Dr Pietro Bartolo has seen more suffering and death in his career than any one man should have to witness.
As director of the small hospital on the Italian island of Lampedusa, the 59-year-old gynaecologist has for more than two decades overseen the emergency medical response to the incessant waves of migrants and refugees passing through the island in their attempt to cross the Mediterranean from North Africa.
Sitting in his office at the hospital, beneath a framed photo of an encounter he had with Pope Francis, he shared some of his experiences with a visiting Amnesty International delegation.
“I meet every single migrant and refugee who arrives in Lampedusa,” Bartolo said.
By his own estimate, this amounts to around 250,000 people in the past two decades.
I meet every single migrant and refugee who arrives in Lampedusa. By his own estimate, this amounts to around 250,000 people in the past two decades.Dr Pietro Bartolo
He has spent thousands of nights at the island’s tiny port, awaiting boats overcrowded with those rescued at sea.
Medical workers promptly screen all new arrivals, to separate the sick and wounded from the healthy. This ensures that those most in need can get speedy access to medical care, while the relatively healthy are transported to Lampedusa’s reception centre, for shelter, warmth and a meal.
“People are wet, very cold and shivering, so we prefer to send them quickly to the centre where they can get a change of clothes,” he said.
Hundreds have arrived in body bags.
Bartolo told us about one fishing boat which arrived in Lampedusa after plucking 20 people out of the sea. Four people had already been placed in body bags near the fishing nets on the boat’s deck. Upon closer inspection, Bartolo saw that one of them was still alive:
“We took her out [of the body bag] and hurried to the hospital. We spent 30 minutes resuscitating her – her lungs were full of water and gasoline. After half an hour, her heart started beating again.”
She is now healthy and living in Sweden, he said.
“For me, even if it’s just that one, it’s worth it. Otherwise I have to do the job of the undertaker.”
However, the small glimmers of success are surpassed by overwhelming stories of suffering.
Bartolo recalled another woman who had been in labour when she crossed the sea in 2013. Neither she nor her baby survived the trip.
“They were found with the umbilical cord still attached. I put them in the same coffin; I didn’t even cut the umbilical cord. These are the very bad things that hurt you. People tell me: ‘you’re used to it’. But it’s not true, you don’t get used to it,” Bartolo said.
They were found with the umbilical cord still attached. I put them in the same coffin; I didn’t even cut the umbilical cord. These are the very bad things that hurt you. People tell me: ‘you’re used to it’. But it’s not true, you don’t get used to it.Dr Bartolo
Over the many years that Bartolo has been doing this work, changes in how people attempt the crossing have changed the type of injuries he and his staff have to treat.
In the 1990s, he said, migrants and refugees tended to arrive on much sturdier vessels that spent longer at sea, leading to lots of cases of dehydration.
In recent years however, there has been a shift. A much greater volume of people are now coming, but in smaller, less-seaworthy vessels. They often lack enough fuel for the trip and are simply given a satellite phone to send out a distress call when they run into trouble on the high seas.
Hypothermia is much more common now since people get sprayed with seawater as the flimsy boats get tossed about on the waves. Chemical burns are also rife, since petrol often spills inside the boats and clings to people’s clothes and skin. This results in serious injuries, including skin peeling off.
The bleakest moments
Bartolo has witnessed the aftermath of many sea tragedies, but some stick out in his mind as especially horrific. One is quite fresh in his memory: an incident on 17 April this year which he described simply as “disastrous.”
A boat had set sail from Libya at close to midnight with around 70 passengers, including 22 people with very serious burn injuries. Before they had set sail, a gas canister had caught fire and exploded in the place near Tripoli where they had been staying. Ten people died. In an act of appalling cruelty, the people in charge of the trip forced the other seriously injured migrants to board the boat, despite their clear need for medical assistance.
The following morning, the boat began to lose air and they phoned for help. Italy’s Guardia di Finanza responded to the SOS call later that afternoon, bringing all 70, including the burn victims, to shore in Lampedusa. One of the injured women, around 20 years old, was declared dead on arrival.
After seeing the injuries, Bartolo knew there was no way that Lampedusa’s small hospital could cope with the emergency. Three ambulances made multiple trips to bring the injured to the hospital, and then he arranged for Italy’s Ministry of Defence to supply a fleet of helicopters to ensure all the victims were brought to hospitals in Sicily to receive the intensive care they needed.
Among the victims was a baby girl who had severe burns on her face and neck.
They also included an Eritrean woman who had fallen into a coma. She was flown to Sicily to be hospitalized. In the chaos, she had been separated from her two-year-old son, who was subsequently taken to Lampedusa’s reception centre. It took almost a week for the various agencies involved to piece together what had happened and reunite mother and child.
Suffer the little children
The fate of the children rescued at sea seems to weigh heaviest on Bartolo.
Confronted with case after case of migrant and refugee children spending time in the hospital while their mothers undergo surgery or medical check-ups, hospital workers and the local community decided to create a special space for them.
Ludoteca – “playroom” – is painted in bright colours on the door of a room near the operating theatre. Bartolo’s eyes lit up as he unlocked it and revealed what lies within.
Murals of brightly coloured animals, scenes from nature and letters of the alphabet adorn the walls. Four small tables have rainbow-coloured miniature seats for around 20 children to sit and play or watch videos. And donated toys are distributed about the room – Bartolo said there is a stockpile of fresh toys so that each migrant child can bring something with them when they leave.
It’s clear that this room is one of the few havens of solace left in Bartolo’s work life.
‘They continue to die’
However, Bartolo’s prognosis of the wider situation is not so optimistic.
When a devastating shipwreck happened several hundred metres off the coast of Lampedusa on 3 October 2013, resulting in 366 deaths, there were widespread calls for change.
But resistance to migration has meant it has been difficult for political leaders to agree on how best to save lives and create more safe and legal routes for migrants and refugees to reach Europe. Meanwhile the deaths on the high seas continue apace.
“Almost two years later, nothing has changed. They continue to arrive; they continue to die. So what have we fixed? Nothing,” Bartolo said, dejected.
“We do what we can, because it’s right to do it. We want to save as many lives as we can, but in the end it’s the system that’s broken.”
We do what we can, because it’s right to do it. We want to save as many lives as we can, but in the end it’s the system that’s broken.Dr Bartolo
From the EU institutions in Brussels and Strasbourg to the UN Security Council in New York, there are currently moves under way to change this. It finally looks like European leaders are poised to up their game on collective search-and-rescue efforts in the Mediterranean.
But more will still die and Bartolo’s services will still be required – 3,500 people perished last year, even as Italy’s Operation Mare Nostrum saved tens of thousands of lives.
So long as Europe insists on building a fortress to keep out those fleeing misery, more people will drown in its moats. More needs to be done to provide safe, legal routes for refugees and migrants to make it to the continent without risking arriving in a body bag.