Doctors Without Borders: MSF gives ‘psychological first aid’ to migrants

Team helps desperate arrivals after a harrowing voyage to Sicily

As a warm sirocco blew across Trapani harbour in western Sicily last October, Andrea Ciocca huddled with his team and quietly began reading out a message that had just come through on his smartphone. It was from the Dignity I, a search-and-rescue ship that had arrived from international waters off the Libyan coast and was docking in front of them. 

On board were 336 men, 142 women, and 70 children, including 11 under age five, said Mr Ciocca, the co-ordinator of the mental health programme for refugees in Sicily run by the aid organisation Médecins Sans Frontières. But then came much grimmer details.

“There are people on board who say they have lost family members; women with first and second degree burns covering 10-15 per cent of their bodies; and there is a man who is a victim of torture,” he told his group of five staffers, who included psychologists and cultural mediators. “It’s quite a list,” he added, “they may not have been able to do triage on everyone.”

The team sprung into action. First to be taken care of was Berenice, a 38-year-old woman from Cameroon whose husband Omar had died of a suspected pulmonary embolism after a harrowing rescue in the Mediterranean Sea. As she disembarked — holding her husband’s photo — Mr Ciocca took her arm and walked her to a small white tent reserved for MSF. 

Meanwhile, Omar’s body was being carried off the ship in a white bag, placed in a wooden coffin on the dock, and rapidly loaded on to a local funeral home’s grey van. 

Andrea Ciocca, a field coordinator for MSF in Trapani, looks after a girl whose mother died during the crossing from Libya to Italy © Alessandro Penso/MSF

In the MSF tent, Berenice was comforted by Ester Russo, an Italian psychologist, and Moussa Zarre, a French-speaking cultural mediator from Ivory Coast, who said Berenice’s main concern was to be there for her husband’s funeral in the following days. They also helped her call her family back home — which Berenice hesitated to do because it was so deeply painful.

“Fundamentally we are doing emotional support — it is not a therapeutic intervention but it is about addressing the person’s needs in that moment,” said Ms Russo. “The suffering is so raw that we work on concrete things, like ‘what will happen to my husband’s body?’ and ‘will I see him again?’”.

Another critical case was Jean Paul, a 38-year-old man from the Ivory Coast who had lost a wife and three children during the same shipwreck, when their boat split in half just a few miles after leaving the Libyan coast. Luckily, his four-year old daughter Angelique survived. Mr Ciocca held her as her father sat in a white plastic chair grieving. Another MSF cultural mediator managed to make her giggle as he took his glasses on and off.

“We try to do our best, to calm people down, to lift them up, but it’s very difficult when someone is telling you, ‘I lost my husband, I lost my wife, I lost my child’,” said Mr Zarre. 

MSF is the FT’s partner in this year’s Seasonal Appeal. The organisation refers to the kind of interventions made by Mr Ciocca and his team as “psychological first aid”. They have rapidly increased in recent months, as the number of migrants arriving on Italian shores from Africa so far this year — nearly 165,000 — has already eclipsed the total for 2015. But it is not just the high number of arrivals that drives their activity, but also the fact that 2016 is already the deadliest year for migrants in the Mediterranean Sea. More than 4,000 people are believed to have perished along the route. 

The MSF team at Trapani prepares to counsel a 15-year-old boy from Nigeria whose parents died while trying to cross the desert to reach the Libyan coast © Alessandro Penso/MSF

The result is that increasing numbers of migrants are arriving with deep psychological trauma from having lost a loved one, or witnessed death and injury along the way. That day, other members of Mr Ciocca’s team were in the larger port of Palermo tending to survivors on another boat which was carrying 17 dead bodies.

The team’s work is not confined to psychological first aid. It also works in reception centres across western Sicily, including one clinic in Trapani itself, to help migrants who have been in Italy for months — even years — and are suffering from longer-term mental health issues. According to an MSF report released in July, the most common problems are post-traumatic stress disorder, anxiety and depression.

Even after overcoming the shock of the sea crossing and rescue, many migrants struggle to come to terms with their new lives in Italy. They are often isolated and unemployed — sometimes for years — as they wait for a decision on their asylum applications. In worst-case scenarios, they are exploited for low-wage labour, or become victims of organised crime or sex trafficking.

Emmanuel Anton in his room at the reception centre in Custonaci © Alessandro Penso/MSF

With tears in her eyes, Ms Russo recounted the story of one Nigerian patient who came to her because he feared he could no longer remember how to be a mechanic, his profession back home. “They say: ‘I’m afraid that I am no longer myself’. So the work we do is to revitalise parts of them which they believe are dead,” said Ms Russo. “It’s extremely hard work, it’s about impotence and frustration.”

In Custonaci, a small town just north of Trapani, MSF has been working with migrants staying in a former hotel, now a reception centre. One is Momodou Lamin Jatta, a 21-year-old from Gambia, who arrived in Italy at the end of August after fleeing the authoritarian regime. His father and brother were both jailed, and he has no news of his mother. “At night I just wake up and start crying. The whole day I cry because I am thinking about them,” he said. 

Another is Emmanuel Anton, a 23-year-old Nigerian whose first asylum application was rejected. With his appeal hearing coming up, he was worried that he could not find a translator to help him make his case in court. “I cannot sleep, I cannot think, I cannot do anything,” he said. 

Occasionally he makes it to the beach to “relax my brain” but otherwise he is isolated and disorientated. He was orphaned at an early age and has no family connections left in Nigeria. 

“My mom died giving birth to me, and life was very difficult,” Mr Anton said. “I never felt joy in my life.” A conversation with a member of the MSF team, which works with the reception centre’s own psychologist, is his only solace. “They help me so much,” he said. 

Photographs by Alessandro Penso


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