AMMAN, Jordan — Thaer al-Rahal knew if he didn't do something drastic, his 3-year-old son could soon die of leukemia. He was a Syrian refugee in Jordan, but the United Nations refugee agency couldn't pay for his son's treatment. Another donor funded some chemotherapy sessions, but only intermittently. He saw no other option but to board a smuggler's boat to cross the Mediterranean Sea to Europe.

"We don't want money, and we're not just trying to live comfortably. The most important thing in the world is for my son to get cured," he told a friend in one of his last voice notes, shared with NPR.

He planned to go to Germany and in other voice notes asked Syrians residing there for advice on which city to go to for the quickest family reunification process. "So I know where to head to — if I make it," he said.

His wife, Narmeen al-Zamel, says he swallowed his shame and asked to borrow thousands of dollars from family and friends to pay the smuggler who promised him passage to Italy. Rahal traveled to Libya, where he waited some four agonizing weeks — always worrying about his son Khaled's condition — before eventually boarding an old fishing trawler on June 8. It was so packed with people he could hardly move.

A few days into the journey, they ran out of food and water on the boat. As they passed Greece, someone on the ship called Alarm Phone, a humanitarian group with a hotline for people in distress in the Mediterranean Sea. The call recorded passengers saying they could not survive the night in the intolerable conditions. They needed help. The Greek coast guard was alerted, and two other nearby vessels donated some supplies to the migrants on the fishing trawler.

Then, that night, the fishing trawler's engine cut out. What happened next is still disputed. Some eyewitness accounts have suggested the overloaded boat capsized after the Greek coast guard tied its boat to the vessel — allegations the coast guard denies. Others say the boat destabilized when passengers moved to try to catch bottles of water being donated from another ship. Rights groups say the Greek coast guard could have better supported a rescue operation and could have called for an independent investigation.

What is known is that at 2:04 a.m. on June 14, Rahal was flung into the dark seawater along with hundreds of other passengers, as the boat rocked violently and flipped on its side.

Accounts by survivors describe children desperately clutching at adults who themselves couldn't swim. And dozens of people trapped, helpless, in the hold as the fishing trawler sank thousands of feet down to the seabed.

Witness accounts suggest there may have been as many as 750 people on board. There are only 104 known survivors. Rahal is not among them.

Some of the people on the boat were Syrians fleeing military service for the regime in their country's civil war. Others were escaping economic destitution in Pakistan and in Egypt. All of them knew that in boarding the boat they might not survive.

The Mediterranean crossing is deadly

The journey across the Mediterranean to Europe is among the most dangerous migrant routes in the world. The International Organization for Migration says 12,345 migrants died on the route between 2018 and the end of last year. In 2019, 1 in every 21 migrants who tried to cross along the central Mediterranean route perished.

Smugglers often cram people into barely seaworthy vessels, with few life jackets and little food and water. Migrants also face dangers from the Libyan coast guard, which, funded by the European Union, aggressively turns back the boats it encounters, sometimes even opening fire on them. Once returned to Libya, many migrants are left to languish in squalid detention centers, where stories of torture and rape are common. Some migrants are also sold into slavery in the country.

Rights groups also criticize the policies of European countries and their coast guard. Efi Latsoudi, a Greek human rights activist, says coast guards from Greece and Italy have become increasingly aggressive in trying to prevent migrant ships from entering their waters. "We know that there is a policy of deterrence, that's trying to keep the people outside our borders and to operate systematic and very violent pushbacks," she says.

Nedal al-Ameri, a Syrian living in Cologne, Germany, after making his own dangerous journey to Europe on a smuggler's boat in 2015, conveys the cost benefit calculation that goes on for a migrant on one of these journeys.

"It's horrifying, sickening and terrifying. But always you have that hope, that promise that if you make it, there is a new life waiting for you in Europe," Ameri says. He learned of Rahal's situation through relatives who lived near him in Zaatari refugee camp.

They spent all of their money on medical costs

For Rahal, the decision to attempt the trip came only after many years of hardship and personal tragedy. He, his wife and eldest daughter fled Daraa, a city in southwest Syria, to escape the fighting from the country's now 12-year-long civil war.

They moved to Jordan, and for several years they managed to get by. They rented an apartment and Rahal found work as a carpenter. "We were living, praise God," Zamel, his widow, recalls.

But then Rahal had to have a cornea transplant, which led to an infection. The medical procedures cost more than $11,000 total, Zamel says. They lost their savings and could no longer keep up with rent, so they had no choice but to move into Jordan's Zaatari refugee camp — home to some 80,000 people.

Then on June 29, 2022, Zamel says, they received the devastating diagnosis: Khaled, their youngest son — then 2 years old — had advanced leukemia. He needed urgent treatment. When they turned to the U.N. refugee agency, UNHCR, Zamel says the agency responded that it could not help them "because it's too expensive."

When Khaled's condition worsened, one night Zamel ran to UNHCR staff at the camp, she recounts. "It was after midnight and I begged them to take us to a hospital." A staff member drove them to a cancer hospital in the capital, Amman. Seeing how serious Khaled's condition was, Zamel says, a doctor there helped her find a donor who could pay for some chemotherapy sessions.

Rahal could not bear being unable to help Khaled or to watch him suffer, she says. Every time nurses took blood or inserted a cannula into the little boy's hand, he would leave the room.

At one point, the funding from donors stopped and Khaled's chemo was temporarily interrupted. Doctors told the family that Khaled may soon need a bone marrow transplant, a difficult and expensive procedure. The family had no idea how they would pay for it.

"My husband became scared when Khaled's treatment stopped for a while. We didn't know what the implications would be. What would happen to him? God only knows," says Zamel. "We lost whatever nerves we had left. My husband decided we had to take a risk. He had to go."

"Mama, is Daddy coming back?"

Now Zamel remains in the refugee camp in Jordan with four children to take care of on her own and still no durable solution for Khaled's treatment.

When asked by NPR why they are not able to help more with Khaled's cancer care, the UNHCR staff said they can't discuss individual cases. In a written statement they said they try to ensure refugees have access to "primary, secondary, and some tertiary healthcare services, including emergency and life-saving services" but that these are restricted by a shortfall in funding. And recently some services have had to be reduced or shut down.

In the days after learning of her husband's death, Zamel was back in the hospital with Khaled. They make the journey almost every week. Unable to afford a taxi, they usually travel through part of the night on public transportation to arrive in time for their 8 a.m. appointment. With no wheelchair, Zamel carries the weak little boy almost a mile from their camp shelter to the perimeter fence, where she gets a shared van. Then once they get to Amman, she carries him again from the drop-off point across a bridge over a highway to reach the hospital.

During a recent visit, accompanied by NPR, Khaled was exhausted, curled up under a blue blanket on a hospital armchair as he received the chemotherapy through a cannula in his left hand. His mother watched over him through a black niqab face covering she said she had put on to mourn the loss of her husband.

Later, on the journey back to Zaatari camp, Khaled played on repeat a video of his father hugging one of his siblings as he left home for the last time before setting out for Europe.

"Mama, is Daddy coming back?" Khaled asked. Gently, tearing up, Zamel replied: "He's not coming, baby. Didn't I tell you that Dad is going to heaven?" "To heaven," Khaled repeated to himself.

Zamel says her other children's spirits are destroyed. They imagined leaving the dust and poverty of the refugee camp, for a life where they could study and their brother might be cured. Now, their father is gone, and they and their mother are alone.

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