Every year, thousands of people fleeing violence, insecurity, and privation at home attempt a treacherous journey via North Africa and across the Mediterranean Sea to Europe. And every year, countless lives are lost during the passage. In 2014 alone, more than 3,400 people are thought to have died during the crossing; already this year, more than 1,500 people have been left to drown.

Those who manage to survive the crossing are frequently detained in substandard conditions in Europe. Many European Union countries have closed their land borders, and transit and reception facilities are ill-equipped to deal with the high volume of arrivals who are sometimes even deprived of basic shelter inside host countries. 

And yet those who are detained could perversely be called the "lucky" ones. Through its first four months, 2015 is shaping up to be the deadliest year yet for people attempting the journey, particularly now that the Italian rescue operation, Mare Nostrum, has been canceled. "A mass grave is being created in the Mediterranean Sea, and European policies are responsible," said Loris De Filippi, president of MSF-Italy. "Faced with thousands of desperate people fleeing wars and crises, Europe has closed its borders, forcing people in search of protection to risk their lives and die at sea. There is no more time to think, these lives must be saved now."

In response to the urgent need for maritime search-and-rescue activities, MSF has partnered with the Migrant Offshore Aid Station (MOAS) to provide assistance to people fleeing crises and risking their lives to reach safe haven in Europe. The operation will take place between May and October 201, when the number of desperate people attempting to cross the Mediterranean is expected to peak. A joint MSF and MOAS team will be stationed in the central Mediterranean aboard the MY Phoenix, a 40-meter rescue ship. Equipped with high-speed, rigid-hull inflatable boats and surveillance cam-copters, and with a crew of 20, the ship will provide lifesaving support to those in distress. MSF medical personnel will provide lifesaving emergency care and treat conditions such as dehydration, fuel burns, severe sunburns, and hypothermia. They will also be equipped to deal with more complex emergencies, including obstetric emergencies, and able to provide resuscitation and basic life support.  

Along with the search-and-rescue mission, MSF continues to provide medical assistance to those arriving in Europe and to advocate for increased assistance to refugees and asylum seekers across the globe.

Why has MSF decided to intervene in the Mediterranean?

MSF has decided to take to the Mediterranean because we see that people fleeing some of the worst humanitarian crises of our time are taking deadly risks and dying at sea in their attempts to escape. Last year more than 3,500 men, women, and children died trying to reach Europe, and we find that fact both tragic and completely unacceptable.

The numbers of people already reported missing and dead in the first quarter of 2015 represent a historical record for the Mediterranean. We know that our operation by itself is not enough, but we have the capacity to act and we will do what we can to save lives.

Where are these migrants and refugees coming from?

Available data suggests that there are high numbers of asylum-seekers fleeing conflict and humanitarian crises in Sub-Saharan Africa and the Middle East. It is essential to understand that these people take great risks and their decisions are often influenced by extremely dire circumstances in their home countries.

If MSF is apolitical, why is the organization entering into the realm of European politics?

We feel compelled first and foremost to assist people who are dying in the Mediterranean right now. We have the means and, for us, ignoring the problem is not an option. Of course, we are aware that by doing this we are entering a very contentious political debate in Europe. However, we believe that inaction cannot be justified on ideological grounds and that, in fact, as a medical organization that takes its cues from medical ethics, we must take action.

Aren’t search-and-rescue operations encouraging asylum-seekers to take risks and making the job of people-smugglers easier?

The availability of rescue ships is not what is driving people across the sea. Safe and legal routes to reach Europe have been closed, forcing men, women, and children to make extremely difficult and dangerous choices. Smuggling is a symptom of this problem, not the cause—it is a business that preys on people’s misery and desperation and thrives under restrictive immigration policies.

The only thing that can put people-smugglers out of business is the opening of safe and legal routes to Europe for those fleeing their countries. No matter how high European governments build their fences, people will continue to come.

Aren’t search-and-rescue operations like the MOAS/MSF collaboration a pull factor that could encourage people to risk their lives in the Mediterranean?

People have been fleeing wars, inequality, and misery in search of better lives for themselves and their families for thousands of years. More specifically, people have been crossing the Mediterranean in vessels not fit for the journey for more than a decade. Over that period more than 20,000 have lost their lives on Europe’s doorstep. We do not want to see that number climb.

The reality is that people will not stop attempting to cross the Mediterranean because Europe has turned its back on them. In fact, data shows that, following this year's discontinuation of the Mare Nostrum program, arrival numbers are even higher than in 2014, which was the biggest year on record for boat arrivals in the Mediterranean.

If these people are fleeing crises at home, wouldn’t MSF’s resources be better-spent in their countries of origin?

For us, it is not one or the other. MSF is present in more than 60 countries across the globe, including in many of the countries from which those who flee across the Mediterranean have come, as well as their countries of first refuge, transit countries, and destination countries in Europe. Our operations in these places will continue. These are people who require medical attention—they are on the move, so we too must be on the move in order to continue assisting them. We will not abandon them at their most vulnerable and our other operations will not stop.

Why has MSF decided to partner with MOAS?

MSF has chosen to partner with MOAS (Migrant Offshore Aid Station) because they have expertise in search and rescue on the Mediterranean Sea. As we have seen with some of the latest tragedies, the process is dangerous and trained crews are necessary to ensure that a rescue goes as smoothly as possible.

While MSF is well-versed in providing medical care to people with acute needs in very difficult circumstances, this search, rescue, and medical aid operation is a first for us. MOAS was responsible for saving 3,000 lives in the Mediterranean last year; their proven expertise in search and rescue will be crucial to the success of the overall operation.

What kind of boat is the MY Phoenix?

The MY Phoenix is a research vessel that has been specially adapted by MOAS for rescue purposes. It is 40 meters long and has a maximum capacity of 400 people. The boat's crew of 20 will comprise a professional team dedicated to surveillance and search and rescue, and a medical team that will be able to provide quality emergency medical care once patients are on board. The Phoenix is equipped with two rigid-hull inflatable boats which can be launched to reach vessels in distress and transfer passengers. It is also equipped with two large surveillance cam-copters.

How do you decide who is rescued?

We will always work in close coordination with the Italian Maritime Rescue Coordination Center (MRCC) and coast guard. Rescues come about in two different ways: when a vessel in distress is spotted during surveillance, we will share information with the MRCC in Rome, who will help ascertain the vessel's condition and the needs of the people onboard. They will then direct us to assist as required. Alternatively, the MRCC in Rome will contact us and direct us to a vessel they have already identified as being in distress.

What is the difference between an asylum seeker, a refugee and a migrant? Are the terms interchangeable?

No. While the media and even some officials often use the terms interchangeably, they have very different legal definitions. 

A refugee is a person who has fled his or her country and cannot return because of a well-founded fear of persecution due to their race, religion, nationality, or membership of a particular social group. Refugee status is assessed by the United Nations High Commission for Refugees or a sympathetic state.

An asylum-seeker is someone who says he or she is a refugee and is seeking asylum in another country, but whose claim has not yet been definitively evaluated.

A migrant is someone who chooses to move in order to improve the future prospects of themselves and their families.

As a humanitarian agency involved in search and rescue, MSF does not have a mandate or means to assess the immigration status of the people we assist. We provide medical care without judgment and strongly believe that no human being should drown when the means exist to prevent it.

Where do you take those who are rescued?

Our primary aim is to prevent loss of life, not to ferry people across the Mediterranean. When a situation arises in which we must intervene, we do so under the direction of the Maritime Rescue Coordination Center in Rome. They also decide where those we rescue should disembark, as dictated by the laws of the sea. As a rule, those we rescue will be taken either to reception centers in southern Italy (Sicily) or transferred from the Phoenix to an Italian coast guard vessel.

What kind of medical activities will take place on board?

The emergency medical team on board the Phoenix, comprising two doctors and a nurse, will have the necessary skills, equipment, and medications to treat a wide range of conditions from sunburn and dehydration to resuscitation and advanced life support. Staff will also offer primary health consultations, treatment for chronic illnesses like diabetes and heart disease, and obstetric services, including safe delivery as required.