Health Security and the Refugee Crisis in Greece: The Refugee Perspective

*Thomas Papadimos, Scott Pappada, Michael Lyaker, James Papadimos and Andrew Casabianca*

### **Abstract**

The flight of refugees has been part of the human condition since the beginning of time. Recent events in the Middle East have caused a mass migration of refugees from Syria, Iraq, and Afghanistan. Their primary destination has been Europe, more specifically, the affluent, better industrialized countries of central and northern Europe. However, the European law currently requires that refugees must be processed at the first port of entry to Europe. In most cases, this involves the eastern Aegean Sea islands of Greece. Here the refugee camps have become overcrowded and underfunded, and have little medical care and security. The Greek government has limited resources and the response for support from the more affluent European countries has been underwhelming. Here we summarize the lack of health security from the refugee perspective of those that are awaiting entry to Europe and are encamped in Greece.

**Keywords:** human migration, Greece, public health, refugees, refugee camps

#### **1. Introduction**

The early to mid-twenty-first century will be known for its mass migration movements. In fact, Greece has become the gateway for the mass migrations of refugee populations since the end of World War II [1]. The current Middle East refugee crisis is taxing many national health care systems [2, 3]. Greece is in a particularly unique position regarding the flood of refugees into Europe because of their proximity to Turkey, which is the conduit for Syrian, Afghan, Kurdish, Iraqi, and in some cases, African refugees. Greece is not a stranger to refugees. In 1922, Greece experienced a massive inflow of Greek refugees fleeing Asia Minor after Greece's military defeat at the hands of Turkey. The Greek nation absorbed them successfully and in the 1990s was able to face a similar, but smaller refugee challenge with the migration of many people from Eastern Europe [4]. However, the current refugee problem, that is a consequence of the conflicts in the Middle East, is different; it involves a tidal wave of refugees that are of non-Greek origin. This was, and remains, a challenge for a homogenous society [5]. The challenge of supporting refugees is especially difficult in the context of the recent Greek debt crisis of 2008 that left the Greek economy devastated. The term migrant many times refers to economic status and can be considered derogatory, whereby they are not given the

consideration or status of refugees. In our work, we use the terms interchangeably and do not cast aspersions on those who are not truly refugees as defined by the 1952 United Nations Convention relating to the Status of Refugees (and the 1967 Protocol relating to the Status of Refugees).

Even before the debt crisis, there was a notion that Greece was not a safe host country for refugees [6]. Skordas and Sitaropoulos indicated that while the Greeks generally observed *non-refoulement* (the practice not mandating asylum seekers/ refugees to return to a country in which they are liable to be persecuted), the Greek system of asylum suffered from a "calculated ambivalence towards the legal situation of the victims of non-state agents" and failed to provide for "basic subsistence needs … and social protection for refugees and asylum seekers [6]." Despite Greece being on the receiving end of wave of refugees/migrants, the national policies were reactive with the occasional passing of ad hoc laws, executive decrees and polices directed at the behest of the European Economic Union (EU). These measures did not take into consideration the long-term view [7, 8]. Additionally, oppressive austerity initiatives forced on the Greeks by the EU have triggered "resistance" initiatives across the country making refugee-friendly positions/responses less likely [4]. In spite of these internal and external factors, the Greek nation, through anti-racist efforts and solidarity movements, managed to provide refugees with legal services, shared information regarding available social programs Greek language instruction and basic elements of health care [4, 9].

However, in 2015 a breaking point was reached. The conflicts in the Middle East resulted in more than 1,000,000 refugees arriving in Greece over a period of approximately 15 months [10]. This happened at the same time that the debt crisis was exacting a devastating toll on the Greek economy. Millions of people were leaving their home countries to find a safer place to relocate [11]. Most of these refugees were trying to get to central and northern Europe, through the route from Turkey to Greece [12]. However, the closure of the Western Balkans transit route on the border of Greece and the Former Yugoslav Republic of Macedonia in February/ March 2016 (EU-Turkey agreement), transformed Greece "from a transit country to a country hosting tens of thousands of third-country nationals for a still undefined, yet long-term, period. Greece progressed from the logic of repression (meaning to keep all foreigners out) to the logic of reception," and received 90% of the total population of refugees from 2016 to 2018 [9]. This resulted in between 10,000 and 20,000 asylum seekers who were unable to leave Greece and becoming confined to refugee camps where they were trapped and forced to live under poor economic and health conditions [13, 14]. Over time, this number has now has swollen to over 60,000 people [15]. In effect, since 2011 one half of the Syrian population has been displaced, either as refugees to another country or internally (secondary to conflict, poverty, food insecurity or loss of infrastructure) [16]. Herein, we will review the multitude of public health and medical problems that dominate the health security of refugees in Greece. These problems include infectious diseases, mental health, women's health issues, traumas and burns, and children's health issues.
