Serious gaps in the care of refugees in Greek hotspots; Vulnerability assessment system is breaking down

Following the departure of Non-governmental organisations (NGOs), medical and social services have seriously been minimised in the Registration and Identification Centres (RIC), the so-called hotspots of the Aegean. Ever since the needs of refugees are not being covered effectively. Huge gaps have been observed concerning psychological aid, and this in a period where the mental health of refugees is deteriorating severely due to being stuck and under constant threat to be readmitted to Turkey. At the same time, the system of vulnerability assessment seems to be breaking down. It is not known, how far the state agencies who are planned in to take this job over, will be able to replace the work the NGOs had provided until recently.

The working contracts most of the NGOs had signed with the Ministry of Migration Policy ended end of May. As a result the staff left the RIC and dozens of people lost their jobs. More than that, a huge service gap emerged all of a sudden. Until recently those NGOs had been tasked with a large part of the medical and social services, which are among the responsibilities of the Reception and Identification Service.

The Hellenic Red Cross (HRC) took over to fill this gap temporarily until the state department «Centre of Control and Prevention of Diseases (KEELPNO)» will start its work by mid-August with the Ministry of Health program PHILOS. The replacement of the NGOs by state agencies is also increasing the danger of the RICs further isolation from the civil society.

The human power of the Hellenic Red Cross providing for services in the RIC on Lesbos, Chios, Kos and Leros at this moment include in total about 50 people, according to the HRC in an answer to RSA, without further elaborating on the distribution of staff according to island. The program has been limited to the period of June and July, eventually also for August. In regards to the staff, there are specifically doctors, nurses, psychologists and social workers that are also supported by volunteers of the Hellenic Red Cross. The collaborating interpreters covering the general needs of translation in the RICs are employed by the NGO METAdrasi.

The organisation points out that the staff is sufficient to meet primary health, psychological and psychosocial support needs for the transitional period and until the Ministry of Health and the KEELPNO will be able to fully meet the needs in these sectors.
It should be noted that there are hundreds of refugees in the RICs, including those with chronic illnesses, victims of torture and those with severe psychological problems that need constant monitoring and support. Without these services, these people are at risk of not being recognized as “vulnerable” and will remain without the medical and psychological care they need.

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. In Moria at the moment there is a Greek army doctor who comes only when he is called, while the Hellenic Red Cross has one doctor and one part-time doctor, as well as a psychologist and a social worker who only work weekdays. There is also a doctor from the Boat Refugee Foundation. Only the Hellenic Red Cross is currently making the vulnerability screening and meeting medical control needs.

Another unclear issue remains the medical and psychiatric aid of those detained for the aim of deportation, as the access for organisations is problematic and the psychologists who have access aren´t sufficient to cover all emergency incidents.

«There is a great need for medical care. The hospital and the Primary National Health Network (PEDY) in Lesvos can not bear the burden, as they are asked to examine even 80-100 cases from Moria every day. In one case, a refugee in Moria had been burned by a tea that was poured on him and for three days wasn’t able to see a doctor. He went to PEDY when the burn-damaged skin was already stuck on his clothes. The needs for psychological support of these people are enormous and there is still also a huge gap in psychiatric care. There is specifically a huge gap in psychological aid during the night, as there are people with serious panic attacks, as well as many cases of psychiatric illnesses that need help,» stresses Efi Latsoudis, a social scientist in Refugee Support Aegean (RSA).

The same is true of the situation at the RIC Vial of Chios, where according to the Refugee Crisis Management Co-ordination Center there are currently around 800 people, while there were no arrivals in the last few weeks. The Greek Army has allocated a general practitioner (physician) and a nurse who accept patients only on working days and during this period only give appointments for the vulnerability assessment after 20-25 days. There is also a psychologist and a social worker from the Hellenic Red Cross. In fact, the agency is looking to hire another doctor for the current month to meet screening needs in Vial, but so far this has not been feasible. The delays in the immediate vulnerabilty assessments have a direct impact on the asylum process and the prolongation of their stay on the island.

According to information from the field, in the RIC Leros the Hellenic Red Cross has one doctor, one psychologist, one social worker and two nurses, while the medical aid of the refugees is insufficient, especially with regard to psychopharmacies. 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 the 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 with a population that is already psychologically stressed – with the result that difficulties arise. Explosions of anger, panic attacks and tendencies of self-injuries and suicide attempts are now a daily phenomenon,” Matina Katsivelis points out from the Leros Solidarity Network.

There are also concerns about the difficulty that seems to exist in order to find a sufficient number of doctors and interpreters to work in the RIC in the period when the KEELPNO will take over in mid-August.

“Anyone working in the field at this time notices a lack of interest from health practicioners, notably doctors, to work in these camps. If local jobs are not filled, local hospitals must respond. It is less important to have a doctor inside the camp than to support the local hospitals, something that is already foreseens by the PHILOS program,” said KEELPNO vice-president Agis Terzidis.

The program also provides for the provision of primary health care in hospitals on the islands, the organization of referrals to hospitals, the identification of victims of torture and trafficking, the identification of domestic violence victims and the protection of unaccompanied minors. The program was designed to be completed in August but was extended until the end of the year for both mainland Greece and the Eastern Aegean islands, where it has not yet even begun.

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