The first distress call comes in at around 6 a.m. with the grim news that several boats are in trouble in the southern reaches of the Mediterranean Sea.

It's become an all-too familiar morning routine for Jens Pagotto, Médecins Sans Frontières' head of mission on board the Aquarius, one of three rescue ships the NGO has stationed in the Mediterranean. The mission is increasingly difficult with no let-up in the number of people risking the perilous journey across the sea from North Africa to Europe.

As soon as the alert comes through from Italy's Maritime Rescue Co-ordination Centre, he and his team rush to the nearest boat in distress which, at nearly two hours away, isn't very near at all.

The distance makes their race against time a herculean challenge with hundreds of lives hanging in the balance.

Floating refugee camps

The MSF crew arrives to find a flimsy rubber boat bobbing precariously on the waves and begins transferring its desperate passengers — half of them women and children — onto their rescue ship.

The painstaking process takes over an hour as the crew urges those being saved to remain calm to prevent their fragile boat from capsizing.

Once everyone is safe on board, the MSF vessel becomes a floating refugee camp and doctors scramble to treat their new passengers, ill from hours — sometimes days — adrift at sea.

A Red Cross member talks with a child after disembarking from the Medecins Sans Frontieres (MSF) vessel at Pozzallo's harbour in Sicily, Italy, on April 25. MSF officials say they've seen an increase in the number of unaccompanied minors making the journey across the Mediterranean. (Antonio Parrinello/Reuters )

The priority is getting them to the mainland as soon as possible, but they must go to a port designated by Italian officials.

If it's been a busy day for rescues across the Mediterranean and Italy's southernmost ports are too busy processing other survivors, the rescue ships could be asked to head farther north.

Depending where, it can sometimes take up to three days for crews to transfer the rescued passengers onto dry land and another three days to return to the search and rescue area, Pagotto says.

That's nearly a week with one less rescue ship ready to respond to a crisis taking on an increasingly horrific scale.

More than 2,443 people have died trying to cross the Mediterranean so far this year, a 34 per cent increase over the same period last year, according to the International Organization for Migration.

"These are huge numbers," Pagotto said. "It's putting incredible strain on the system."

Co-ordinating rescues

This MSF rescue, which happened on May 24, is indicative of how Mediterranean life-saving operations work overall.

Much of the activity is co-ordinated through MRCC, an office of the Italian coast guard located in Rome, which alerts rescue ships and other vessels to boats that are in distress.

Because the vessels carrying migrants don't tend to have any tracking equipment, the process relies heavily on an informal information relay system, according to journalist Patrick Kingsley, who details the process in his book, The New Odyssey: The Story of Europe's Refugee Crisis.

Migrants float on a dinghy as the SOS Mediterranee's ship Aquarius approaches off the coast of the Italian island of Lampedusa. The European Union's border agency says the number of migrants crossing the Mediterranean Sea to Italy more than doubled last month. (Patrick Bar/SOS Mediterranee/Associated Press)

It's usually triggered when someone stuck on a drifting, sometimes sinking, vessel calls a contact in Italy who in turn calls MRCC, Kingsley writes. In some cases, the migrants call the office themselves.

If they're able to tell MRCC the boat's location, it will notify a ship in the area — be it an NGO ship, a European Union navy vessel or a commercial shipping liner — and, with some luck, it will get there in time to help.

Sometimes crews will spot boats in trouble before being notified and will let MRCC know a rescue is underway.

"It's not an organized and well-thought-out and well-funded search and rescue plan," Pagotto said. "We're trying our best to fill this gap and make sure as few people as possible die, but you can see that every year the number of people dying is increasing."

Changing tactics

Efforts to deal with the dire situation in the Mediterranean have evolved several times in recent years.

In 2013, the Italian navy launched Mare Nostrum, a program with an explicit search and rescue mandate that operated near Libya's territorial waters.

Human rights organizations lauded it for saving more than 100,000 lives, but the Italians struggled to bear the burden of running, not to mention funding, the program without broader European help.

It also proved to be politically unpopular with some European politicians who said it created a "pull factor," encouraging more people to attempt the Mediterranean crossing.

The program was suspended just over a year after it began and was succeeded by a mission called Operation Triton, managed by the European Union's border agency, Frontex.

Critics have called Triton a woeful replacement, arguing its mandate is more about patrolling Europe's sea borders than saving lives.

They point out that the number of people dying in the Mediterranean has risen significantly since Mare Nostrum was cancelled.

Members of a search and rescue team give assistance to a migrant who was on a crowded dinghy in the Mediterranean sea on May 16. (Giorgos Moutafis/SOS Mediterranee/Associated Press)

When it began, Operation Triton operated with a third of the budget of Mare Nostrum and fewer ships, although the EU was compelled to bolster the mission after more than 700 people died in a shipwreck in April 2015.

Later that year, the EU launched another mission, this one with a more militaristic bent. Dubbed Operation Sophia, its goal is to break smuggling networks in the Mediterranean by giving EU naval crews the power to seize and destroy smugglers' boats.

But the operation's results have been mixed, with 2016 proving to be a "particularly deadly" year, according to the UN.

The EU says it has helped to save more than 9,000 lives, but a recent report from a British parliamentary committee found it has failed to disrupt Mediterranean smuggling "in any meaningful way."

The report also found that since smugglers know their boats are now more likely to be destroyed, they've moved away from using wooden boats, which are more expensive, and are opting instead for rubber dinghies, putting more lives at even greater risk.

Supporting Libya

Some experts predict European officials will continue to pursue increasingly aggressive approaches, particularly now that there's a UN-backed government in Libya with which the EU could partner.

They point to one of Operation Sophia's biggest limitations: it doesn't have clearance to operate within Libya's nautical borders.

The EU would like that to change, says Jeff Crisp, a research associate at the University of Oxford's Refugee Studies Centre who has held senior positions at the UN's refugee agency and the Global Commission on International Migration.

"As soon as the UN-recognized government was in place in Libya, the European Union started negotiations to enable more forceful operations against the smugglers," he said.

Refugees are seen on a capsizing boat before a rescue operation by Italian navy ships Bettica and Bergamini off the coast of Libya on May 25. (Marina Militare via Reuters)

The Libyan government has so far not authorized foreign naval vessels to patrol its waters, but it has asked for help in the fight against smuggling.

The EU has committed to helping rebuild and train Libya's navy and coast guard, neglected after years of civil war.

There has also been talk of NATO doing more to patrol the waters near Libya with a mission similar to the one it established in the Aegean Sea earlier this year after an exodus of refugees crossed from Turkey to Greece.

That mission, along with a controversial deal struck between the EU and Turkey to help stifle the flow of people setting out from its shores, and the closure of the Balkan route to northern Europe have taken away some of the perceived benefits of the Aegean crossing compared to the trip from North Africa to Italy.

The fear is that could lead to a spike in the number of people attempting the latter journey, which is longer and more deadly and where, as Pagotto described, rescue crews are in a constant race against time to save lives.

He says rescuers are seeing an increase in the number of boats departing from Alexandria, in Egypt, which could be linked to the crackdown on the Aegean route. More than 50, 000 refugees were stranded in Greece after the Balkan route to northern Europe was closed in March. Aid agencies have raised concerns about their living conditions. Many of them are sleeping rough in makeshift camps. (Ellen Mauro/CBC )

The crisis continues

Aid organizations have been calling on the EU to abandon its approach and instead focus on creating more legal routes to the continent. They argue it's the only way to prevent more tragedies at sea.

It's unlikely to happen. The political will to take in more refugees is waning, even in those European countries that previously welcomed them with open arms.

"It's become such a toxic issue," Crisp said. "From where we are now, it's difficult to see how this problem can be addressed in a short-term way."

What is clear, though, is that summer, with its warmer weather and calmer seas, will bring another chapter in the world's worst refugee crisis since the Second World War: an inevitable rise in the number of people willing to risk their lives on a dangerous journey to what they hope will be a better life.

And so Europe's challenge is set to become even more vexing.