ROME — You’d be forgiven if, at first glance, you thought Fuocoammare, or Fire at Sea is a brilliant work of scripted fiction and not a documentary about life on the front lines of the deadly European migrant crisis.

After all, it’s much easier to watch the film if you convince yourself that the desperate man whose voice crackles over the Coast Guard radio begging for someone to rescue the sinking ship he is on with 250 others is an actor. And it’s much easier to assume a fairytale ending, hoping that someone, somehow, found them, even though the SOS call cut off before any coordinates for their location were given. It’s also marginally easier to look at the entangled, swollen bodies in the hull of a battered fishing vessel if you believe they aren’t real corpses.

Instead Fire at Sea is a riveting two-hour documentary filmed by Italian director Gianfranco Rosi during a year he spent living on the Sicilian island of Lampedusa. The film, which is Italy’s entry for best foreign language film nominee for the 2017 Academy Awards, will make its American debut at the New York Film Festival in early October.

The film, which won a Golden Bear at the Berlin Film Festival earlier this year, uses no narrator and employs only a few captions at the beginning that simply state the facts in black and white. Lampedusa, with a total area of just 8 square miles, is 70 miles from Africa and 120 miles from Sicily. More than 400,000 migrants and refugees have passed through the island in the last two decades. More than 15,000 have died trying to cross during the same time period.

Meryl Streep, who led the Berlin festival jury, applauded Rosi’s work for its relevance and originality. “It’s a daring hybrid of captured footage and deliberate storytelling that allows us to consider what documentary can do,” she said when announcing the award. “It is urgent, imaginative, and necessary filmmaking.”

The film is dark, but not entirely gloomy. The marvelous sunrises and craggy steep cliffs of the very real island of Lampedusa look like they could be computer generated or even a Photoshopped postcard from an Italian tourism board. And Rosi’s authentic local characters seem straight out of Central Casting, from 12-year-old islander Samuele Pucillo, the seasick son of a fisherman whose lazy eye seems a poetic metaphor for the world’s reluctance to look straight at the migrant crisis, to the mustachioed Giuseppe Fragapane, the island’s only radio station DJ, whose elderly aunt calls in daily to request her favorite old songs and let him know she’s listening.

The film also boasts an impressive soundtrack anchored by Fuocoammare, which is actually the name of a catchy fox-trot melody that Fragapane and his accordion and saxophone band reworked from an old Lampedusa folk song his grandfather sang during World War II. The fire at sea in the original song refers to the La Maddalena war ship that burned in Lampedusa’s port after being hit by Allied bombs dropped by British forces. The fire lit up the entire island and the locals apparently screamed “fuocoammare” which, in local dialect, means “fire at sea.”

Throughout the film, the islanders seem to go about their business paying little mind to the hundreds of thousands of migrants and refugees who have been crashing on their shores for years. Glimpses of wrecked boats in the background of the island’s main port town are just part of the landscape.

Many of the scenes capture elderly housewives in their kitchens, preparing local dishes and listening to Fragapane on the radio, intertwined with the innocent exploits of Samuele, while he struggles to correct his lazy eye by trying to hit songbirds and giant prickly pear cacti with pebbles shot from his homemade slingshot.

In a highly symbolic scene, Samuele is out on his father’s fishing boat with seas so rough he can’t help but vomit overboard. A few minutes later, hundreds of migrants, including many women and children, are shown being rescued from unseaworthy boats in the same rough seas. Men who have passed out are dragged off the rickety fishing boats by their arms, dehydrated, burned from chemicals, and barely clinging to life. The scene then cuts back to Samuele in his grandmother’s kitchen, slurping spaghetti and apologizing to his fisherman father for letting him down by getting sick.

The sea rescue scenes show the logistical side of processing the relentless tide of desperate people risking their lives to reach safety. Rosi’s camera captures migrants of all nationalities being photographed, each holding a number beside their head. Someone asks where they are from, even though they don’t always wait for an answer. “Eritrea? Nigeria?” a man calls out. Often the refugees are in shock and can’t answer. No one has documents. No one is fingerprinted. They are given water but little food. They sit on the deck and sleep in the hallways of the rescue vessels until they reach solid ground. Then they are bussed to the island’s notoriously overcrowded detention center. Rosi never follows anyone off the island. The scene repeats itself too many times to keep track.

Once the survivors are safe, Rosi follows the same first responders back out to the migrant boats as they fill the body bags with the dead. No words are necessary. The wind and waves mingle with the refugees’ cries. The solemn body language of the first responders in HAZMAT gear says it all. Just as the viewer is tempted to look away, the scene cuts back to Samuele and his slingshot. The banality of lonely island life is a welcome relief.

Then the scene switches again. It might be to a Nigerian survivor who recants his journey through the desert and Libyan prisons in a prayerful song thanking God for his rescue. At another moment, the island’s only doctor Pietro Bartolo tries to show an African woman pregnant with twins the profile of her unborn babies in a grainy ultrasound in broken English she does not seem to understand. In another scene, rescue workers wearing masks marvel at the stench of gasoline from a leaky boat engine on a group of men.

“Don’t light a match,” says one. “Or we’ll all go up in flames.”

It’s like eavesdropping in purgatory as people finally escape hell.

Fragapane’s Lampedusa radio station provides a haunting soundtrack of old Sicilian love songs. During the breaks, he gives weather forecasts and general announcements, along with news reports that start with the number of corpses recovered and the number of migrants who arrived on the island on a particular day. The old ladies in their kitchens pause to listen, then go about their housewifery.

The lack of narration and commentary doesn’t slow down the two-hour film. Instead, the tension is thick. Daytime scenes of local children playing on ancient ruins and a recurring shot of an elderly fisherman free diving for sea urchins beg for a confrontation between the migrants and the locals.

Night scenes of rescue operations at sea play out, including some disturbing images of people who have been beaten and whose burns from the leaking fuel in the boats are horrific. There are snippets of both Muslim and Christian prayers of thanks among the migrants and glimpses of the locals’ devout Catholicism and statue worship.

Moments of joy are sacred. In one rare shot inside the island’s only detention camp, refugees divide up by geographical region to play a soccer match behind a high fence hung with wet clothing while the women and children cheer them on. It is a relief to hear laughter.

The only person in the entire film to bridge the gap between the very separate, yet intrinsically intertwined, world of the locals and the refugees is the island’s Dr. Bartolo. As the island’s only physician, he is tasked with seeing to the banal office visits of the local residents, including tending to young Samuele, who complains to him about pre-pubescent anxiety. But he also delivers the pregnant refugee’s babies and performs autopsies on the dead who are brought in on the rescue vessels. He signs both the birth certificates and death certificates for every single person on the island, now matter why they are there.

When asked what he thought of the film’s success and the honor of being Italy’s choice for a foreign film Oscar nominee, he told The Daily Beast by phone, “If it helps shine a light on this tragedy, then it is a good thing,” he says. “But life on Lampedusa has not changed.” Just this summer, Bartolo made headlines when he wanted to adopt a 9-month-old baby girl he named Favor whose mother perished from chemical burns from a leaky engine. Heroes like Bartolo live on even after the cameras stop rolling.

Rosi met Bartolo when he visited Lampedusa in 2014 when he was on the island to shoot what he thought would be a 10-minute short film that he intended to enter in a film contest about the migration crisis. He came down with bronchitis and met Bartolo in the island’s emergency room. The doctor, unaware he was talking to a notable director, recounted some of the stories of his experiences over the last 30 years.

Rosi says he knew immediately that his 10-minute film should be a full-length documentary. A few months later he moved to Lampedusa and started filming. “My decision to move to Lampedusa changed everything. In my year on the island I weathered the long winter and then the sea-going months, and I came to know the true rhythm of the flood of migrants,” Rosi said at a press conference after winning the Golden Bear in Berlin with Bartolo by his side.

“Living there I realized that the term emergency is meaningless. Every day there is an emergency. Every day something happens.”

Even so, nothing changes.

More than 3,500 people have died so far in 2016 alone trying to cross the sea near Lampedusa. Since Fire at Sea was filmed, Bartolo estimates he has performed “hundreds” of autopsies, many on pregnant women and children. “But I’ve delivered several babies, too,” he says. “The cycle of life, even here in the margins of hell, goes on.”