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Health care for refugees when it’s not an emergency

Authorities expect Piraeus port to be completely evacuated over the coming weeks, but NGOs such as Praksis and Doctors Without Borders stay, providing vital primary care and referrals to hospitals in Athens. (Credit: Charlie Ensor)

ATHENS — Greek authorities have been evacuating refugees from the port of Piraeus south Athens since April in what has been a lengthy and protracted process for both NGOs and refugees. The Port of Piraeus, normally a commercial trading hub for ships in the Mediterranean as well as departure point for tourists seeking sun and sand on the Greek islands, became one of the main landing points for a different set of travelers in March – refugees.

Nongovernmental organizations such as Doctors Without Borders and Praksis, a Greek health-care group, began offering health services to refugees. They set up mobile clinics in camps such as Piraeus earlier this year. Initially these clinics provided basic care to refugees, but as the Macedonian border was closed, the clinics began to focus on longer-term care, diagnostics and referrals to secondary and tertiary health units in the capital.

Such projects were “initially set up when the borders were still open,” said Lenio Capsaskis, health programs coordinator at Praksis. When the borders were still open in March, “people were not seeking secondary or tertiary care” as they did not want their conditions to affect their journey onward.

Essentially, as Christina Papageorgiou, project coordinator for Doctors Without Borders in Athens explained, “they still hoped that they would be able to move out of Greece” and that “at the port [rather than in camps], they were freer to make this move.”

For refugees, Piraeus was only ever supposed to be a temporary stop-off point. At its peak, it was home to more than 6,000 refugees, both Afghans and Syrians. It is now estimated that fewer than 1,000 people remain in the camp. Many had hoped to travel across the Macedonian border to continue travels into the Balkans and into Europe. But when the border was closed shortly after the initial arrivals, many refugees were left stranded, unable to continue their journeys until the relevant authorities preregistered their status as refugees.

Piraeus was also never intentionally set up to provide long-term humanitarian support to refugees. As a result, “people were stuck in Greece without having any infrastructure in order to host them and offer them the needed services,” Papageorgiou said. “Today, people are living in tents and in the heat without any proper showers, toilets and water facilities.”

Once the word about border closures had reached the port, many decided to disclose their health conditions “because they knew that they were going to stay here for longer than anticipated,” said Timos Chaliamalias, project medical referent for Doctors Without Borders. Those less able to move, as well as those waiting to be preregistered, are among those left behind, typically the disabled or elderly with more chronic conditions such as diabetes and hypertension.

As these circumstances unfolded, medical staff had to start building patients’ health records, which were often patchy or even completely missing. Exacerbating the situation, many patients were missing records of medications they had taken and treatments they had received prior to fleeing their countries.

“We have seen a number of people who have lost their medicines along the journey, and they were coming to us looking for medicine. More than care, it was just about continuing their current prescription,” Capsaskis said.

Upon arrival in Greece, refugees are expected to preregister their status and obtain the right paperwork so they can register for residence within a camp as well as the “right to access services,” according to a recent joint European Union-UNHCR press release.

But this process has been slow and arduous, with many refugees lacking the appropriate paperwork to access these services or register their movements into more formal camps. The current four-month-long campaign to preregister the 60,000 refugees currently living in Greece is due to end in August. Lack of coordination from the authorities and the time taken in preregistering arrivals has, in part, slowed down the process of moving refugees to newer camps on the mainland, such as Oinyfita.

It has “also affected their health care,” said Capsaskis. “It’s linked to that because lots of people’s papers are now no longer valid,” meaning that “they don’t have another valid piece of paper validating their legal presence in the country.” The lack of valid paperwork limits movement into and out of the camp.

Critically this has also meant that refugees without valid papers are unable to access important secondary-health services, especially when their needs are not deemed as urgent. Refugees can, however, access services “if it’s an emergency,” said Capsaskis, stating that hospitals have a duty of care to protect lives when it is an emergency.

What is not clear, however, is whether refugees are allowed back in. Though in some instances Praksis was able, with help, to gain information about three cases where refugees had temporarily left the camp to seek treatment and, ultimately, return them to Piraeus, medical teams are not prepared to take that risk sometimes, especially if a refugee’s needs are not urgent.

“How can we send people to the hospital if we cannot be sure that they can return and might not have anywhere to stay and nothing to eat?” said Eleni Nikolia, nurse and social worker at Praksis.

For Eleftherios Pallis, a medical doctor at Praksis, “[it is]one of the biggest issues that we have been facing. We know that this person might need to go to the hospital. They can get out, but they can’t come back in.”

Even if patients are able to reach hospitals outside the camp, they face a “very overburdened system,” which recently saw budget cuts of up to 40 percent, Capsaskis said.


About Author

Charlie Ensor

Charlie Ensor is a Nairobi-based freelance journalist, focusing on refugee rights, development and humanitarian crises in East Africa. His work has also featured on the Guardian and WhyDev; he also writes his own blog on development and aid issues. Charlie tweets @charlieensor, and you can contact him at