Dr Conor Kenny (32) from Rosses Point in Sligo with one of the rescued children

My alarm clock didn't get a chance to go off on Good Friday. The sound of quick, urgent footsteps on the narrow corridor outside my cabin wakes me up instead.

I'm out on deck a few minutes later - trying to negotiate the loose strap ends of a life jacket as a thin line of diaphanous dawn rises over the deceptively tranquil sea.

It's 5.10am; we're roughly 25 nautical miles from the Mediterranean coast of Libya and a rescue is imminent.

The rubber boat that has been spotted by the ship's captain soon comes into view, first as a dot and then as a discernible vessel. At least one hundred people are on board, sitting cheek to jowl, their legs dangling over the side.

I'm on board the Aquarius, a sturdy 77-metre-long former fishery protection vessel. It's one of a number of ships rescuing migrants who attempt to cross the Mediterranean through one of the last remaining openings in Europe's closed borders.

An 'unacceptable mortality rate'

The Aquarius is chartered by two humanitarian organisations - SOS Méditerranée and Médecins Sans Frontières (MSF). The groups work in tandem: the former performing the rescues and the latter delivering emergency medical care.

MSF launched its search and rescue (SAR) operations in April 2015 in response to "an unacceptable mortality rate at sea". At the time, Europe had wound down its Mare Nostrum SAR operation and the organisation believed that Europe was prepared to allow many fleeing war, persecution and poverty to drown at sea. The UN Migration Agency reports that over 43,000 migrants, including refugees, have entered Europe by sea this year. By April 23, 1,089 verified deaths were recorded.

There are four MSF medics on board the Aquarius - two nurses, a midwife and Dr Conor Kenny, a mild-mannered, 32-year-old doctor from Rosses Point in Sligo, who is waiting pensively on deck as the first RHIB (essentially an inflatable speed boat) is lowered into the water.

Rescues follow strict protocols. The SOS team first approaches the rubber boat to assess the situation while a cultural mediator delivers instructions to the people on board in French, Arabic and English. Next, initial observations are relayed to the crew on the Aquarius via two-way radio:

Expand Close Helping hand: Katie Byrne hands out supplies to migrants on board MSF Aquarius / Facebook

Twitter

Email

Whatsapp Helping hand: Katie Byrne hands out supplies to migrants on board MSF Aquarius

The women are squeezed - really upset and screaming - over

Unconscious person, still breathing, at the bow

Unconscious person, not breathing

Minutes later, an unresponsive African man is lifted on to the boat and the medical team starts CPR. Adrenalin is delivered; chest compressions are performed - 26-27-28-29-30 - but he cannot be resuscitated. The sun is starting to rise when he is pronounced dead. We never find out the man's name - he was travelling alone.

Just the night before, Conor had been discussing the last cardiac arrest situation on the ship. "She was a young lady in her twenties - who may even have been pregnant," he said.

The young woman had severe fuel burns, which she sustained on the rubber boat. These chemical burns occur when gasoline mixes with seawater and then comes in contact with human skin. People sitting in the bottom of the boat are most likely to get them, as the canisters often get knocked over or dumped overboard if the boat is capsizing.

Expand Close A young migrant shows her appreciation for the team on board MSF Aquarius / Facebook

Twitter

Email

Whatsapp A young migrant shows her appreciation for the team on board MSF Aquarius

A PALPABLE RELIEF

"If you have half or three-quarters of your team caught up in cardiac arrest and many others expected, your decision-making changes," he explained. "You have to make big calls and either decide to stay or move on, based on the overall context."

Sure enough, as the young man's body is covered in a blanket and carried off the deck, the rest of the crew continue their work, helping migrants aboard and passing out drawstring bags containing a tracksuit, T-shirt, socks, blanket, hat, hand towel, water and high-energy food.

The migrants' relief is palpable when they are eventually brought to safety. Some of them burst into tears. Some of them drop to their knees in thanksgiving.

The medic responsible for greeting the migrants uses the opportunity to perform triage and smell their clothing for gasoline. Some instinctively cower and raise their hands in the air.

"You are very welcome," says one of the nurses as the migrants, many of them barefooted, walk in single file towards the back of the ship. "You are safe now."

During this operation, we rescue a total of 515 people from four rubber boats and one wooden one - 397 men and 118 women, 21 of them pregnant. The vast majority are West African - Nigerian, Gambian, Senegalese.

Twenty-five of them are from Bangladesh; four from Morocco. It's a cross-section of culture, yet their experiences in Libya are almost identical. The Bangladeshis, for the most part, were lured to Libya on the promise of lucrative jobs. On arrival in Tripoli, they were detained by militias, their money, mobile phones and jewellery was taken and they were ordered to call their families for a ransom fee of €400.

The Africans were afraid to walk on the streets of Tripoli for fear of being kidnapped by 'Asma Boys' - gangs of young armed robbers - and sold by their captors in slave markets.

'THE BACK WAY' FROM GAMBIA

"If they see you on the street, you are money. They kill a lot of blacks," says Kebba, a 19-year-old from Gambia.

His 21-year-old brother, Malik, adds: "Sometimes, when you reach Tripoli, they come to the vehicle and collect the passengers and some of them give you a fake story. 'I am going to lodge you where I am'.

"They'll take you there, and there they will make contact with their Arab friends and say, 'I have the blacks which I want to sell'. Then he will take you to his friends and lock you up - it's like a jail."

Kebba and Malik embarked on what is known as 'The Back Way' - the 3,000-mile journey from Gambia to Europe via the Sahara - when Gambian president and dictator Yahya Jammeh indicated that he wouldn't be stepping down. They set off on the journey as a group of 25. Only four of them made it through the desert.

A designated area for women and children is positioned at the other end of the ship, run by a sprightly 69-year-old American midwife, Elizabeth Ramlow, who has been working with MSF for the last 10 years.

Elizabeth explains that she has just performed a number of pregnancy tests. Some of the women were happy with the news. Some are them were not.

Many of the migrants on this boat - both male and female - are victims of gender- and sexual-based violence, and their stories are harrowing.

Hope, a 33-year-old woman from Nigeria, was illegally detained with 30 other Africans and repeatedly raped by Asma Boys. When the women she was detained with became pregnant, their captors demanded oral sex instead. One of them was beaten to death. "They don't like blacks," she says. "They treat us like we are slaves."

ACCUSATIONS OF COLLUSION

Jojo, a 21-year-old Gambian man, says the boat smugglers carry AK47s - and shoot at the ankles of migrants who don't follow orders as they are directed on to the boats.

This was Jojo's third attempt at making the crossing - each time he paid roughly €330 to the smugglers. During one of these attempts, he was given a mobile phone with $50 credit on it and the number of the MRCC (the Maritime Rescue Coordination Centre) in Rome.

This time, the boat he was on was driven by one of the smugglers to within a certain distance of the rescue ships. The smuggler then transferred to another boat and went back.

All of the migrants I speak to tell me that they were expecting to encounter a rescue boat shortly after setting sail. Such testimonies have led the European Border and Coast Guard Agency, Frontex, to accuse NGO search and rescue missions of colluding with migrant smugglers.

Yet while it's clear that the smugglers are taking advantage of NGOs, I don't see any evidence of collusion. Furthermore, international maritime law states that all vessels have a legal obligation to assist boats in distress.

As MSF puts it: "If we weren't there, other vessels that do not specialise in search and rescue operations would be asked to assist boats in distress."

"Criticism has been levelled by some political forces in Europe that search and rescue is a pull factor," adds a spokesperson from MSF. "But we know that it's the push factors that are sending people out to sea in unseaworthy and dangerous vessels and causing death in such massive numbers."

Grinding poverty and horrific conditions in Libya are obvious push factors, but there are lesser understood cultural and religious motivations, too.

HOPE AND BEAUTY

Jojo explains that taking the Back Way is considered a badge of honour in Gambia. When I ask Kebba why he got on the rubber boat when 97 people died attempting the very same journey the day beforehand, he tells me that the choice wasn't in his hands. "Whatever God decides, that is what you will receive."

Later on, I ask someone to translate the words of a song that a group of African women, wearing washcloths fashioned into turbans on their heads, are singing. "It means God is my good," he says.

There are so many tragic stories on this ship, but there are moments of hope and beauty too: The tenderness of the Bangladeshi men, who gently place their hands on one another's shoulders when we ask them to get into single file; the relentless enthusiasm of nurse, Mary-Jo - an MSF 'lifer' - who greets every single passenger like a child who has just seen a puppy for the first time.

At midnight, I call into Conor in the clinic. "We have a few sickies," he says, as he looks across at the bunk beds where two African teenagers are sleeping. One of the young men was found wandering around the back deck in a state of confusion, and observations confirmed that he was septic.

Other medical cases include fuel burns, respiratory tract infections and scabies.

The disembarkation process the following day at Pozzallo is slow and tedious. Half a dozen people from various agencies come on board wearing white decontamination suits. The unidentified dead body is carried away in a hearse and groups of migrants - 10 at a time - are escorted off the ship.

A barefooted man in his fifties, whose only possessions looks to be a plastic bag of antibiotics that the medical staff gave him, breaks down as he disembarks. A crew member gives him a hug and the man gathers himself just enough to offer a sailor's salute as he walks away. Another man asks how long it will take him to walk from here to Rome.

Where do they go from here? Some of them will be taken to nearby refugee camps - one of which is a former US military base. Some of them will apply for asylum. It's likely that a few of the women will end up working as prostitutes under Sicily's Nigerian Mafia.

It's unlikely that the pregnant women who have been raped will get an abortion in a country where doctors often refuse to perform the procedure.

"When we disembark, a lot of the rescued people are keen and happy to go, which is great that they have this positive spirit," says MSF coordinator Marcella Kraay.

"But I'm thinking to myself: 'My friend, your journey is not over yet'."

Médecins Sans Frontières/Doctors Without Borders (MSF) is an independent international medical humanitarian organisation that delivers emergency aid in nearly 70 countries worldwide. For more see msf.ie

Indo Review