Midterm Essay

EDITORIAL

Refugee crisis in Greece: not a one-country job

Antonis A. Kousoulis . Myrsini Ioakeim-Ioannidou .

Konstantinos P. Economopoulos

Received: 14 June 2016 / Accepted: 26 August 2016 / Published online: 18 October 2016

� Swiss School of Public Health (SSPH+) 2016

During the past years, tens of thousands of refugees have

arrived at the rocky coasts of the island of Lesbos, Greece;

occasionally in hundreds in one day, while thousands of

their compatriots have not made it alive (Lancet 2015;

Abbasi et al. 2015). Starting mainly from Syria, they have

arrived in Greece first by walking through rough areas to

the western coasts of Turkey, and then via a long, costly

and highly risky trip in inflatable, overcrowded boats

(Abbasi et al. 2015). Lesbos is situated on one of the most

direct passages to the European continent and is refugees’

hopeful safe haven. It has come to represent asylums

seekers’ gateway to a potential escape from a troubled past.

However, upon arrival to Greece, the desperate travelers

have encountered a new set of challenges.

Greece has not received consistent support from other

European countries. Notable exceptions include buses

offered by the United National High Commissioner for

Refugees (UNHCR) to transport people to Moria in Les-

bos, where Frontex (agency of the European Union) staff

have been screening and identifying refugees. Moria hosts

a hotspot, an EU-run reception centre to identify and fin-

gerprint migrants and refugees. Following the EU and

Turkey agreement on refugee movement, Moria has been

largely operating as a detention camp. It is there that

refugees have queued for their registration by the Greek

police authorities, received necessary documentation to

continue their trip to other European countries (Germany,

Hungary, UK among others) (Abbasi et al. 2015), or been

deported. Often a few have disappeared in the island’s

countryside during the night, remaining anonymous,

unaccounted for and eventually undocumented. Lesbos saw

a new influx of asylum seekers in early summer as well as

riots in June. It is in this context, that the lack of a long-

term sustainable solution to address the violation of the

basic rights of thousands of refugees going through Greece

remains important. International public health authorities

would have a role to play in assessing the unsafe and

unsanitary conditions of the hotspots. Further, as a signif-

icant number of refugees are being detained in camps for

months, they incur eventually far higher costs to receiving

societies than becoming integrated (Razum and Bozorg-

mehr 2015).

This new health crisis in Greece is reflecting the extent

of the problem on the other receiving end: Syria. During

the recent conflicts, wide destruction of health care facili-

ties, lack of secure routes, shortage in medicines, re-

emergence of polio and widespread famine and malnutri-

tion have been recorded (Ben Taleb et al. 2015). Syria

faces a human tragedy and remains a sad reminder of the

impact that neglected determinants, like conflict and poli-

tics, have on public health. This leaves Greece to

experience the consequences of the Eastern Mediterranean

refugee crisis to the utmost degree (Lancet 2015). The

country faces a significant economic and social crisis and

its approach to healthcare delivery has known problems,

A. A. Kousoulis � M. Ioakeim-Ioannidou � K. P. Economopoulos

Society of Junior Doctors, Athens, Greece

A. A. Kousoulis (&) Faculty of Epidemiology and Population Health, London School

of Hygiene & Tropical Medicine, 10 Norwood Avenue,

London HA0 1LY, UK

e-mail: [email protected]

M. Ioakeim-Ioannidou

Medical School, University of Athens, Athens, Greece

K. P. Economopoulos

Massachusetts General Hospital, Harvard Medical School,

Boston, MA, USA

Int J Public Health (2017) 62:1–2

DOI 10.1007/s00038-016-0890-0

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namely: lack of coordinated public health programs,

unequal access to healthcare, insufficient rural and remote

primary care provision (Kousoulis et al. 2013). If it aimed

at realistically supporting this international public health

agenda, Greece would indeed be required to, no less, rev-

olutionize its national healthcare system. Rather, the

country is experiencing the burden of this crisis without all

the necessary provisions in place to share the obvious

collective responsibility.

It takes creative thinking beyond borders to address

some of the health needs of refugees. Many important

predictors of long-term mortality and morbidity in immi-

grant populations are well documented: age at

immigration, burden of existent long term physical condi-

tions, and emerging conflict- and trauma-related mental

health problems (Ben Taleb et al. 2015; Holmes et al.

2015). However, whilst universal health is recognised as a

fundamental human right, it has frequently been subjected

to heterogeneous regulations and interpretations, often

impacting most negatively on migrants (WHO 2014). The

existing evidence base which addresses the needs of pop-

ulations in transit should grow further to challenge policies

and practices impacting on migration and provision of care

(Smith 2016). Thinking beyond borders in the current

context requires EU coordination and best use of available

support. However, European funding is far from sufficient

and countries with much more organized care structures

and available funds (like Germany or the UK) are

increasingly taking inward-looking approaches (Abbasi

et al. 2015).

It is unlikely that the movement of refugees across

Europe will slow down any time soon. Thus, decisive steps

should be taken to deal effectively with the mass suffering.

In addition to what has been suggested (Lancet 2015;

Abbasi et al. 2015), further actions are needed: local

authorities and large international Non Governmental

Organizations need to establish channels of interaction;

European countries should work more closely with the

Greek state; international support should be provided for

volunteers wishing to be deployed to areas like Lesbos.

Public health needs to be safeguarded by using a serious

project plan, including, at least, screening for infectious

diseases, trauma assessment, mental illness stigma pre-

vention and mass vaccination. Greece cannot -and should

not- face this alone.

References

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call for moral leadership. BMJ 351:h4833

Ben Taleb Z, Bahelah R, Fouad FM, Coutts A, Wilcox M, Maziak W

(2015) Syria: health in a country undergoing tragic transition. Int

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Holmes JS, Driscoll AK, Heron M (2015) Mortality among US-born

and immigrant Hispanics in the US: effects of nativity, duration

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Kousoulis AA, Angelopoulou KE, Lionis C (2013) Exploring health

care reform in a changing Europe: lessons from Greece. Eur J

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Lancet (2015) Adapting to migration as a planetary force. Lancet

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2 A. A. Kousoulis et al.

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