Hundreds of refugees currently live in structures outside Leros hotspot, in exceptionally risky conditions; they stay in tents by the sea, in makeshift shelters and in abandoned buildings of the former Psychiatric Hospital, without electricity, water and sanitary facilities. At the same time, medical assistance for those living inside the hotspot as well as those living outside, is nearly non-existent. Meanwhile due to the significant gaps in medical staff, vulnerability assessment procedures have been stalled and consequently the speed of transfers of refugees to the mainland. The critical situation was identified during a visit by a member of Refugee Support Aegean (RSA) between 20 and 24 October, also through the testimonies provided by refugees.
There are two official structures for the reception of refugees on the island of Leros. The first is the hotspot in the area of Lepida that is few kilometres from the town of Lakki. The hotspot started operating in March 2016 and it is situated in the area of Leros Psychiatric Infirmary. The second is PIKPA – a former shelter for children with disabilities -that started operating in July 2016. The Reception and Identification Service – an independent Agency under the Ministry of Citizen Protection – is tasked with the management of both structures. PIKPA is also supported by volunteers of the Leros Solidarity Network. According to information provided by the UN Refugee Agency (UNHCR), there are approximately 1, 200 individuals living in the hotspot and its capacity is for 860 individuals. PIKPA hosts 135 individuals who have been characterized as vulnerable. It is difficult to assess the number of individuals living in tents or the abandoned buildings inside the hotspot, as several have rented places in houses or hotel rooms in the small villages of Leros. However, they are estimated to be between 1000 to 1,100 individuals. In addition, 4 to 5 families live in Villa Artemis – a building inside the area of Leros Hospital. The Villa was renovated by the Regional Authorities and operates as an extension of PIKPA. The families living their live autonomously as there is no staff. Staff from Workforce Employment Organisation (OAED, Greek:ΟΑΕΔ) and members of the Leros Solidarity Network supervise the area daily. At the same time, there are sixteen flats with 131 spaces providing accommodation to refugees and asylum-seekers made available by the NGO ARSIS in the framework of ESTIA Programme.
Currently the total number of refugees on Leros, is estimated to be 2.500. The majority of new arrivals are from countries with high recognition rate such as Syria, Palestine and Somalia. 
Pictures from the Hotspot of Leros
Out of bounds
The number of refugees, asylum-seekers and migrants on Leros increased gradually since June 2019 and the situation is currently out of bounds despite the fact it is is significantly lower in comparison to that of the rest of Eastern Aegean islands where there are hotspots.
The particularity of Leros hotpot is the fact that is based in the areas of a Public Infirmary (Psychiatric Hospital). Recently, Eleni-Leda Sarika, the Governor of the Leros Public Hospital, noted among others individuals with mental health issues who are inpatients in the Public Infirmary as well are refugees are deprived from their fundamental rights.
Transfers of refugees from Samos other and neighbouring islands to Leros that appear of take place without any planning contributed to the increase of the number of refugees on the island and burdened even more the situation on the already overcrowded hotspot. According to information provided by UNHCR, around 115 individuals departed in October in the framework of organized transfers to reception centres and ESTIA flats while there were 896 new arrivals. The overcrowding on Leros started last April, when the competent Ministry decided to channel new arrivals from Samos to the Leros and Kos hotspot and following the intense increase of new arrivals directly on the island during September and October. «The rationale behind the transfers is bureaucratic and administrative. Most times, the transfer does not solve any problem, it simply shifts it and maybe worsens it, and it is short sighted and a quick fix without taking into account the real needs of individuals», notes Efi Latsoudi, RSA’s social scientist.
In additions, transfers from other islands have led to serious reactions from a part of local society and activation of xenophobic reflexes. Indicatively, on 1 November, the local mayor together with residents reportedly blocked the arrival of forty refugees who were transferred to Leros and Symi while, the Municipality did not operate that day. Finally, the refugees were transferred to Kos island.
Those who know the situation on Leros reported that arrivals have increased significantly for the first time since 2016 while there has not been a similar precedent of refugees finding shelter in such a large area of land outside the hotspot, in the beach and inside the abandoned – since 1995 – buildings of the former Psychiatric Hospital. These buildings are dangerous and are considered not fit for purpose. According to reports, there is also a hygiene concern as there is garbage inside the buildings and in animals lived there during the time that they were abandoned. It is characteristic that the buildings have written in the walls the sign «Do not entry danger».
Inside one of these buildings that carry a significant symbolism, we met Z* a 63-year-old woman from Iraq. She suffers from diabetes, musculoskeletal problems and is unable to walk. She is on the island with her son and his family. Z* sits on a blanket during the whole day since the family arrived on the island 25 days before their meeting with RSA. She told us: «We live without toilets, showers, electricity inside this building that is ready to collapse. Outside it is written ‘Do not enter’. I asked and they told me what it says, but what can we do? We felt cold outside. I am constantly sick (…) Till today, I have not managed to see a doctor (…). We are affected all day. What will happen to us?».
Concerns over covering basic needs
For those forced to live in tents and makeshift shelters by the sea, the gaps also tragic as apart from the weather conditions including the cold and humidity, they have no access to a toilet, shower or water. M* is a middle-aged man from Afghanistan who lives for a month and a half in a tent by the sea with his wife and three children. He tells us: «The food is not edible, and we are not able to cook in the tent we stay. We buy sometimes canned food to eat or some fruit for the children. I buy fruit; they do not give them to us». Η Α* is a 32-year-old Palestinian woman from Syria who lives in a tent by the sea and described how difficult is accessing sanitation facilities. She says: «When we want to have shower, we beg those who have one in their pre-fabs to allow us to have bath. We knock doors, some say yes, other say no. Every day, we have the same worry». According to reports, refugees have bought the summer tents where they live by the sea while few meters away small pools of waste water are running.
Overcrowding makes conditions unbearable
Those that have found a place inside the hotspot speak about the unbearable overcrowding. A* is a 20 year old man from Syria who has been living inside the hotspot for the past three months. He says: «We sleep inside now. Some people left, and I found a place but honestly, we are one on top of the other. It is inhuman what we experience. I am desperate». Everywhere, there is serious lack of blankets, sleeping bags and basic necessities. Some of the refugees’ needs and clothing and necessary items are being covered by PIKPA, while clothes in the hotspot are made available only in urgent situations. «Solidarians from Leros, the rest of Greece and abroad who are active in the Leros Solidarity Network continue to support PIKPA. It is a massive network that is based on donations from ordinary citizens or organizations. In the period of one month, we provided jackets, clothes and all necessary items to 1.056 individuals who reside inside and outside the hotspot. In the past two months, we also gave 600 sleeping bags», notes Matina Katsiveli from the Leros Solidarity Network.
Pictures from PIKPA, Leros
According to UNHCR, the National Public Health Organization (NPHO)  has currently deployed four nurses, one midwife, a social worker and four psychologists. However, there is no doctor to certify vulnerability assessments. However, there is no doctor to certify vulnerability assessments. The lack of psychologists from mid-August until September, the withholding of labour by social workers for two weeks in October and the resignation of NPHO doctor have led in the accumulation of cases awaiting a medical examination for the assessment of their vulnerability. NPHO is supported by a Greek Navy doctor who makes the necessary referrals to Leros Hospital. 
According to reports, and for the aforementioned reasons, for the assessment of a case and for the lifting of geographical restriction what is exclusively taken into consideration are any certificates provided by the local hospital instead of the reception system established in Greek law.
«The number of individuals transferred from Leros to the mainland is very low. The procedures of vulnerability assessment and lifting of geographical restriction do not function and in essence someone must be at death’s door in order to be prioritized. There is a weakness to evaluate the seriousness of the medical condition of asylum-seekers because of the lack of the NPHO doctors. The responsibility is shifted to the Asylum Service that is called to assess the necessity of patients to Athens» notes Efi Latsoudi.
Medicines made available by NPHO staff are reportedly not sufficient to cover needs. Significant issues arise when an ambulance is called in emergencies as on many occasions refugees are obliged to go to hospital by taxi. An illustrative case happened in the presence of RSA staff in the areas outside the hotspot when a pregnant woman fainted because of high blood pressure. When her husband arrived, it was asked from him to call a taxi so his wife could be transferred to the hospital.
The lack of initial medical screening for new arrivals an insufficient access to primary health care, tests and medicines results in cases with simple medical conditions or more serious chronic conditions that could be dealt with timely with the provision of regular medication ending in hospital for treatment putting in at risk people’s lives and burdening the local hospital and health structures. In cases where the condition requires for the individual to be transferred to Athens for further investigation and hospital treatment, his/her temporary transfer to Athens is reportedly permitted in view of the lack of NPHO doctors that conducts vulnerability assessments. The patient is then obliged to return to Leros. 
It should be noted that Regional Local Hospitals such as that of Leros are called to cover with limited resources and staff the needs of local population, tourists during the summer and a large number of asylum-seekers who often have increased medical needs that worse because of the conditions in and outside the hotspot.
Interpretation in the hotspot is provided by interpreters of the European Asylum Support Service (EASO), while UNHCR supports Leros General Hospital and the Psychiatric Hospital with interpretation services provided by METAdrasi.
The refugees’ testimonies as far as the lack of medical and pharmaceutical care is concerned are shocking. R.* is a 28-year-old from Somalia who lives his 7-year-old son in a tent by the sea outside the hotspot. The boy requires immediate assessment by a child surgeon and during RSA’s visit had been on Leros for a month without any prospect of being transferred to the mainland. The father said to us: «I do not know what to do. I need catheters for my child but have no money to buy them». It should be noted that the expenses for buying the necessary medicines and medical material are covered by the child’s father because the hospital cannot prescribe the catheters as the family does not have a social security number (so-called AMKA).
The difficulties faced by thousands of newly arrived asylum-seekers in accessing free public medical and pharmaceutical care spiked since July 2019 because of the withdrawal of a Circular Regulating the granting of AMKA to asylum-seekers by the Ministry of Labour, and the non-operation of the system of a Card for the Health Care of Third Country Nationals. The cash assistance of 90 euro received by each asylum-seeker from the programme of financial assistance (cash-cards), particularly when they have a health problem, is not sufficient. The issue is expected to be resolved for asylum-seekers following the adoption of Law 4636/2019 and in particular of Article 55 that provides the granting of a Third Country National’s Temporary Number on Insurance and Health Care to asylum-seekers (P.Α.Α.Υ.P.Α). This number secures access to public health care services. However, to materialize such access, a Joint Ministerial Decision must be signed. Meanwhile, the problems from the non-granting of AMKA accumulate.
Children exposed to danger
Many of the children we met have dermatological problems as they do not have access to water and they are exposed to all kids of bites in the tents, abandoned buildings and makeshift shelters.
«My 6-year-old has fever for three months. We cannot even afford the medicines. They tell us that our child should be seen by a doctor to another hospital. But how? I do not know what is required for us to be referred to a hospital in the mainland… Do we have to die first or be at death’s door?», says K.* from Iraq who lives in the hotspot with his family.
A group of volunteer paediatricians, a psychotherapist and two educators visited Leros on 19 October and provided pharmaceutical material and donations. They examined a total of 170 children in the hotspot and PIKPA and said that only few of them were completely healthy.
A large number of acute and chronic conditions that require urgent treatment and place the children’s health in in some cases life at risk, were identified for the first time by the volunteer paediatricians and medical certificates and pharmaceutical treatment were provided. Among others, the doctors identified a three-year-old with a splinter in the eye that could endanger the child’s sight in the future as well as children with autism that remained on Leros without receiving substantive support.
Pregnant women without appropriate support
Pregnant women face a massive problem as they require monitoring, regular tests, vitamins and medicines. They receive only very few and many are forced to stay in tents outside the hotspot. As the volunteer doctors said during their visit, many mothers who breastfeed do not get the right nutrition and either their milk production stops or they suffer from anaemia and their babies are not being fed properly.
According to UNHCR data, there are 500 refugee children on Leros including 300 school-aged children. 40 children are registered in the state school but not all attend classes because they are not immunized or do not have the individual pupil’s health card (ADIM). The number of unaccompanied minors reaches 55 and are hosted inside the hotspot in an area that does not host adults. The International Organization for Migration (IOM) will create a “secure zone”. NGO ARSIS with fund by UNHCR runs LEDU – a centre of non-regular education. Currently, 141 students attend, and around 110 attend daily while classes are provided by the NGO ΕCHO HUB LEROS. In the hotspot area, there is also a nursery that is currently not in operation.
Fears for even more dangerous conditions in advance of the winter
Increased arrivals, continuing transfers from other islands and the reduced rates of transfers to the mainland make the situation on Leros particularly difficult since overcrowding creates massive problems and the impasse for the refugees as well as those working in the hotspot is getting bigger. There is also intense in advance of the winter and it is assessed that conditions for those sleeping in tents by the sea and in unfit buildings will become even more dangerous.
RSA and PRO ASYL call once more for an end to the EU-Turkey deal and for the Greek authorities to speed the transfers of refugees from Leros to the mainland and take urgent measures for tackling the reception conditions crisis as well as providing secure and dignified conditions to asylum-seekers as provided by international and EU legislation. They must also secure access to the required medical assistance as this will relief public health structures on the island. Finally, the two organizations call other EU Member States to show solidarity and halt the returns of asylum-seekers to Greece as there is a possible serious risk to be exposed to unacceptable conditions on the Aegean islands and in the mainland.
- Leros PIKPA does not have a psychologist, doctor or interpreter. When there is scheduled appointment, psychologists working in the hotspot visit PIKPA. There are four National Public Health Organization (NPHO) nurses working in shifts. There are also 30 contracted persons employed by the Manpower Employment Organization. There are two lawyers from the NGOS Greek Council for Refugees and METAaction who provide legal assistance to refugees and visit PIKPA on a weekly basis. The playroom created inside PIKPA operates with volunteers, a teacher employed by the Manpower Employment Organization and two social workers of the NGO Arsis. The social workers visit PIKPA twice a week. Children who have not been granted a social security number cannot attend public education as they have not been immunized. ↑
- Source: UNHCR, 7 November 2019. ↑
- Source: http://www.arsis.gr/ergo-accommodation-and-services-to-asylum-seekers-and-beneficiaries-of-international-protection-in-greece/#more-19504. ↑
- Currently, there are 112 individuals staying in the flats. In the forthcoming period, the renting of another flat is anticipated and the increase of places to 136. Source: ARSIS, 5 November 2019. ↑
- Source: UNHCR, October 2019. ↑
- These are the buildings of the former Psychiatric Hospital where patients of the former Psychiatric Asylum lived for decades in inhumane conditions. The Asylum began its operation in the empty buildings of the Italian Αdmiralty because the psychiatric wards of Athens hospitals could not receive more patients. At the end of 1970s and early 1980s, a huge international scandal broke out when the institutional brutality experienced by the patients was exposed. See http://www.ekathimerini.com; http://iscreta.gr/. ↑
- Names have been changed to protect the privacy of those interviewed. ↑
- Previously the Organization was called Hellenic Centre for Diseases Control and Prevention. ↑
- Source: UNHCR, 7 November 2019. ↑
- UNHCR covers urgent transfers for medical reasons following a request. Source: UNHCR, 7 November 2019. ↑
- Source: UNHCR. 7 November 2019. ↑
- https://rsaegean.org/el/ta-anthropina-dikaiomata-sto-vomo-tis-dimokratikqis-austirotitas. ↑
- https://www.synigoros.gr/resources/20190915-dt.pdf. ↑
- A problematic aspect of the provision is the requirement for the deactivation of the number when an asylum claim is rejected, and this rejection does not have a suspensive effect. See: https://www.e-nomothesia.gr/kat-allodapoi/prosphuges-politiko-asulo/nomos-4636-2019-phek-169a-1-11-2019.html. ↑
- Source: UNHCR, 7 November 2019. ↑
- Source: Αrsis, 5 November 2019. A total of 845 pupils have been registered since February 2018. There are four classrooms and 7 classes. Four classes for pupils aged 6 to 11 attended in the morning and three classes for pupils aged 12 to 18 attended in the afternoons. ↑
- Source: UNHCR, 7 November 2019. ↑