In the last few weeks, hundreds of people have been moved out of refugee camps in Northern Greece into hotels or similar accommodation. Snow has been falling, and temperatures hit minus ten at night. Frustration and dis-empowerment is everywhere. After months of waiting, those who remain in the camp know that when they are relocated, it will be without warning or explanation.
When the time comes to move families or individual refugees out of the camp, they are often told late one evening that a van will be moving them the next day. They are given only hours to pack their belongings.
During one of my days volunteering for the Syrian American Medical Society, I spoke to refugees and families who were about to be taken by bus to the next place that would serve as home. Not one could tell me the name of the street, town or even the region that they were about to be driven to. Only a couple knew which organisation was taking them.
Coming as I do from a health service and a society where we place a high value on ‘patient engagement’, ‘patient autonomy’ and ‘patient choice’ the lack of engagement, autonomy or choice afforded to refugees here seems derisory. There’s little I can do to counteract the sense of helplessness that many feel under these circumstances.
Gaining the trust of Syrian refugees who access NGO services or Greek healthcare services is difficult. Before the breakdown of the Syrian healthcare system, Syrians were used to relatively easy access to specialists and to many treatments, including antibiotics, that are used more judiciously in Europe.
The intricacies of good communication to build a relationship with a patient are hard to access in overcrowded clinic rooms via translators who have had no formal training. The vast majority of the volunteer organisations working in Greek refugee camps rely on ‘local translators,’ meaning members of the refugee community. Few of the translators have received more than basic education, though many have worked very hard to teach themselves English.
Managing any long term health condition is difficult without access to medical records, without well-established organisations and structures for coordination between agencies. The systems to support migrant populations will need to work better and more flexibly to cope with the frequent and unpredictable changes for many years to come.
Supporting people with mental health or social problems in a refugee camp is particularly challenging. A plethora of mental health problems, from depression to psychosis, are more common in those who have been forced to migrate. A lady I saw in clinic has suffered from increasing pains, confusion and anxiety since she arrived at the camp eight months ago. She recently started to express hopelessness and difficulty being a mother without her husband here in Greece.
Defining ‘normal’ mental health, appropriate behaviour and good care for children in this setting is not straightforward. Cold conditions, a poor diet and a lack of education and stimulation are the norm. Frustration and depression may result in parents giving less of the right kind of attention to their children.
When I ask patients who come to clinic what their worries are, they most often tell me that it is ‘the situation’ that causes their troubles. “What can we do?” They feel trapped and without control over their lives. Their children haven’t been at school regularly for months or years. They have no work or prospect of work. They may have had one or both of their asylum interviews but they are invariably facing months of waiting to receive the date of, and then the outcome from, an interview.
The humanitarian organisations working here are also in the dark about what the future holds, both short term and longer term. Rumours circulate that the camps will be cleared and more refugees will be brought here from the islands, but no one seems to know when. Part of the reason that refugees are not being moved from the exposed camps on Lesbos, Chios and the other Greek islands may be the EU-Turkey deal. Under the deal, ‘irregular migrants’ (including those who haven’t claimed asylum yet, or have claimed asylum in another country and then moved on) are not to be moved to the Greek mainland, but instead to be returned to Turkey and ‘swapped’ for a migrant in a Turkish refugee camp who will be resettled in the EU.
I wondered during my days in Northern Greece what effect the noxious mix of uncertainty, cold and dis-empowerment will have on those who are growing up with the title of ‘refugee’. How will they process the traumas and challenges of their long journeys? Some refugees tell me that they can talk to a friend and some receive psychological support from one of the humanitarian organisations. But many don’t.
Those refugees acting as translators have a particular burden. “They tell me so many stories, but I have my own story,” one translator said to me. Though ‘the migrant crisis’ is such a large scale calamity, it is important that we don’t overlook the horrors that individuals have faced. It will take time and courage to examine and heal their wounds.