“ They had walked for 5 days across the mountains to reach the coast and then crossed on a boat this very morning. They had not had a proper meal for those 5 days, and had been drinking water only when they could get it .”
In August 2018 I spent a month working as a volunteer doctor with MedGlobal in Moria camp on Lesvos. I worked alongside Greek doctors, nurses and midwives who make up the Keelpno medical team (the Greek ministry of health response) as well as other volunteers from Kitrionos (another medical NGO) and refugees from Moria camp itself. This piece is an attempt to summarise my experience and to try and articulate the experiences of some of those people I met there.
The first sign that you are nearing Moria camp is the surrounding olive groves turning into makeshift tents and shelters, an indicator of the rapidly growing population that has far exceeded the camps intended capacity. On arrival it becomes clear that this is an unhappy place. Graffiti reads “Welcome to Prison” (with Moria crossed through beside it). Although, technically, Moria is not a prison it can feel very much like one. Originally built as a military base, the imposing high security walls and watchtowers have rolls of razor wire along them, and there is a large security and police presence. Depending on the time of day you may have to jump over a stream of sewage that often floods in front of the entrance. I often wondered what the newly arrived refugees who have risked their lives to cross the sea must think when they arrive here.
Once newly arrived refugees are given their initial police papers they are free to come and go from the camp, but they are not able to leave the island until they get the necessary asylum status approval. Different levels of approval grant you increasing amounts of freedom of movement. The process is lengthy, often lasting several months, with some people waiting more than a year in Moria before gaining asylum status approval to leave the island, with an ever-present potential threat of deportation hanging over them. I cannot claim to fully understand the Greek asylum system, but even with my brief experience it is clear that it is at breaking point.
The Greek health system is similarly struggling to stay afloat, simultaneously navigating its own domestic economic crisis and now also supporting an ever-growing population with multiple complex health needs. Talking to my Greek colleagues – the nurses, doctors and midwife of Keelpno – was an invaluable eye-opener to the changes they have witnessed on their island. Those who have worked at Moria the longest explain that during the 2015/2016 years they saw huge swells in population as thousands of people arrived in a day, but only a few days later these people would have been registered and moved onwards to the mainland to continue their asylum case. Some days the camp would be quiet with hardly any people there. Now it is very different. Very few refugees are leaving the island but people continue to arrive. During August 1725 refugees arrived, and by the end of the month there was a total population of 8305, in a camp built for 3100. As one of the nurses said to me, “we have never experienced it like this before”.
I saw the health mal-effects of overcrowding and poor sanitation on a daily basis. Skin infections were common, and suspected scabies was an almost daily event, along with diarrhoeal illnesses and respiratory tract infections. Management of chronic diseases like diabetes, hypertension, strokes and ischaemic heart disease was challenging given that there was on average a 4 week wait for blood tests and a variable supply of longer-term medication. Someone had said that the chemical agents that were used to clean the water were causing kidney stones. I can’t verify the truth of this statement but there certainly seemed to be a higher than normal incidence of ureteric colic and renal calculi.
Perhaps the most challenging part of my workload however was the psychological morbidity. Depression, anxiety and PTSD as a result of unimaginable previous trauma was then exacerbated by the living conditions and environment in Moria. Panic attacks, self harm and severe physical manifestations of psychological illness were a daily occurrence. One evening a 34 year old lady was brought in after being forcibly restrained because she was self harming: hitting her head against walls, biting her tongue, lips and hands and her husband’s arm. Somebody had put a towel in her mouth to protect her lips and tongue, her hands were clenched tight, nails digging into her palms and she was staring straight ahead not responding to any verbal or physical stimulus, in an almost catatonic state. It took around an hour, and the incredible work of Gunilla (a volunteer providing sessions on Trauma Tapping Technique: http://www.selfhelpfortrauma.org/) to get her back onto her feet.
Keelpno run a psychology service within Moria. However, unsurprisingly they are constantly overwhelmed by the need. An appointment for a routine referral may take several months, and even then they are only able to offer an assessment and referral service as there is no capacity for actual intervention with psychological therapy. In the face of such huge amounts of psychological trauma with limited intervention it is easy to feel helpless and overwhelmed.
The situation in Moria cannot and should not be sustained. However, it can be difficult to envisage a solution within the current political climate. The European response to the crisis has been uneven at best, and straightforwardly inhumane at worst. Most of our politicians sadly do not have the foresight or courage to build a concerted European wide plan to fulfil our legal and moral obligations to people fleeing war and persecution. Let alone to do so in a way that acknowledges the differing resources of the countries of Europe. This could be done. Not easily, but feasibly, if the political will existed.
I cannot write about this experience without talking about the people I worked with in the clinic. The inspiring and committed individuals from Greece, Syria, Congo, Afghanistan and Iraq (to name a few) triaging, assessing, translating and coordinating, often working fourteen hour days on the trot are the hopeful light of this narrative. Without them, I would not have been able to do the work I did and would have been rendered entirely helpless. My thanks goes to them for welcoming me from day one.
I walked into the room, smiling at the two women sitting at the desk and the man in the corner. Introducing myself to them all, I established that the man was the Somali interpreter, and the two women were sisters, arrived just this morning from Turkey. The smaller of the two sisters was incredibly thin and did not look well, it was evident that she was the patient.
Her sister began to tell me their story. Her younger sister has cancer, which has spread, most recently to her chest (pointing to a large visible mass over her sternum which she told me had developed over the last few months). They had been staying in Turkey and she had been receiving chemotherapy up until November last year, at which point the doctors had told them that she was too unwell to continue the treatment so had stopped. Just recently their father, who had been working in South Africa and was sending them money to pay for hospital care and treatment, had suddenly died, and so the older sister had taken the decision to make the journey to Greece, in hope of improved access to healthcare for her younger sister. They had walked for 5 days across the mountains to reach the coast and then crossed on a boat this very morning. They had not had a proper meal for those 5 days, and had been drinking water only when they could get it. Her younger sister is unable to eat solid food due to restriction of her jaw movement secondary to the tumour mass, so ordinarily the older sister would make her porridge or similar foods to eat. However, this had not been possible the last 5 days. She told me how this morning they had each been given a chocolate croissant (the standard breakfast provided by Moria camp), so she had torn off pieces of this croissant and soaked it in water before feeding this to her sister in order that she would be able to eat something.
You could tell what a difficult decision it had been for the older sister to make the journey to Greece, trying to decide which of the unappealing options was better: to stay in Turkey, where without money they were no longer able to access healthcare, or make a long risky journey to a country they knew little about, other than the potential for accessible healthcare. She broke down in tears several times whilst she spoke.
The younger sister hardly spoke, uttering only a few half words when we asked her questions about her pain. Yes, she was in pain, motioning to her mouth and neck and face. Yes the diclofenac tablets helped a little. She had a fentanyl 100mcg patch (a very strong pain killer) on her back, which she had been using for around a year. This was what was concerning her older sister the most – that they only had one patch left before they ran out completely. Whilst their story was being told the younger sister’s head repeatedly fell forwards as she fell asleep in her seat, and each time she would with great effort lift it upright again. The older sister explained that over the last 5 days she had become increasingly sleepy and drowsy. She had a nasty sounding cough and her sister explained that she had been coughing up blood intermittently. When we weighed her (to calculate a safe dose of paracetamol – the only analgesic I could offer) she weighed only 18kg. She is 19 years old.
There were so many needs to address within this story; was she opiate toxic or was this a progression of her already very advanced cancer? Did she have metastases to her lungs, a chest infection or perhaps TB? And the larger more difficult questions: what was their understanding about her prognosis? What were their expectations and their own wishes about future care?
I have never dealt with a story which was as deeply sad as theirs was. The interpreter was also affected. It is a job that so often demands an emotionally intense intimacy that I, as a shamefully unilingual English speaker, am protected from. Despite only meeting them this morning, he volunteered to accompany them to hospital in order to interpret to the doctors there. Another Somali woman, also newly arrived and who only met the sisters this morning, offered to look after the older sister’s 4 year old son whilst they went to the hospital, knowing that in all likelihood it would mean at least an overnight trip. When people are surrounded by hardship and tragedy, these demonstrations of human kindness feel all the more profound.