The birth lottery

Bryant_MSF_cropSimon Bryant is a Canadian Physician currently volunteering with MSF in the Mediterranean

Editor's note: This piece combines two of Simon's blogs published on Médecins Sans Frontières' staff blog 'Moving Stories' on April 26th and May 4th respectively.

Since I arrived in Malta on April 18th over sixteen hundred people have drowned in the Mediterranean, and it's sadly starting to look like the deadliest year ever for trans-Mediterranean crossings. European politicians have scrambled to respond and the "Triton" program, consisting of naval and coast guard ships patrolling Europe's maritime frontiers, has just seen its funding tripled. Still it seems their objective won't be specifically "search and rescue" (SAR) benefiting those near death and close to the Libyan coast, but rather "wait and see" much, much farther north. There's chatter in the media about a possible "pull-factor" of Mediterranean SAR operations perhaps luring migrants to their deaths. But people at sea needing rescue and medical care can't really wait for the long-term solution of peace and social justice in Syria, Libya, Eritrea, Iraq, and sub-Saharan Africa to begin, let alone fully kick in. They deserve at least a chance, and certainly nobody deserves to drown at sea.

My six team-mates on this pilot project are all veteran Doctors Without Borders/Médecins Sans Frontières (MSF) staff, with far more than a few dozen missions amongst them, but it's the first such on a ship for all of us. There's a lot involved in setting up for a six-month season, rescuing and providing medical care for an estimated 10,000 persons! A typical day begins at 8 a.m. making our way in the crazy Malta traffic to the shipyard and/or bonded warehouse near the airport, then some combination of picking through boxes to find just what you're looking for, carrying supplies onboard or stacking and sorting in our warehouse at the shipyard, and setting up our clinic onboard the Phoenix. Medications and supplies are getting organized into sea-worthy storage, and equipment unpacked and tested and batteries checked and charged. A "cold chain" cooler with backup batteries is going in, for perishable medications and some vaccines. The obligatory meetings and other interruptions must happen, such as a safety-tour of the ship and briefing from the captain, etc. One day rolls quickly into the next.

[W]e're equipping the clinic with some serious medical equipment including a Dash 4000 monitor with capnometry, oximetry, EKG, and temp probe, a portable iStat chemistry analyzer, two oxygen concentrators, an ultrasonic nebulizer, a Monnal T50 ventilator and associated supplies, EZ-IO drill and supplies, prn isolation tent, diagnostics for malaria, Hepatitis E, and other conditions, obstetrical and gynecological equipment and supplies such as fetal doppler ultrasound, vacuum extractor, and so on. We wouldn't and won't have to use any of it, in a perfect world, but it would be more than a shame to come up short at a critical time, in this imperfect one.

The Phoenix and the MSF flag finally sailed out of safe harbor at noon on May 2nd. Journalists hustled onto an accompanying boat to record the event, and a helicopter made several overview passes as we entered open water. This mission obviously saves lives and relieves human suffering. It also inevitably and not to be disingenuous about it, intentionally makes a political statement that European governments are using the mediterranean as a border fence, very deliberately not providing adequate SAR capability in the waters they are responsible for by international convention and any standard of human decency. Safe, legal ways must be made available for these justifiably desperate "boat people" to apply for asylum without risking their lives in this way.

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Photo © Ikram N'gadi/MSF, May 3, 2015

It’s midnight May 3rd under a full moon at the end of our first full day at sea. At noon we began three and a half hours of bringing 369 people on board who before our arrival were praying for their lives without pumps, lifejackets, or any realistic hope of staying afloat or alive much longer. All have received medical treatment as needed, water, clothing, food, and a blanket for the night. The search-and rescue (SAR) team is now painstakingly ferrying another 110 people from a precarious inflatable raft to a diverted oil-tanker. The wind and current have cruelly carried the fragile migrant craft far away from the much larger vessel, which only an hour ago loomed over us as a 16-meter steel wall. We’re standing by on the Phoenix with searchlights on the scene, glad there are no critically-ill aboard the inflatable.

Whatever the reasons these people began their journeys from Eritrea, Bangladesh, Nigeria, Syria, or wherever, they have in many cases since come through a kind of hell I do not like to think about. I simply won in the birth lottery, and they lost. Embarking in those very dubious craft to traverse the Mediterranean, they were prepared to risk death over the life they’d come to know, through no fault of their own. They have stories to break your heart, and are some of my heroes.

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