Medical and humanitarian assistance for people on the move, experience and challenges Apostolos Veizis,M.D Head of SOMA apostolos.veizis@athens.msf.org
Iro Evlampidou, MSF, Refugee crisis in Europe: health status, life experiences, and mental health problems of transiting refugees and migrants on the Balkan route in 2015
The needs Restrictive policies Detention as deterrence Poor reception conditions (as deterrence?) Externalization of border controls/containment Closure of borders Active forced/voluntary return policy Push-backs Readmission agreements Consequences Lack/discrimination in access to health care Violence and violations of human rights Torture and ill-treatment Interruption of chronic treatment MH disorders Correlation between substandard living conditions & diseases Labor exploitation and human trafficking
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
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
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
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)
Traumatic life events before & during the journey (N=1064)
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
Impact of detention 9,921 medical consultations (2008-2014).
ECDC field visit report, 2011 The main problem is the increased risk for communicable diseases in the detention centers, mainly linked to severe overcrowding, lack of hygiene, lack of basic supplies (e.g. blankets, shoes, soap, etc.), lack of the possibility for outdoor activities and the long duration of detention. The conditions in the centers are below the internationally accepted minimum standards in all visited detention centers. It is well documented that overcrowding increases the risk for communicable diseases spread, such as tuberculosis, diarrhea, upper respiratory infections, etc European Center for Disease Control, 2011.
Impact of detention on physical health Upper respiratory tract infection (24,7%), musculoskeletal condition (13,7%),gastointestinal disorders(14,7%), skin infections (8,5%), dental problem (7,9%). In total 63% of total diagnoses were linked directly or indirectly to the substandard detention conditions: overcrowding, lack of hygiene, water and sanitation problems, lack of ventilation and no possibility to spend time outdoors.
Impact of detention on mental health 39% of patients presented symptoms of anxiety such as constant worry, fear, panic, restlessness. 31% of patients presented symptoms of depression, such as sadness, loss of interest, hopelessness, and thoughts of death. 17.3% of patients sought psychological support due to the previous experience of traumatic events - PTSD was diagnosed in 9.5% of all patients. Detention exacerbated existing symptoms, hindered the healing process and contributed to psychological distress. 3.2% of patients had attempted suicide or self-harm during the period of their detention.
Migrants and asylum seekers in detention suffer from medical problems caused or aggravated by the substandard conditions, the length of detention, and the lack of consistent or adequate medical assistance. MSF s experience demonstrates that detention is a cause of suffering and is directly linked to the majority of the health problems for which detained migrants require medical attention