Catherine Baker and Jessica Hanlon, with edits by Aula Abbara

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Key Points

• A large fire devastated Moria Camp, on Lesvos island, which housed over 12,000 people.

• The majority have been rehoused in Kara Tepe Camp, which has raised many concerns, including those about the immediate environment of the new camp.

• Despite numerous challenges, one positive outcome has been the overhaul of medical provision.

• COVID-19 has disproportionately impacted the physical health, mental health, rights and safety of refugees in Greece.

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Timeline:

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On 8th September 2020, in the midst of the COVID-19 pandemic, large fires, which 5 refugees have been accused of starting, destroyed most of Moria refugee camp in Mytilene on the Greek island of Lesbos, which at that time was the largest refugee camp in Europe.(1,2) Some 12,362 people, who had already been living in appalling conditions, were forced to flee. (2,3,4)

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Following the fire, approximately 1200 refugees were transferred to mainland Greece and other European countries.(5,6) Thousands of others made their own way off of the island.

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Approximately 9000(7) refugees who remained stranded on the road-side in Lesvos were transported to an improvised, closed camp built by the EU commission and the Greek authorities, at the nearby Kara Tepe Facility.(8) While conditions in the original Moria camp were considered dire due to overcrowding, insufficient water and sanitation facilities and inadequate shelter, the new Kara Tepe camp is regarded as even worse by many of its resident refugees. Asylum seekers and migrants worry how they can look after their health and protect themselves from the pandemic under such conditions, a concern that is reflected by many other parties.(9)

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In this blog, we explore the different factors which affect the health of the population in the newly established Kara Tepe camp and the potential impacts of the COVID-19 pandemic. We use the term refugee to describe the refugees, migrants and asylum seekers in the camp though of course these terms are not interchangeable.

 

 

 

 

 

 

 

 

 

 

 

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The location of the new Karatepe camp, Lesvos

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Environmental risks

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Many aspects of the new Kara Tepe camp have been criticised with international and human rights organisations seeing the fire as an important wake up call to support the refugees and asylum seekers with better shelter. 

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The choice to build a camp on low land adjacent to the sea is itself controversial, and this decision has been condemned by multiple aid groups, as well as the Greek opposition political party, Syriza.(10) The Kara Tepe site, on the east side of the island between Mytilene and the old camp, is completely exposed to the elements.  As a result, there have been multiple floods.(10) With the arrival of winter and the combination of exposure to wind, sea water and extreme temperature drops, there is concern about hypothermia and frostbite, as well as potential drownings due to the proximity to the sea. This is even more pertinent, given that approximately 33% of the refugees living in the camp are children. 

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The layout of the new Karatepe camp

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“The new camp is horrible - mostly the weather. It’s cold and when it’s cloudy, it’s too much cold. The tent is not going to protect you against the cold weather. I feel most for the families. It’s beside the sea and during the night, when it’s raining, it’s too much cold. We have blankets, but it’s not enough, they don’t help in this cold weather.” A resident of the camp, 10/02/21. 

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The site was previously used as a firing range by the Greek army.(11) Concerns regarding unexploded bombs and potential lead poisoning have been raised.(12,13,14) Recently, a study of 12 samples of the soil found that unacceptable levels of lead were found in one location, although the actual level of lead in this location (or in the locations deemed ‘safe’) have not been released.(15) This puts asylum seekers, and especially children, at risk of lead poisoning, which can damage the brain and nervous system.(16) 

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The camp itself was initially made up only of tents, most of which shelter up to 12 people. There are a few much larger tents which were designed to house single males who make up a significant proportion of the camp population. There are reports that these large tents house about 150 men each, leading to concerns about the potential rapid spread of COVID-19. As time has progressed, some containers (‘iso-boxes’) have been installed, although these are primarily for administration teams, rather than for housing. Other structures have also been introduced, such as temporary toilets and shower blocks.

 

“The new temporary camp feels remote and dangerously exposed, despite just being a few miles down the road from the island’s capital, Mytilene. From the neighbouring port town, Panagiouda, you can see the sea of tents sprawling across the headland between two bays. When you are in the camp, you can taste the salt of the sea and feel the grit of the sand in your eyes whilst gusts of wind make the air feel even colder. Working in the medical area is tough. For the first four weeks, there was no running water for healthcare providers or patients to wash their hands with. Wearing PPE was incredibly difficult - the wind would plaster the face visors with dust, and gusts would whip them off your face and onto the ground frequently.” - Quote from a medical doctor working in the new camp. November, 2020.

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A new camp is planned to be built by the end of 2021 however details are sparse. Its location was selected after the European Asylum Support Office (EASO) brought an expert group of engineers from five EU countries to assess suitability of several locations on the island.(17) 

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COVID-19 

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COVID-19 has affected the refugees in a variety of different ways; residents are unable to take simple precautions to protect themselves and have seen their freedom of movement restricted even further. 

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A recent preprint retrospective analysis(18) of policy documents and surveillance data showed high rates of transmission among those living in reception facilities. Authors concluded that the risk of COVID-19 infection increases as living conditions deteriorate. The risk of acquiring COVID-19 infection was 2.5 to 3 times higher among refugees living on the Greek islands when compared to the general population. 

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Movement has been increasingly restricted with evening and weekend curfews and a limit of 750 residents allowed to leave the camp at any one time, with huge fines imposed if camp residents are not able to return in time(19). 

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Whilst measures are taken to get public health messages out in a variety of appropriate languages, it is unclear how well these crucially important messages are communicated within the camp, which could contribute towards health inequality and anxiety. 

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Appropriate contact testing and management is near-impossible due to the large numbers of people living in each tent, and crowding in queues for basic amenities(20). Masks are mandatory everywhere in the camp. There is a COVID-19 isolation zone in the camp which is reportedly poorly run and residents avoid being tested for this reason. However, there are reportedly sufficient tests available, and any healthcare actors working within the camp are able to refer patients for COVID-19 testing which happens without delay. New arrivals enter quarantine before entering the main camp. 

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Co-pandemics of COVID-19 and mental health

 

Even prior to the COVID-19 pandemic, mental health services were inadequate to serve the needs of the camp’s traumatised population. In December 2020, the International Rescue Committee (IRC) published a report stating that there had been a 71% increase in the number of people experiencing psychotic symptoms and a 66% increase in self-harm since the start of lockdown in March 2020(20). This is thought to be secondary to the new physical restrictions on movement and the large numbers of people sharing hygiene facilities, which together lead to hugely increased anxiety about health and wellbeing(20). It seems clear that treating symptoms of anxiety and depression caused by unsanitary, unsafe and cruel living conditions is almost redundant when the underlying cause of the mental health concern is not improving. 

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“Patients often present to the clinic ‘in extremis’ with their mental health conditions. In fact, the majority of emergency cases that present are related to mental health. These are almost always because previous experiences have been exacerbated by the living situation in the camp. As doctors we feel helpless - there is very little that will help these patients. The only thing that will really make a difference is to remove them from the horrific situation that they are trying to survive in. It’s impossible to reassure them when you don’t know whether their situation will improve - a lucky few may be transferred out of the camp in the coming months, but many will be there for much longer, or even be deported to the country and dangers that they were fleeing from.”  - Quote from a medical doctor within the camp

 

Better organised healthcare provision 

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Since the opening of the new camp, a more ‘collective’ approach has been taken to healthcare when compared with the piecemeal setup of Moria camp.  All medical actors now work under the supervision of EODY (Greece’s national public health organisation), with a more organised structure and more clearly defined roles. This does appear to be one clear benefit of the new camp. NGOs continue to provide the majority of the care and the pharmacy stock, while EODY does the ‘medical registrations’ and oversees referrals to the hospital.  The local hospital has limited outpatient appointments and surgeries since the pandemic began, both for locals and for refugees. This means that the refugees’ previously limited access to secondary healthcare has almost completely gone. When patients do make it to the hospital, they often have to wait hours for a SARS-CoV-2 test before they will be seen, even if presenting acutely unwell.

 

How many Morias? 

 

“So building another place or improving conditions such as food, water,etc...doesn’t help the immigrants much, they just have to get out of the situation. Building another place means the emergence of Moria 3. They should just transfer them, nothing else. There is no way to improve, or get the situation better. They should just transfer, to get out of this situation. There is no way.” - Quote from a previous refugee and resident of Moria Camp. December, 2020

 

As Europe looks to strategies for longer term suppression of COVID-19, there is no better time to integrate refugees in response planning, including vaccine roll out. Efficient, dignified asylum processes and humane conditions will reduce COVID-19 outbreaks which will in turn reduce risk to host populations. Inadequate or hostile healthcare facilities will result in undeclared COVID-19 symptoms and uncontrolled spread, in addition to other recognised public health consequences of poor health care provision.(21) Conversely, enabling and encouraging marginalised populations to access quality healthcare and investing EU funds intended for refugees into existing healthcare services, is likely to contribute to improved health for the local as well as the refugee population. Highlighting these facts could change the political discourse and pave the way for more humane, harmonious and inclusive refugee policies.

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References 

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1. https://www.bbc.co.uk/news/world-europe-54082201

2. https://en.wikipedia.org/wiki/Moria_refugee_camp

3. https://www.theguardian.com/world/2020/feb/09/moria-refugee-camp-doctors-story-lesbos-greece

4. https://ec.europa.eu/commission/presscorner/detail/en/ip_20_2287 Migration: Commission and Greece agree joint plan for a new reception centre in Lesvos 3/12/2020 

5. https://ec.europa.eu/home-affairs/sites/homeaffairs/files/pdf/03122020_memorandum_of_understanding_en.pdf Annex to the commission decision approving the memorandum of understanding. 2/12/2020

6. https://www.infomigrants.net/en/post/27595/greece-to-transfer-hundreds-of-refugees-from-lesbos-to-mainland Greece to transfer hundreds of refugees from lesbos to mainland 28/09/2020

7. https://www.dw.com/en/three-quarters-of-moria-refugees-relocated-to-new-tent-camp/a-54990827. Three quarters of moria refugees relocated to a new tent camp. 29/03/2021

8. https://ec.europa.eu/commission/presscorner/detail/en/ip_20_2287 Migration: Commission and Greece agree joint plan for a new reception centre in Lesvos 3/12/2020 

9. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3788086 The Impact of the COVID-19 Pandemic on Migrants, Refugees and Asylum Seekers in Greece: A Retrospective Analysis of National Surveillance Data (Feb-Nov 2020)

10. https://www.bbc.co.uk/news/world-europe-54749509. Earthquake hits Greece and Turkey bringing deaths and floods

11. https://www.infomigrants.net/en/post/27464/more-than-240-new-covid-19-infections-among-migrants-on-lesbos More than 240 new Covid-19 infections among migrants on Lesbos 22/09/2020

12. https://www.aljazeera.com/news/2020/10/2/lead-poisoning-greece. Lead Poisoning Fears at Greek Refugee Camp Built on Military Site. 02/10/2020

13. https://www.thetimes.co.uk/article/children-in-danger-from-unexploded-bombs-in-lesbos-refugee-camp-wlbb87d33. Children in Danger from Unexploded Bombs in Lesbos Refugee Camp. 07/12/2020

14. https://migration.gov.gr/kato-apo-ta-diethni-oria-ta-epipeda-molyvdoy-sto-mavrovouni/

15. https://www.hrw.org/news/2021/01/27/greece-migrant-camp-lead-contamination. Greece migrant camp lead contamination. 

16. https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health. WHO: Lead poisoning and health 

17. https://ec.europa.eu/commission/presscorner/detail/en/qanda_20_2284 MoU - Q&A 3/12/2020

18. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3788086

19. https://euobserver.com/migration/150704. Reality bites EUs ‘No More Morias’ pledge

20. https://eu.rescue.org/press-release/refugees-greece-enduring-mental-health-crisis-irc-psychologists-witness-66-increase#:~:text=New%20data%20from%20the%20IRC's,their%20time%20living%20on%20the Refugees in Greece enduring a mental health crisis, as IRC psychologists witness a 66% increase in self harm among people in camps 17/12/2020

21. https://www.bmj.com/content/366/bmj.l4160. Healthcare is not universal if undocumented migrants are excluded. 

Images: 

1. https://www.keeptalkinggreece.com/2020/09/21/coronavirus-kara-tepe-lesvos-refugees/

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