At least 78 people have died and many more are feared missing after a fishing boat carrying refugees and migrants capsized and sank off the southern coast of Greece, in one of the worst such disasters this year.

The Greek coastguard said in a statement on Wednesday the vessel sank in international waters, 47 nautical miles (87km) southwest of Pylos, off the Peloponnese coast. The spot is close to one of the deepest areas of the Mediterranean.

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The accident prompted an extensive rescue operation complicated by strong winds, the coastguard said, adding that about 100 people had been rescued so far. Six coastguard vessels, a navy frigate, a military transport and an air force helicopter, as well as several private vessels, were taking part in the search for those missing.

Four of the survivors were hospitalized in the port city of Kalamata with symptoms of hypothermia. Dozens of others were taken to sheltered areas in the city that were set up by the ambulance services and the United Nations Refugee Agency to receive dry clothes and medical attention.

None of those rescued had safety equipment such as life jackets, the coastguard said.

It was unclear how many passengers might still be in the water or trapped in the sunken vessel, but some initial reports suggested hundreds of people may have been on board.

Map of Tobruk, Libya and Pylos, GreeceThe vessel sank 47 nautical miles (87km) southwest of Pylos, off the Peloponnese coast [Al Jazeera]

The Italy-bound boat is believed to have sailed from the Tobruk area in eastern Libya.

Greek authorities did not immediately confirm its port of departure but a shipping ministry official said most of those on board were from Egypt, Syria and Pakistan.

Greek authorities and the European Union border protection agency Frontex were first alerted about the approaching vessel on Tuesday.

After that first alert, Frontex aircraft and two merchant ships spotted the boat heading north at high speed, according to the Greek coast guard. More aircraft and ships were sent to the area. But repeated calls to the vessel offering help were declined, the coastguard said.

“In the afternoon a merchant vessel approached the ship and provided it with food and supplies, while the [passengers] refused any further assistance,” it said. A second merchant ship that approached it later offered further supplies and assistance, which were turned down, it added.

In the evening, a coastguard patrol boat reached the vessel “and confirmed the presence of a large number of migrants on the deck,” the statement said. “But they refused any assistance and said they wanted to continue to Italy.”

Support service Alarm Phone said on Twitter it had alerted authorities after being contacted on Tuesday by a boat on distress in the Greek Search and Rescue zone. “According to the people, there were 750 people on board,” it wrote on Twitter. “Contact was lost shortly after midnight.”

It was not clear if that was the vessel that sank.

Yannis Karvelis, regional health director, described the situation as “tragic and very difficult”.

”I am afraid the number of victims will be higher because the number of the people on board was much higher than the boat’s capacity.”

Paramedics of the Greek National Emergency Ambulance Service (EKAV) and members of the Greek Red Cross helps migrants upon arrival to the Kalamata's portFour survivors were hospitalised in the city of Kalamata with symptoms of hypothermia [Bougiotis Evangelos/EPA-EFE]

Separately on Wednesday, a yacht with more than 70 people on board was towed to a port on the south coast of the island of Crete after authorities received a distress call.

Rescue operations are common, but last month, the Greek government came under international pressure over video footage reportedly showing the forceful expulsion of migrants and refugees who were set adrift at sea.

Last year, nearly 3,800 people died on migration routes within and from the Middle East and North Africa, the highest number recorded there since 2017, according to data published on Tuesday by the International Organization for Migration (IOM).

The IOM’s Missing Migrants Project recorded 3,789 deaths in 2022 along sea and land routes in the region, including crossings of the Sahara Desert and Mediterranean Sea.

Eleni Spathana, a lawyer working with the Greek NGO Refugee Support Aegean, told Al Jazeera there were “no words” to describe the latest tragedy.

“Our reaction is of shock, of course,” said Spathana, stressing, however, that the repeated sea disasters were a byproduct of the European Union’s migration policies.

“[They are] a side effect of the deterrent EU policies and all these efforts – no matter what – to keep people in need of protection and support outside the EU territory.”

Rescued people in GreecePeople arrive in Kalamata after the rescue operation [Eurokinissi via Reuters]

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