The worst part is the mental torture, Patricia Joseph says. The “gut-wrenching” flashes of wondering what her mother’s last moments were. The infinite state of limbo.

Six years after her mother’s mysterious disappearance, Patricia still catches herself looking out for the distinctive orange-lined raincoat that Hyacinth Gage, 74, was wearing the day she vanished, in the hope it may hold a clue.

Tragically, Hyacinth is just one of an ever-increasing number of people on the tiny Caribbean island of Antigua to disappear without trace in what some have dubbed an epidemic, others a crisis. At least nine have vanished in the last two years alone.

That day back in May 2019 started out ordinarily enough. Hyacinth, described as sprightly and self-sufficient, had gone for a routine check-up at the public hospital, but failed to return. She has never been seen since.

It was to trigger an excruciating series of fruitless, island-wide searches and desperate appeals for help.

“We became detectives. My sister and I teamed up to look for leads. I went back to the hospital asking questions,” Patricia explains.

She was able to verify that while her mother had completed scheduled blood tests, she had not shown up for an electrocardiogram. Further investigations revealed she had apparently handed her handbag briefly to another patient to keep an eye on, but never returned. The bag was found by security staff the next day.

The family were also able to track down a motorist who said she had given Hyacinth a lift to a location a short distance from the hospital.

“The police got angry at us for investigating and told us to stop,” Patricia recalls. “Then they became annoyed at our constant questions, so eventually we had to back off and just pray.”

Anniversaries are particularly painful: 6 March would have been Hyacinth’s 80th birthday, a milestone for which the family had long planned a big celebration. Instead, Patricia took the day off work to spend in quiet reflection.

The number of people to vanish in Antigua appears to be disproportionately high compared with neighbouring islands, Patricia says, a notion supported by sources in several of the islands who spoke to the BBC.

In St Kitts, for example, which has a population of 48,000, official police stats provided show that of the total 54 people reported missing in 2023 and 2024, all but two are accounted for. The remaining two are believed to be Haitian migrants who have since left the country.

Antigua’s small size of just 108 sq miles, home to fewer than 100,000 people, makes the phenomenon particularly perplexing.

Speculation is rife. Theories range from the banal – a lack of will to investigate by an under-resourced and under-paid police force – to the sinister.

“Other islands find bodies eventually,” Patricia says. “My mind goes all over the place wondering what happened. People suggest organ trafficking. I’ve even thought of gang activity. Is it something they’re required to do as an initiation?”

The disappearance of a nine-year-old girl on 12 March sent the nation reeling and sparked extensive searches. Chantel Crump’s body was found two days later in a case that has caused widespread public outrage and protests – and sent rumours into overdrive. A woman has been charged with Chantel’s murder.

Antigua’s Acting Police Commissioner Everton Jeffers acknowledges there is “room for improvement” when it comes to the force’s public relations, but rejects the idea that it is uncaring.

He also says he is keeping an open mind on the reason for the high number of disappearances, including a possible organ trade operating on the island.

“It’s something we’ve been hearing and something we will look into. There’s no evidence to support it, but it’s very important we don’t dismiss anything,” he explains.

Patricia has found some solace in connecting with families of other missing people and now plans to set up an action group to ask for international help.

“This isn’t a random thing any more, this is serious, there’s a crisis,” she adds.

Aaron (not his real name) has collated a list of almost 60 people missing in Antigua – more than a third in the last decade alone – and believes there are several more. Men account for roughly two in three of the disappearances, ranging from teenagers to people in their 70s.

“I’ve personally experienced this pain. One of my family members went missing and another was murdered,” he says, speaking on condition of anonymity because of threats he says he has received for highlighting the issue.

“Families are suffering. Many have gone to their graves without ever seeing justice for their loved ones.

“While some may have disappeared due to their involvement in criminal activities, there’s growing concern that an organised organ harvesting ring could be operating behind the scenes,” Aaron adds.

Police say they are collating official figures for missing people covering the last two decades but by the time of publication had not provided any figures.

This year has already seen two more.

In late January, Orden David did not return home after a night out at a local casino. Orden’s burnt-out car has since been recovered, but there have been few other clues.

Alline Henry recalls Orden as her “best friend of 23 years”.

“The worst part is not knowing if he’s being held against his will,” Alline says.

“Is someone abusing him, torturing him? Every day my thoughts run wild. If, God forbid, it’s the worst case scenario, we need closure,” she adds.

Orden, 39, is well known in Antigua as a key litigant in a landmark 2022 case that overturned legislation criminalising same-sex acts.

“I can’t explain how much it hurts that instead of focussing on the fact he’s missing, some people focus on him being gay.

“I believe the case may have made him a target,” Alline says sadly.

With swathes of bushland and ocean all around, the ostensible ease of concealing a body in Antigua may partly explain the absence of answers many families suffer.

“Clearly the local police can’t solve these disappearances. They need to bring in outside help. How many more people have to go missing before they do something. Who’s next?” Alline adds.

Keon Richards, 38, who works for the national school meals programme, was last seen leaving work on 26 February. His mother Dian Clarke says she is “trying to stay positive”, adding: “You hear about people going missing in the news and then it creeps up on you.”

With the exception of a 43-year-old woman, all those to vanish without trace in the last two years are men, aged between 18 and 76.

Hindering investigations is the lack of a local forensic lab which means crucial DNA samples must be sent overseas for analysis, equating to lengthy waits for results.

Director of Forensic Services Michael Murrell tells the BBC that a new lab capable of analysing trace evidence such as hair, blood and semen will become operational within months, but admits DNA capabilities are some way off because of meagre finances.

Updated technology cannot come soon enough for some.

Gregory Bailey’s son Kevorn, 26, has not been seen since he received a phone call from an unknown person who he apparently left his home to meet in August 2022.

Gregory says the telecoms firm claims to have given the caller’s name to police long ago, but “up to now the police can’t tell me who it was”.

His frustration and despair are evident.

“It’s like a part of me is missing. Some people talk about closure, but I couldn’t handle seeing him in a coffin; I prefer to picture him alive,” he says.

“It’s emotionally aggravating to pursue the police. If I don’t call them I don’t hear anything; if I do, I get sweet nothings,” he adds. “I want the government to know people are grieving; I don’t know if they appreciate that.

“I put up missing posters everywhere, but I couldn’t put up any around my home; I couldn’t bear it. It’s the most painful experience of my life.”

Gregory believes the high number of disappearances is largely due to the extent with which criminal factions get away with murder.

Aaron has also collated a list of more than 100 unsolved killings.

“People don’t trust the police; corruption is rampant in law enforcement,” Gregory says.

Aaron agrees: “There’ve been cases where perpetrators have retaliated against the families of victims when reports were made.”

Police Chief Jeffers says “no police force in the world is perfect”. But adds: “I can guarantee 90% of our officers are good.”

He also admits limited finances impede investigations.

“There’s no police force in the Caribbean that has enough resources to do everything we have to do.

“We do a lot to look for people, get leads from the public and matter and pledged a raft of new measures including the establishment of a designated missing persons’ task force and the acquisition of dogs trained to detect bodies.

But that may not be enough to appease those desperately awaiting answers.

“It’s time to take serious action,” Patricia urges. “I hope this doesn’t happen to someone close to them before they take a good fresh look at these disappearances.”