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.