The hotspot Moria on the island of Lesvos: There is great need of medical care and assistance for refugees here and elsewhere in Greek hotspots – with a huge gap in meeting this need. Photo: UNHCR / Roland Schönbauer

Refugee Support Aegean, implementing partner of PRO ASYL in Greece, reports on serious gaps in the provision of medical and psychological care for refugees on the Aegean islands. Following the non-renewal of the contracts for NGOs to provide medical and social services and vulnerability assessments on the island, urgent needs are no longer met.

After the departure of non-governmental organisations (NGOs), medical and social services have seriously been minimized in the Registration and Identification Centres (RIC), the so-called hotspots on the Aegean islands. The needs of refugees have not been met effectively ever since. Huge gaps in psychological aid provision have been observed, while the mental health of refugees is deteriorating severely as people are stuck and under constant threat of being readmitted to Turkey.

At the same time, the system of vulnerability assessment seems to be breaking down. It is not known to what extent the state agencies that are supposed to take over this work will be able to replace the role the NGOs have played until recently.

There are hundreds of refugees in the hotspots, including some with chronic illnesses, victims of torture and those with severe psychological problems, who require constant monitoring and support. Without these services, they are at risk of not being recognised as »vulnerable« and may remain without the medical and psychological care they need.

Expiring NGO work contracts create serious supply gaps

At the end of May, the work contracts most NGOs had signed with the Ministry of Migration Policy expired. As a result, NGO staff left the RIC, dozens of people lost their jobs and suddenly a huge service gap emerged. Until recently, these NGOs had been tasked with a large section of the provision of medical and social services (which are among the responsibilities of the Reception and Identification Service). The replacement of NGOs with state agencies also increases the danger of the hotspots’ further isolation from civil society.

The Hellenic Red Cross (HRC) has temporarily stepped in to fill this gap, until mid-August, when the state department »Centre of Control and Prevention of Diseases (KEELPNO)« will start its work in co-operation with the Ministry of Health programme PHILOS. According to the HRC – in an answer to RSA, which was given without elaborating further on the distribution of staff on the different islands – the Hellenic Red Cross’ human resources for providing services in the hotspots on Lesvos, Chios, Kos and Leros currently equate to around 50 people.

The programme’s duration was initially limited to the months of June and July, but was eventually extended to also include August. Staff members are comprised of doctors, nurses, psychologists and social workers, supported by volunteers of the Hellenic Red Cross. The participating interpreters who carry out the general interpreting tasks in the RICs are employed by the NGO METAdrasi.

The organisation states that staff levels are sufficient to meet primary health, psychological and psychosocial support needs for the transitional period and until such a time when the Ministry of Health and KEELPNO will take over the important tasks in these areas. The reality on the islands, however, paints a very different picture.

Lesvos: Great need for medical care and psychological support

The RIC in Moria is currently overcrowded, with some refugees sleeping in tents. According to official data, about 4,000 people remain in the RIC, while in June a total of 940 refugees and immigrants arrived on the island. Currently, a Greek army doctor is employed in Moria, who only attends the site when he is called in. The Hellenic Red Cross provide one full-time and one part-time doctor as well as a psychologist and a social worker, who only work on weekdays. The Boat Refugee Foundation provides another doctor. Currently, only the Hellenic Red Cross are carrying out vulnerability screenings and medical controls.

»Some people suffer serious panic attacks at those times, as well as many other psychiatric conditions that require urgent attention.«

Efi Latsoudi, a social scientist working for RSA

The medical and psychiatric care for those detained and awaiting deportation is another issue that remains unclear. Access for organisations is problematic and the psychologists who do gain access are too few to cover all emergency incidents.

»There is a great need for medical care. The hospital and the Primary National Health Network (PEDY) on Lesvos cannot bear the burden, as they are asked to examine up to 80-100 cases from Moria every day. In one case, a refugee in Moria had been scalded badly by hot tea but was unable to see a doctor for three days. By the time he was able to go to PEDY, his scalded skin was already stuck to his clothes. These people’s need for psychological support is enormous and there is still a huge gap in the provision of psychiatric care. Specifically, there is a huge gap in the provision of psychological aid during the nights. Some people suffer serious panic attacks at those times, as well as many other psychiatric conditions that require urgent attention,« stresses Efi Latsoudi, a social scientist working for Refugee Support Aegean (RSA).

Chios: Insufficient support and delays in vulnerability assessments

The same is true of the situation in the hotspot Vial on Chios, where, according to the Refugee Crisis Management Co-ordination Centre, there are currently around 800 people. No arrivals were recorded in the past few weeks. The Greek Army has allocated a general practitioner (physician) and a nurse, who accept patients only on workdays. During their working hours, they give out appointments for the vulnerability assessment, the waiting time for which is 20-25 days. In addition, there are a psychologist and a social worker from the Hellenic Red Cross, who, in fact, currently is trying to hire another doctor for the current month to meet screening needs in Vial – but so far this has not been possible. The delays in the immediate vulnerability assessments have a direct impact on the asylum process and the prolongation of refugees’ stay on the island.

Leros: Lack of administrative staff and psycho-social support

According to information on the ground, the Hellenic Red Cross has one doctor, one psychologist, one social worker and two nurses in the hotspot of Leros. The medical care for refugees is reported to be inadequate, especially with regard to psychotropic drugs and psychiatric medication. The RIC is located within the premises of the well-known psychiatric hospital of Leros, which can directly accept referrals of refugees with psychological and psychiatric problems. However, there are serious gaps in other sectors.

»Due to the lack of administrative staff and adequate psychosocial support, both in PIKA and the Hot Spot, the situation is deteriorating – especially for a population that is already psychologically stressed – with the result that difficulties arise. Outbursts of anger, panic attacks, instances of self-harm and suicide attempts are now a daily phenomenon,« says Matina Katsivelis from the Leros Solidarity Network.

About Refugee Support Aegean

Refugee Support Aegean (RSA) is a Greek non-profit organisation focusing on strategic litigations in support of refugees, monitoring human rights violations, as well as the provision of legal, social and humanitarian support in individual cases. Members of the organisation are based on the islands and on the mainland and visit different parts of Greece in order to document the situation there. RSA is the implementing partner of the PRO ASYL foundation project RSPA-Refugee Support Program Aegean in Greece.