Migrants who make the journey to Europe in boats face huge risks – not least to their physical and mental health. Those who become ill during their journey receive treatment on arrival, but they often struggle with lasting psychological trauma.
"For some of the people rescued, the
medical consultation by our team onboard marks the first time in a very long
time that someone is listening to them,” says Italian doctor Luca Pigozzi.
In August, more than 350 people – many suffering health problems – were trapped on the rescue ship Ocean Viking for two weeks before Malta finally allowed them into port. While the ship – operated by Doctors Without Borders (MSF) and SOS Mediteranee – remained stuck at sea, Pigozzi was among the doctors on board who operated a mobile clinic. Most of the patients were suffering from skin and respiratory infections, but some had received war wounds, such as grenade shrapnel under the skin, or had serious chronic illnesses like diabetes.
"When the rescued people come onboard the Ocean Viking, they are completely exhausted," the leader of the MSF's medical team on the Ocean Viking, Stefanie, blogged. "They have spent many hours at sea, with no sleep, no water, and no food.
"Immediately after embarkation, patients typically present with dehydration, general physical weakness, dizziness, hypo-or hyperthermia, and burns – mainly caused by fuel or the sun –, or with newly sustained injuries associated with crossing itself.
"After the first 24 hours, people start to recover from these initial symptoms. But, in the subsequent days, they continue to come to us with minor conditions, which can be general body aches and pains, nausea, generic abdominal pain or feelings of weakness. These symptoms are often psychosomatic, which means the body is physically responding to a psychological trauma that the mind is struggling to cope with."
Dehydration, hypothermia and trauma
MSF provides medical assistance to migrants arriving at the EU's external borders, including medical triage, first aid, psychological support and vulnerability assessments and referral to hospital. It lists the most common physical symptoms associated with harsh conditions suffered by migrants during their journey:
- dehydration as a result of traveling for days without water
- hypothermia from being exposed to cold during long journeys at sea
- musculo-skeletal complaints mainly from having to stay in the same position for long periods, eg in overcrowded boats
- traumas and traumatic lesions as a result of abuse by smugglers
- headaches and general body pain due to traumatic traveling experiences
Violence and abuse while traveling
MSF says many migrants also show signs of temporary post-traumatic reactions as well as depressive symptoms, which can be the result of violence and abuse experienced during their journey.
Health workers have reported symptoms associated with trauma from being beaten by smugglers with sticks, pipes, rifle butts and knives. A high proportion of women migrants are subjected to sexual violence while traveling, according to MSF.
Unhealthy living conditions
On the Greek islands, the main medical needs of migrants are related to the living conditions experienced in refugee camps, according to MSF's advocacy manager Sophie McCann. Migrants who end up in detention or in camps where there is overcrowding and living conditions are poor often suffer from respiratory tract infections from exposure to the cold, musculo-skeletal problems also associated with exposure, diarrhoea and gastro-intestinal disorders related to poor-quality food, lack of exercise and stress.
Migrants, including young children, are also susceptible to diseases like chicken pox and scabies, a contagious parasitic skin disease. Scabies is caused by mites and is transmitted through close person-to-person contact usually in schools, aged care facilities, hospitals and refugee camps.
"In our pediatric clinic outside Moria (camp) we see children with repetitive skin infections related to really poor hygiene, like scabies and lice, because there is a really big issue related to basic services, such as a lack of clean blankets and sanitation," McCann says.
In 2014, French authorities evicted hundreds of people from the Calais "jungle" camp ostensibly because of an outbreak of the skin disease among migrants living in unsanitary conditions.
'Migrants don't carry diseases': Lampedusa doctor
Spending long periods crowded onto boats also makes people susceptible to skin infections. Large groups of migrants arriving in Italy have been placed in isolation because of suspected scabies and chickenpox infection.
When 155 people were rescued from a shipwreck in October 2013 that left more than 360 dead, the survivors were seen as a contagion threat, according to Pietro Bartolo, the now famous Lampedusa doctor who treated migrants for 30 years before entering the European Parliament.
"[...] No one wanted them [the rescued migrants] because they say they carry diseases like scabies," Bartolo writes in Tears of Salt. "Scabies is just like lice, you apply a treatment in about three minutes and you are cured. Migrants don't carry diseases, because they are healthy people and it is us who often pass on diseases to them."
Many of the people who arrived night after night at Lampedusa's Favaloro pier – to be met by Bartolo – were suffering from non-contagious but serious conditions. Many had been tortured until they were close to death, he told the British Medical Journal. Others had what he called "rubber dinghy disease" – chemical burns from petrol that spills inside boats and sticks to clothes and skin.
Bartolo's immediate job was to separate the sick and injured from the healthy. On Lampedusa, he organized an air ambulance to transfer seriously ill migrants to Palermo. Those in better health were taken to the island's reception center where they received shelter, warmth and a meal.
Overwhelmed and understaffed
"We are providing as much as we possibly can but we are still only able to cope with taking the most severe of the severe cases," Sophie McCann from MSF admits.
When people arrive on the Greek islands and in other first arrival points, they go through a medical assessment. In Greece this is carried out by the ministry of health. But because of the high number of arrivals on the islands and a shortage of medical personnel, a backlog has been created. As a result there are 6,000 newly-arrived asylum seekers in Greece who are still waiting to have a medical screening examination, McCann says.
There is also a problem in accessing primary health care, like access to medicines and tests, and even translators, she adds. "The hospitals and clinics are already overwhelmed and understaffed, and so they struggle to deal with the additional needs of the asylum seekers and refugees."