Refugee crisis in Europe: health status, life experiences, and mental health problems of transiting refugees and migrants on the Balkan route in 2015 Iro Evlampidou, C. Baruzzi, C.Peruzzo, A. Meimaridou, E. Loyens, E. Faga, A. Ponthieu, ME. Ingres, S. Moissaing, F. Zamatto, N. Severy, S. Argenziano, M. Van Herp, JP. Jemmy, C. Montaldo Médecins Sans Frontières Operational Centre Brussels @MSF/Achilleas Zavallis
Refugee crisis in Europe, 2015 1,015,078 total arrivals to Europe in 2015 3,771 Deaths in 2015 250 000 200 000 Monthly arrivals to Europe, 2014-2015 150 000 100 000 50 000 0 Source: UNHCR, http://data.unhcr.org/mediterranean/regional.php
Source: IOM, http://doe.iom.int/docs/flows%20compilation%202015%20overview.pdf
Response: agencies, NGOs, volunteers, governments
MSF Operations Primary health care (PHC) Referral - Health promotion Chronic diseases Mental health care (individual & group) Victims of torture Food & Non-Food Item (NFI) Transportation, Shelter, Water & Sanitation Search & Rescue Vulnerable groups: identification & referral Advocacy
@MSF/Vicky Marcolefa @MSF/Alessandro Penso @MSF/Alex Yallop @MSF @MSF @MSF/Alessandro Penso
Objective In 2015, among transiting refugees/migrants in Greece & Serbia we aimed to determine the: Socio-demographic characteristics and vulnerabilities Physical and mental health status Traumatic life-events In order to better understand their needs and guide interventions
Methods Primary health care: Jan-Dec 2015 Mental Health: May-Dec 2015 Referral (self-/ngos), MH group sessions, medical consultations, patients social networks Cultural mediators Anonymous program data
Vulnerable groups Pregnant women Elderly (>65yrs) Children <5yrs Disabled Unaccompanied minors Chronic physical or mental health illness Single parents with minor children @MSF/Anna Surinyach @MSF/Alex Yallop @MSF/Vicky Marcolefa @MSF/Guillaume Binet
nb of consultations PHC consultations, Greece (N=43,619) & Serbia (N=38,249), 2015 20 000 18 000 16 000 14 000 12 000 10 000 8 000 6 000 4 000 2 000 0 Greece Serbia
Socio-demographics: Primary health care
Socio-demographics: Mental health
Vulnerabilities: Primary health care & mental health sessions Mental Health Primary health care sessions (N=1064) N n % n % Vulnerable group 81,868 12,796 16 326 31 Under 5yrs 81,595 9,443 12 6 1 Pregnant woman 16,583 1,523 9 34 3 Unaccompanied minor 22,165 1,118 5 41 4 Elderly (>65) 81,592 440 <1 10 1 Disabled 81,732 136 <1 39 4 Single parent with child of minor age 81,868 136 <1 59 6 Chronic physical illness 81,868 4,564 6 75 7 Chronic mental health illness - - - 48 5
@MSF/Alex Yallop Primary health care: Medical consultations
Health status by country (N=81,868) 93%: symptom onset during the migration trip
Chronic diseases & referrals (N=81,868) Chronic diseases (4564; 6%) Cardiovascular (26%) Diabetes (25%) Chronic lung disease (15%) Epilepsy (3%) @MSF/Achilleas Zavallis Referrals (681; 1%) Trauma (20%) Respiratory (14%) Gyneco-obstetric (12%) 11% (77/681) referral refused Gynaeco-obstetric (n=21) Respiratory (n=12)
@MSF Individual mental health sessions
Traumatic life events before & during the journey (N=1064) 100% 80% 60% 40% 20% 0% 97% before journey 0 events 1 events 56% during journey
Self-reported traumatic life events
Self-reported intentional violence State authorities Community/smugglers Physical violence 12% 7% Ill-treatment 7% 10% Sexual violence @MSF/Juan Carlos Tomasi 0% 5% 10% 15% 20% 25%
Mental health symptoms (78%; 830/1064)
Challenges Overwhelming numbers of people Multiple actors: Coordination - collaboration Cultural mediation: Many languages Not enough Patients on the move Quality care Refusal of referrals Follow-up continuity of care @MSF/Anna Surinyach @MSF/Jodi Hilton
Conclusion Increased vulnerability Multiple traumatic life-events Physical & Mental health needs chronic diseases Transit population: difficult to follow-up continuity of care @MSF @MSF/Alessandro Penso @MSF/Achilleas Zavallis @MSF/Florian Lems
Recommendations At transit and destination countries in EUROPE: Authorities need to assume their humanitarian and legal responsibility & take action: Safety living conditions early vulnerability screening Free, easy access to healthcare (physical/mh care) Preventive (screening, perinatal, vaccinations) Curative (acute/chronic) Cultural mediation Innovative ways for continuity of care & follow-up @MSF
Thank you Acknowledgements Patients Field & coordination teams Refugee Task Force members Cell 2 Roma HQ staff Luxor team @MSF/Florian Asis Schulz
Organizations responding to the crisis A21 ActionAid Apostoli Caritas CRI DRC Serbia DRC First Reception Service GCI Greek Asylum Service HCG Hellenic Police HRC Human Appeal ICMC in the Balkans IOM IRC Islamic Relief IsraAID MdM Mercy Corps METAction - METAdrasi MMTF MoI Greece MoI Italy MSF NetHope NRC OXFAM PRAKSIS Pro Asyl Samaritan's Purse SCI Save the Children ShelterBox Solidarity Now TSF UNHCR Europe Bureau UNHCR - Italy UNHCR - Greece UNHCR - MENA bureau UNHCR -Africa bureau UNHCR Malta UNHCR SMI UNHCR fyr Macedonia UNHCR Serbia UNHCR Croatia UNHCR Slovenia UNHCR Austria UNHCR Hungary UNHCR - Spain UNICEF WAHA Source: UNHCR: http://data.unhcr.org/mediterrane an/partnerlist.php#
Mental Health: Group sessions 2,464 group sessions (Greece: 2,098 (85%), Serbia: 366 (15%)) 75% Other psychosocial 13% psycho-education 6% therapeutic groups 4% distraction 3% therapeutic play 24,901 total participants Languages 59% Arabic, 20% Farsi, 10% English, 7% Dari, 7% Urdu, 3% Pashto, 1% Kurdish, 1% French, 0.6% Spanish
% Proportion of MSF-OCB consultations out of total arrivals, Greece, 2015 10 9 8 7 6 5 4 3 2 1 0 0 0 3 9 6 6 4 4 4 4 6 8 250 000 200 000 150 000 100 000 50 000 0 Total arrivals in Greece Total MSF-OCB consultations Greece % consultations out of total arrivals
Proportionate morbidity by sex 50% 40% 30% 20% 10% 15% 10% 9% 12% 0% Respiratory tract Trauma GI tract Skin Female Male
Proportionate morbidity by age group 70% <5 years 5-17 years 18-44 years 45-64 years 65+ years 60% 50% 40% 30% 20% 10% 0% Respiratory tract Trauma GI tract Skin
Proportionate morbidity by nationality 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Respiratory tract Trauma GI tract Skin 9% 6% 9% 9% 13% 11% 10% 27% 12% 10% 11% 12% 10% 10% 11% 12% 5% 14% 14% 17% 20% 56% 47% 44% 39% 32% 37% 28% Afghanistan Africa Iran Iraq Other Pakistan Syria *Numbers do not add up to 100 due to multiple diagnoses
Trauma cases by country and epidemiological week, Greece & Serbia, 2015 70% Greece Serbia Linear (Greece) Linear (Serbia) 60% 50% 40% 30% 20% 10% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Self-reported traumatic life events (1)
Self-reported traumatic life events (2) Discrimination/racism/exclusion Physical violence by community Severe illness/handicap Death of family member Ill treatment by authorities Saw dead bodies/corpses Incarceration/kidnapping/hostage Marital violence/intrafamily conflict Accident (land or sea) Torture Child abuse/ill-treatment Combat experience Sexual violence by community members Sexual violence Sexual violence by authorities Family separation Prostitution 0 2 4 6 8 10 %