Last Wednesday, Simon Bryant, a Canadian physician with the humanitarian group Médecins sans frontières (Doctors Without Borders), boarded a large wooden boat that was taking on water off the coast of Libya. The aptly named Poseidon was carrying more than 500 people fleeing the war-ravaged nation, including 52 who were found dead.
The deceased, most of whom were half-submerged in the bilge water below deck, likely succumbed to carbon monoxide poisoning from the engine exhaust. They served as human ballast.
"On an MSF mission, you see a bit of everything in terms of health problems, but going on-board looking for survivors among the dead is a special bit of hell," Dr. Bryant said in an interview from Valleta, Malta. "It was a stark reminder of the danger and suffering that these refugees routinely endure." While the now-iconic photo of the body of three-year-old Alan Kurdi was a graphic reminder that thousands of migrants drown, there are many other health risks they face on their perilous journeys, and lingering effects that can last a lifetime.
Before even boarding a boat, migrants have to escape war-torn countries over land. When they arrive at a departure point – dehydrated, hungry and having paid with their life savings – migrants have to deal with ruthless smugglers. They are hidden in cramped quarters and can be beaten and sexually assaulted. Lice and scabies flourish in these insalubrious surroundings and respiratory illnesses spread quickly.
Conditions at sea are as bad, if not worse. Boats are invariably overcrowded and rickety. The seas can be rough and the risk of capsizing – and drowning – ever-present.
In addition to carbon monoxide from the engine, oil and gasoline in bilge water can cause serious burns and loss of skin. Crushing injuries like broken bones are common; so too are seasickness, sun stroke and dehydration from lack of drinking water, and delirium from lack of sleep.
"The physical injuries are easy to see," Dr. Bryant said. "The psychological effects are just as real, but a lot more invisible."
He works aboard the Phoenix, a Doctors Without Borders rescue boat that has a small medical clinic where they can patch people up before they are transferred to a facility at their point of arrival. Those who are seriously ill are airlifted to European hospitals.
Dr. Bryant said that while many migrants are physically strong at the outset, their journeys are physically punishing. They also bring their underlying health conditions with them, such as a woman with kidney disease who went from twice-weekly dialysis in Tripoli to no care for several weeks. "People risk their lives for a better life," he said.
Once migrants arrive in countries like Germany and Italy – and eventually onward to Canada – they often carry the scars, physical and psychological, of their traumatic experiences.
"We see a lot of PTSD [post-traumatic stress disorder] because of what people have endured: persecution, sexual violence, war and so on," said Ritika Goel, a Toronto family physician and member of the grassroots group Health For All.
The refugee claims process is also quite stressful. Claimants, often penniless when they arrive, have to wait at least three months before they obtain a work permit and receive only minimal social assistance. Many, depending on their status, can also be denied access to health services, after changes to the rules in 2012. Currently, Canada has about 28,000 refugee claims a year, a mix of those who are approved as refugees at Canadian embassies overseas, those who arrive at the border and make a claim, temporary foreign workers who do not want to return to their home countries and other undocumented persons.
With growing calls for Canada accept more refugees, especially those fleeing Syria, some wonder if the health system can absorb an influx.
Dr. Goel has no doubt it can. "The system can handle what we want the system to handle. It's about political will."
She noted that refugees tend to be young and healthy – the "people strong enough to survive the ordeal of getting here."
She said it is heartbreaking to hear her patients "tell of the hell they went through to get here and, at the end of the day, their greatest obstacles to thriving are Canadian bureaucracy and politics."
Dr. Bryant has similar views, saying it is frustrating that Western countries are not doing more to alleviate the crisis. "There are 60 million displaced people in the world. It's past time for a concerted effort."
War and mass migration have left the world teetering. Ballast is needed – but in the form of compassion, not in the form of more dead migrants.