Dr. Conor Kenny:

My name is Dr. Conor Kenny and I come from County Sligo. I have been qualified as a medical doctor for four years with interests mainly in general medicine. From February to May 2017, I was part of the Médecins Sans Frontières medical team on board the MV Aquarius, located in international waters, patrolling at 25 nautical miles from the coast of Libya. I served as the ship’s medical doctor, alongside a small medical team comprised of one midwife and two nurses. I will speak about my work and experience on this MSF assignment, detailing how we conduct rescues in the central Mediterranean, the medical care we provide and the recent developments and areas of concern.

We existed in a world of two extremes aboard the ship. My team and I would spend days at a time diligently watching the seas and running near-daily medical drills, ensuring that we were fully prepared for the next emergency rescue. Then, upon receiving instruction from the Italian maritime rescue co-ordination centre, MRCC, we would enter an intense 72-hour period involving rescue, provision of care and safe disembarkation. I would repeat this process many times during my three and a half month assignment in the central Mediterranean.

Images of my experience there can be found at the end of the document distributed.

Typically, as the ship’s medic, my initial role in a rescue was that of first response. That means that I would go with a rigid hull inflatable boat, RHIB, to the vessel in distress. Next to the boat in distress and from the RHIB, I would survey the scene and prioritise the people we rescue first, focusing on those who are seriously unwell, as well as children and women. Sadly, the sickest are usually the ones one cannot see, often lying on the floor of the overfilled boat. Retrieving these people from their boat may often be complicated because they may be panicked, for example, if their boat is sinking. This may lead to crush situations or even capsizing. Throughout this process I was in constant contact with the rest of the team aboard the MV Aquariuswhich allowed us to prepare the necessary medical response back on boat based on their health needs. This could include a mass casualty response or a multiple casualty response. From the point of rescue to disembarkation, we responded to whatever medical needs arose from emergency care to outpatient consultations. As one can imagine, demand was high and we got very little sleep over the usual 72-hour period between rescue and disembarkation. During this time in the MSF clinic, I treated wounds, broken bones were set, and we provided psychological first aid. Sometimes babies were born.

The majority of our rescued patients were suffering from hypothermia, dehydration and exhaustion when they reached us and often had been severely burned by the gasoline used to power these boats' engines. It is important to note that when the fuel powering the engines mixes with the seawater, it turns into a highly corrosive and hazardous substance. Many of those who ended up in my clinic had been forced to sit in this substance, often resulting in severe burns to their genitalia. Many had also swallowed and inhaled the toxic liquid mix into their lungs during a drowning process. One occasion that sticks in my mind is the attempt my team and I made to resuscitate an unconscious young women who had been brought on deck by staff on one of our RHIBs. As I approached her the toxic smell of the gasoline fumes emerged from the patient as I noticed that the skin on the right side of her face had dissolved in the fuel. Tragically, resuscitation attempts were unsuccessful and this young woman died. On closer examination this facial burn extended the length of her thorax to the bottom of her chest. Clearly she had been face down in the fuel lining the base of the rubber boat she was in. This is an horrific way to drown.

The other types of medical conditions we were faced with in the medical clinic include respiratory tract disease, gastrointestinal tract disease and trauma. The greater part of people on board the boat had been subject to, or had witnessed, physical, and in some cases sexual, violence while in Libya and presented with the marks and scars of those abuses. They often spoke to us about this abuse, which they had suffered at the hands of smugglers, armed groups and private individuals in Libya when they were on the boat. Here, many told us stories of how they were bought and sold on trade markets as a commodity, working in hellish conditions as labourers without payment. I have heard testimony from many patients who were duped into working in Libya, seemingly offered good jobs there where they would have the opportunity to send money to their families at home. However, in reality, Libya is not a functioning state. With three competing governments and virtually no rule of law, many people whose final destination was to be Libya and not Europe, are rounded up by the state security forces and other armed groups and forced into detention centres and asked to work off unreasonable sums for their freedom. Some are then forced onto boats and into the sea, while others view it as their only chance of escape from what they told us is a slavery-type situation and the violence they face if they stay in Libya.

One such story that sticks with me is that of three boys we rescued in April. Incredibly, once taken on board, two of the boys recognised a medical nurse on the ship who had treated them as small children in the Darfur region back in 2003. Fourteen years later they told us the harrowing story of how they had ended up in the Mediterranean Sea. Two of the boys, Samir and Abbas - which is not his real name - had at the age of 17 left the conflict in Darfur to seek out a better life working in the Libyan economy. They told us about how they had left Darfur with many others, travelling through Sudan and into Libya. Things began to go wrong when after a number of days on the road, their Libyan driver shot dead a fellow passenger following an argument. Furthermore, their driver was overheard making numerous phone calls, auctioning them and their fellow travellers to prospective buyers in Libya. After a number of hours they heard that they were to be sold for €70 each based on their physical attributes such as their height and muscle mass. After reaching Libya they were sold on to different owners many times in the coming months, enduring regular beatings and abuse at the hands of their captors. It was when they were auctioned for the third time that they met the third boy, Ahmed. After 50 days together and again facing severe abuse, the three boys, along with others, found an opportunity to escape from where they were being held. However, as they made their dash to freedom a neighbour of their captor spotted the attempted escape and fired at them as they fled, hitting Ahmed in the leg. Samir and Abbas, who had now evaded capture, reached a market in Tripoli. Adamant that they would not leave Ahmed behind, they found a Sudanese man who helped them by raising enough money within the Sudanese community in Tripoli to buy both the freedom of Ahmed, as well as their escape into the central Mediterranean.

There have been worrying recent developments at sea involving unsafe behaviour of those identified as the Libyan Coast Guard. On 23 May this year, my colleagues aboard theMV Aquariusreported that while we had a rescue operation under way a boat with men identifying themselves as Libyan Coast Guard approached one the boats in distress we were assisting, intimidating the passengers and firing their guns in the air. Armed and in uniform, members of the Libyan Coast Guard then proceeded to board one of the rubber boats. They took phones, money and other belongings from the passengers. They attached a line to one rubber dinghy and towed it back towards Libyan waters. The testimony of the survivors of this encounter paints a worrying picture. According to one of the people on board one of these boats:

When the Libyans pointed their weapons at us, asking us to give them all our money and cell phones and telling us to jump in the water, we did what they said and many of us jumped in. I was not afraid. I preferred to die at sea rather than being repressed and to die in Libya.

Fortunately many had already received their life jackets from the MSF rescue team before they jumped into the sea out of fear that the Libyan Coast Guard would again fire into the air. Our teams pulled 67 people from the water. The behaviour of the Libyan Coast Guard was reckless, if not directly threatening to the people on the boats, and it is a miracle no one drowned or was injured. We know that predominantly, those returned to Libya by the Libyan Coast Guard are taken to detention centres where they are held in inhumane conditions. The fact that the Libyan Coast Guard has been in receipt of training and support to build its capacity from the European Union makes the incident all the more disturbing and casts a shadow on the training provided by the European Union. While countries have a right to have a coast guard and to engage in their missions, we would flag this recent worrying incident that put people in great danger.

From my testimony as outlined this morning, it is clear to see why people are looking to flee Libya. They need help and safety regardless of where they come from or what took them to Libya in the first place. It appears to be a place of extreme danger with no rule of law. We must make every effort to make it clear. Ireland needs to know that returning people to Libya, within this context and in this way, is simply not an option. This humanitarian crisis will continue in the central Mediterranean. There needs to be some solution found, and NGOs and we in MSF are not it.