On the back deck of the Geo Barents rescue vessel, a circle of 11 Bangladeshi males was assembled. They had been amongst the 73 individuals pulled from two diminutive boats in the Mediterranean Sea the day prior, and soon they would be in the hands of the Italian authorities. Albeit, at present they were enlisted in a group conversation.
A medical professional belonging to Médecins Sans Frontières (MSF), the charitable organization in charge of the ship, initiated a discourse around ‘mental health’. The response from one Bangladeshi man, who volunteered to translate, was “Feeling positive, a joyous peak of wellbeing”. His words were met with a collective agreement from the group.
Probing further, the medic inquired about how they reacted when faced with sorrow. The unanimous sentiment reflected their current situation – life aboard was pleasant.
After some time, an additional group was brought in for a similar dialogue, again all males from Bangladesh. This time a “cultural mediator” was present, their role being to assist with exchanges and definitions.
Because of the language barrier and unfamiliarity with mental health concepts, getting in-depth information was challenging. However, when explored with a more relatable approach like, having overwhelming thoughts, inability to sleep, preoccupation with their homeland or family without knowing how to control it – one man admitted of such worries.
The translation of his experience was that his entire village had been decimated and deserted. When asked about his coping mechanism, the translator responded “His journey led him here”. The statement was followed by a silent nod and smiles of agreement from all.
Around 30,300 lives have been lost or people have disappeared in the Mediterranean Sea since 2014. The stretch between Libya or Tunisia, and Italy or Malta in the central Mediterranean, is considered one of the most perilous migratory passageways globally.
Individuals escaping from wars, oppressive regimes, environmental changes and extreme poverty are often treated as pawns in political agendas by European leaders. Meanwhile, claims are made that non-European autocratic leaders view these individuals as a means to secure foreign aid and enable human rights violations to be ignored. Throughout all this, the health and safety of the individuals undertaking these perilous escapes are continually compromised.
From January to early September 2024, over 41,000 individuals made the risky journey by sea, reaching Italy. The bulk of these arrivals were from Bangladesh, Syria and Tunisia. The International Organisation for Migration reports that another 1,116 lost their lives or disappeared while attempting this journey within the same year.
Only a small fraction, around 8 per cent of these arrivals in Italy, were saved by civilian rescue vessels, as per the Associated Press. Many of these rescuers, however, feel compelled to offer a range of services including medical aid, legal counseling and additional support.
Interactions on the Geo Barents underline the complexities of providing mental health services when there’s unpredictability in the identity, origin in Asia, Africa or the Middle East, or retention time with the rescued individuals, contingent on the “place of safety” allocated by Italian officials. The rescued could be survivors of torture, eye-witnesses of heinous acts, coerced to consume drugs or engage in combat; might have experienced the loss of dear ones, were detained for significant durations or deprived of health services, or sexually violated. Their ordeal may not end upon reaching Europe.
Amandine Branders, a practicing psychologist, discussed that Doctors Without Borders (MSF) are reassessing their mental health framework for the individuals onboard, which can sometimes exceed 200. They have established a triage process to aid individuals who either seek assistance or those identified with severe mental conditions. This includes individuals whose suffering has prevented normal functioning such as eating, sleeping, or personal hygiene, as well as those who pose a direct risk to themselves or others.
She suggested that individuals with intense histories may qualify for a referral to receive psychological support and aid in Italy. They also have the option to acquire “mental health certificates” if they’ve undergone individual treatment. This could be particularly beneficial upon arrival in Italy as it will lessen the repetition of traumatic episodes, consequently reducing the chances of enduring long-term effects from such trauma. According to her, the certificate might note that for trauma sufferers, memory and recall confusion or a lack of coherence is a typical occurrence.
MSF has been working on expanding group support on the ship, including training for “psychological first aid” to enable individuals to identify crisis situations in themselves and others after arriving in Europe, said Branders. This initiative was temporarily halted when the Geo Barents was impounded by Italian authorities, accused of breaching maritime safety rules- an allegation MSF refuted. The ship was freed again on September 11th, following a legal challenge.
Many rescued individuals aboard the ship find the notion of mental health completely unfamiliar, Branders stated, although the level of familiarity varies according to their origins. “People hailing from Syria, for instance, are familiar with what a psychologist does, despite the lingering stigma… On the other hand, those from Bangladesh, seem to have no clue,” she added.
MSF has been aiming to make their care more culturally tailored, Branders mentioned, including identifying distinct “health-seeking behaviours” across societies and the unique ways respective birth countries tackle these issues. She cited religion as a significant factor for some.
Branders noted that there’s an initial wave of euphoria that rescued individuals experience after ending their perilous journey, this occurs even while they’re in a “survival state”, a time when the potential for psychological destabilisation is less pronounced. However, psychological issues tend to surface upon establishing stability in Europe – procuring legal documentation, securing housing. “This is the moment when the body acknowledges stability and prepares to confront the past experiences,” she explained.
“Typically, at this point, they find themselves in absolute solitude, extremely isolated, and they might not be able to access any help,” says Branders. It’s usually during these moments when their mental well-being escalates to a level that poses “serious danger to their lives and those around them”.
They may start to experience a range of symptoms including feeling detached and disconnected, experiencing confusion in their daily actions, amnesia or loss of determination. Some aspects of the asylum procedure can also cause these reactions, such as dealing with people who are in positions of power or the anxiety brought on by locked doors during private, in-room interviews.
According to Branders, encountering violence or mistreatment in Europe is especially damaging for recent immigrants. Their hearts are filled with anticipation as they come here. The prospect of a land that values human life is what they are hopeful to find here, in Europe. In their minds, Europeans were believed to be the beacon of light. This experience, sadly, only serves to diminish their remaining hope in the world.