Survivors Survive

Sarah is a doctor on board MV Aquarius, a search and rescue vessel in the Mediterranean Sea. Here, she blogs about the people who make the journey, and the patients who never reach the safety of her clinic on board...


A truism of medicine is that survivors survive. For example, those who arrive to hospital by ambulance from the scene of an accident have already survived the initial incident and have an increasing rate of survival as time passes, but we all know there are people who died at the scene who never make it to hospital. 

I am the doctor currently working on the MV Aquarius, a joint venture between MSF and SOS Mediteraranee. Out here on the Mediterranean, we count the number of people who are rescued and those who are known to have died during the attempt to cross the Sea. But the people we see out here are not necessarily indicative of those who started the journey.
At least 60% of the people we rescue are healthy young men, but that number is deceptive. There were surely people in less robust health who died along the way. The journey to the shores of Libya, where most people board the woefully inadequate rubber dinghies that offer them a chance of getting to Europe, is the long part of the story that few people are discussing.
Our patients speak of great challenges along this journey, which is often hundreds of kilometres in distance, covered by foot, truck, or a combination of the two.  They tell us of friends and family members who died of dehydration in the Sahara desert. They tell us of friends beaten prior to getting on trucks. They tell us of people being shot or starved to death in enforced detention in Libya.
Those who actually make it onto the boats into the Mediterranean are actually the survivors. It seems cruel and ironic, but those who have survived the desert, the beatings, and the sexual assaults, are considered to be “lucky”.
“Lucky” doesn’t quite seem to be the right word.
I worry about the patients I never meet. Those who, rescued people tell us, have been shot in the legs and are physically unable to get in the boats.Those who are too weak to get out of their hiding spot, a trench in the sand, where they sometimes wait for days for appropriate conditions under which their raft can be launched. Those who are picked up by authorities and returned to Libya – a country where they have no rights as refugees but from which they cannot be repatriated.
I worry.
Though we know there is a fleet of humanitarian, coast guard, and military ships in the Mediterranean who can help, not all do. At least 2,742 people are known to have lost their lives in the first half of 2016 alone (that's more than in all of 2015 combined). We have no idea how many have been lost at sea without having their deaths recorded. More over, we have no idea how many have lost their lives in the longer and more tedious part of the journey where NGOs and governments are unable to monitor the situation.
There are no NGO boats patrolling the Sahara desert, but the desert is undoubtedly littered with the bodies of those who were searching for a new life.
People attempting to cross the Mediterranean are only a symptom of a crisis. The crisis is NOT desperate people getting onto boats. The crisis is the situations in their home countries: abject poverty, civil war, discrimination, and/or a lack of opportunities.
Rather than building walls in the seas, we need to be improving the lives of people in their home countries so they do not find themselves pushed into deadly journeys. Would it not be wiser to invest funds to help countries that produce the most refugees rather than shoring up naval capacity at sea?  We must treat the cause, rather than merely looking at the symptoms – that’s what good doctors do.