BACKGROUND:
Overall, the number of arrivals by boat to Europe has already passed the 219,000 figure of 2014 numbers with
the UNHCR reporting that a total of 806,000 have reached Europe by boat so far this year. The largest number
has come via Greece (660,698) then Italy (142,400) with smaller numbers arriving in Spain (2797) and Malta
(105).
For more information the IOM http://missingmigrants.iom.int/en and UNHCR
http://data.unhcr.org/mediterranean/regional.php have excellent websites with up to date information on
arrivals, demographics and deaths.
According to the IOM the majority of arrivals to Greece are from Syria, Afghanistan and Iraq whilst the biggest
numbers arriving in Italy are from Eritrea, followed by Nigeria, Somalia, Sudan, Syria, Gambia and Bangladesh.
KEY MSF MESSAGES
People need safe channels to seek asylum and migrate: There are very few safe channels that people can take to
reach protection, safety and a better life. With Europe’s land borders sealed, people are forced into the hands of
smugglers and into leaky, overcrowded boats on the Mediterranean and Aegean seas.
In 2015, more than 788,000 crossed the sea to reach Europe. Most of them crossed the Aegean Sea, with more
than 610,000 people arriving in the Greek islands and 300 deaths in the months of September and October alone.
At the same time, the Central Mediterranean crossing between Libya and Italy remains the deadliest border
crossing in the world. In 2015 more than 2,860 people have died in the waters between Libya and Italy whilst over
140,000 have arrived on Italian soil -that means that 1 in every 50 people who cross from Libya to Italy died trying.
Even before this point, many have contended with long, risky journeys over land and life threatening conditions in
countries such as Libya. People will continue to risk their lives in the hands of smugglers as long as there are no safe
alternatives.
People should not be forced to risk their health and sacrifice their dignity whilst crossing Europe this winter:
After risking their lives at sea, those who arrive in Greece, still considered an unsafe country for asylum seekers
because of its overwhelmed asylum system and inexistent reception system, have little other options than to
cross the Balkans. This journey has a direct impact on their health and dignity, with people waiting for long hours
at borders with only the assistance provided by volunteers and NGOs. We expected a reduction of arrivals due to
the weather and sea conditions in the cooler autumn and winter months but so far, the reality shows that the
number of arrivals is dramatically increasing in the Greek Islands with more than 230,000 in the month of
October in the islands alone. While one would expect the most vulnerable to wait for spring to come back to take
the road again, we see an increase in the number of children and women. People tell us they are rushing, as they
hear borders are closing. As the temperatures drop, people will continue to cross borders, no matter what
obstacles are put in the way. MSF is concerned about the risks these people will continue to take to reach safety
and calls on the European authorities to provide proper transport across the borders of Europe.
Search and rescue is not an adequate response to the situation but resources must be sufficiently allocated to
mitigate for more unnecessary loss of life: Although the last 6 months have seen a welcomed increase of search
and rescue vessels in the Central Mediterranean, the death toll shows that this is not enough. There were still a
staggering 2,860 men, woman and children who lost their lives on the Central Mediterranean alone in 2015. The
dangers and conditions of the boat crossing that people are willing to suffer demonstrate the desperate
measures that people are willing to take in order to reach safety. Winter months will see a decrease in crossings
due to deteriorating weather conditions, but there are many who are ready to depart Libya at any time. The
winter conditions make it even more dangerous for those who do cross and search and rescue teams need to be
appropriately prepared. Even in winter, there is need for adequate patrolling in the most at risk zones.
The focus of European policies remains on targeting smugglers with a military operation, the so-called
“Operation Sophia” (named after a baby girl delivered on board an Italian ship earlier this summer). This should
not take precedence over the urgency of providing lifesaving assistance and appropriate humanitarian assistance
for those who risk their life in search of safety and a better life. Adequate rescue operations should be put in
place in the Aegean Sea where the number of arrivals in Greek islands is not decreasing while the upcoming
winter and conditions at sea are making this trip every day more dangerous. MSF continues to call for the
adequate allocation of search and rescue resources in both the Mediterranean and Aegean Seas.
The need for improved transit and reception conditions: As there are inadequate alternative for people to enter
Europe, most have no choice but to use the maritime routes through Italy and Greece. Reception systems in
these countries and transit countries have many shortcomings and remain woefully under-prepared to humanely
and fairly treat the people arriving at their borders. With winter coming, MSF calls for humane and dignified
reception and transit conditions including shelter, food, water, sanitation, medical and mental health care and
access to asylum procedures to be urgently organized at arrival points in Greece, Italy, and in transit countries
such as France and the Balkan countries.
Push factors: The biggest displacement of people since the Second World War is being fueled by considerable
push factors that force people from their homes. From the increasingly brutal war in Syria, to the difficulty of life
under an oppressive dictatorship in Eritrea, everyone we meet has a very strong reason for fleeing their country.
We see these considerable push factors first hand in the countries in which we work. Many tell us that they
didn’t want to leave their homes, but did so because they had no other choice – they were fleeing for their lives.
People also tell us how they have been forced from third countries of hosting to Europe, for fears of safety or
due to lack of future prospects.
Europe’s restrictive policies mean that we put some of the world’s most vulnerable people in more danger,
causing more suffering, as they risk it all to try to bring themselves, and their families, to safety. European
countries (and transit countries) have the responsibility to ensure their policies guarantee the right to seek asylum
and respect fundamental rights and human dignity.
European countries are only accepting a small share of the total number of displaced: Most of the world’s
displaced people live elsewhere in their home countries or in the counties surrounding their home countries,
relatively few are granted asylum elsewhere. For example, twelve million Syrians have been displaced by the
ongoing conflict. Eight million have fled to other parts of Syria. Four million live as refugees in the countries that
surround Syria – many of these countries are now overwhelmed (one in four people living in Lebanon are now
Syrian refugees). Only a quarter of a million people have made it to Europe – that is less than 2% of the total
number of those displaced. It is more than time for European countries to adopt more humane and asylum
policies.
Externalized border controls at transit and countries of origin cannot be the EU's solution to the European
refugee crisis: Enforcement of migration cooperation deals between the EU and its member states with third
countries is resulting in unacceptable humanitarian consequences, including high levels of violence and a
sustained erosion of refugee and asylum law. The EU can no longer turn a blind eye to the well documented
abuses1 associated with such externalization of border controls. Unless concrete protection measures to assure
equal treatment and the dignity, safety and protection of people on the move are in place, abuses of migrants
and refugees will worsen with increased externalization of border control. Our experience in Morocco and Libya
amongst others has shown such policies to have severe medical humanitarian consequences, with people
suffering high levels of abuse and ill-treatment.
MSF @ SEA OPERATIONS
OCA MY Phoenix: MSF is no longer working on the MY Phoenix. On September 22 nd MOAS informed MSF
that they would cease operations in the Mediterranean Sea. As a result MSF is no longer in partnership with
MOAS or working on board the Phoenix.
OCB Bourbon Argos: MSF OCB launched an additional ship on 9 May to carry out search and rescue operations in
the Mediterranean Sea. The ship has 26 people on board (of which 14 are MSF staff), including an experienced
search and rescue team as well as MSF medical staff, watsans, logs etc. The Bourbon Argos has the capacity to
carry up to 550 rescued people to land.
OCBA Dignity I: Launched on 13 June, Dignity I has a crew of 18 people, which includes medical staff. The 50
metre-long vessel left the port of Barcelona on 13 June and has the capacity to carry 300 people to land.
INTERNAL: DIGNITY will leave the SAR area in the coming days. It will be temporarily based in Spain as
she undergoes some repairs and renovations.
Aegean Sea Rescue Operations (INTERNAL): MSF OCB and OCP launching two rescue operations at sea in the
Aegean in collaboration with the Swedish Sea Rescue Operations in Samos and with Greenpeace in Lesvos. OCBA
team will conduct rescue operations from Leros. Activities to start up shortly.
To date, the THREE boats on the Central Mediterranean have RESCUED 18,447 PEOPLE. The
total of rescues and assists stands at 19,643 people
1
See for e.g. From a Rock to a Hard Place - highlighting the needs of migrants and refugees in Tunisia (fleeing Libya 2011) and
Trapped at the Gates of Europe (Morocco 2013) which includes MSF data showing that more than half of the medical problems
diagnosed among 10,500 sick and wounded migrants treated by MSF between 2010 and 2012, were diseases closely related to poor living
conditions. In the same period, 18% of MSF’s medical consultations were related to physical and sexual violence. MSF treated almost 700
male and female survivors of sexual violence, attacked in their country of origin, en route and in Morocco. In 2012 alone, MSF teams in
Nador, neighbouring Melilla and Oujda assisted more than 1,100 people with violence related injuries, many perpetrated by Moroccan
Security Forces and the Spanish Guardia Civil. A 2012 MSF survey found 63% of people interviewed experienced violence in Morocco, with
92% stating that the violence was intentional. MSF teams also recorded worrying increases in the expulsions of vulnerable groups. In 2012,
191 incidents were recorded and more than 6,000 people were expelled, including pregnant women, minors and people requiring medical
treatment for violence related injuries. The real numbers are likely to be considerably higher.
MSF calls on the EU to provide safe and accessible alternatives, for people fleeing torture and persecution, to the
sea crossing between North Africa and southern Europe which has in 2015 alone claimed 2, 860 lives.
BROADER MIGRATION PROJECTS:
ZARZIS (TUNISIA)
MSF has been working with fishermen in Zarzis, Tunisia to offer training in search and rescue. Fishermen are
often on the first line of the response when boats get into trouble near their fishing grounds and have been given
material as well as training to assist them in their efforts. MSF has also provided training to the Tunisian and
Libyan Red Crescents in dead body management.
ITALY
Sicily
MSF is working in the first reception centre in Pozzallo (Ragusa province, Sicily) in collaboration with the local
Ministry of Health to provide medical services to migrants, asylum seekers and refugees from the time they
arrive and during their stay in the centre. MSF also provides psychological first aid to survivors from traumatic
events during the sea journey, for example those who have experienced shipwrecks. A team composed of
cultural mediators and a psychologist are ready to be deployed to different landing ports in Italy within 72 hours
after receiving the alerts. So far, the team has intervened at fourteen different landings, in the Italian ports of
Palermo, Augusta, Pozzallo, Catania, Lampedusa and Taranto with the aim to provide a first practical and
material assistance, to alleviate the concerns and help the survivors to face the first moments immediately after
landing.
MSF also provides mental healthcare support to people living in reception centres in Ragusa province, Sicily.
During the first nine months of 2015, the team met more than 467 people in group sessions, visited 300 people
and provided psychological care to 126 asylum seekers. Nearly half of the people who have benefited from
psychological support have been through traumatic experiences related to their journey, including
imprisonment, and physical and psychological violence. Most of the people are male, between 19 and 30 years
old, coming from Nigeria, Mali, Gambia and Senegal. Between January and September 2015 the MSF team in
Pozzallo has provided medical screenings to 12269 people on arrival, before entering the primary reception
center. Within the primary reception centre, MSF has provided consultations to 4755 people.
Rome
Since mid-July MSF has been providing psychological first aid to people in transit. As of 30 October, the team had
provided psychological and emotional support to 903 people. MSF teams also provided support for basic needs
and information session during 2020 session. 435 people were referred for medical support. MSF teams are
working mainly in the Baobab Center (run by volunteers) and in the Tiburtina area, behind one of Rome Train
Stations where, lately, the Italian Red Cross set up a temporary tents’ camp. Most of the people that are staying
in Baobab and Tiburtina’s centres are leaving for northern Europe few days after their arrival. The majority of the
transients in the two areas are of Eritrean origin, but also Sudanese, Ethiopian (both Amhara and Oromo).
GREECE
MSF is providing medical care, shelter, watsan services and distributing relief items to refugees and migrants
arriving in the Dodecanese Islands as well as on Lesbos and Samos; in Athens and at the Idomeni border
crossing to FYROM.
Since the beginning of this year, MSF teams in Greece have witnessed a marked increase of arrivals in the Greek
islands. By November 4th, 619,101 people had arrived in the Greek islands this year (vs 43 500 in 2014), with a
384% increase in the first 10 months compared to the same period last year (UNHCR figures). In October alone,
more than 230,000 people arrived. The vast majority of the people arriving in Greece come from Syria,
Afghanistan and Iraq. In September and October 300 persons lost their life in the Aegean Sea, many of them
children.The Greek central authorities have yet to organize adequate reception in accordance with EU standards.
MSF calls on theGreek authorities to meet their obligations and commit to reception, by providing and managing
spaces in all Greek islands, where people can be welcomed with shelter, food, hygiene facilities and a medical
screening. This is all the more urgent as the flow of people arriving will not stop in the winter and the harsh living
conditions for them will have a bigger impact on their health. MSF calls on the EU to provide an alternative to the
dangerous sea crossing, specifically to create a safe passage at the land border between Turkey and Greece.
Kos/Leros
There is no reception system at all in any of the Dodecanese islands. The lack of shelter, hygiene facilities, food
and medical screening has become even more apparent in Kos since the local authorities pushed in September
for the closure of the Captain Elias camp, an abandoned hotel MSF had rehabilitated to house people waiting for
their registration papers. As a consequence, people are now forced to sleep outside in Kos town with no roof
over their head. With night temperatures dropping and winter approaching, there is still no solution in sight: the
authorities in Kos have so far categorically refused to have any type of reception on the island that would go
beyond the sole registration of people. MSF was searching alternatives with other stakeholders but the
opposition of the authorities is particularly strong.
In Leros, MSF is scaling up its activities, creating shelter and hygiene facilities to host the people brought to the
island for registration from the neighbouring military island of Farmakonissi.
The MSF team has been conducting vulnerability screenings to identify the most vulnerable groups like pregnant
women, minors, but also people without any resource to have access to the basic needs, providing medical
consultations and mental health support in Kos town since March. From mid-March to October 31st 2015, MSF
carried out 7113 consultations and distributed more than 12210 relief items such as soap, combs, toothbrushes,
sleeping bags, towels and survival blankets. As of June 15th, MSF is also running mobile clinics for primary health
care and mental health in the neighbouring Dodecanese islands, primarily Leros. With the important increase of
arrivals in the last weeks, MSF decided to scale up activities in Leros with a permanent presence, providing
medical care , shelters, water and sanitation. In Kalimnos, MSF organised a psychological support for the victims
for shipwreks. . Up until October 31st, this team carried out a total of 2720 medical consultations.
Lesbos
Lesbos receives half of the total number of arrivals in the Greek islands. Although Lesbos is one of two islands
where there are reception facilities, the system has failed to respond to the needs of newly arrived people ever
since April this year. An MSF emergency response team was sent to the island in June. MSF is providing medical
consultations, mental health support, distributing relief items, wifi connections and organising the transportation
of new arrivals between the North and camps where there is registration. In total, MSF provided 7595 medical
consultations, 3432 of them only in the month of October. Our teams - that are providing medical care to
refugees and migrants in Kara Tepe and Moria camps and at the port of Mytilini, observed several pathologies
related to the upcoming winter conditions, such as respiratory tract infections and the first worrying cases of
hypothermia. These were the results of three days of rain and the inadequacy of registration point, where people
waiting for many hours and days with no shelter. MSF also works on improving water and sanitation in Kara Tepe
and Moria camps and ensures cleaning services. MSF is also offering transportation through 14 buses to new
arrivals, transporting an average of 1000 to 2000 people every day so they do not have to walk 70km from their
arrival point to the registration centre in Mitylini. MSF also organized a transit center in the town of Mantamados
to provide first assistance to new arrivals.
The Greek authorities have yet to identify an additional suitable space to the existing reception center in Moria
and Kara Tepe camp where people can be offered shelter, food, hygiene facilities and medical screening. As long
as this is not done, in the face of chronic mismanagement by the authorities, it is likely that the island will go
from crisis situation to crisis situation MSF negotiates since months with authorities in order to have a space near
the harbour where people wait for their ferry in order to put some heated tents at least for children and
vulnerable people. MSF is assessing the needs at the points of arrival in the North of the island and planning to
launch an emergency medical care activity in support of the hundreds of volunteers providing first assistance.
Idomeni
In Idomeni, close to the border with FYROM (Former Yugoslav Republic of Macedonia), MSF is running a clinic
and distributing relief items for those who first arrive in Greece and chose to continue onwards throughthe
Balkans to go to Western Europe. From April 3rd until October 31st, MSF provided primary health care to 8456
persons. 7221 people participated in individual and group mental health consultations. With winter approaching
and taking into account the high possibility of FYROM closing the border at any moment, effectively leaving
people stranded in a no-man’s-land, MSF installed 4 rub halls of 240m2, each with a capacity to offer shelter to
160 people, 2 tents of 45m2 for our medical activities, 40 latrines, 30 showers and 10 water taps. MSF negotiates
with authorities to have an additional space in order to offer more capacity in case of closure of the border.
In all the rub halls that MSF is putting in place, some heating system has been put in place.
Samos
Samos is the second most important island after Lesbos where refugees land when they cross over from Turkey.
One MSF team has been in Samos since October 5 to provide medical assistance to refugees as volunteers in the
area are becoming exhausted. They do a first assessment and screening when a boat arrives. They continue to
provide medical care once migrants are transferred to the port of Karlovathi and Vathy where the team has set
up medical consultations. As people stay at least 2 or 3 days before leaving to Piraeus, the team will see how to
respond to shelter, NFI and watsan needs.
Athens
In Athens, MSF launched in October 2014 a project offering medical rehabilitation to asylum seekers and
migrants who have been victims of torture, in collaboration with two Greek organizations (the Greek Council for
Refugees and Syneirmos/Babel).
SERBIA
MSF teams have been providing medical and mental healthcare and distributing relief items such as hygiene kits,
food, survival items, tents, blankets and raincoats to people crossing through Serbia since late 2014.
The team has a mobile strategy, moving according to the routes that people are taking to cross the country.
MSF's mobile teams, which each include a doctor, nurse and translators were working on the Subotica crossing
point with the Hungarian border, in the capital Belgrade, in and around the Asylum centers and are still working
on the border with the Former Yugoslavian Republic of Macedonia (FYROM) in Presevo, Miratovac and
Bujanovac. After the border with Hungary closed and the migratory route changed with the majority of people
bypassing Belgrade going straight to the border with Croatia, the teams started to focus on the crossing points
with Croatia at Sid. Recently our team were able to build three tents of 240m2 in in Sid, which can shelter up to
150 people each, and will increase their activities in the coming days, while at the same time remaining mobile.
The team in Presevo, where people arrive in Serbia, have set up a clinic and organizes transport from the border
for the most vulnerable people – people have to walk for several kilometers. MSF has also set up toilets and
helps with garbage collection.
The teams report seeing a large number of pregnant women, from very early to very late stages. They meet
babies who have been born during the journey. In October the numbers of children and women increased
significantly. There are also elderly people and a large number of very young children travelling and each day the
teams see at least one person in a wheelchair. Over the past two months the number of consultations has risen
sharply, with the teams treating 6858 people in September and 6380 in October, compared to 2903
consultations in August. The total number of consultations since April is 20163. The main medical needs are
treatment for respiratory illnesses, for injuries sustained on the walk including blisters and body pains. People
are stressed that they will not be able to pass the border; we have seen some cases of anxiety requiring medical
attention. With winter approaching, bringing rain and lower temperatures, MSF is also treating people for
common colds and treated several cases of hypothermia. As a direct result of the poor living conditions that
people face, MSF teams in Presevo have also seen cases of scabies.
There are major needs for shelter in Serbia: there have been nights in the past months in which up to 3,000
people who were waiting in line to get registered or were stranded at the border with Croatia had to sleep
outside, without shelter and assistance. At the registration point of Presevo up to 4000 people were waiting to
be registered with low temperatures and no shelter. MSF is concerned about the arrival of the winter when
temperature in Serbia can reach -15.
CROATIA
MSF has been working in the border between Croatia and Serbia for the last month, in a transit camp in
Opatovac near the border with Serbia (at about 15 km from Tovarnik) where refugees spent about a day before
being transferred to Hungary. In the camp, which hosted around 5000 people daily, MSF opened up a clinic. MSF
also deployed mobile clinics to be able to rapidly assist refugees at the different crossing points (Bapsaka and
Sid). The situation improved substantially by middle October with migrants being transferred rapidly in buses
from the border to the camp and from the camp to Hungary. The number of migrants also increased to reach
8.000 people per day rotating at the camp in which they stayed for a few hours/night. Croatian authorities had
plans to close the camp (and old military base) to open a new one with permanent structures in the coming
weeks. Medical teams treated people mainly for respiratory infections (due to the cold, the precarious living
conditions and the long journey the migrants are enduring), grastrointestinal problems and skin diseases. The
majority of the patients were children. The decision taken by Hungary to close its borders created a domino
effect that meant leaving thousands of people stranded for hours waiting at crossing points with restricted
access, to travel through Croatia to reach Slovenia instead. MSF is monitoring the situation in the Croatian side of
the borders with Slovenia and Serbia.
SLOVENIA
From 20th of October till early November, MSF has been supporting the MOH at Brezice transit center (at the
Croatian/Slovenian border) with medical teams. 24/7, our doctors and nurses have been providing medical
consultations to people entering the Slovenian territory. The teams were mainly treating exhaustion,
hypothermia, respiratory infections and flu symptoms.
End of October, trains were organized from Croatia to bring directly people to the Austrian/Slovenian border.
The Brezice area was closed. The medical needs are now managed by the authorities. MSF continue to monitor
the situation with one doctor in Slovenia.
FRANCE
Around 6,000 refugees and migrants are living in Calais on the so called Jungle site in dire conditions, despite the
efforts of non-profit organizations and local charitable initiatives. Calais is the city located near the Channel
Tunnel linking France and the United Kingdom and for several years migrants have been trying to reach the UK
on trucks via the Channel Tunnel. An MSF medical team is providing medical consultations and physiotherapy in
the clinic run by Médecins du Monde on the site. An average of 80 consultations is given every day. MSF has
started the construction of a proper OPD in order to enlarge the medical offer on site and improve working
conditions.
MSF did watsan repair work and built 66 chemical toilets in an effort to fill the gap of showers and toilets. MSF
also set up a system for collecting and managing garbage. An MSF van is gathering every day 20 tons of trash.
And to respond to the need of shelter, MSF is supplying building material and providing technical support to
volunteers building wooden shelter for migrants.
Refugees and migrants are also living on different sites around Dunkerque, further north of Calais. An MSF team
started running on the 9th of November a mobile clinic on six different sites to provide medical care. The team is
also seeking on how to respond to non-medical needs such as watsan and shelters.