In June/July 2020, Anne was the Medical Doctor on the Ocean Viking’s first mission with a fully integrated SOS MEDITERRANEE medical team. When the psychological distress of a group of survivors became so severe that some of them attempted suicide and threatened to inflict harm on themselves and others, the team onboard took the unprecedented step of declaring a State of Emergency on the vessel – a means of last resort to request immediate assistance.
What was the physical condition of the people you rescued in June?
“Some of the rescued people had been at sea for up to four days. They were suffering from seasickness, dehydration, exposure, exhaustion, severe sunburn, as well as the severe psychological effects from the stress of not knowing if they would live or die at sea for up to 4 days and nights.
On top of that, many of them had suffered during their time spent in their countries of origins, in Libya and throughout their journey. Some reported forced detention, being kidnapped, being beaten and tortured by their captors. Some of them had old traumatic injuries (contusions following beatings, burn scars, articular traumas due to forced and prolonged inappropriate positions, sequelae of trauma such as broken leg or foot with inadequate treatment), some also had physical injuries from the extreme nature of the forced labour they endured in Libya. Due to the lack of access to health care or medication, many survivors with chronic medical conditions became more unwell. Some also had conditions related to living conditions, such as abscesses needing surgical intervention, infectious skin diseases, and malnutrition.”
Did any of the 181 migrants show signs of violence? How did their psychological condition develop after the rescues?
“We saw many patients with old and new injuries and saw incalculable signs of invisible traumas that were caused by their journey so far, such as internal physical traumas that could not be identified onboard with precise assessment as medical diagnosis tools would be needed (such as laboratory exams, X-rays etc.) and psychological traumas (cause by sexual violence for example) that may be identified onshore several weeks of months after disembarkation.
Onboard the Ocean Viking, they suffered from psychological stress as they had just faced a near-death experience after spending days in the open sea and then a prolonged standoff with no information, not knowing what would happen to them next and some started fearing they would be forcibly brought back to Libya. The stress was mainly caused by the unknown. The fact that our crew received no information and was therefore not able to share any with them made our ability to build up trust with the survivors more difficult, leading to severe psychological distress. The ship is designed to keep people safe for a short period of time before being disembarked in a Place of Safety. The deck is not very comfortable – survivors are sleeping on the deck, there was not a lot for the survivors to occupy their minds with, and it was very difficult for most of them to get good restorative nights, which led to huge anxiety, and nothing else to think about apart from their traumatic past experiences and the worries of their families.”
How did you manage the situation during the stand-off?
“We explained all the steps to all survivors onboard but their fear of being forcibly returned to Libya was stronger than our words. Despite making seven requests for a Place of Safety, we received nothing other than two refusals and no information from competent maritime authorities. All we were able to tell them each day to answer their questions was that we were doing our best to be assigned a Place of Safety swiftly as per maritime law but that despite our numerous attempts to get information, we had none to share yet. This fueled the frustration and created a level of distress culminating in them considering harming themselves and others. Another cause of stress was the inability to contact their families who did not know if they were alive or dead. There were six suicide attempts onboard, several panic attacks, numerous feelings of suffocation, depressive ideas, report of feeling overwhelmed by darkness. Some survivors were regularly telling us they wanted to jump overboard. The medical team responded with Psychological First Aid (PFA) and medical support and care, however without being able to remove the external causes of their distress, we were limited in what help we could offer.
Even towards the end of the standoff, following the visit of an Italian doctor sent by authorities after our declaration of State of emergency on Saturday 4th, another medical visit for COVID-19 testing on Sunday 5th, and after they were told they would be allowed to disembark and that the Ocean Viking was authorised to enter into the port on Sunday evening, they were again being forced to wait for more than 15 hours with land in sight, before being disembarked between 11:40pm and 3:15am on the night between Monday 6th and Tuesday 7th. This last day and half night was again extremely distressing for them.”
Photo credits: FLAVIO GASPERINI / SOS MEDITERRANEE