Rodolfo Saracci: The public health community must speak out on rising rates of migrants dying at sea

Migrants continue to drown in the Mediterranean sea attempting to reach Europe. [1] On 20 August, Italy’s far-right interior minister, Matteo Salvini, refused authorisation for a group of 177 refugees and migrants to disembark from an Italian coast guard ship docked in Catania. He said that they would not be allowed to disembark “until Europe steps in to help.” Although the stand-off has been resolved, this is the third time that a ship has been prevented from landing migrants in an Italian port, due to interventions from the Italian government. Subsequently Salvini has been formally placed under investigation for possible illegal detention and kidnapping [2]

The number of asylum seekers that the European Union (EU) receives has decreased from a peak of about 1,323,000 in the year 2015 to nearly 705,000 in 2017. [3] Numbers have also sharply decreased on the highly perilous Central Mediterranean route, which leads to Malta and Italy [4]. The number of migrants reaching Italy has decreased by almost 30% from the yearly average of 169,000 in 2014-2016, to nearly 120,000 in 2017, totally invalidating the claims of an ongoing “uncontrolled invasion.” [5]

While the number of migrants has gone down sharply, the risk of dying at sea has gone up markedly. The death rates, from any cause, during the crossing have been increasing steadily, from 1.85 % in 2014 and 2015 to 2.34% in 2017, and to a high of 5.86% in the first seven months of this year [4]. There are several possible explanation for this, including an increased detection of lost boats and dead bodies in recent times, due to improved surveillance. However, this would also increase the opportunities for rescuing people, thus decreasing the number of deaths. Whatever the explanation, these findings imply that the existing safety-net system is inadequate in preventing deaths at sea—an obvious public health problem that will only be aggravated by the policy of denying access to ports to NGO’s salvage ships as advocated by Salvini.

The European Council concluded on 28 June 2018 that: “…EU policy relies on a comprehensive approach to migration which combines more effective control of the EU’s external borders, increased external action and internal aspects, in line with our principles and values.” [6] Yet it would seem that these principles and values are not sufficient to make governments pay attention to the high (and increasing) death rates of migrants trying to get to Europe. The whole document only makes a passing reference to “tragic loss of life” as a result of human-traffickers and smugglers transporting migrants across the sea in inadequate boats. Reluctantly, one is forced to conclude that the deaths of migrants are regarded as the “collateral damage” of Europe’s priority of defending EU borders against unarmed people seeking safety, including children.

As a result Daniel Cohn-Bendit, a former member of the EU parliament stated recently that “Europe has no strategy on the migrants’ question.” [7]  As we wait and hope for as yet undefinable global solutions, it must be reasserted that whatever these might turn out to beprotecting the life and health of migrants must be the first priority in all circumstances.   

That this is attainable is shown both by the lower rate of death at sea (1.85%) in the years 2014 and 2015 and, especially, by a low rate of 0.9% in the period January-April 2015, when the issue of saving lives “was briefly a priority” for the EU, and better means of naval and aerial rescue were deployed. [8] To argue that ensuring migrants’ safety encourages more people to take the journey and therefore should deliberately not be pursued (e.g. by preventing harbor access to NGO rescue ships) violates both international maritime law and basic human rights to life and health.    

In June 2016, the International Red Cross and Red Crescent Movement made a forthright plea for the safety and dignity of migrants worldwide. [9] Two years and several thousand migrant deaths later it is high time for leaders and professionals in public health and medicine to speak up and specifically address the European migrant issue, particularly the rate of deaths at sea. First and foremost this is a public health problem. International and national scientific and professional organizations, particularly those in the field of public and population health, should join in a statement to the EU Commission, parliament, and member states stressing European governments’  direct responsibility to ensurewhatever their  policy on migrantsthat an adequate number of naval and aerial assets, including those of qualified NGOs with search and rescue tasks, are available along the routes taken by migrants boats as long as departures continue. A similar recommendation appears in a recently published Amnesty International document [10].

As James Orbinski, former president of “Médecins sans Frontières, noted, “We are not sure that words can always save lives, but we know that silence can certainly kill “[11].

Rodolfo Saracci is a former president of the International Epidemiological Association. He has been chief of the unit of analytical epidemiology and later senior visiting scientist at the WHO International Agency for Research on Cancer, in Lyon, France. He is the author of the book “Epidemiology—A Very Short Introduction.”

Conflict of interest: none to declare


[1] UNHCR. The Refugee Brief-2 July. At : http:// , accessed 2 July , 2018.

[2] https://www.the

[3] Eurostat. Asylum Statistics. At : , accessed 2 July 2018.

[4]  Elaboration of figures published periodically by the International Organization of Migration. At : , last accessed 6 August 2018.

[5] Sampino A. Migranti al centro del dibattito politico. Il Giornale di Sicilia , 18/01/2018.

[6] European Council conclusions 28 June 2018. At : /2018/06/29/201806.28-euco-conclusions-final, accessed 29 June 2018.  

[7] Cohn-Bendit D. L’Europe n’a pas de strategie sur la question des migrants. Le Monde , 15/8/2018.

[8] Amnesty International. A perfect storm- The failure of European policies in the central Mediterranean. At :, accessed 2 July 2018.

[9] Dallaire Farland R. Red Cross Red Crescent leaders ask governments to review migration policies. At :, accessed 20 June 2018.  

[10] Amnesty International. Between the devil and the deep blue sea. At :, accessed 14 August 2018.

[11] Orbinski J. Médecines sans Frontières Nobel lecture, 1999 . At :, accessed 2 July 2018.