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Large-scale Right to Health violations in Moria refugee camp on Lesbos Island, Greece

Date:13 February 2020

Written by Dr. Adriaan van Es, a.van.es planet.nl        

Living conditions in the Moria refugee camp are highly inhuman. The situation is explosive and characterised by daily demonstrations of desperate Moria people and confrontations with police. These are largely due to the overcrowding of the camp; while it is designed for 3.100 persons, it currently has reached a number of over 20.000.

In June and October 2019, I was in Moria as a volunteer physician providing medical relief through the Dutch Boat Refugee Foundation. Operating in these circumstances certainly calls for a reflection on the question of ‘what to do with what we witness’. It is a dilemma shared by many of my colleagues who don’t want to be a ‘medical ornament’ on a perverse and inhuman system.

Being a human rights activist, I decided to make an assessment of the situation through the lens of the Right to the Highest Available Standard of Health (Right to Health), conceived in General Comment 14 to Article 12 of the UN International Covenant of Economic, Social and Cultural Rights (1966).

As a doctor, I found that almost all patients I saw are severely traumatized due to having experienced torture and violence not only in their country of origin but also during their journey and after their arrival at the camp. Many women were repeatedly violated and children had experienced trauma and horrific living conditions. Large numbers of vulnerable people, such as minors traveling alone, are in a particularly difficult position. Furthermore, possibilities for adequate support and help are grossly limited and substandard.

We treated many cases of stabbing wounds, including deadly ones; we saw serious infections and untreated advanced cancer cases. In addition, as health workers, we were frustrated by the lack of health care facilities. In fact, there were almost no facilities for referral to specialist care, laboratory or x-ray assessment, in contrast to health care for island residents and tourists.

Given the situation, a health worker's perspective and input in the assessment of an infringement of the Right to Health is appropriate and relevant. Based on the assessment outlined in the tabs below, the final conclusion is that the refugees’ Right to Health in the Moria camp has been violated in most of its aspects, both the underlying conditions for health and health care. Greece is in a particularly difficult position as one of Europe’s “frontier” countries where most refugees and asylum seekers enter Europe. This fact should be considered when it comes to assessing accountability. Thus, it is to be concluded that accountable parties are not only the Greek Government but also the European Union.

 It is recommended for NGOs working on Lesbos, including the Dutch Boat Refugee Foundation, to establish a coalition for the protection and advancement of human rights of the refugees on Lesbos. Furthermore, they should provide input in parallel reports for periodic reviews of i.a. the Committee on Social, Economic and Cultural Rights, the Committee of the Right of the Child and the Committee on the Elimination of Discrimination of Women. Lastly, they should advise and seek the cooperation of the UN Special Rapporteur on the Right to Health and approach European human rights institutions. It is also recommended for the Dutch Boat Refugee Foundation should publish a human rights and accountability statement.

 Assessment of a violation of the Right to Health in the Moria refugee camps

Underlying conditions of health

Food

The food provided in the ‘food row’ is of substandard quality and quantity (not responding to increased population). Some food support by NGOs is present.

Housing

Housing is below any standard. People are living in overcrowded cabins and tents.

Water and sanitation

Many have to walk far to fetch water. Toilet and shower facilities are substandard in quality and quantity, and unsafe for women and girls.

Clean and safe environment

The environmental situation is totally substandard. Overcrowding creates unhealthy conditions which stimulate  viral and bacterial infections, the rise violence and the creation of an overall unsafe environment.

Social services

The registration of refugees and the handing out of a small allowance for basic life needs to newcomers (as required by EU and UNHCR regulations) are severely backlogged.

Conclusion:

Underlying conditions of health, as defined in the Right to Health, are absent and/or substandard

Healthcare elements

Availability

Availability is limited. Public health by the Greek authorities is limited and often much delayed. Some NGOs (i.a. Boat Refugee Foundation) provide emergency care without adequate referral possibilities.

Accessibility

There is limited accessibility on grounds of discrimination.

As to economic accessibility (affordability), the NGO’s health facilities are economically accessible for all refugees, but not for more complicated assessment or specialist care. 

Acceptability

Within the budget and other restraints, the health care facilities, respect cultural and gender perspectives is in place.

Quality

Presence of qualified physicians, nurses, psychologists provide a reasonable level of quality. However, referral limitations mentioned above render the quality care severely substandard.

 Conclusion:

 All health care elements under the Right to Health requirements are substandard ad/or violated

 Maternal, child and reproductive health

The limited capacity of specialized care for children, pregnant women, and women who have faced sexual violence, by an MSF clinic, is far from what is necessary.

Prevention, treatment, and control of diseases

Huge overcrowding of the camp and overburdening of health care facilities pose severe restrictions on the right to prevention, treatment, and control of diseases.

 Non-discrimination and equal treatment

There is structural discrimination between refugees and European citizens on the island.

Within the healthcare facilities in the camp, there is no discrimination on the basis of gender, sexual orientation, language, political orientation or social status.