CRISIS INFO # 9: MSF EUROPEAN MIGRATION - 25 September 2015

CRISIS INFO # 9: MSF EUROPEAN MIGRATION - 25 September 2015 BACKGROUND: Overall, the number of arrivals by boat to Europe has already passed the 219,000 figure of 2014 numbers with the UNHCR reporting that a total of 264,500 have reached Europe by boat so far this year. The largest number has come via Greece (158,456) then Italy (104.000) with smaller numbers arriving in Spain (1,953) and Malta (94). According to the IOM the majority of arrivals to Greece are from Syria, Afghanistan and Iraq whilst the biggest numbers arriving in Italy are from Eritrea, followed by Nigeria, Somalia, Sudan, Syria, Gambia and Bangladesh. Key messages Search and rescue resources must be adequately allocated for as long as the need remains: While search and

rescue resources have been significantly increased, there have been periods where there were fewer boats available to carry out rescues. MSF s rescue boats have subsequently been particularly needed because they are actively patrolling in the zone in the international waters close to Libya where most incidents occur. MSF continues to call for member states to ensure adequate resources are allocated as long as necessary to search and rescue operations. We continue to stress the importance of active patrolling in the most at risk zones, as close as possible to the Libyan coast. Push factors: The biggest displacement of people since the Second World War is being fuelled by considerable push factors that force people from their homes. From the increasingly brutal war in Syria, to the difficulty of life under an oppressive dictatorship in Eritrea, everyone we meet has a very strong reason for fleeing their country. We see these considerable push factors first hand in the countries in which we work. Many tell us that they didn t want to leave their homes, but did so because they had no other choice they were fleeing for their lives. People need safe and legal ways for people to seek asylum and migrate: There are very few safe, legal channels people can take to reach protection, safety and a better life. With Europe s land borders sealed, this forces people into the hands of smugglers and into leaky, overcrowded boats. Even before this point, many have contended with long, risky journeys over land and life threatening conditions in countries such as Libya. However, search and rescue is not a long-term solution people will continue to risk their lives in the hands of smugglers as long as there are no safe alternatives. Europe s restrictive policies mean that we put some of the world s most vulnerable people in more danger, causing more suffering, as they try to bring themselves, and their families, to safety. European (and transit countries) have the responsibility to ensure their policies guarantee the right to seek asylum and respect human dignity. The need for improved reception conditions: As there are no safe and legal routes for people to enter Europe, most have no choice but to use the maritime routes through Italy and Greece. Reception systems in these countries have many shortcomings and remain woefully under-prepared to humanely treat the people arriving at their borders. MSF calls for proper and humane reception to be urgently organized at arrival points in Greece and Italy: including shelter, food, water, sanitation, medical and mental health care and access to asylum procedures. In Greece in particular, the situation is critical, with thousands of people scattered in different islands of the Aegean Sea, without any facilities to receive them. European countries are only accepting a small share of the total number of displaced: Most of the world s displaced people live elsewhere in their home countries or in those that surround it, relatively few are granted asylum elsewhere. For example, twelve million Syrians have been displaced by the ongoing conflict. Eight million have fled to other parts of Syria. Four million live as refugees in the countries that surround Syria many of these countries are now overwhelmed (one in four people living in Lebanon are now Syrian refugees). Only a quarter of a million people have made it to Europe that is less than 2% of the total number of those displaced. It is more than time for European countries to adopt more humane and asylum policies. MSF @ SEA OPERATIONS MY Phoenix: MSF is no longer working on the MY Phoenix. On September 22 nd MOAS informed MSF that they would cease operations in the Mediterranean Sea. As a result MSF is no longer in partnership with MOAS or working on board the Phoenix. Bourbon Argos: MSF OCB launched an additional ship on 9 May to carry out search and rescue operations in the Mediterranean Sea. The ship has 26 people on board (of which 14 are MSF staff), including an experienced search and rescue team as well as MSF medical staff, watsans, logs etc. The Bourbon Argos has the capacity to carry up to 900 rescued people to land. Dignity I: Launched on 13 June, Dignity I has a crew of 18 people, which includes medical staff. The 50 metrelong vessel left the port of Barcelona on 13 June and has the capacity to carry 300 people to land. To date, the THREE boats have RESCUED 16,350 PEOPLE! They have also assisted a further 1,166 others with safe passage to Italy (after they were rescued by other boats) making it a total of 17,516 people assisted by MSF s teams on the Mediterranean! BROADER MIGRATION PROJECTS:

ZARZIS (TUNISIA) MSF has been working with fishermen in Zarzis, Tunisia to offer training in search and rescue. Fishermen are often on the first line of the response when boats get into trouble near their fishing grounds and have been given material as well as training to assist them in their efforts. MSF has also provided training to the Tunisian and Libyan Red Crescents in dead body management. ITALY MSF is working in the first reception centre in Pozzallo (Ragusa province, Sicily) in collaboration with the Local Ministry of Health to provide medical services to migrants, asylum seekers and refugees from the time they arrive and during their stay in the centre. MSF has also started to provide psychological first aid to survivors from traumatic events during the sea journey, for example those who have experienced shipwrecks. A team composed of cultural mediators and a psychologist are ready to be deployed to different landing ports in Italy within 72 hours after receiving the alerts. So far, the team has intervened at twelve different landings, in the Italian ports of Palermo, Augusta, Pozzallo, Catania and Lampedusa with the aim to provide a first practical and material assistance, to alleviate the concerns and help the survivors to face the first moments immediately after landing. MSF also provides mental healthcare support to people living in reception centres in Ragusa province, Sicily. During the first seven months of 2015, the team met more than 353 people in group sessions, visited 238 people and provided psychological care to 109 asylum seekers, for a total of 600 consultations. Nearly half of the people who have benefited from psychological support have been through traumatic experiences related to their journey, including imprisonment, and physical and psychological violence. Most of the people are male, between 19 and 30 years old, coming from Nigeria, Mali, Gambia and Senegal. Between January and September 1 2015 the MSF team in Pozzallo has provided medical screenings to 9376 people on arrival, before entering the primary reception center. Within the primary reception centre, MSF has provided consultations to 4160 people. Since mid-july MSF provides mental health support to people in transit in Rome. Up until 30 August, the team provided psychological and emotional support to 538 people. MSF teams are working mainly in the Baobab Center (run by volunteers) and in the Tiburtina area, behind one of Rome Train Stations. Since mid-july MSF has provided mental health support to people in transit in Rome. Up until 30 August, the team provided psychological and emotional support to 538 people as well as support for basic needs and information to 1754 people. MSF teams are working mainly in the Baobab Center (run by volunteers) and in the Tiburtina area, behind one of Rome Train Stations. GREECE MSF is providing medical care and distributing relief items to refugees and migrants arriving in the Dodecanese Islands as well as on Lesbos; in Athens and at the Idomeni border crossing to Macedonia. Since the beginning of this year, MSF teams in Greece have witnessed a marked increase of arrivals in the Greek islands. By September 23 rd, 357 065 people had arrived in the Greek islands this year (vs 43 500 in 2014), with a 295% increase in the first 8 months compared to the same period last year (UNHCR figures). In August alone, more than 107,843 people arrived, which is more than the total number of arrivals for all of 2014 (43,500). The vast majority of the people arriving in Greece come from Syria, Afghanistan and Iraq. The Greek central authorities have yet to show any initiative to organize long-term reception in the islands in accordance with EU standards. Their only actions so far have been to increase the presence of riot police on the islands and organize short term emergency evacuations (from Kos in August, from Lesvos in September) to relieve the pressure on the islands, with no vulnerability screening or provision of medical services. MSF calls for the Greek authorities to meet their obligations and commit to reception, by providing and managing spaces in all Greek islands, where people can be welcomed with shelter, food, hygiene facilities and medical screening. This is all the more urgent as the flow of people arriving will not stop in the winter but living conditions for them will become even harsher. Kos and the Dodecanese There is no reception system at all in any of the Dodecanese islands. The lack of shelter, hygiene facilities, food

and medical screening has become even more apparent in Kos since the local authorities pushed in September for the closure of the Captain Elias camp, a dilapidated building, where people were directed to stay while awaiting their registration papers. As a consequence, people are now forced to sleep outside in Kos town with no roof over their head. With night temperatures dropping and Winter approaching, there is still no solution in sight: the authorities in Kos have so far categorically refused to have any type of reception on the island that would go beyond the sole registration of people. The MSF team has been conducting vulnerability screenings to identify the most vulnerable groups like pregnant women and minors, providing medical consultations and mental health support in Kos town. From mid-march to August 31 st 2015, MSF carried out 4455 consultations and distributed more than 8492 relief items such as soaps, combs, toothbrushes and towels, including 2400 sleeping bags and survival blankets. As of June 15 th, MSF is also running mobile clinics in the neighbouring Dodecanese islands through a mobile team visiting the smaller island locations where people arrive daily. Up until August 31 st, this team carried out 979 consultations. MSF is also providing mental health support on Kos and the neighbouring islands. Up until 31 August, 1804 people participated in group and individual consultations. Lesbos An MSF emergency response team was sent to Lesbos in June. Although Lesbos is one of two islands where there are reception facilities, the system has failed to respond to the needs of newly arrived people ever since April this year. MSF is providing medical consultations, mental health support and distributing relief items. MSF also works on improving water and sanitation in the Kara Tepe and Moria camps and ensures cleaning services. MSF is also offering transportation through buses to new arrivals so they do not need to walk the 7-km distance from arrival points on the north coast to the registration centre in Mitilini. The Greek authorities have yet to identify an additional suitable space to the existing reception center and Kara Tepe camp where people can be offered shelter, food, hygiene facilities and medical screening. As long as this is not done, in the face of chronic mismanagement by the authorities, it is likely that the island will go from crisis situation to crisis situation. Idomeni In Idomeni, close to the border with FYROM (Former Yugoslav Republic of Macedonia), MSF is running mobile clinics and distributing relief items for those who first arrive in Greece and continue crossing the Balkans to go to northern Europe. From April 3 rd until August 31 st, MSF provided primary health care to 4060 persons, and referred 53 people to local hospitals. 3906 people participated in individual and group mental health consultations. The teams also distributed 7918 relief items such as hygiene products, energy food, blankets and socks. With winter approaching and taking into account the high possibility of FYROM closing the border at any moment, effectively leaving people stranded in a no-man s-land, MSF installed 4 rub halls of 240m2, each with a capacity to offer shelter to 160 people, 2 tents of 45m2 for our medical activities, 40 latrines, 30 showers and 10 water taps. Athens In Athens, MSF launched in October 2014 a project offering medical rehabilitation to asylum seekers and migrants who have been victims of torture, in collaboration with two Greek organizations (the Greek Council for Refugees and Syneirmos/Babel). So far, our team has received a total of 140 patients. SERBIA MSF teams have been providing medical and mental healthcare and distributing relief items such as hygiene kits, food, survival items, tents, blankets and raincoats to people crossing through Serbia since late 2014. The team has a mobile strategy, moving according to the routes that people are taking to cross the country. Until last week MSF's three mobile teams, which each include a doctor, nurse and translators were working on the Subotica crossing point with the Hungarian border, in the capital Belgrade, in and around the Asylum centers, at the Bulgarian border and on the border with the Former Yugoslavian Republic of Macedonia (FYROM) in Presevo, Miratovac and Bujanovac. After the border with Hungary closed and the migratory route changed with the majority of people bypassing Belgrade going straight to the border with Croatia, the teams started to focus on

the crossing points with Croatia at Sid and Bapska. They continue to work at the Macedonian border which remains the major entry point into Serbia. The teams report seeing a large number of pregnant women, from very early to very late stages. They meet babies who have been born during the journey. There are also elderly people and a large number of very young children travelling and each day the teams see at least one person in a wheelchair. Over the past two months the number of consultations has risen sharply, with the teams treating 2,856 people in August and 3,485 in September, compared to 621 consultations in May. The total number of consultations since April is 10,464. The main medical needs are treatment for respiratory illnesses, for injuries sustained on the walk including blisters and body pains. With winter approaching, bringing rain and lower temperatures, MSF is also treating people for common colds. As a direct result of the poor living conditions that people face, MSF teams in Presevo have also seen cases of scabies in Presevo. There are major needs for shelter in Serbia, and on nights in the past week up to 2,000 people have been sleeping outside without shelter. CROATIA MSF is working in Croatia, in a transit camp near the border with Serbia (at about 15 km from Tovarnik) where refugees spend about a day before being transferred to Hungary. In the camp, which hosts around 5000 people daily, MSF has opened up a clinic. Given the unpredictability of the opening and closing of borders between Serbia and Croatia, MSF has had to deploy mobile clinics to be able to rapidly assist refugees at the different crossing points. FRANCE A team arrived Sept 10 in Calais, on the so called Jungle site where around 4,000 exiles are living in dire conditions, despite the efforts of non-profit organizations on site and local charitable initiatives. Calais is the city located near the Channel Tunnel linking France and the United Kingdom and for several years migrants have been trying to reach the UK on trucks via the Channel Tunnel. The site is a former garbage dump where the rain caused damage. Recently a quarter of the site was flooded within one week. An MSF doctor and nurse are helping the Médecins du Monde team provide medical consultations. MSF started also doing watsan repair work and launched on September 21 a large clean-up campaign to gather the trash and set up a system for collecting and managing garbage.