Courtney Bercan always wanted to join Doctors Without Borders (MSF), so the Canadian pursued a degree in nursing in the hopes of working for them. After completing her first assignment in the Democratic Republic of Congo earlier this year, she now works on MSF’s Refugee Search and Rescue Mission in the Mediterranean Sea.
Here, she tells the story of her first rescue mission on board rescue vessel, the Dignity 1.

It’s still pitch black out when I wake up to a siren-like alarm. I’m disoriented and it takes me a moment to remember where I am. I look at my phone: 4:34am. I remember that I’m aboard MSF’s rescue vessel the Dignity 1. The alarm means we have received a distress call from one or more boats who left in the night to attempt to cross the Mediterranean from Libya to Italy. It means we have about 20 minutes to get to our stations to respond to the distress call. I scramble to get dressed, put on my safety gear and splash water on my face. This is my first rescue ever and I am nervous, thinking about everything that could go wrong. I receive a reassuring smile from the logistician, who grins and says “This is it. This is why we are here”. I know he is right. We are well stocked, organised, and prepared for a safe rescue.

I am told that the flimsy white boat that’s barely visible in the distance has over 100 people in it and that there are several more in the vicinity. I feel unexpectedly overwhelmed with emotion when I see the refugees perched, without life jackets, on their dinghy. I have seen so many pictures of these boats that I didn’t think it would hit me this hard. It is so dark, all it would take is one stray wave and the entire boatload of people would be swept into the sea; the only proof that they were ever there being some white plastic and floating water bottles. It’s truly a terrifying thought and I feel more at ease when I see our sailors distributing life jackets to everyone and bringing the first group on board.

The men line up to be registered and receive provisions, a few weak or near fainting when they first board, but no one seriously ill. The sun is coming up by the time they are all aboard. During a lull I strike up a conversation with one of our new passengers, who tells me what he thought when he first saw our boat: “Some of us, we were so scared. We thought you were going to shoot us. We didn’t know what to do. We were so scared”.

Hearing this, it becomes clear to me why people collapse upon boarding our boat – they have just gone from abject terror to relief, which is a lot for a malnourished, dehydrated, seasick, heat-exhausted person to process and accept. He tells me how he left his country a year ago to escape a difficult life there. When he arrived in the new country his papers were confiscated and he was put to work in slave-like conditions. He shows me the scars he has from abuse at his previous “job”.

We arrive at another 100-plus passenger boat, this one carrying over 20 women and children. The women start to board our boat, while I register them and identify any unaccompanied minors or passengers needing medical attention. I try to smile and make eye contact with each woman and child I register – I can see that many are scared or unsure and I want them to know they don’t have to be. A woman collapses as she enters the women’s waiting area and my colleague helps her sit up and eat and drink a bit. We place a white bracelet on her wrist signalling that we need to do a more thorough assessment as soon as everyone has boarded. The next woman enters, cradling something tiny. My heart beats faster; if the men arriving on the boat are collapsing, what condition will we find this baby in? I uncover the baby’s face to see she is breathing and responding normally. I feel a wave of relief. She is only 10 days old and already on quite a journey.

The process of loading four more boat loads of people onto the Dignity 1 continues all morning while the medical team (a doctor, another nurse, and I) are in the hospital seeing urgent patients. By noon, our final passenger count is 466 people. My colleague Antonia and I complete a general health check for all passengers aboard and send urgent cases to the hospital to be seen to immediately by our doctor, Pierre. After the general check, we join Pierre in the clinic and start treating patients as well.

We find a lot of emotional distress, dehydration, skin conditions, and sea sickness, but luckily, no one is in too critical a condition to be treated by our team in our very limited medical setting. I come across a patient I triaged earlier with somewhat vague symptoms, but a temperature of 38.5. He struggles to lie down. We can see he is in pain, but he is unable to express to us what is wrong. Suddenly the young man breaks down sobbing and the truth pours out. He tells us he had been held captive and forced to work in Libya for the last several months. He was tortured and shows us many scars. The most recent beating left him with severe bilateral rib pain (likely a combination of fractured ribs, pneumonia, and a hemothorax — blood pooling in the lungs) and he is in complete emotional and physical agony. This is the first time he has had medical attention. Pierre manages to treat and soothe him, while listening to his story. The patient walks out of our hospital looking more hopeful than when he came in.

We continue seeing patients throughout the day and into the evening as the seas grow rougher. I make a last round with anti-nausea medications, and go to bed knowing that we all (staff and passengers included) feel relieved that the day is over with no deaths or major emergencies.

The next morning I do a round in the women’s waiting area and everyone seems to be doing well. I stop to chat to a woman who has a 4-month-old baby with her. He is healthy and bright and I gush about how beautiful he is. She smiles, then pulls me in close and whispers “Il etait jumeau…”. “He WAS a twin? What happened to his brother?” I ask. She shakes her head and I see tears rolling down her cheeks. She doesn’t want to talk about it, but says she hopes her remaining son has more of a chance than the one who passed away. I hope he does too.

Later that morning, a woman approaches me saying she thinks she is pregnant. We give her a test and Pierre informs her that she is not. She seems relieved, revealing that the pregnancy would have been the product of a rape. I sit down with her to record the details of her rape in a medical certificate that she may use as she likes. I treat her empirically for common sexually transmitted infections and explain the importance of an HIV test. She nervously offers her finger for me to take a blood sample, and sits emotionless waiting for the results. After 20 minutes I am able to share the good news: that her test is negative, and she can consider herself HIV-free. A wide grin spreads across her face. Her joy is infectious. She starts jumping up and down and I can’t help but join her. She throws her arms around me and gives me a heartfelt hug.

We continue seeing patients, many of whom seem to be dealing with as much psychological pain as physical complaints. The stories of trauma bubble over unlike anything I have ever experienced. Seeing one patient for a simple skin infection leads to him telling the story of seeing his brother get shot in front of him in Libya. He said he knew it would be hard to make a life there, but used his savings to get to Libya to join his brother anyway – only to see him get shot and killed by men he couldn’t identify. He kept repeating to me: “I didn’t know them; I don’t know why they did it. I don’t know why they shot my brother”. I could treat his skin condition, but aside from giving him the space and time to talk, there was not much I could do for this grieving man.

The seas have been rough through the night and morning, but are getting worse and the boat rocks incessantly. Waves are as high as 2-3 metres. Our passengers are seasick. We are seasick. In our old shipping boat, it is over 40 degrees in the hospital, and there is no airflow. The need to stay hydrated pales in comparison with the need to have nothing in my stomach. My colleague Antonia, looks green, vomits over the side of the ship and admirably, somehow, returns to work. I have to keep leaving the room to get air to keep from getting sick myself. We are by no means working at maximum efficacy, but we have dealt with all the urgent cases, pre-natals, and children, and decide to do a round on all decks with anti-nausea medications before taking a break ourselves.

We take turns doing watch shifts in the evening so the sailors who have slept little and worked constantly throughout the last two days can finally get some rest. Most of us get to bed late. Early the next morning we arrive at the port in Sicily. The Red Cross tents are waiting for us, along with other NGO’s, Italian government officials and a medical team. The disembarkation of our passengers takes several hours and the atmosphere is a little impatient, a little nervous, but joyous. The women sing and play with their children. The passengers exchange contact information, joking and talking like they have known each other for years. Finally, our last passenger disembarks and we begin the task of cleaning the ship. We are tired, but happy. Every one of our 466 passengers has made it to shore alive.