It's Not Always the Sea's Fault: Hydrocarbon Poisoning Killed Two Migrants in the Central Mediterranean.

The Central Mediterranean migration route is as a vital yet perilous pathway for individuals attempting to reach Europe, particularly via Italy, from North African countries such as Libya and Tunisia. This journey, motivated by conflict, poverty, persecution, and the impacts of climate change, frequently involves treacherous sea crossings to destinations like Lampedusa and Sicily. Tragically, this route is the deadliest globally, with over 17,000 deaths and disappearances recorded since 2014. In the first quarter of 2024 alone, 367 confirmed fatalities were reported, predominantly due to drowning. This case report explores the tragic deaths of two sub-Saharan African women, aged 19 and 33, who lost their lives while attempt-ing to cross the Central Mediterranean on an overcrowded vessel. Recovered by a non-governmental search and rescue organization, the younger woman was found deceased aboard the boat, while the older woman, critically injured, succumbed shortly after rescue. Both victims exhibited characteristic chemical burns caused by fuel exposure on their skin (so called "fuel burns"). Although drowning was initially considered the cause of death, autopsy and toxicological findings identified acute hydrocarbon intoxication as the primary cause. Elevated hydrocarbon levels in their blood suggested severe pulmonary damage leading to cardiorespiratory arrest.These findings challenge the preliminary diagnosis and highlight the complexities of distinguishing between drowning and hydrocarbon intoxication. Accurate determination of causes of death in migration contexts is crucial for ensuring accountability and justice. This study underscores the indispensable role of forensic expertise in addressing the legal, political, and ethical dimensions of such tragedies.