Search and Rescue: "As soon as we have stabilised the man, there is another emergency"

Heidi is a nurse on board the search and rescue vessel MV Aquarius, which is run by MSF in partnership with SOS MÉDITERRANÉE. She blogs about her first full week on board...

It feels as though I have been aboard the Aquarius a lot longer than nine days. Every day is different and a new challenge! Actually, I should make a movie to give you a better picture of what this project looks like, but for now I will just go through the week with you. 


Due to the bad weather, we can’t depart from port in Sicily. That gives me time to get a better understanding of our small clinic on board, which consists of two small, narrow rooms. In the afternoon I have time for another city stroll, in the early evening I train in our gym – and in the evening the Aquarius finally departs. I spend the departure on the bridge. Later I enjoy time outside on the deck.

Our treatment room on board. 

This boat trip is a huge adventure for me already, so I wonder how it must be for the people leaving Libya, who have to travel in small, shell-like boats out on the open sea – in the full knowledge that they could lose their lives? One of the journalists on board told me about someone she once met before the beginning of his journey, who told her: "At sea only the body dies, but at home the soul dies."

It is for this reason, the situation in their homeland, that people from many different countries leave their homes to go on a difficult journey. In the case of the people the Aquarius is looking for, they head to Libya. 

In Libya, however, people again face great dangers, like prison, abuse, torture and extortion. They have to pay money again and again. This is why people have no choice but to flee from Libya as well. 

If the people leaving Libya make it into a boat belonging to smugglers, they are almost always in poor physical condition when they are picked up by rescue ships. The little boats never have enough fuel in the tank to get very far. The smugglers assume that they will be found eventually, which is not always the case of course. Nevertheless, people usually have to pay, even for worthless life jackets.


The sea is restless, and the ship is either rolling or pitching, but luckily I'm fine with it. Today we have to clean the deck – we have to do everything ourselves. We also have a meeting about how to deal with people who have been raped or tortured. Later we talk about how to care for the many minors: in many cases, the rescued people are only 14 or 16 years old.

In the afternoon comes the fun part: the ship stops in the open sea, the two lifeboats are launched and every one of us has their turn on the lifeboat in order to practise the processes of a rescue. You don’t have much space in the lifeboats and you have to hold on tight. 

The exercise on the rescue boat


In the morning we are off the Libyan coast, which is still about 25km away. It is much warmer here than in the open sea. We are now in the so-called ‘Search and Rescue Zone’. 

How does one find the refugee boats?

There are two ways: our colleagues from SOS Méditerranée keep watch on the bridge looking for boats. And we get information from the Maritime Rescue Coordination Centre (MRCC) in Rome. This in turn collects information about boats in distress from the navy, helicopters, other boats and drones. The MRCC also decides where rescued people should be brought to.

The 'rescue kit', which every rescued person receives immediately after being brought on board.

In the afternoon we take on 26 people from an Italian Navy vessel. Everyone who comes on board is first registered. We ask some short questions and have to switch between English and French all the time. Then all our new guests are given a ‘rescue kit’ containing a blanket, a tracksuit, a T-shirt, socks, a warm cap, a small towel, water and high-energy biscuits. 

Everyone has to take off their wet clothes immediately, and we have to ‘sniff out’ if they have fuel on the skin, which in combination with sea water causes burns. Anyone who has fuel on the skin must take a shower immediately. 

As soon as possible, people are given hot tea and white bread. As you can imagine, all hands are needed then on deck – especially when many people have been rescued at the same time. 

When there are guests are on board, the crew keeps watch around the clock – always with one MSF and one SOS Méditerranée crew member together. I had the eight to 10pm shift, so quite a humane time. You have to check that all is going well, including specific things like whether the toilets are clean and the water tanks are filled.  


A new day and it continues: today we rescue 126 people from a boat, including 13 women and one married couple. We have some patients, but fortunately no one has anything serious. There is light hypothermia, weakness, wounds, body pain and a lot of scabies.

For dinner, there is what’s known as ‘adventure food’: freeze dried food in a bag, which is mixed with water. While our guests are queuing up for food distribution we check everyone individually for scabies and other possible problems – this takes seconds only. Then everyone washes their hands with chlorine, and starts dinner.

Then suddenly there is the news that a navy boat will take over our passengers in the middle of the night and take them to Italy. Everyone must be provided with life jackets, they need explanations and so on. It takes half the night shift before all the guests have left the Aquarius.


Things start happen really fast: late in the morning we find a boat with 195 people on board. Never before has such a small boat carrying that many people been rescued. The people on this boat only had room to stand, pressed closely against each other. 

A rescue operation always starts with some of the crew members approaching the boat in the small lifeboat. First of all, we talk to the people and assure them that everybody will be saved. This is to prevent a panic among the people on board, which in the worst case could cause the boat to capsize. 

There is always a member of the medical team on the first life boat to assess the situation: Are there any unconscious or injured people? This time it is my turn. 

After the initial assessment, we approach the refugee boat with two lifeboats and distribute life jackets. Next the lifeboats shuttle between the refugee boat and the Aquarius in order to bring everyone on board. The people are so full of joy that the men begin to dance and sing – a very emotional moment for me.

We find also two dead bodies on the boat. They are people who were probably trampled to death during a dispute.

We are fully occupied with the care of all these people when the news comes that a navy boat has an additional 109 people they want us to take on board. When that is finally done, I have a bit of time to rest and eat. Then I have to keep watch from 2am to 4am in the morning – not the best time, but I manage it. 

Men are now laying everywhere on the deck of the Aquarius trying to get warmth, which is difficult. The sea is getting very rough now, and we will surely have a lot with seasickness. Since the rail is fairly low at one point, water continues to flood the deck – we try to keep it mopped up.

Plastic bags should offer some protection against wind and cold.


It’s an extraordinary situation. I am tired because of the short night, yet full of life! My high energy levels are a good thing given the day ahead.

We are all busy distributing breakfast when we have an emergency. A man has just collapsed. He is unconscious and initially is not breathing. We take him to the clinic immediately. The four of us of the medical team work together to save his life. Coming from outside we all still wear winter clothing and rubber boots but there is no time to change.

As soon as we have more or less stabilized the man, there is another emergency. We have to put him on the floor because there is only one stretcher in the clinic. We are taking care of both now. At the same time some colleagues call for a helicopter, and the first patient is soon evacuated to Malta, where he can be treated in a hospital.

After these two emergencies we check all 300 guests again and all the uncertain cases are brought into a warm room. In total, there are 34 people who are too cold, weak or who have vomited constantly. 

Inside we distribute sick bags among these new patients, talking to them and showing them compassion. Medically we control their blood sugar levels, balance them if needed and administer injections against seasickness. We were all busy non-stop until late in the evening. Then we have a quick dinner, and from seven to 8pm I keep watch again.


I have to keep watch from four to 6am. Getting up is really hard, but there is also a very special atmosphere on board at this time in the morning. The coast of Sicily is already in sight, as the sun rises. The guests are very excited. 

As we approach the harbor, the men start again to dance and to sing. That is so wonderful – and yet I worry what will happen to them once they are off the boat.

We come into the port of Messina. An armada of police, local authorities, Red Cross employees and others is already waiting. Unfortunately, the police work VERY slowly, and in the end 80 people have to stay on board the Aquarius until the next morning.

What will happen next? Tomorrow we will disembark the remaining guests and take new supplies and food on board. Depending on the weather the decision will be made about when we go back to the search and rescue zone.