Administration and Leadership, Training

Refugees: A Rescuer’s Perspective

2002: Key West, Fla.

I am a brand new paramedic working for Key West Rescue when a call comes in for an arterial bleed at the Coast Guard station. Today is my first day working alone as a paramedic, with only an EMT trained in basic life support as a partner. I couldn’t be any greener and all day I strive to hide my nerves, secretly hoping nothing really serious happens. My partner, although young, is seasoned and his calm steady presence gives me comfort.

We arrive at the Coast Guard station where men in uniform hand me a patient, give me a quick report, and disappear. My patient is a young Cuban male, about 20 years old, with a blood-soaked bandage wrapped around his wrist. The Coast Guard had intercepted him at sea while he and a friend tried to make it the 90 miles from Cuba to Key West in a small boat. The U.S. has a “dry foot” policy for Cubans—if they make it to shore, they’re in; if they’re picked up at sea, they’re out. Upon the Coast Guard’s approach, the patient had jumped in the water to avoid being picked up. Seeing escape wasn’t possible, he’d slit his wrist with a knife, hitting an artery, hoping he would be brought to shore for treatment. His friend and passenger did not go to such lengths. He would be returned to Cuba.

I evaluate and treat my patient in the back of the ambulance while my partner sits up front ready to drive us to the hospital. We are waiting for the police department or Immigration and Customs Enforcement (ICE) or whichever agency is in charge (I have no idea) to accompany us, but no one comes. Tired of waiting and afraid my patient is going to bleed out on my first day, I yell up to Eddie, “Let’s go.”

While we pull away from the dock, the young man strains to look out the small rear window of the ambulance as if someone might run us down and drag him out. He has a lean, pared-down, dehydrated look and when he strains to see out the window his body tenses like a loaded cable. I know almost no Spanish and he doesn’t speak a word of English. All I know to say is, “Beinvenidos a Estados Unidos.” He looks at me and with a small smile relaxes against the stretcher. Tension unfurls from his body like smoke. He has made it. He is safe.

At the hospital I’m told he’ll need surgery. He’s not only cut through the artery, but the nerves too and he might never regain full use of his hand. I walk to the truck, wondering if he thinks it’s worth it. I’ll never know for sure, but I have a feeling that he does. He’ll become a legal citizen of the United States. And I think about that: risking so much, leaving everything behind and cutting through your own hand to become an American.


2008: Homestead, Fla.

It’s late at night or maybe early morning and I am standing on the side of a dark road looking down at a deceased young Guatemalan who has been struck by a car while he was walking along the side of the road and then left to die. I am now a firefighter/paramedic with Miami-Dade Fire Rescue working in the southernmost end of Dade County. It is a territory holding the last remnants of county farmlands, illegal home to many Mexican and Guatemalan farmworkers. The “45”—a deceased male with a silhouette of strength about him even in death—has no ID. He is a John Doe and I think of his family and wonder if they will ever know what happened to him. When the money he sends home stops, what will they think? Will his mother and father, brothers and sisters, cousins and grandparents ever know he is dead, or will they keep hoping he is out there, somewhere, alive?

Not long before, I’d spent two weeks in the Petén of Guatemala, living with a Mayan family while I tried to learn Spanish. I was staying in a small one-room home with a concrete floor and tin roof. The home was partitioned off with sheets for privacy. At night, while I slept on a straw mattress, I could hear my host madre and padre only feet away breathing and turning in their sleep. While there, I was gnawed on by a tick, horrified I’d acquired lice (I hadn’t, it was the straw making my scalp mercilessly itch), and was too squeamish in the pitch black of the night to use the outhouse swarming with cockroaches in the beam of my flashlight. I peed outside, in the grass beside it instead, knowing if any of the locals saw me peeing outside the outhouse, they’d think I was crazy.

The author sharing some quality time with the children in her Guatemalan village.

The author sharing some quality time with the children in her Guatemalan village. Photo courtesy Gea Haff

The Guatemalans of the village had little electricity. They had no refrigerators, air conditioning, computers, TVs, radios or indoor plumbing. My madre’s kitchen was in a separate open-air structure, which held a small wood burning area for cooking food. I took showers beneath a banana tree. Everyday my madre swept the concrete floor, which was a hundred times cleaner than many of the homes I’d responded to as a paramedic in Miami and Key West—homes with running water, electricity, A/C, vacuum cleaners and dishwashers.

I visited a large Mayan family in the countryside and it was then that a few things dawned on me. Things like what the phrase “dirt poor” really meant—as in people are actually living, sleeping, eating in the dirt—and also where the phrase, “he doesn’t have a pot to piss in” came from—as in some families did not have the money to own a single skillet or pot. I was lucky. My madre had two.

Guatemalan madre

“Mia madre.” Photo courtesy Gea Haff

I also learned that despite their material poverty, the Guatemalans had one thing in spades—family. Large extended families lived under the same roof or in the same village. Aunties and abuelos and sisters and brothers and cousins. My companion, Carly, was living with a family of 17. When it came to family, the villagers were as wealthy as royalty. Everywhere children ran and laughed and played from morning until night. They hung out in little bands, often playing soccer until the sun went down, safe it seemed with the village watching. As an only child, this was far removed from my experience of family. All my grandparents were dead. My mother lived in California, my father, last I’d heard, was in Texas, and my in-laws had retired to Georgia. The only family I had in Florida was my husband, also an only child. It was like the Guatemalans and I were reverse images of each other: my world full of material wealth, their world full of familial wealth. Which is why, back in Dade County, I understood when I looked down at the dead Guatemalan on the side of the road what an enormous thing it must have been for him to leave his loved ones and journey to a country of strangers so that he and his family might have a better life.



November 2015: The Mediterranean

Syria is in the midst of civil war. More than three million Syrian refugees, many of them educated professionals, have fled their country with nothing but their children and a backpack. Two million have landed in Turkey and tens of thousands in small boats continually cross the Mediterranean to Greece where they hope to continue their journey deeper into Europe. The Telegraph reported Oct. 23 that in six days more than 50,000 people were recorded arriving in the Greek islands.1 The Greek Coast Guard, stationed along these islands, is overwhelmed. Sometimes up to 30 boats a night arrive in the waters of Lesbos with only a few coast guard vessels available to meet them. Crews do the best they can.

The single greatest factor determining whether thousands of migrants live or die is the number and availability of search and rescue vessels patrolling the waters. The Mediterranean is rough this time of year and it is common for the tightly packed, overloaded boats to sink and capsize. So far in 2015 more than 3,000 migrants have drowned in the waters between North Africa and Europe. In April, 800 died in one mass sinking off the Libyan coast. Not all the migrants are Syrian. From wherever conflict, tyranny or poverty reigns, migrants will come, and according to a report from the office of the United Nations High Commissioner for Refugees (UNHCR) in June, worldwide displacement is at its highest level in recorded history.2

“Everywhere I looked I saw dead people,” says Fanus, an Eritrean migrant who survived a sinking ship on her way to Italy.3 In total, 366 people drowned in what became known as the Lampedusa tragedy, while Fanus waited for rescue. Medium’s, Ghost Boat, recounts her story and reveals the “Secret Mass Graves of the Refugee Crisis.” Many of these mass graves are in Tunisia where authorities, overwhelmed by a continual flow of corpses washing up on shore or floating by fishing boats, bury them outside of town in a mass unmarked grave. According to a volunteer with the Tunisian Red Crescent, “The bodies are buried in piles. They just dig and put them in the ground.”3

A paramilitary police officer investigates the scene of a migrant boat crash in in Turkey.

A paramilitary police officer investigates the scene before carrying the lifeless body of 3-year-old Aylan Kurdi from the sea shore, near the beach resort of Bodrum, Turkey, early Wednesday, Sept. 2, 2015. A number of migrants are known to have died and some are still reported missing, after boats carrying them to the Greek island of Kos capsized. (AP Photo/Nilufer Demir, DHA, File)

But the largest mass grave by far is the sea. It is a secret grave because many of the bodies it takes are never identified or found. Families are left to wonder if their loved ones survived its passage and are being held in internment camps as smugglers sometimes tell them when boats go missing, or if their families are dead. Many will never know what happened.

A crucial but rare factor stands between a secret mass grave and safety: a search and rescue vessel. Migrants crossing the Mediterranean know the risk and are willing to take it, but their hope is that they will be picked up by search and rescue and transported safely to land. Mare Nostrum, the Italian search and rescue operation created after the Lampedusa tragedy, is credited with saving up to 140,000 lives between 2013 and 2014. The operation was discontinued in November 2014 and replaced with Operation Trident, which has a limited response area, a third of Nostrum Mare’s budget and approximately 65 personnel.4

Of course, rescued migrants need a place to live, and that is where politics and economics come into play. Some argue that implemented search and rescue operations encourage migrants to set off for Europe, but not all migrants want to be intercepted, especially here in the United States.


2015: Miami-Dade, Fla.

My department, Miami-Dade Fire Rescue, responds to migrants (usually from the Caribbean) when they need rescue or medical care via fireboat, air rescue or ground units. As a special ops flight medic, I’ve been trained to rescue migrants at sea via hoist and rescue basket and as an air-deployable diver. Since working in EMS for the past 15 years, I’ve responded to migrant landings in Key West, Key Largo and Miami. Every time I do, I see patients who look scared, exhausted and desperate, and yet on some there is a look of visible relief, as if they believe they have found some sort of refuge. Hence, the word refugee, from the French réfugié: “gone in search of refuge.”

As rescuers, it is not our job to determine the policy of nations, but we are often the ones dealing directly with the consequences. We are the ones picking a lifeless little boy off the sand or pulling drowning people out of the water, and yet it’s common for us to downplay our impact. Plenty of boats make it to shore. I’ve seen multiple migrant landings and when people scramble onto shore, jolted with adrenaline and hope, it’s easy to forget about the ones who didn’t make it. Yet, I remember the nameless Guatemalan lying on the side of the road all those years ago, and after reading “The Secret Mass Graves of the Refugee Crisis,” I can’t help but feel for all the families who will never know if their loved ones made it across the sea.

The main thing I’ve learned from my experience with migrants is that no matter where we call home, we are connected to the rest of the world. What happens in the Caribbean or Middle East, Mexico or Greece affects us all. The globe no longer feels immense, but even if it is, people will risk the immensity. Even if our oceans are vast, some brave and desperate soul will journey over it to find us. They will come on rafts and inner tubes and jam-packed boats. We cannot ignore them. We are connected now like a great extended family, with relations we never knew we had. I can only hope that when the brave ones reach their final destination, wherever that may be, our countries, our civilization will remain worthy of their journey.



1. Spencer R., Lawler D. (Oct. 23, 2015) More than 56,000 migrants arrive in Greece in one week, the highest total of 2015. The Telegraph. Retrieved on Feb. 2, 2016, from

2. The UN Refugee Agency. (June 18, 2015) Worldwide displacement hits all-time high as war and persecution increase. Retrieved on Feb. 2, 2016, from

3. Reidy E. (Oct. 21, 2015) The secret mass graves of the refugee crisis. Medium. Retrieved on Feb. 2, 2016, from

4. Calori A. (Feb. 17, 2015) From Mare Nostrum to Triton, Europe’s response to the Mediterranean crisis is little more than another budget cut. OpenDemocracy. Retrieved on Feb. 2, 2016, from