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Canadian Dr. Simon Bryant works with Médecins Sans Frontières aboard the M.Y. Phoenix in the Mediterranean.Jason Florio

For Canadian doctor Simon Bryant, the reality of the Mediterranean migrant crisis hit him during his first rescue in early May.

The search-and-rescue boat operated by Médecins Sans Frontières (MSF) and the European charity Migrant Offshore Aid Station (MOAS) found a 12-metre fishing boat that had pushed off from the Libyan coast with 369 people aboard. Drifting at sea, they were growing desperate.

"Afterwards, the people told me that they were bailing a bit of water. But they were starting to pray because they recognized they could not get back to land. They obviously weren't going to make it to Europe," said Dr. Bryant, of Canmore, Alta. "That was a bit of an eye-opener," the MSF doctor added. The boatload of mainly Eritrean migrants included 45 children – among them babies.

The six-month mission is MSF's first large-scale foray into running a rescue and medical clinic at sea – and offers a frontline view of the growing wave of boat migrants risking their lives at a time when the European Union is grappling with how to stem the flow of migrant boats and sea deaths. On Monday, the EU approved a naval mission involving warships to target human trafficking networks. The military operation comes as the migrant death toll, already nine times higher than at the same period last year, continues to climb.

The M.Y. Phoenix search-and-rescue vessel helped 692 migrants in the first 10 days since leaving Malta on May 2. That number is expected to rise to 10,000 by the time the mission ends in October.

That is a small fraction of the total migrants expected to cross the Mediterranean. Last year, more than 200,000 attempted the crossing, according to the United Nations refugee agency.

After a migrant boat capsized in April, killing more than 800 people on board, the EU said it would triple funding for its Triton program – which would mean more vessels and aircraft taking part.

The Phoenix operates close to Libyan territorial waters and co-ordinates its rescues with the Italian Maritime Rescue Co-ordination Centre to identify overcrowded and unsafe migrant boats.

"It's really important that rescues are conducted at that stage before boats have to spend more than a day out at sea," said MOAS spokesperson Chris Peregin.

Migrants are eventually transferred to the Italian coast guard or police and can apply for asylum and refugee status.

"What we want to do is give people a chance," Mr. Peregin said. "They might not be eligible for a certain kind of refugee status and might even be returned to their countries, but they don't deserve to drown."

Dr. Bryant's colleagues are not surprised by his latest mission. He has worked with Burmese refugees along the Thailand border. Outside of work, he runs motorcycle tours and participates in heli-skiing trips. As a younger man, he worked as a Canada World Youth team leader in Indonesia and Sri Lanka.

"He's a great soul. He's one of the good ones out there," said Dr. Chad Anker of the South Calgary Urgent Care Centre.

Speaking from the M.Y. Phoenix as it headed to an area just outside the territorial waters off Libya – its cam-copters, or unmanned surveillance drones, searching from above for migrant boats not in the Phoenix's immediate view – Dr. Bryant recounted some of the harrowing tales at sea.

The Phoenix deploys rigid inflatable boats that approach the stern of migrant vessels to avoid a sudden movement of passengers to one side of the vessel. Passengers are given life jackets, and women, children and ill or injured passengers are transferred to the rescue boat and then taken to the Phoenix nearby, Dr. Bryant explained.

But in one case, with the Phoenix at full capacity, rescue officials were instructed by the rescue co-ordination centre to transfer 104 people from a migrant dinghy to a commercial tanker in the middle of the night. Using the Phoenix's rigid inflatable boats, rescue officials ferried 10 to 15 passengers at a time to the tanker over one kilometre away, he recalled.

"Once they get to the tanker, the people have to climb up a five- to six-metre vertical kind of rope ladder … up the side of this oil tanker. … That was a very dangerous part of the operation," Dr. Bryant said.

The migrant boats themselves are bursting with passengers.

"These [migrant] ships can be so crowded that people literally aren't able to stand. They sort of crouch in each other's laps, and when we help them off they are often staggering from seasickness, from cramping of the muscles and just general disorientation," he said.

After being transferred to the Phoenix, migrants are given a rescue kit of water, food, a coverall and dry towel – and medical attention for hypothermia, chemical burns, severe skin infections, dehydration, broken bones and pregnancy complications.

While Dr. Bryant is no stranger to being a ship physician – he's worked on tourist expeditions in the Antarctic and Arctic – he says the patient population he sees in his on-board clinic is very different from Nunavut health clinics and Alberta emergency departments where he has worked in the past.

"The biggest adjustment I've had to make is to stay functioning while hearing the stories that people recount in the course of my caring for them," he said.

A young Somali migrant in his early 20s bore the scar of a bomb blast that struck him in the groin area. Another migrant told Dr. Bryant about being imprisoned in Libya, and regularly beaten, for being in the country illegally.

"They are simply people whose countries have been torn apart and they are fleeing for their lives, their dignity, their sanity – and doing the best they can," the doctor said.

The migrants' stories resonate all the more because of Dr. Bryant's own ship journey to Canada as a three-year-old travelling with his family from England.

"I've very glad that my parents were accepted, and we were accepted. There was a safe, legal channel for us to apply for immigration and we were able to do that," he said. "I think that's what's required here too – a safe, legal way for these people to apply for asylum in countries around the world and not have to risk their lives in this way."

Dr. Bryant knows there is a chance many boat migrants will be returned home.

"I hate to think that they're being sent back to situations where their lives or well-being would be at risk. I just don't know, that's out of my control," he said. "There are a lot of things about this situation that eat at me – that's one of them."