© Francesco Zizola/NOOR

Mediterranean search and rescue

We are currently facing the greatest displacement crisis since World War Two

Every year, thousands of people flee violence, insecurity, and persecution

They attempt a treacherous journey via north Africa and Turkey, in an attempt to cross the Mediterranean to reach Europe.

And every year, countless lives are lost on these journeys.

In 2016 alone, 5,096 people are thought to have died or gone missing during the crossing.

"A mass grave is being created in the Mediterranean Sea. Faced with thousands of desperate people fleeing wars and crises, Europe has closed its borders, forcing people in search of protection to risk their lives and die at sea. There is no more time to think, these lives must be saved now."

Loris de filippipresident of Médecins Sans Frontières/Doctors Without Borders (MSF) Italy

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MSF search and rescue: the facts

MSF search and rescue operations are coordinated by the Maritime Rescue Coordination Center (MRCC) in Rome and comply with the law at all times. In line with international maritime law, all rescue operations at sea happen under the coordination of an MRCC (in this case the Italian Coast Guard Centre for the Coordination of Rescue on Sea).

We patrol in international waters at around 25 nautical miles off the coast of Libya during the day, only moving closer to territorial waters if we have been instructed to do so by the MRCC or we become aware of a boat in distress. At night, we operate in international waters at 30 to 35 nautical miles from Libya.

© Nick Owen/MSF

If deemed necessary to save lives, MSF boats have approached the limit of international waters which are by law – 12 nautical miles from the Libyan coast. Entering Libyan territorial waters is highly exceptional. 

There were three occasions in 2016 when MSF – with the explicit authorisation of the relevant Libyan authorities – assisted in rescues 11.5 nautical miles from the coast.  

We look out for boats in distress using binoculars and respond to directions from the MRCC in Rome in the event of an SOS call. Italian law states that not answering an SOS call from a boat in distress is an omission of rescue, subject to a penalty of one to five years of detention.

Non-governmental organisations account for a minority of search and rescue operations in the Central Mediterranean. EU assets, the Italian Coast Guard, commercial vessels and other actors are also involved in these operations, which are necessary to save lives.

International Maritime law states that all vessels have a legal obligation to assist boats in distress. If we weren’t there, other vessels, that do not specialise in search and rescue operations, would be asked to assist boats in distress.

We debunk some popular beliefs about Europe's so-called 'migration crisis'




KickerThis is a kicker.

> **This crisis is not over, and its nothing new**

People have always moved from one place to another it's what human beings do. From 2010\-15, the number of people migrating worldwide grew by just 0.1 percent \(from 3.2 to 3.3 percent\). What we are seeing now is nothing new and certainly not unprecedented. The crisis has never been the number of people arriving to Europe, but rather the chaotic responses of European governments. In March 2016, the EU signed a deal with Turkey to keep refugees and migrants out of Europe by returning them to Turkey.

The EU\-Turkey deal came into effect in March 2016 at which time many countries in Europe closed their borders, leaving thousands of refugees and migrants stranded in southern and eastern Europe, mainly Greece, Italy and Serbia. Since the deal, very few people are now crossing the Aegean Sea from Turkey to Greece. However, many people continue to cross the Mediterranean from Libya to Italy in unsafe boats with the help of smugglers a crossing which claimed over 5,000 lives last year alone \- and hundreds more arrive each day through the Turkey/Bulgaria or Turkey/Greece land border with the help of smugglers. The crisis is not over and the route is not closed, it is simply that European leaders fail to acknowledge this.

> **Sending people back to Libya would be disastrous**

No\-one who knows what is [really](https://www.msf.org.uk/article/libya\-providing\-care\-detained\-migrants\-and\-refugees) happening inside Libya could possibly think that people should be returned there. Libya is not a safe place. Sub\-Saharan Africans are being snatched off the streets and roads and detained indefinitely with no due legal process and with no way to challenge their detention. Some of these facilities are run by gangs who extort the detainees families for money. The facilities weve seen are dangerously overcrowded. Shortages of food in the detention centres is also a real concern MSF is seeing adults suffering from malnutrition as well as the impact of not having access to safe drinking water.

Sometimes they have less than one litre of water per person per day. Access to toilets or showers is also very limited, resulting in high rates of skin infections and infestations of lice, scabies and fleas. MSF teams on search and rescue vessels in the Mediterranean have rescued more than 50,000 men, women and children and have documented countless firsthand accounts of the alarming level of violence and exploitation experienced in Libya at the hands of security forces, militias, smuggling networks, criminal gangs and private individuals. Every Eritrean person we have rescued from the Mediterranean has, in a [recent report](https://www.msf.org.uk/article/eu\-prevention\-policy\-puts\-eritreans\-risk\-imprisonment\-torture\-and\-death), testified to being either a direct victim or a witness to severe levels of violence. On their journeys to Europe, each of the interviewees also reported being held in captivity of some kind.

> **Refugees, asylum seekers and migrants are not the same, but a persons status can change**

Refugees, asylum seekers and migrants are not the same thing yet over recent years the media and the public have often confused and conflated these very different terms: A **refugee** is a person who has fled their country and cannot return for fear of harm due to their race, religion, nationality or membership of a particular social group. On applying for refugee status, their claim is assessed by the UN Refugee Agency \(UNHCR\) or a sympathetic state. An **asylum seeker** is a person who has claimed refugee status in another country, and is waiting to hear if they have been successful. A **migrant** is a person who chooses to move to another country in order to improve their future prospects.

Labels such as refugee and economic migrant can be unhelpful, as they fail to recognise the complexity of the situation or the vulnerability of all people on the move. Often, peoples motives for moving change during the course of their journey. Take one Senegalese man who was rescued in the Mediterranean Sea by MSF. He had initially left his country to escape extreme poverty. Arriving in Libya, instead of finding work he found himself incarcerated and tortured, so his motive then became simply to find a place where his life would no longer be in danger. Ultimately, people move for lots of different reasons. Some need more urgent protection, but all deserve to be treated with basic human dignity. Quite frankly, the majority of these people are not risking their lives on such a deadly journey because they want free schools and medical care. Its that their lives are so unimaginably difficult and/or dangerous they truly feel it is their only option.

> **Muslim\-majority countries ARE hosting the highest proportion of refugees**

You often hear the argument that refugees would much rather stay in their region where there are far more cultural and language similarities than Europe. And most do, certainly at first. However after years of being unable to work or study and with their savings running out, its only natural that families look further afield for opportunities to lead something like a normal life. There are currently 65.3 million around the world who have fled their homes. Yet those who have fled to Europe in 2016 only represent six percent of this number. To put this figure into greater perspective, the 361,709 people who arrived on Europes door make up just 0.04 percent of Europes population.

Over half of all those displaced globally come from three countries; Afghanistan, Somalia and Syria. Six countries in the world host the highest number of refugees, 7.5m people collectively; Turkey, Pakistan, Iran, Lebanon, Jordan and Ethiopia all of which border one of the three countries people flee the most. Sadly, too many people desperate to escape from war are unable to leave their country at all. Closures along Syrias borders with Lebanon, Turkey and Jordan mean that people are stuck. Even critically ill patients have been denied access across the border to our hospitals in northern Jordan.

> **Just over half of the people arriving in Europe are young men**

This is mainly because their families judge they are better able to face such a tough journey. Sometimes they hope to join them later. Nonetheless, the number of families, women and unaccompanied children is high. According to the UNHCR, 43 percent nearly half of people arriving in 2016 were women and children. But whatever their age or gender, most of the people who make it to Europe are extremely vulnerable: victims of violence and torture, people with disabilities, pregnant women, children and even babies, all of whom are leaving behind conflict, persecution or extreme poverty.

> **The civil war in Syria is not a two\-sided battle between good and evil**

Some people seem to wonder why refugees fleeing war\-torn areas don't stay in their countries and take up arms to defend themselves. A common line of argument makes the comparison to the British during the Second World War. But the civil war in Syria, for example, cannot be compared to a two\-sided battle between good and evil. While the conflict started as a popular revolution against a dictator, it has since turned into a conflict engulfing the entire region, as well as global superpowers like the US, UK and Russia. The groups opposing President Bashar al\-Assads government are wide\-ranging in terms of ideology, and currently six million people live in territory under IS control. Parents of teenage boys in places like Syria, Afghanistan and Iraq are often desperate to get their children away from armies and militias who forcibly recruit to fill their ranks and to a safe place where they can continue to study and work and live a peaceful life. Nearly half a million Eritreans have fled their country \(with a population of five million, thats 10 percent\) to escape the prospect of indefinite military conscription.

According to some Eritreans we have spoken to on our search and rescue vessels in the Mediterranean, some of their countrymen have been forced to serve in the military for 20 years on a wage of roughly 30 per month. It is little wonder that, in 2016, Eritreans were the second largest group after Nigerians to cross the central Mediterranean Sea.

> **Just because people have made it to Europe, it doesnt mean theyre safe**

Many of the people who have made it to Europe are living in appalling conditions. More than 60,000 people, including thousands of children, are stranded in overcrowded camps in Greece.

In Italy, thousands of people who have run out of money or had their claim for asylum rejected have been left destitute, living rough throughout the country often with no access to even their most basic needs. In Serbia, official camps are also overcrowded and thousands of people have spent the harsh winter sleeping rough in sub\-zero temperatures, with no access to toilets or showers.

MSF medical teams in the Balkans regularly treat people for injuries associated with violence at the hands of border police, these include lesions, broken bones and even dog bites. They also treat illnesses that are a result of the conditions these people are forced to live in like scabies, respiratory tract infections, smoke inhalation and even frostbite.

> **Most people couldnt go home even if they wanted to**

Out of desperation, most sold everything they had or spent their life savings on the trip to Europe which went into the hands of smugglers or was stolen from them along the way. Voluntary repatriation or choosing to be sent home is an option in some countries but there is very little budget and few resources to allow this to happen as well as almost no information about how people can apply. Instead, thousands of people are left in limbo, living in camps in poor conditions, held in detention facilities or forced to sleep on the streets.

> **Just because a countrys not at war, it doesnt mean its safe**

The top five countries that people arrived to Europe from in 2016 were Syria \(23 percent\), Afghanistan \(12 percent\), Nigeria \(10 percent\), Iraq \(eight percent\) and Eritrea \(six percent\). Thats 59 percent collectively. A recent UN report noted that the number of civilian casualties last year in Afghanistan were the highest ever recorded. With nearly 11,500 non\-combatants one\-third of them children killed or wounded, the number of civilian casualties was double that of 2009 the height of the war in Afghanistan. In Nigeria, heavy conflict is affecting the north of the country forcing one million people to flee their homes.

Many of them have sought safety in government camps and are entirely reliant on aid, which often isnt reaching them. MSF teams last September found more than one in seven children suffering from severe acute malnutrition. Many of these people lack basic food supplies and have no access to healthcare. In 2016 almost 7,000 civilians were killed by acts of terrorism, violence or conflict in Iraq. IS are carrying out systematic and widespread violence in the country, including holding around 3,500 mainly women and children as slaves. Alleged abuses by troops, militiamen and Kurdish forces have also been recorded. Reports from Eritrea say the government there forces everyone aged 17 or over to take part in indefinite national service in the name of national security this virtually unpaid work which has been compared to slavery can last for many years. In 2016 a UK court ruled that sending people whod evaded this national service back to Eritrea would put them at risk of serious harm.

> **Migrants and refugees are not all saints, but theyre certainly not all sinners either**

Any large group of people will be made up of all kinds of personalities. The vast majority will be people just like you people who love their families and want to live a productive, happy life contributing to society. A small minority will be anti\-social or unpleasant. One or two may even be dangerous. But the person you suspect of being an extremist is actually far more likely to have fled similar extremists or threats. After terrorist attacks like those in Brussels, Paris, Berlin and London, its easy to blame people who look similar to the attackers. But in fact, the perpetrators of these attacks were generally not new arrivals to Europe nearly all of them grew up and became radicalised in Europe itself.

> **Those that hope to get to the UK do so for good reasons**

Some of the people who have arrived in Europe are keen to come to the UK. This is only natural, considering the UKs tradition of presence overseas and the fact that English is so widely spoken globally. Some of these people already have family ties in the UK. But it is certainly not true that most people want to come to the UK. The majority of people are simply hoping for a safe place to live in mainland Europe until they are able to return home safely.

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[_Find out more about MSF's work in Europe_](https://www.msf.org.uk/country/mediterranean\-search\-and\-rescue)

Who is rescued?

Refugees, migrants and asylum seekers are not interchangeable terms. The following is a brief explanation of the very different legal definitions:

  • refugee is a person who has fled his or her country and cannot return because of a well-founded fear of persecution due to their race, religion, nationality, or membership of a particular social group. Refugee status is assessed by the United Nations High Commission for Refugees or a sympathetic state.
  • An asylum-seeker is someone who says he or she is a refugee and is seeking asylum in another country, but whose claim has not yet been definitively evaluated.
  • migrant is someone who chooses to move in order to improve the future prospects of themselves and their families.

As a humanitarian agency involved in search and rescue, MSF does not have a mandate or means to assess the immigration status of the people we assist.

We provide medical care without judgment and strongly believe that no human being should drown when the means exist to prevent it.

Where are the people rescued at sea taken?

Our primary aim was to prevent loss of life, not to provide transport.

When a situation arose in which we had to intervene, we did so under the direction of the Maritime Rescue Coordination Centre in Rome.

They also decided where those we rescued should disembark, as dictated by the laws of the sea.

As a rule, those we rescued were taken either to reception centers in southern Italy (Sicily) or transferred from search and rescue boats to Italian coast guard vessels.

© Gabriele François Casini/MSF

A compromise to MSF’s neutrality?

We felt compelled first and foremost to assist people who were dying in the Mediterranean. We had the means and, for us, ignoring the problem was not an option.

Of course, we are aware that by doing this we are entering a very contentious political debate in Europe. But we believe that inaction cannot be justified on ideological grounds and that, in fact, as a medical organisation that takes its cues from medical ethics, we must take action. Find out more about our principles.

MSF in the Mediterranean: 2016

In 2016, over three hundred thousand people fleeing wars, persecution, poverty and insecurity attempted to cross the Mediterranean in search of safety and refuge, according to UNHCR, the UN’s refugee agency.

Central Mediterranean

It was the deadliest on record: 4,581 men, women and children died attempting to cross from North Africa to Europe.

Of the 181,436 people who arrived safely in Italy after being rescued at sea, the vast majority had embarked in Libya. None would have made it to safety without rescue.

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During the year, our teams were on board three specially equipped SAR boats: Dignity I, a 50-metre vessel with the capacity to take 400 people on board, and a crew of 19 MSF staff; Bourbon Argos, a 68.8-metre vessel with the capacity for 700 people, and a crew of 11 MSF and 15 non-MSF staff; and Aquarius, a 77-metre vessel run in partnership with SOS MEDITERRANEE, with the capacity for 500 people.

All three boats actively searched for boats in distress in international waters north of Libya.

Between late April, when the first boat, Dignity I, was launched, and the end of the year, teams rescued 21,603 refugees, asylum seekers and migrants and assisted 8,969 more in over 200 operations.

Medical teams onboard treated violence-related injuries linked to detention, torture and other ill-treatment, including sexual violence, in Libya.

Medics treated skin diseases, dehydration, hypothermia, scabies and serious injuries like chemical burns caused by fuel mixing with sea water in the boat.

Pregnant women were cared for by midwives onboard and several babies were born safely at sea. Lifesaving emergency care was also provided in emergency rooms on the ships or through medical evacuations, when needed. 

People continued to try to cross the Mediterranean even as winter approached. From October onwards, MSF in collaboration with SOS MEDITERRANEE, ran the only NGO boat continuously carrying out search and rescue in this stretch of sea

Eastern Mediterranean

Despite harsh weather conditions, in the first three months of 2016, 151,452 people made the eastern crossing from Turkey to the Greek islands, the largest number landing on Lesbos.

During the same period, 366 men, women and children lost their lives in the Aegean Sea.

We provided assistance to boats in distress off the coast of Lesbos until June, when the drop in arrivals meant that the team’s presence was no longer required.

Between December 2015 and June 2016, the MSF-Greenpeace rescue operation assisted more than 18,117 people in 361 interventions.

MSF medical teams also treated people on disembarkation and referred 30 individuals to hospital for further assistance, mainly for trauma-related injuries.

Find out more in our International Activity Report