In 2014, 57.3 million people around the world were forced to flee their homes by armed conflict, generalised violence and natural disasters. Some 14.4 million refugees fled to another country. Since January 2015, 841,627 migrants, including refugees, are reported to have arrived to Europe by sea. There have been over 40,000 fatalities since 2000, and some 3,500 are dead or remain missing in the Mediterranean alone. According to the International Organisation for Migration, “Approximately 3,900 are known to have died around the world in the first eight months of 2015. Many more are unaccounted for.”

This is what organisations like MSF are up against and, by the sounds of it, they are fighting a losing battle. It was difficult to reach Gil – or anyone on the team, for that matter.

“We had a medical evacuation very early this morning and it took a long time. The team is very tired,” communications officer, Marta Soszynska, told me apologetically, the day before the interview.

Their battle, it seems, just got harder. And yet, not for the reasons one might immediately think. Following the Paris attacks, there has been an outpouring of defences of assistance to migrants, refugees and asylum seekers in media outlets the world over.

“Nobody denies that this year’s wave of migration is overwhelming some EU countries, and that solidarity among them is crumbling. But the truth is that the European economy badly needs the young people pouring across its frontiers from the greater Middle East and Africa,” Giles Merritt, Secretary General of Friends of Europe, recently said. The Niskan Centre issued an impassioned response to US backlash against Syrian refugees, pointing out that the mysterious Paris perpetrator who (maybe) held a fake Syrian passport, was not a refugee. Columns, op-eds and analysis pieces in some of the world’s most respected media have defended the opening of borders, and the continued backing of sea rescues. But it is, of course, not as simple as that.

The UN fell short of the $8.4 billion it needed to support Syria’s refugees alone by more than $4.6 billion, and although arguments have been made that new blood coming in can contribute to host countries’ economies, this will not always occur immediately. According to Factcheck.org, good news for fear mongers is that the majority of refugees are not “young males”; nearly 40% are, in fact, children 11 years old and younger. Contribute economically they may, but not before they have been assisted and educated.

Then there is also the administrative quagmire. In terms of definition, the three common terms are close, but different. Migrants are those seeking a better future somewhere other than their home country; refugees are those who have fled because of a well-founded fear of persecution due to their race, religion, nationality, or membership of a particular social group (refugee status is assessed by the United Nations High Commission for Refugees or a sympathetic state), and asylum seekers are those who say they are refugees, but have not yet been formally granted such status. Those with a conservative approach are more prone to lumping the three together, alongside illegal immigrants and terrorists too. Those with a more liberal view tend to focus more exclusively on the plight of refugees. The truth, however, is that one can only differentiate between individuals.

Médecins Sans Frontières (MSF) is but one of the bodies assisting such persons, and an increased threat of terror is but one of the complications they face.

“Every day thousands of vulnerable people fleeing war and violence are forced to cross the sea and the Balkans in search of safety in Europe – that one of the perpetrators of the Paris attacks may have crossed through the same route does not change anything to their need for assistance and protection. We are extremely worried that potential closure of borders or hostility linked to this event will lead to further deterioration of the refugees’ health and dignity. If stricter security measures are to be put in place, humanitarian assistance and protection will have to be scaled up significantly to avoid the worsening of an already quite critical situation,” MSF spokesperson, Angela Makamure, told Daily Maverick.

“As a medical humanitarian organisation, MSF’s role is to provide assistance to people in conflict zones and everywhere medical and humanitarian assistance is needed. In our projects in the Greek islands, on the route of the Balkans and elsewhere, we meet thousands of people escaping war and violence. These people are then forced to risk their lives in traumatic journeys into Europe, a harrowing experience that has direct consequences for their health and dignity.”

Makamure said that following the Paris attacks – or any others of their kind – nothing would change. “MSF will continue to care for vulnerable people in need and reiterates its call for safe and legal passage for those fleeing, who are the first victims of this indiscriminate violence and its terrible consequences.”

That said, increased security had not been making life any easier even before the attacks, Gil told Daily Maverick. “Once [people] disembark [from a rescue boat], normally a medical screening is done. First we see to the pregnant women, and after that all the other people, who are then taken to a reception centre where everyone is assisted first with food and then with legal assistance,” he said.

“This is the theory. What happens, though, is that these centres are absolutely overloaded. They don’t have the capacity to provide this quality of service. Financial resources have been increased by the European Union (EU) to these places. They are trying to build what is called hot spots, or special centres to identify smugglers. There is more in-depth registration, and they have earned the right to expel people immediately from the country. We would like to know how efficient these systems are. We are afraid that this would really affect the operation. We assist people from Eritrea, Libya, Syria. We are very concerned that they might be forced back into forced labour, physical violence or prostitution. So to see that they would be forced back – it would be disastrous.”

A typical day, Gil says, involves waiting somewhere in the Mediterranean for a distress call. “When we hear that a boat is in danger, we approach the boat and take our small team. We explain who we are and what we are going to do. We take a life jacket, which is very important, as most of the time people don’t know how to swim and are often in a panic. We bring all of the people into our big boat, which has the capacity for three hundred or four hundred people. We do several rescues – those small rubber boats which carry around 120 people are absolutely packed.”

In May, the Bourbon Argos was launched, which has 26 people on board (14 are MSF staff). There’s also an experienced search and rescue team as well as MSF specialists, water and sanitation experts and logisticians. The Argos has the capacity to carry up to 700 rescued people to land. On 13 June, another ship was launched, namely, Dignity I. The ship has a crew of 18 people, which includes medical staff. The 50 metre-long vessel has the capacity to carry 300 people to land.

Compared to the beginning of the year, there are more boats allocated, thanks in no small part to the EU allocating more boats to rescue operations. However, says Gil, the critical issue for MSF in this respect is one of “quality, not quantity”. “We are not a military operation. We prefer the humanitarian approach,” he says. “This implies treating the people like human beings at all times. We are prepared to do rescue operations, not with military boats. We are taking into consideration that these people need medical care and basics, like water and food. So on one side, the quantity of resources has increased, but in terms of the quality we don’t see a big difference.”

The MSF team’s worst day at sea, Gil says, was when they were called to two boats in distress at the same time. “A boat capsized when we were on our way to a rescue. Less than four hundred people were rescued. We were called in the middle of another rescue, but we continued to the first. When we arrived there, the boat had already capsized. It was a boat that normally carried around 700 people. We managed to rescue some people who were floating in the sea. That was very hard; the most difficult situation.”

That stress, however, is replayed daily on a smaller scale, he adds. “Until everyone is on board we are really tense,” he says. “We cannot afford even a small mistake. If we do, we are talking about people facing violence, women facing sexual violence.”

So what, then, would he say to critics who say the rescue operations are creating an open door or encouraging a greater influx?

“I would say they are not examining their data. Now, with greater resources allocated, there are the same number of people coming in or maybe even a little bit less. People who continue crossing the sea do not really pay attention how many resources are dedicated to rescue operations.

“What we are working on is a bigger problem; the potential to expel all these people looking for a future. What we need is resources, not only quantity, but in quality. We need people who are prepared to enrich; to approach the issue from a humanitarian perspective and treat every person like a human being – with dignity and respect.

“This is what we would like to see in the sea, and how we want to approach it the response of the authorities everywhere.” DM

Read more:

• People not numbers: message from MSF
• 1600 rescues: MSF’s busiest day 

Photo: A migrant child smiles as he waits to be transferred from the Migrant Offshore Aid Station (MOAS) ship MV Phoenix to the Norwegian ship Siem Pilot off the coast of Libya August 6, 2015. An estimated 600 migrants on an overloaded wooden boat were rescued 10.5 miles (16 kilometres) off the coast of Libya by the international non-governmental organisations Medecins san Frontiere (MSF) and MOAS without loss of life on Thursday afternoon, according to MSF and MOAS, a day after more than 200 migrants are feared to have drowned in the latest Mediterranean boat tragedy after rescuers saved over 370 people from a capsized boat thought to be carrying 600. Photo taken August 6, 2015. REUTERS/Darrin Zammit Lupi