Refugees, migrants and asylum seekers are forced to live in dreadful conditions until their asylum claims are processed, says Irish GP, Dr Claire Dunne, who is currently working on the Greek island of Lesbos for Médecins Sans Frontières.
Refugees’ mental health suffers as they live in dreadful conditions until their asylum claims are processed, says Irish GP Claire Dunne, who is working on the Greek island of Lesbos for MSF
Lesbos is a place of contradictions — there are azure vistas of the Aegean sea, silvery knotted olive groves, pomegranate trees, and acres of crumbling neoclassical mansions. There are sleepy fishing villages at the foot of volcanoes where life flows along gently and one can almost forget the truth, as many in Europe have. But dotted along isolated rocky shores, in tidy bundles, are brightly coloured reminders — life jackets.
In another world, on the same island, thousands of men, women, and children are packed into an area made for less than a third of their number. They sleep side by side, in bunk beds, on mats, on the floor, on the ground. To eat they must queue at designated times in a narrow-fenced area where fights frequently break out.
There is limited access to toilets and showers and a constant threat of violence, sexual violence, riots, and fire.
I was told to expect this during the height of summer in Moria camp. With the good weather comes a spike in arrivals by sea, overcrowding worsens (in August numbers in the camp reached 10,000) and tensions rise. The sense of foreboding is hard to describe and must be so much more difficult for the many asylum seekers who are spending a second or third summer in the camp while waiting for their asylum claim to be processed.
When I first arrived with Médecins Sans Frontières (MSF) in May and Moria was not so overcrowded (although still 60% above its official capacity of 3,100), I was struck by how some of its inhabitants had tried to make parts of the camp or the overspill area (the ‘Olive Grove’) more homely by putting plants outside their tents, or upcycling pieces of rubbish into makeshift furniture. I noticed a group of children playing games with bottle caps.
It seemed to me that, in the most desperate of situations, people could still find joy or hope.
However, having seen how the camp has deteriorated over the last few months, with extreme overcrowding, hope now seems at odds with reality. Recently a child died tragically in Moria’s ‘safe zone’. In the current context, more tragedies are expected. It is heartbreaking.
MSF runs two medical units on Lesbos for people living in Moria camp — one provides paediatric primary health care, mental health services, and sexual and reproductive health services to women and children.
The other, whereI work as medical activity manager, provides specialised mental health services to people with severe mental health issues related to traumatic experiences (torture, violence, sexual violence) usually occurring in their country of origin, but also on the journey to or in Greece.
Almost everybody in Moria has survived a nightmarish ordeal or two fleeing their homes, but unfortunately we can only accept the most severely affected — those who are actively suicidal, have lost the ability to function or care for themselves, or have such intense post-traumatic stress disorder) that they have developed psychotic symptoms.
Referrals come from a small number of medical NGOs working in or near Moria. The referrals in my inbox tell stories of families torn apart by war and violence; women fleeing for their lives only to be trafficked as sex slaves or raped by smugglers; men imprisoned, tortured, and raped in their country of origin or in Turkey (a country that is considered ‘safe’ for refugees under the EU-Turkey deal).
Symptoms are multiple and complex — “non responsive”, “disorientated”, “stopped speaking”, “bedwetting”, “refuses food”, “severe psychotic symptoms”, “sees people with knives that are after him”, “sees men who raped her”, “suicide attempt twice in the consultation room”, “screaming in the night”, “ran away into the forest”, “people lying on floor around him in his tent remind him of dead bodies in the water”.
Iin Ireland, I work in a context where trauma and mental health issues are rife but have never encountered anything like this.
Although we have tried to make our waiting area more appealing with plants, relaxing music, and artwork, it has had little effect on our new and most unwell patients who wait here staring into space blankly, or with their heads in their hands.
Occasionally one will have a dissociative episode or ‘flashback’, where they are triggered by a sound, a touch, a smell, and lose contact with their surroundings believing and behaving as though they are back experiencing a violent event in the moment that it happened.
Patients who have been attending our service for a couple of months and have ‘stabilised’ often use their time in the waiting area to sleep because it is a safe space where they can relax. Restful sleep is difficult to find in Moria.
In the clinic, our team (a psychiatrist, psychologists, nurses, doctors, cultural mediators, and case workers) provide a holistic and multidisciplinary approach in order to stabilize patients, help them function, and treat any medical complications of torture or sexual violence.
We do not aim for rehabilitation because this is not possible for peopleliving in such an unsafe and uncertain environment, at risk of further trauma on a daily basis.
In the first consultations, many patients have completely lost contact with reality.
A young man in his early 20s with multiple suicide attempts by knife and rope spends much of his staring at the ground,completely still and mute.
Towards the end of the session he suddenly looks frantically around the room, trembling, trying to get out of the windows and onto the balcony, convinced that there are other people in the room trying to attack him.
We repeatedly tell him that he is safe and that he is in an MSF clinic in Greece but he doesn’t hear.
When we eventually convince him to take some medication he calms down and starts sobbing uncontrollably, but later abruptly stands up in a salute to an invisible person.
Although he is suicidal and psychotic, requiring close observation, he is not hospitalised by the local psychiatry department — there is effectively no inpatient psychiatry access for our patients.
Each evening as he goes back to Moria, we hope he will survive the night and we will see him the next day. We know conditions in Moria camp are dangerous for him and certainly aggravating his condition, but we cannot arrange a transfer out in this case.
After weeks of regular sessions, and antipsychotic medication he starts to talk (ultimately it turns out he speaks three languages!). He recognises us. It is as though a light has been turned on.
Unquestionably, the time they spend ‘living’ there is detrimental to their mental and often physical health. However, the most frustrating thing is knowing that their containment in such clearly inhumane conditions, is something man-made and EU policy driven and ongoing for more than three years with little sign of change.
On the walk home from the clinic this evening I passed a superyacht. Lesbos is indeed a place of contradictions.
Claire Dunne is an Irish Doctor working for Médecins Sans Frontières on the Greek island of Lesbos.