Over the past five years, an entirely avoidable and predictable policy-driven humanitarian crisis has been unfolding in the Greek islands of Lesvos, Samos, Chios, Leros, and Kos, with devasting consequences for the people trapped there. After fleeing their homes and surviving harrowing journeys to Europe, the indefinite containment, limbo, and systematic violence in Greece further traumatises people seeking protection. Nearly 10,000 people are currently being held in five Greek islands ‘hotspots’, also known as Reception and Identification Centres (RICs1).
The ‘hotspot approach’ has been envisaged as a model of operational support by the EU agencies to the Member States such as Italy and Greece to facilitate the swift identification, registration, and fingerprinting of migrants arriving in Europe. In Greece, this approach is closely intertwined with the implementation of the EU-Turkey Statement (also known as the ‘Deal’) and has proven to be a disaster. The Deal signified a tipping point, creating a European border that is fortified and closed; embedding structural violence at the heart of EU migration policies. After the introduction of the Deal, the hotspots quickly transformed into mass containment sites intended to facilitate the fast-track border processing and return of people to Turkey. Thousands of people remain confined in degrading and inhumane conditions as they wait for protection.
As a humanitarian medical organisation providing care on the Greek islands, Médecins Sans Frontières (MSF) has been treating the physical and mental wounds these migration policies have inflicted on people for many years. In October 2016 and October 2017, MSF published several reports highlighting the health implications of containment and the significant mental health emergency emerging on the islands.2 Nearly four years on and, astonishingly, rather than address the situation, the EU and its member states intend to intensify and institutionalise its containment and deterrence strategy.
In September 2020, the notorious Moria RIC was burned to the ground in a destructive and symbolic moment. EU leaders promised ‘no more Morias’ while ignoring similar facilities on Samos, Kos, Chios, and Leros. From the ashes of Moria has emerged a new, temporary camp, Mavrovouni, that replicates many of the worst elements of the Moria hotspot. The Moria RIC is the blueprint for the proposed EU Migration and Asylum Pact screening and asylum regulations announced on 23 September 2020, and the new EU-funded Multi-Purpose Reception and Identification Centres (MPRICs) – one is being built on Samos and may be operational in June 2021. Commonly referred to as ‘closed centres’ by the Greek authorities, MPRICs are designed as more restrictive versions of the current facilities, and reinforce the ability to contain, detain and deport people arriving in Europe.3
In this report, MSF takes stock of five years of providing medical care on the Greek islands. The report’s analysis is based on documentation and medical data from MSF operations on Lesvos, Samos, and Chios, as well as testimony from patients and MSF staff.
MSF once again calls on European leaders and the Greek government to take accountability, recognise the harm caused and end this deadly and dangerous approach
“What we found in Moria was inhumanity and violence. It was an open-air prison. We are survivors of torture, but in Moria we were not even treated as human beings. We were told that our country of origin is safe and that we would be rejected and returned. We were told that it didn’t matter what we had been through. We didn’t receive any protection. We didn’t receive any support. We weren’t even told what the decision of our asylum application was. We didn’t have access to a fair asylum process. Now that we have been freed from this hell, we call on you to stop treating human beings like criminals on the Greek islands. We don’t want more lines to queue for food, people left without dignified shelter, no more people trapped in uncertainty and insecurity. We who have suffered the most degrading and insurmountable violence, cannot but refuse inhumane and degrading treatment for anyone in any way. Every person deserves to be treated with humanity with respect to their dignity and freedom.”
Survivors2 is a group of survivors of torture, cruel and inhumane treatment, and EU migration policies. All Survivors2 members are either current or former patients of MSF’s rehabilitation clinic in Athens.
Key findings: The Human Cost of Containment
People seeking protection in Europe have already been exposed to violence and hardship, and the hotspots are neither safe nor healthy places for them. The majority of people treated by MSF have experienced one or more traumatic events in their country of origin and during their migration journey. This trauma is compounded by their containment and the everyday structural violence of life in the hotspots. As a result, MSF teams on the Greek islands respond to alarming levels of mental health suffering. Between 2019 and 2020, MSF mental health clinics on Chios, Lesvos, and Samos treated 1,369 patients.
Major stressors for patients’ mental health included navigating daily life in poor living conditions and unclear administrative procedures, exposure to violence and insecurity, unaddressed medical needs, and fear of deportation. Many require treatment for post traumatic stress disorder, moderate to severe depression, reactive psychosis, and anxiety, all of which are serious mental health conditions that demand long-term treatment
I Structural violence refers to the social structures or institutions that put individuals and populations in harm’s way specialised care often inaccessible on the islands. MSF has treated hundreds of survivors of violence, ill-treatment, and torture, who have not been identified by the authorities and have not received any support. Instead, they have been placed in conditions that are not only unsafe but re-traumatising.
Children seeking mental health support often display trauma- and fear-induced symptoms triggered by their environment in the hotspots. There are alarmingly high rates of self harming and suicidal acts among children; the youngest seen by MSF was six years old. As people’s sense of hopelessness intensifies, their mental health state worsens; MSF has documented this in similar contexts around the world.4
The living conditions in the RICs expose children to unhealthy and unsafe environments. Between 2018 and 2020, MSF conducted over 42,000 paediatric consultations at its clinic near the Moria RIC, which included treating children for injuries and burns from accidents, hazards, and violence. The most common issues were linked to poor sanitation and exposure to cold weather.
Europe’s leaders have continued to prioritise containment and deterrence above the provision of basic essential services such as water, sanitation and access to health. MSF and other NGOs have continuously stepped in to provide crucial services. From 2019 to May 2021, MSF has trucked in over 43 million litres of safe water for people in the over-capacity Vathy RIC, where the water is unsafe to drink.
There are significant gaps in access to adequate and timely healthcare for people held on the Greek islands. This may lead to otherwise manageable medical and mental health conditions deteriorating, becoming more severe and potentially chronic. The COVID-19 pandemic should have been the final straw to abandon cramped hotspots. Instead, the pandemic has amplified the suffering of migrants subjected to a chaotic COVID-19 outbreak response and harsh lockdowns in poor living conditions, with little to no access to water, hygiene, or essential services. Measures taken have dangerously conflated public health and migration control agendas.
The hotspot approach harms people’s dignity, health, and well-being and is designed as deterrent to those who dare to seek safety in Europe. This report’s detailed analysis demonstrates how indefinite containment, appalling reception conditions, expanding detention, violent border controls and pushbacksII, and rapid border procedures work as a system that inflicts misery and puts lives in danger.
Moving Forward: EU Intensifies a Dangerous Approach
MSF is extremely concerned about the human cost of the MPRICs. Continuing and intensifying this policy of violence will cause a worsening health and protection crisis. The new facilities will be in isolated and remote areas of the islands. People will be held in shipping containers, surrounded by high, barbed wire fences, with controlled entry and exit. This cannot be sold as an improvement in people’s living conditions.
The right to asylum is also in jeopardy. The new pre-entry border screening regulation (proposed in the PACT), together with separate pre-removal detention facilities inside the MPRICs, will lead to widespread deprivation of liberty and the potential for mass deportations of people seeking international protection. Increased security, surveillance and segregation from the rest of society will limit access to services and remove any agency or semblance of a ‘normal’ life. An anticipated decrease in NGO presence means that the MPRICs will make people’s suffering more invisible and further isolate the most vulnerable.
II Pushbacks refer to informal and illegal cross-border expulsion of people by States.
Call to Action
“I want Europe to notice, to take care of refugees, to see their problems. We are human beings, we are human beings, like you. As we see each other. They cannot leave us in these conditions.”
Menele, 30 years old in Samos, from Democratic Republic of Congo
For European leaders, creating the illusion that migration can and must be stopped is more important than the safety of people and their potential contributions to society through consistent reception and integration programmes. Europe’s dangerous approach to migration is the cause of the medical humanitarian crisis in Greece. Demonising and degrading people seeking safety in Europe is not a solution, but the problem itself.
There is a vacuum of accountability, enabled by the EU-Turkey Statement and the hotspot model, which has blurred informal agreements, legal frameworks and responsibilities between national governments and EU institutions. The European Commission, European member states and Greek authorities must take responsibility. Rather than pursuing a brutal, inhumane system and deadly chaos, Europe must instead adopt policies that protect human lives and do not jeopardise people’s health and well-being.
Key Recommendations :
− Evacuate people from the island hotspots to safety on the Greek mainland and in other European states.
− End the policies of containment and deterrence, and immediately halt the creation of the Greek island MPRICS. The only purpose of centres on the Greek islands must be the provision of urgent assistance, facilitation of access to protection and relocation to safe reception.
− Ensure access to quality, timely medical care, tailored to the medical and mental health needs of the population, and provided sustainably within the public health system.
− Invest in a dignified reception system and safe accommodation for asylum seekers, refugees and migrants, such as housing within communities, as well as integration programmes for refugees.
− Establish a fair and transparent asylum process that upholds all necessary procedural safeguards and does not violate the rights of asylum seekers through border procedures.
− Ensure no refoulement, violence and death at EU borders: end the violence and pushbacks and stop criminalising humanitarian assistance. Instead provide safe passage for those seeking safety in Europe. Alongside this, invest in family reunification, refugee resettlement, humanitarian visa and other complementary protection pathways, as well pathways for work and study.
Read the Full Report here: Constructing crisis at Europe’s borders
1 Ministry of Citizen Protection (6 May 2021), National Situation Picture Regrading Eastern Aegean Sea https://infocrisis.gov.gr/13156/apotyposi-tis-ethnikis-eikonas-katastasis-gia-to-prosfygiko-metanasteftiko-zitima-tin-6-5-2021/
2 Médecins Sans Frontières (2016), Greece: Vulnerable People Left Behind, https://www.msf.org/greece-2016-vulnerable-people-left-behind; Médecins Sans Frontières (2017), Confronting a Mental Health Emergency on Lesvos and Samos, https://www.msf.org/greece-eu-border-policies-fuel-mental-health-crisis-asylum-seekers
3 Ministry of National Defence (November 20 2019), Five step plan on immigration [Press Conference], https://www.amna.gr/home/article/409666/Pente-sun-mia-draseis-tis-kubernisis-gia-to-metanasteutiko
4 Médecins Sans Frontières (2018), Nauru : Indefinite Despair, https://www.msf.org/indefinite-despair-report-and-executive-summary-nauru
