Philippa Jeacocke is a GP trainee in Sheffield currently taking a year Out of Programme Experience (OOPE) between ST2 and ST3 to further explore her interest in refugee health and palliative care.

In August 2018 I spent a month working as a volunteer doctor with MedGlobal in Moria camp on Lesvos. MedGlobal is working to support the existing Greek governmental clinic in Moria known as “Keelpno” by providing an extra doctor. As such, during my shifts I worked alongside the Greek Keelpno medical team as well as volunteers from Kitrionos (another medical NGO supporting the clinic) and refugees from Moria camp itself. On my arrival to Lesvos I was greeted by the friendly face of John Kahler, co-founder and chairman of MedGlobal, who gave me an invaluable introductory orientation to the camp.

  Although, technically, Moria is not a prison it can feel very much like one.

The first sign that you’re 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 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 leave 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 status 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 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. This August 1,725 refugees arrived, and by the end of the month there was a total population of 8,305 in a camp built for 3,100. 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 and hypertension was challenging given the average four 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.

One patient that sticks in my mind was a 19 year old Somali woman who I saw with her older sister. They had arrived just that morning from Turkey. Her older sister began to tell me their story. Her sister had cancer, which had spread, most recently to her chest (she pointed to a large visible mass over her sternum). 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 treatment. Just recently their father, who had been working in South Africa and was sending money to pay for hospital treatment, had suddenly died, and so the older sister had taken the decision to make the journey to Greece, in hope of better access to healthcare.

The younger sister uttered only a few half words in response to questions. She had a nasty sounding cough… She weighed only 18kg.


They had walked for five days across the mountains to reach the coast and then crossed by boat. They had not had a proper meal for those five days, and had been drinking water only when available. Due to the tumour in her sister’s jaw she couldn’t eat solid food so ordinarily the older sister would make her porridge or similar foods to eat. However, this had not been possible in the last five days. That morning they had been given a packaged croissant (the standard breakfast provided by Moria camp), so she had torn off pieces and soaked it in water before feeding this to her sister. You could tell what a difficult decision it had been for the older sister to make, trying to decide whether to stay in Turkey, where without money they were no longer able to access care, 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 uttered only a few half words in response to questions. Yes, she was in pain, motioning to her mouth, neck and face. Yes the tablets helped a little. She had a fentanyl 100mcg patch on her back, which she had been using for around a year. Her sister was concerned – they only had one patch left. 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. She had become increasingly drowsy over the last 5 days. She had a nasty sounding cough and had been coughing up blood intermittently. She weighed only 18kg.

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 such a deeply sad story. 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 to interpret to the doctors there. Another Somali woman, who had met them that morning on the boat, offered to look after the older sister’s four year old son. With people surrounded by hardship and tragedy, these demonstrations of human kindness felt all the more profound.

In the face of such huge amounts of psychological trauma with limited intervention it is easy to feel helpless and overwhelmed.

Perhaps the most challenging part of my workload however was the scale of psychological illness. 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, and biting herself. 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 will 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.

I cannot write about this experience without mentioning my colleagues. The inspiring and committed individuals from Greece, Syria, Congo, Afghanistan and Iraq (to name a few of the nationalities represented) 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. My thanks goes to them for welcoming me from day one.

The European response to the crisis has been uneven at best and straightforwardly inhumane at worst.

The current situation in Moria cannot and should not be sustained. This firstly needs to be recognised by the local and national Greek authorities, and then supported by the EU, so people can be transferred and rehoused into decent accommodation on the mainland. NGOs like MedGlobal need to continue to advocate and raise awareness of the unacceptable conditions, like this statement released earlier this month.

Importantly though, we must remember that Moria is a symptom of a broken system which, if not addressed will continue to recur. The European response to the crisis has been uneven at best and straightforwardly inhumane at worst. We need a concerted European wide resettlement plan that acknowledges the differing resources between countries.

This could be done. Not easily, but feasibly, if the political will existed.

 

Featured photo by Fancycrave on Unsplash