It’s 10.30pm on board the Phoenix, the search and rescue vessel in the Mediterranean run jointly by @MOAS (Migrant Offshore Aid Station) and @MSF. I joined a few days ago, in a mid-sea midnight transfer. Before I go to bed, I go up on the darkened foredeck and remember how it looked yesterday, packed with people crammed together on their blankets after having been rescued. I wonder how and where they are now, what the future holds for them, these 415 people from 20 different countries, among them Syrians, Eritreans, Somalis and Iraqis? They disembarked this morning in Taranto, Italy, their hopes high, thinking the worst was over. But what problems still lie ahead of them as they seek refuge from their war-torn, repressive, or poverty-stricken countries?

I look out to sea, to that vast, dark expanse of water, and am glad of the full moon giving some light to it, and that for the moment the sea is calm. I am here on this strong, safe boat, but there are people out there, on this same stretch of water, travelling in fear of their lives in leaky, unseaworthy, wooden boats. Tomorrow, or maybe the day after, we will be back in the rescue zone between the Libyan coast and Sicily. Who knows what that day will hold for us all?

……………

The call has come in from the MRCC, the organisation in Rome that coordinates the rescues: we’re being directed to help two wooden boats with about 700 people on board. Our adrenalin starts pumping. What are we going to find? What sort of state will the refugees be in?

The MOAS crew—Igor, Antoine, Mimmo—lower the rescue boat (RHIB) into the water and set off with Simon Bryant, MSF’s Canadian doctor, to assess the situation. The rest of us, the small MSF team, stay on board the Phoenix to help prepare for the embarkation. I check the clinic to make sure everything is in order: the drugs, the oxygen concentrator, the monitors—we have no idea what we’ll need.

“Ali, Ali!” I hear someone call. I rush to the embarkation gate at the side of the boat, where Mimmo hands a tiny child up to me from the RHIB, his big brown eyes wide open in stunned amazement. (I later learn that at about the time I am holding this little boy in my arms, the world is being shocked by the photo of little Aylan Kurdi, drowned on a beach in Turkey.) The small boy is quickly followed by a seemingly endless stream of exhausted, bedraggled women and children. We welcome them on board: life-jackets off, hands filled with a rescue package containing water, nutritional biscuits, a protective onesie, towel and a pair of thick socks. Gabriel, our communications officer, checks everyone’s age and nationality. The RHIB goes back and forth to the leaky wooden vessel, bringing people back to the Phoenix. The lower deck quickly fills up; now we’re starting to place people on the upper deck.

Soon we have 332 people on board, nearly all Eritrean, 28 of them young children. They trickle into the clinic for medical attention: dehydration, general exhaustion, headaches, insulin for a diabetic who hasn’t had any for too long. They are escaping from a country with political repression and arbitrary arrests, of enforced national service that lasts a lifetime. To get onto that leaky boat on the shores of Libya, they have already travelled thousands of miles, and many of them will have suffered in detention centres in Libya as they wait for their last chance saloon, an unseaworthy boat in which they will risk their lives in the hopes of a better future. Why do they do it? Why would a father risk the lives of his wife and small children? “Because to remain is worse, it’s a living death or even death itself, ” was one reply.

Soon the decks are quiet, as everyone collapses onto a blanket; and, packed side by side, mothers curled round their children, with no spare inch, they sleep the sleep of total exhaustion.

The next morning the clinic is already busy by 6am, as people come in looking for relief from headaches, fever, sea-sickness, skin infections, respiratory tract infections, general aches and pains. We treat them all as best we can, and constantly walk between those crammed together on the deck to make sure there is no one who still needs attention.

One young girl stays in my mind. She is sixteen, and she is travelling alone. I will call her Miriam. She has a high fever due to pneumonia, but we can treat that with antibiotics. It’s not too severe. What is worse, what worries me more, is that she can hardly walk. She is limping, dragging her right leg. She speaks little English, but manages to convey to me where it hurts, and why: “I was beaten, here and here and here,” pointing to the back of her calf, her thigh, the bottom of her foot, “In Libya.” I am told that this happens in the detention centres, where smugglers are attempting to extort more money from these already poverty-stricken and oppressed people. I give Miriam some tablets for the pain; but I can do little for the pain in her mind. I hope that when she disembarks in Italy, and we hand the rescued people over to the authorities, that she will receive the care she needs and deserves.

The day goes past in a blur of consultations, of making up baby bottles and handing out nappies and dry clothes, of checking pregnant women, of treating people with sea-sickness as the sea gets rougher. I see Miriam again, and am glad to find her fever is down; but her leg is still painful. On the upper deck, our nurse MJ is helping the young men make a huge chequers board to keep them amused and occupied; on the lower deck, one of the journalists is playing games with the young children.

Another night and another morning. Italy is approaching. Soon, Will, our emergency coordinator, is giving a talk to the crowded group: explaining what happens on arrival, and some indications of what the process for them will be. The decks begin to buzz with excitement.

Then something happens that takes my breath away. A young woman, her head swathed in a bright pink scarf, stands up in the centre of a group and starts a rhythmic chanting as she sways and moves in time to the tune. She is joined by another woman, then another; soon the whole deck seems to be clapping and singing this repetitive tune. Their faces are wreathed with smiles; they are singing of hope, of relief, of joyful expectation. I can control the lump in my throat no longer, and tears pour down my cheeks.

Later, when everyone has safely disembarked, I go to the upper deck and stand in the stern, looking out to sea. And suddenly spot a small padlock, locked onto the protective netting. This is the deck where the refugees have been. One of them has put it there. Like the padlocks lovers lock onto bridges in Paris, it glistens there in the evening light as a symbol of hope, of hope that a new and better life is beginning.

Alison Criado-Perez is the medical team leader on board the MY Phoenix.

Competing interests: None declared.