When African Refugees Board Boats to Italy, They Know They're Going to Die

An Israeli-Arab psychiatrist who rescues refugees in the Libyan sea explains the trauma they suffer, and why their plight is our fault

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Dr. Essam Daod rescuing refugees in Libya.
Dr. Essam Daod rescuing refugees in Libya. Credit: David Blumenfeld
Ayelett Shani
Ayelett Shani

Talking to: Dr. Essam Daod, 35, lives in Haifa; child psychiatrist and founder of the Humanity Crew aid agency. Where: Haifa Port. When: Wednesday, 7 P.M.

Two years ago we spoke here about your organization, which offers psychological aid to Syrian refugees who have managed to escape to Greece by sea. This time we’re meeting after you spent almost a month on the Libyan Sea, the part of the Mediterranean north of eastern Libya, with African refugees trying to get to Italy.

Actually, Libya was supposed to be the continuation of the Greece project. I had intended to go to Libya a year ago, but I just couldn’t do it. It took me a long time to get myself back to Greece, too. I preferred occupying myself with the paperwork and administrative tasks involved in setting up the organization.

You found it hard to get over all the horrors you saw there.

Yes. I always say that I’m okay emotionally, but you know that’s not completely true.

Then why go to Libya? It’s hell, after all.

I don’t think I really understood what was going on there until I went, and I’m not sure I understand it now, even after being there. That difficult feeling of being on the high seas, not seeing any land on the horizon. Suddenly you understand how small you are and how vast the sea is. Even though I was on a boat with a professional crew and proper lifesaving equipment, that uneasiness didn’t leave me. How do people feel whom we rescued after 15 hours on the sea, on a crowded boat, with people who urinated into bottles and made in their pants, all of them suffering appalling skin diseases from the camps [they were imprisoned in], and with women who were raped in Libya and are undergoing a terrible trauma, simply trembling with fear? And this boat is drifting and drifting, and they don’t even know where to.

Trying to cross to Italy.

It wouldn’t be accurate to say they’re trying to cross, because that’s impossible. Not one boat has actually managed to make it from Libya to Italy. It’s as if we were now to take off from Haifa Port here in a rubber dinghy and head for Cyprus. When these people board these boats, they know they’re going to die. That’s what I didn’t understand at first – how much they want to die.

Just to clarify: You were on the rescue boat of the Spanish organization Proactiva Open Arms, which was sailing in international waters off the coast of Libya. The only chance such refugees have of staying alive and making it to Italy depends on their being found by a rescue boat.

Yes, and still, when they see us, the rescuers, they go into a mad panic. Right away they start shouting and crying for us to leave them alone, they want to stay on the boat, they don’t want to go back to Libya. There are boats that aren’t even found, that are simply lost. The people on them don’t even enter the statistics of the missing and the dead, because there’s no record of them. Ghost boats. No one even knows what happened to them.

How does the rescue take place?

It’s a very long operation. The rescuers get a distress signal – a boat has been located at such and such a point. It’s located by means of drones or Italian military radar, because the boats are small and the area is huge, and the rescue boats’ radar can’t detect them. The boat itself is of course not static; there’s wind and currents, it’s hard to find, it can take a few hours.

When it’s located, a motorboat is sent from the rescue vessel, because the big rescue boat is too cumbersome. As soon as the passengers see the motorboat drawing close to them, the chaos starts. They get hysterical. Shout. Cry. Jump into the water. The rescuers calm them down and hand out life jackets. In the meantime, the big boat is already approaching. The people are then taken off the boat, one by one, and pulled up onto the deck, where they’re covered with a blanket and given initial medical care. Pregnant women undergo an ultrasound, a hot energy drink is handed out. If there are bodies, they’re covered and pulled onto the deck so the others won’t see them.

Everything is done in coordination with the Italian Coast Guard. They’re the ones who decide, depending on where we are, whether we drop them off at Lampedusa or Sicily, or whether they themselves will come to collect them.

A migrant boat in Libya.Credit: David Blumenfeld

What happens to them in Italy?

A detention camp, of course. They’re divided into groups. Anyone classified as a work migrant is deported back. Refugees from disaster zones can submit a request for asylum in Italy.

Let’s talk a little about your role as a psychiatrist in this whole scenario. It’s not trivial. Why is a psychiatrist needed in a maritime rescue operation?

It’s simple. It’s impossible to rescue the body without rescuing the psyche. The rescue itself is traumatic, and it comes on top of a large number of previous traumas. These people sit there in the boat, they don’t know what’s happening with them, they gape. Someone has to be there, to calm things down, explain to them where they are, what’s going to happen next.

In what way do you get involved in what’s happening?

I’m involved from the start of the rescue. I’m on the motorboat, and when we approach them, I tell them first of all that we’re rescuers, that we’ve come to rescue them. There’s a big deal about a Libyan flag on the boat. That really scares them, makes them panic. I explain to them why it’s there, show them that there’s also a Spanish flag. Because at this point they’re still processing events, and it’s possible to try to change the experience.

The idea is actually to try to mitigate the trauma, to provide a positive experience.

Exactly. What was amazing, by the way, is that the Spanish rescuers understood this intuitively. For example, they would play music for them and dance, or say to them, ‘Messi, Messi” [Barcelona soccer great Lionel Messi], and this immediately calmed them down. I understood that the work I had done in my work with children in Greece could also work with adults in Libya. I would say to the kids who came off the boats in Greece, “What heroes you are. What an achievement!” I’d retell the story as a heroic tale. So in Libya, too, I would say to them, “What courage, you did something that couldn’t be done, our captain thought you were dead, but you triumphed.” I discovered that after I told them this three, four, five times, their expressions changed.

Yes, like in the narrative approach in psychology. You reconstruct the story with a different meaning. So they can tell themselves a different story.

The story is told to them in a way that makes it possible for them to emerge from the position of the victim to a position of strength. With children it’s easier, of course. For them it really does completely erase the trauma, because they don’t understand what’s happening or why the adults are being cruel to one another. So you can give them another presentation completely. Like in [filmmaker Roberto] Benigni’s “Life Is Beautiful.”

Dr. Essam Daod with child who was rescued in Lesbos, Greece. Credit: Maciek Musialek

And timing is critical.

There’s a window of opportunity before the memory becomes fixed with the feelings, the smells, the voices – before it’s processed as trauma. When you do it at the very moment [the event is happening], you reduce dramatically the chance of post-trauma. We had a refugee from Darfur in one of the boats who seemed to me completely disconnected from reality. Even after I boarded the boat and did an evaluation of everyone and quieted them down, he kept on asking, “But why is there a Libyan flag on the boat? Why is there a Libyan flag?” I told him, “I explained to you that we weren’t Libyans; don’t worry, we will help you.”

But he wasn’t convinced and he didn’t calm down. I didn’t know what to do. I knew it would be a few hours before the Italian boat arrived – and he might fall apart completely, suffer a psychotic attack. I said to the crew chief: Do you think I can tell the Italians that we have an emergency psychiatric case? He laughed and said: We’re not even sure yet that there’s room for you here, it was agreed for you to come only because you’re also a surgeon – and now you want to put another person aboard?

What did you do?

I decided to take the risk. I went over to the man and said, “Tell me what happened to you in Libya.” He said, “I haven’t spoken to my mother for a year. She thinks I’m dead.” I asked why, and he said he’d been in a slave camp in Libya for a long time. He was caught when he fled Darfur and was sold to a farm in the desert where they grow hashish. He tried to escape a few times but was caught and abused, subjected to electric shocks. His family kept on looking for him. Do you know what the Libyans made him do?

I don’t want to know ...

They told him to make a sign with his name on it, with his date of birth and the current year. He was told to dig a grave, and then he saw that they sent his mother a picture of the grave with the marker. So they would stop looking for him. From then on, it was as if he really had died. By a miracle he managed to escape. He told me all this and cried and cried and couldn’t calm down. His condition was still dangerous. I went to the captain and asked to use the phone. He said, no way, no one touches the phone. It’s a satellite phone. It’s only for emergencies. I insisted. I told him it was the biggest emergency there could be.

Calling Mom.

Of course. We called his mother. Imagine that conversation. A mother who thought for a year that her son was dead, and suddenly he calls her and says, Mom, I’m alive. I’m on a boat. Speaking to you by satellite phone.

It was in Arabic – you understood the whole conversation.

Yes. He spoke to her for five minutes, a crazy conversation. She didn’t believe it, he couldn’t persuade her. Around him the whole crew, the rescuers and me are crying like children. In the end I took the phone and said to her: Auntie, your son is really alive. He’ll talk to you again in a few days. I gave her my phone number and hung up. I looked at him. It was really as if he had come back to life. The cook came, she hugged him and gave him a piece of chocolate. As soon as he saw the chocolate he jumped, started to tremble and began crying again.


I asked him what was going on and said eat, it’s chocolate. It’s good. He said: No, no, after I escaped [unsuccessfully], I was punished by being forced to eat only cockroaches. That looks like cockroaches. Everyone was in shock and started to cry again. I hugged him. I gave him money. I told him it was for food and phone calls. And that I could help when he got to Italy.

Did he call you?

Dr. Essam Daod. Credit: rami shllush

Yes. We speak by WhatsApp. I’m treating him.

What did the refugees tell you about what they went through in Libya?

These are people who fled poverty, hunger, wars and then got to Libya where they underwent more and more trauma. In Libya, before reaching the coastal region, you have to go through areas that are each under the control of a different militia. Each time you manage to get through one area, the nightmare begins anew. From militia to militia.

I saw one fellow whose leg was amputated, and he told me that his family had been asked to pay 10,000 dirhams [about $2,700 in UAE currency] as ransom. His father could send only 5,000, so they cut off his leg, bound the wound with a rag and threw him into the street. The women – I don’t want to say 100 percent, but I believe it was 100 percent – underwent rape and abuse throughout. Most of the women who have been rescued have been pregnant.

Even if Italy does accept them – even if everything goes like a dream for them – what’s going to happen to these people? What are they going to do with their lives? Will they go to university? Integrate into society? These are people whose psyche has been damaged in the most profound way. They’re people who will be a burden to society. Who will turn to drugs. To alcohol.

You can’t assimilate such horrors and remain sane.

Impossible. Their mental condition will only continue to deteriorate. Europe’s behavior in the refugee crisis leaves a huge vacuum because of the lack of psychological treatment, because even if they’re integrated, it’s not done in a good way. Religious extremists and terrorist organizations enter the vacuum. That’s what’s going to happen in Europe in the years ahead, I think. It will only get worse. What I find truly terrible is that these people, who are mentally unstable, are also strong people. They’re people who were ready to cross the sea to find meaning to their life.

They weren’t looking for meaning, they were looking for life.

They did have a life in Africa. They didn’t want that. They wanted to truly live. They wanted a different life. So you have to look at them as human beings, not as migrant workers who have come to take from us and eat from our pie. They deserve to have a piece of our pie.

Yes. They paid for that pie.

It’s their pie as much as ours. These refugees have come to demand payment for what colonialism did all those years. They won’t give up. And rightly so. The British don’t know that the taxes they pay fund not only the palaces of their royal family, but also drilling for oil in the Congo, which set off a civil war there. [A British oil company’s involvement in drilling in the Democratic Republic of Congo’s Virunga National Park led to hostilities between the army and local rebels.]

Let’s say I’ve just rescued a refugee from Eritrea. Part of the taxes I pay [as an Israeli citizen] are intended to deport him to Rwanda. Because we know what’s going on in Rwanda, we can say it’s likely he’ll flee again and cross the border to Libya, and then maybe he’ll come back to me. Will I rescue him again? It’s clearly a type of money laundering. Why deport in the first place? After all, we know what’s happening in Africa. What kind of solution is that?

One refugee told me that this was the second time he had tried to cross. Once he was caught and sent back, and spent four months in prison. He said: Don’t even ask what they did to me there. But even so he tried again. There was also a Somali making a second attempt. And everyone has scabies, which is a terrible disease, a parasite that simply erases the sex organs. It’s appalling to see. They themselves say that scabies is worse than rape and the electric shocks.

Dr. Essam Daod rescuing refugees in Libya. Credit: David Blumenfeld

What’s the meaning of this abuse? The abusers, most of them, are probably normal people. Or at least they were once. What connection do they have with electric shocks? Or psychological torture, like making someone dig his own grave.

You won’t see abuse like this on the French Riviera, right?

No. So you think it’s abuse that springs up in a particular environment? I don’t know.

The citizens of Libya have experienced horrific trauma in recent years. It was the Western world that intervened in Libya, out of greed, and these normative people you’re talking about saw murder and torture and decapitations and the rape of their wives. I’m not justifying them, of course, but it has to be understood that they’re part of the chain of victims. A victim who abuses another victim. And we’re the ones who started this chain. You and I, too. Children worked in mines so that we would have a telephone. We’re part of this cycle. We don’t need to pretend that we’re better than the smugglers. The only difference is that their urge is overt and ours is hidden.

Why am I on the boats? Why did I set up an organization? Not to rescue people but to feel better about myself. Because the evil I do in the world is so great. I have to balance it. If I can’t manage without my telephone, this is the way I’ll pay for it.

That’s how you understand the dramatic shift in your life – as compensation for being part of Western culture?

It is what it is. I say that all the time.

The argument is correct, but it’s a reductive interpretation. Many good things have happened to you since you established your organization. Maybe you simply feel guilty that you’re deriving benefit from the suffering of others.

Certainly, if the refugee crisis hadn’t occurred, I’d be some bland psychiatrist with a small clinic in the Haifa suburbs. So now I’m getting media attention and also prizes. It’s the narcissist need in me, and it’s good that it can be exploited to derive benefit. I’m very careful not to exploit the refugees themselves. Half a year ago, I used the picture of a girl’s dead body for the first time. I feel guilty, because I still dream of her at night. I used the picture because if I hadn’t used it, I would have had to shut down the organization. Unfortunately, people need to see such pictures in order to donate.

You find it very difficult to raise funds.

There is no funding. The Israelis think we’re Arabs, and the Arabs think we’re Israelis. BDS attacks us, and donations we actually received from Jews in Holland get frozen.

Because of Israel’s NGO-funding law.

In one and the same week the Foreign Ministry published an article about me in Arabic in which they praised me for saving Syrians, but also froze my money, and then BDS attacks me for being part of the propaganda effort. So things are rough now. My wife Maria and I put our money into the organization. Happily. Money no longer interests us. We have a car that costs 7,000 shekels [$2,000] with a hole in the roof. I used to dream of a new car, now I make do. I derive fun from simple things. I don’t look for it outside, I find it more within myself, because I’m more connected to my emotions.

We’re continuing to work with refugees in Greece. Precisely because of Humanity Crew’s financial difficulties we built a super-effective treatment program. I can’t pay for a lot of psychologists, so with the help of a psychologist and one social worker I offer services to 600 people in a camp. We’re building communities. We work with people so they’ll integrate and contribute to the countries they enter.

And you won’t be able to expand and work in Libya, I suppose.

No. I’d really like to, but I’m committed to [my regular job in] the Clalit HMO. To make a living and be part of my profession. I can’t jump ship, because there aren’t many psychiatrists in the [Israeli] Arab community, and no child psychiatrists at all. Even with all my flights I don’t miss a day’s work.

I see myself being occupied with this my entire life. Bringing the issue of mental health to the focus of the refugee crisis. Particularly children. They shouldn’t have to suffer like this. It’s not enough to save them physically, and then have them sit in the ambulance staring into space like the child in Syria covered with dust.

You’re always treading a line between hope and despair. Between naivete and cynicism.

I understand that the game is much bigger than us, that the forces involved are huge, that you can’t really change the situation. The understanding that you are very small naturally leads to despair. But I have succeeded in overcoming this despair, and understand that the little bit I am able to give is a lot for other people. Even if I was able to help [only] one person among millions who are suffering. Look at [the man from Darfur]. I helped him be able to speak with his mother. He recovered. He’s in Italy, he feels good, he’s beginning to think about the future, he tells me that he wants to study and to become a doctor, like me. I will visit him in Sicily, and I will keep working with him by way of our online clinic. The entire trip to Libya was worthwhile because I was able to save one human being. It’s like someone being trapped beneath the ruins – I got him out from the ruins of his spirit.



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