A group of 11 Bangladeshi men were sitting in a circle on the back deck of the Geo Barents rescue ship. One day earlier, they had been among 73 people rescued from two small boats in the Mediterranean Sea. Soon, they would be handed over to Italian authorities, but for now they were participating in a focus group.
“What do you think when you hear ‘mental health’?” asked a medic from Médecins Sans Frontières (MSF), the medical charity operating the rescue ship.
“Feeling good, feeling excellent,” responded the Bangladeshi man who had volunteered to act as an interpreter. He smiled widely, and the others nodded.
“What do you do when you’re sad?” asked the medic again.
“Here things are nice,” came the answer.
A while later, MSF staff tried to ask questions again to a new group, also from Bangladesh. This time, they had a “cultural mediator” with them, another crew member whose job was to help with communication and explanations.
“Do you know what is a psychologist? A doctor of the mind?” one asked the group.
“Yes?” responded one young man.
“Are you familiar with it?” she questioned again.
“No.” He shook his head.
“Would you be interested in knowing more?”
He looked confused.
The cultural mediator tried another tactic to explain mental health problems. “You have a lot of thoughts, you don’t sleep, you think about Libya or your family and you don’t know how to stop,” she said.
A discussion in Bengali ensued, before one man volunteered that he had experienced some worries.
“His village was washed away, his whole village emptied,” translated the Bangladeshi English-speaker.
“And what does he do to stay strong?” the medic asked.
“He came here,” said the translator, and all the Bangladeshis nodded and smiled.
More than 30,300 people have died or gone missing in the Mediterranean Sea since 2014, with the central Mediterranean – between Libya or Tunisia and Italy or Malta – recognised as one of the deadliest migration routes in the world.
Refugees and migrants fleeing a host of crises – including wars, dictatorships, climate change and crushing poverty – continue to be used as a political football by European politicians, while authoritarian leaders outside of Europe are accused of seeing them as a way to secure aid and have human rights abuses overlooked. Meanwhile, the wellbeing of those making these dangerous journeys suffers.
Between January and the beginning of September 2024, more than 41,000 people arrived in Italy by sea, with Bangladeshis, Syrians and Tunisians making up the top three nationalities. At least 1,116 more people died or went missing attempting the same journey this year, according to the International Organisation for Migration.
Only about 8 per cent of those arriving in Italy are rescued by civil rescue ships, according to the Associated Press, but many of the crews on those ships feel a responsibility to provide a level of medical care, legal advice and other supports.
The conversations on board the Geo Barents highlighted the challenges that come with providing mental healthcare when crews can’t predict who they might rescue, and where they might come from in Asia, the Middle East or Africa. The crew don’t know how long they will spend with those on board, as this depends on which “place of safety” Italian authorities assign them.
Among those rescued can be torture survivors and people who have witnessed other horrific acts or tragedies. Some have been forced to take drugs or fight; lost close friends or family members; were detained for long periods; left without healthcare; or were sexually abused. Their suffering may be far from over, even after they reach Europe.
Amandine Branders, a clinical psychologist, said MSF was reviewing its mental health strategy for those on board – the number can sometimes reach 200 or higher at a time.
They have a triage system to provide help for either those who ask for it or for people they identify with severe mental disorders. The most serious cases include those with “such a high level of suffering that are not able any more to function, to eat properly, to sleep properly, to shower themselves”, and people who are an immediate danger to themselves or others.
A referral can be given to those who have very intense pasts, she said, so they can access help and psychological assistance in Italy. They also offer “mental health certificates” to people who receive individual care, which might be useful once they arrive in Italy, potentially lessening the need to constantly repeat stories about what they have gone through, which can heighten the risk of long-term effects from trauma.
The certificate might point out that confusion in terms of recall and memory, or a lack of coherence, is normal among those who have been through traumas, she said.
MSF has also been trying to develop group care on the ship, Branders explained, including “psychological first aid” training so that people can recognise crisis situations in themselves and those around them, after they reach Europe.
Those efforts were temporarily put on hold when the Geo Barents was detained by Italian authorities for 60 days in late August, accused of violating maritime safety regulations – allegations that MSF denied. The ship was released again on September 11th, following a legal challenge.
For many rescued people who come on board, Branders said, mental health can feel like “a concept that is totally new for them”, though this differs depending on where people are from.
“People coming from Syria, they know what a psychologist is [even though] there is still a lot of stigma around it… But, like you saw, people from Bangladesh, they have no idea.”
[ Sally Hayden: A Syrian writer's journey to EuropeOpens in new window ]
She said MSF was trying to make care more culturally appropriate. This includes identifying the “health-seeking behaviours” in different communities and the ways problems are addressed in their birth countries. “For example… religion might be very important.”
When people are rescued at sea, after months or years of dangerous journeys, there can be an initial euphoria, Branders said. Even before that, when they are in “survival state,” Branders explained, there is “less space for the psychological decompensation to happen.”
Psychological difficulties often occur once they reach a stable situation in Europe – receiving legal documentation, getting a place to live. “This is the moment that the body received the message of ‘Okay, I’m stable enough, and I’m going to open the box and see what happened’,” she said.
“Usually, at that moment, they are totally alone, super-isolated, and [sometimes] they cannot receive any support.” This is often the time when their mental state becomes “really risky for their life and for others”, Branders said.
Among other symptoms, they can dissociate and disconnect, getting confused about what they are doing, losing memories or motivation. They can also be triggered by parts of the asylum process, including by being in rooms with authority figures or having doors shut behind them during closed-room interviews.
Branders said experiencing violence or abuse in Europe can be particularly devastating for new arrivals because “they come here with so much expectation… They have this hope that there is humanity and humanity is what I’m going to find in Europe… [They think Europeans] were supposed to be the good guys… It confirms, somehow, the lack of hope in the world.”
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