Yemen: Doctors on the beaches

Night after night, from September to May, Yemen's wild, remote southern beaches provide the backdrop for a slow-burn humanitarian crisis.

Somali refugees stagger from the black sea in weak starlight. Some collapse on the sand flats, weak and exhausted. Others paddle in the silvery surf looking for plastic bags – thrown from the boat – containing their few belongings.

Shocked, hungry and dehydrated, these men and women are survivors of a gruelling and dangerous journey across the Gulf of Aden. They pay $100 to sail from Bossaso, on Somalia's north coast, in tiny fishing vessels.

Passengers are loaded onto the boats like cattle and forced to squat for 36 hours on the open sea. They can only eat and drink what they can hold in their hands or carry in their pockets. If they move, they are beaten by brutal smuggling crews, who use random violence to control their human cargo.

Many passengers suffocate in the overcrowded hold or drown when they're forced to jump from the boats and swim to the shoreline. Dead bodies wash up on the beaches and Yemeni fishermen bury the dead in the sand dunes.

Since the outbreak of civil war in Somalia in 1991, Yemen has offered automatic refugee status to Somalis – but in recent years, migration from the Horn of Africa to the Arabian Peninsula has been rising. In the first five months of this year, 20,000 people made the sea journey – double the number who arrived during the same period in 2007.

From May to early September, high winds in the Gulf of Aden prevent the boats from crossing but a new migration season started last Friday. The medical charity Médecins sans Frontières (Doctors without Borders) has already received several hundred people at their new coastal reception centre in Ahwar.

MSF's Head of Mission Alfonso Verdu Perez says: "The refugees come ashore at many points along a 270km stretch of coastline. We can't predict when or where the boats will arrive."

Armed local tribes use foreigners as bargaining chips in their struggle to extract promises of new roads and hospitals from Yemen's weak central government. The risk of kidnapping means that international organizations have to keep a low profile, and effective community outreach is essential.

"We created local liaison teams in five villages situated within the landing zone," says Alfonso. "We employ community leaders to alert our staff at the Ahwar centre to new arrivals. We've also given them supplies of dates, blankets and dry clothes – and we ask them to provide immediate humanitarian assistance until our mobile medical teams are dispatched from Ahwar."

There are 65 staff based at Ahwar – including four expatriate staff to ensure quality of treatment and implement training programmes. MSF provides emergency health care, psychological support, obstetric care and treatment of infectious diseases.

"In many cases, psychological assistance is the most important service that we offer. These people have survived famine, escaped civil war, and passed 100 checkpoints on the road from Mogadishu before they even embark on their traumatic boat journey," says Alfonso.

Before MSF established a project in Yemen last year, there was very little assistance for the refugees during their first hours after the boat landings. The United Nations' Refugee Agency had no active presence on the coastline, relying instead on an implementing partner to transport the refugees to an in-land processing and registration centre – but, in my opinion, the arrangements were haphazard and inadequate.

I spent a week on the landing beaches in 2006, making a film about the refugees with Swiss camerawoman Marie-Laure Widmer Baggiolini - we both felt that Yemen, and the UNHCR, needed more support and resources to deal with an escalating problem. (Here's the link to the Channel 4 News report)

I think MSF has come up with an innovative solution, providing a much-needed service that deserves full praise and plenty of publicity. It's a brilliant example of what can be achieved once an agile, professional organization decides to get involved and designs intelligent, tailor-made services.

I'm running out of time with this current trip, but I hope I can spend a few days at Ahwar if I come back to Yemen later this year.