. Where necessary, they refer them to local health facilities. Identifying the most vulnerable is not an easy task, as everyone who has undertaken the journey has experienced immense suffering.

Together we can improve the reception system

The year 2014 ended with record numbers of arrivals. The flow of migrants shows no signs of stopping – rather it is gaining pace. The reception system still has the characteristics of an emergency plan, and struggles to provide a respectable level of care. Those running the reception system are frequently unprepared for the number of people arriving. The dynamics between all those involved are extremely complex and often badly coordinated.

MSF has decided to stay in Sicily because of the scale of the crisis and because it concerns the dignity and health of thousands of people. We want to maintain our independence, our neutrality and our physical proximity to our patients, and we want to represent their voice. We want to care for our patients on an individual level, and at the same time to promote a new and different approach. We want to throw light on the dynamics that force people to make such journeys, and on the aspects of the reception system that need to be improved.

The only way to make this work is by creating and strengthening networks with the other involved parties, including both national authorities and NGOs. Since 1 February, MSF has been working in Pozzallo reception centre alongside local health authorities. I admit this is challenging: the decision to work within a governmental facility is a radical one, especially for an organisation such as ours that is built around the concept of independence. The real challenge is to work side by side with others, without ever forgetting who we are and what we represent. Without making compromises, but at the same time understanding all of the difficulties that implies. Contributing to creating synergies that lead to sustainable improvements of the system, particularly the reception system for arriving migrants.

Hell on the other side of the sea. And on this side, us. I don’t know whether to hope the sea will be rough or flat. Either way, tomorrow we will be standing on that dock.