WMC Women Under Siege

‘Less Than a Number’: How European Policies Leave Pregnant Refugees to Die in the Mediterranean

“When the Alan Kurdi rescued me, I was unconscious,” said Raissa*, a refugee woman from Cameroon, referring to the rescue vessel operated by Sea-Eye, non-profit and civil sea rescue organization patrolling the Mediterranean. She had just fled a detention center in Libya, reaching the coast to cross the sea and — hopefully — make it to Europe. She was six months pregnant at the time.

On the dinghy she shared with more than 30 other passengers, Raissa was vomiting from seasickness. Then, the dinghy began to capsize. “Eventually, I passed out.” If the Alan Kurdi vessel hadn't come to their rescue, those on board might have died.

(Cedric Fettouche/Sea-Eye)

Raissa had fled Cameroon in 2016, when her community was caught in the middle of violence in the Anglophone regions, and traveled through Nigeria, Niger, and Algeria before crossing the Mediterranean from Libya. In Libya, she met her current partner, who is also a refugee, and became pregnant in 2019. After being rescued by the Alan Kurdi, Raissa was transferred to Malta, where she gave birth to a baby girl.

But Malta would only allow the refugees aboard the ship to disembark on their territory under one condition: that none of them would stay. All of those onboard had to be relocated to other European countries. Raissa and her daughter were sent to Portugal, where they now live in a refugee accommodation center.

The Mediterranean Sea has been deadly for at least 1,907 people in 2020, and for more than 20,000 since 2014. According to recent Frontex data, as of December 22, 2020, 34,187 people attempted to cross the Central Mediterranean route from Libya to Italy and Malta last year.

In spite of the high mortality rate, large numbers of refugees are still continuing to cross, mostly fleeing war, food insecurity, or violence in their home countries. Refugee women face especially unique risks, including rape and other sexualized violence, not only at home but also on the journey. And for pregnant women, the road to Europe is all the more perilous.

One of the world’s most neglected crises

Raissa’s life in Cameroon was under constant threat. “I am Francophone and my husband was Anglophone,” she explained. “When he refused to join [the] fighting against the Francophones, he was murdered by the people in his village.” Her husband was killed in front of her eyes, Raissa told Women Under Siege.

Human Rights Watch reports that more than 3,000 civilians and hundreds of security forces personnel have been killed in Cameroon’s Anglophone regions since 2016, when the crisis started. The country also tops the Norwegian Refugee Council’s list of the world’s most neglected humanitarian crises in 2019.

After her husband was killed, Raissa was raped and later received death threats. Fearing for her life, she decided to flee the country amid the chaos, accompanied by a friend who helped her cross the border into Nigeria. Raissa barely knew where she was going, making her way through three other countries over the course of the next year. Eventually, she found her way into Libya, where smugglers told her that they would help her find a job. Instead, Raissa told us, she was sold to traffickers.

A cycle of abuse in Libya

In 2017, a CNN investigation exposed Libya’s migrant slave trade. As the Libyan coastguard was clamping down on boats leaving for Europe, smugglers had to improvise to offset the loss of income. “The smugglers become masters, the migrants and refugees become slaves,” the investigation found.

Raissa spent the next year in what looked like a prison. As she and other refugees were held captive, her pregnancy was developing.

In April 2019, renewed fighting in the ongoing Libya conflict — between the internationally-recognized, UN-backed Government of National Accord (GNA) of Prime Minister Fayez al Sarraj and the self-proclaimed Libyan National Army (LNA) of General Khalifa Haftar — broke out in the country’s capital of Tripoli. According to an Amnesty International report, the violence killed or wounded more than 100 civilians and displaced at least 100,000 more. Meanwhile, dozens of detained migrants and refugees — like Raissa — were trapped in the middle of indiscriminate air strikes, artillery barrages, and shelling.

Raissa said she managed to flee the center during a bombing. A Libyan man took pity on her and offered to help her get to Europe, she said. That’s how she found her way aboard the dinghy, which was adrift out at sea for a day before the Alan Kurdi found them.

When the crew pulled Raissa out of the water, she was unable to speak or move. After she recovered, she could not recall the last time she had eaten, let alone give any details about her pregnancy.

No safe spaces

Amnesty has widely documented violations against refugees and migrants in Libya, including arbitrary detentions, torture, ill-treatment, unlawful killings, and sexualized violence directed particularly against women, in both official detention centers and unofficial places of captivity.

Sophie Weidenhiller, a spokeswoman for Sea-Eye, said that while she served as a volunteer on search-and-rescue missions aboard the Alan Kurdi, she saw that the people they had rescued showed signs of severe physical and psychological torture, bearing scars, burns, broken bones, and gunshot wounds. Many had been starved, beaten, or sold into slavery.

“Even those who manage to escape the centers might be abused by criminal gangs or become victims of human trafficking and exploitation,” said Matteo De Bellis, a researcher at Amnesty International. “Women are specifically targeted for sexual violence, which leads to a high number of unwanted pregnancies.”

Ana Paula Cruz, a humanitarian doctor who also worked aboard the ship, explained that experiencing abuse during pregnancy has harmful impacts for the woman and child. “If there are any problems with the placenta early in the pregnancy, the woman should rest,” she said. “But migrant women cannot rest.”

Cruz said that pregnant migrant women are hardly ever afforded safe spaces on their journey. She has heard stories of women being beaten or assaulted while boarding the dinghy, as well as stories of those raped in detention centers. All of this, she explained, can increase the likelihood of miscarriage or further complications during pregnancy. But those fleeing torture still continue to cross and are willing to board unseaworthy dinghies hoping to reach safety in Europe.

Pregnancy care in a humanitarian context

“When pregnant women are rescued in the Mediterranean by NGO vessels, the doctors on board often lack information about their health needs,” said Cruz. Normally, a pregnant woman would have at least 10 checkups during her pregnancy, including ultrasounds and blood tests. “But women who flee usually do not have access to any of that.” When pregnant women are rescued, they are often dizzy with low blood pressure and a weak pulse due to dehydration, seasickness, vomiting, and heatstroke. Sometimes, the women will need intravenous fluids and anti-vomit medication.

Rescue ships don't usually have an ultrasound on board, so doctors often must rely on a fetal beat detector to make sure the baby is growing well. “But if we do not have that, we can only check the baby’s health by asking the mother how she feels,” Cruz said. With only the bare minimum available for care throughout their pregnancies, the longer-term health consequences for pregnant refugee women remain unseen.

“We know from previous studies that babies that have been born in famines or exposed to stressful environments in utero can suffer from longer-term health consequences, perhaps mediated by genetic and epigenetic changes,” said Kerrie Stevenson, a public health doctor at the London School of Hygiene and Tropical Medicine.

Stevenson pointed to emerging evidence of higher levels of the stress hormone cortisol circulating in the mother’s body affecting the baby as it grows. “Our understanding of that phenomenon is still very new, but it puts the pregnancy period in the forefront, to protect not only the mother’s physical and mental health, but also the longer-term health of the child.”

According to Cruz, non-governmental organizations (NGOs) at sea are filling a gap left on purpose. “We cannot ask a NGO with a 35-meter ship to have an equipped maternity setting inside — that’s not possible,” she said. Instead, she said, Europe should work on safe passages, family reunion strategies, humanitarian corridors, and making migration safe.

Europe’s complicity in outsourcing a humanitarian crisis

EU Member States have long cooperated with Libyan authorities to prevent migrants’ departures and intercept those who cross. In 2017, Italy and Libya signed a Memorandum of Understanding that Italy, backed by its European counterparts, would aid Libya’s military and border control forces “to stem the influx of illegal migrants,” including with the provision of speedboats given to the Libyan coastguard.

These policies have a clear objective: to contain people in Libya and reduce the numbers of those who cross. But in war-torn Libya, civilians and refugees can also become victims of unpredictable fighting and kidnappings, while 1.3 million people in the country are in need of humanitarian assistance. Still, Human Rights Watch reported that the EU has poured millions of euros into fortifying the GNA’s capacity to intercept boats and detain those onboard in detention centers despite the ongoing conflict and rampant human rights abuses.

“EU governments have accepted to compromise on human rights guarantees in order to reduce the number of people arriving in Europe, at the price of inflicting human rights violations on those attempting to cross,” De Bellis told Women Under Siege. “We need EU governments to stop these policies. Detention centers in Libya should not exist, and people rescued at sea should be disembarked in a place of safety — not in Libya."

Cruel and inhumane treatment against refugees has also been documented in other EU neighboring countries, like Turkey or Morocco, where migrants and refugees face pushbacks and violence at the hands of both the authorities and criminal groups, including smugglers and traffickers.

Minette, another refugee woman from Cameroon, tried to approach the EU along the Western Mediterranean route in 2013. She told Women Under Siege that she had been a victim of severe physical abuse at the hands of her smugglers in Morocco. Like Raissa, she was also pregnant at the time.

“The smugglers tortured me in all possible ways. One day, they forced nine of us to get inside a car for five passengers. All of them were pushing and hitting me on the belly. I was so scared that I passed out,” she said. “It was one of the worst experiences of my life.”

In 2018, EU-funded security forces in Morocco carried out unlawful, large-scale raids in neighborhoods where refugees and migrants lived, forcibly seizing and deporting them to remote areas without due process. “In many cases migrants had to walk for several kilometers before reaching the first urban center from which they could attempt to travel back to their homes,” said Amnesty. To escape authorities, some hide in forests or unofficial camps, where they are vulnerable not only to the elements and routine raids but also to attacks from local Moroccans, “some of whom threaten them whenever they leave the forest to buy supplies or beg for money,” Al Jazeera reported.

“Europe’s policies show different facets of the attempt to prevent irregular entries — not at the EU border, but externally," said Christian Jakob, co-author of the book Dictators as Gatekeepers: Outsourcing EU Border Controls to Africa. "Preventing people from reaching European borders has led to an enormous increase of human rights and fundamental freedom violations — both in transit countries and in the migrants’ countries of origin.”

No safe port in sight

Once pregnant women arrive in Europe, many are still not safe. Some women, like Raissa, end up in detention cells while they are waiting to be relocated. “From the hell of a detention center in Libya, I ended up in a detention facility in Malta for four months,” Raissa said.

Other pregnant women end up in unsafe refugee camps. Zeinab Nourzehi, a refugee woman from Afghanistan who was six months pregnant at the time, ended up in the notorious Moria camp on the Greek island of Lesbos in 2019, after crossing the Mediterranean from Turkey. “People in the camp showed us an empty tent and said, ‘This is your new home,’” she said. “There was no food, no sanitation, and we had to go to the mountain instead of a toilet. All I could do was cry.”

Nourzehi slept in a wet tent throughout the winter until she was transferred to a refugee accommodation facility in Mytilene only four weeks before giving birth. She safely welcomed a baby girl, Selena, in January 2020.

“Women need support and need to be provided with safe, warm accommodation, especially in winter time,” said Stevenson. “Infants are very vulnerable to infections and illness in the period after birth.”

Neither Raissa’s relocation to Portugal, nor Nourzehi’s safe transfer out of Moria, was systematically facilitated by EU member states. Search-and-rescue NGOs say that EU authorities often fail to assign their vessels a safe port. “When you fail to assign us a safe port, you are also depriving the refugees on board of their fundamental human rights — especially if there are pregnant women or infants lacking vital healthcare,” said Cruz.

According to NGO reports, EU authorities often do not show any consideration for those on board, pushing them back or failing to respond to their calls for help. Some member states should be prosecuted for the deaths in the Mediterranean, lawyers and activists say.

“No one is monitoring the exact numbers of refugees in North Africa and in the Mediterranean,” Cruz added. “Europe has completely dehumanized them — these people are less than a number.”

“From a policy perspective, we need to focus on planning for a response to the arrival of migrants, including providing tailored screenings and assessments for pregnant women on arrival, and recognizing that they are at high risk of health complications, as well as thinking about their health in the long term by implementing robust integration policies, including free access to health and social care,” Stevenson said. “When governments fail to implement fair policies, charities and NGOs are left to pick up the pieces, and this is not sustainable.”





*Raissa’s name was changed for her protection.



More articles by Category: Gender-based violence, Health, Immigration, International, Violence against women
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