In the summer of 2020, the Ocean Viking left for her first mission with an SOS MEDITERRANEE team covering all aspects of post-rescue care for survivors on board, including medical care, after the partnership with Médecins Sans Frontières (MSF) ended. Since then, SOS MEDITERRANEE medical teams assisted 1,329 people rescued over the course of four missions at sea, requested and prepared 3 emergency medical evacuations, provided care for a total of 9 pregnant women and performed more than 1,400 consultations on deck and in the onboard clinic for a wide range of morbidities.
Each of the four missions of the Ocean Viking of the past year brought a different set of challenges for the medics on board. Hygiene protocols and COVID-19-related Standard Operating Procedures (SOPs) brought fundamental changes to the way the team conducts rescues, moves across the deck and inside the ship and interacts with survivors.
Among the 181 people rescued during the mission in June and July 2020, many suffered from severe mental distress, resulting in agitation, depression, insomnia, and decreased appetite. This distress was exacerbated by a long stand-off: having to wait for a Place of Safety for days without any guidance from the relevant authorities brought an uncertainty that became unbearable for some survivors.
After the Ocean Viking was released from a five-month administrative detention in Italy, the mission in January and February 2021 brought challenges of a different kind. Out of the 84 adult women rescued, two women in late stages of high-risk pregnancies had to be evacuated from the Ocean Viking. Many of the rescued women disclosed experiences of sexual violence to the medical team on board.
During the mission in April/May 2021, several survivors were treated for body pain and showed hematoma and contusions on their body. Smugglers had beaten them to force them onto the rubber boat when they departed from Libya as people were anxious and hesitant to embark when they saw the dinghy and the bad weather that night.
The medical team detected cases of COVID-19 among survivors during several missions of the past year. Isolation measures that had been designed for this scenario were implemented to mitigate the spread of COVID-19 among survivors and crew on board.
Looking at the medical activities on board more generally, the main medical conditions that survivors were treated for on deck and in the clinic on board were skin infections and exposure-related skin conditions, scabies, upper respiratory tract infections, pain (including generalized body pain, muscular pain and contusions), violence and non-violence related wounds and injuries including fuel burns, as well as sea sickness. The high prevalence of skin conditions and scabies, the numerous cases of body aches and upper respiratory tract infections are a testament to the dire living conditions many of the survivors endured on their journeys and especially in Libya and the lack of access to medical care. Other conditions are directly related to the perilous sea crossings, such as cases of fuel burns, exposure-related skin conditions, sea sickness and dehydration.
Another vital part of post-rescue care for survivors is the mental health component. Since mental health is very personal and individual, people who go through the same event might not experience the same reactions. We therefore cannot make a generalised statement on the mental health of survivors on board. The reactions to distress that we see on board can take different forms: Grief or sadness makes some people shut down and withdraw, but it can also lead to tension or frustration. We also see great resilience – rescued people coping with the horrific events that many have gone through by making plans for the future and supporting and relying on each other.
Since survivors are not meant to spend a long time on board, our teams cannot offer any form of therapy. However, the whole team on board is trained in Psychological First Aid, and it is the medical team that ensures this training. Psychological First Aid training enables all team members to provide immediate first aid when dealing with a person who recounts a traumatic event or appears to be in emotional distress. Upon disembarkation, the medical team tries to refer people who need specialised mental or physical health care on shore.
From ensuring regular COVID-19 testing, to providing health care to rescued people who in many cases have not seen a doctor in years, to referring patients to make sure they receive follow-up care on shore, the work done by the nurses, midwives, doctors and medical team leaders on the Ocean Viking as well as the work done on shore to coordinate and support the teams on board has been vital.