In March 2018, I returned from the Greek Island of Lesbos, where I had been volunteering as a doctor in a refugee camp called Moria.
When I arrived back at Heathrow, weary-eyed and irritable after just one night of travel, I placed my passport in the automatic scanners and, as the glass doors slid open, a fierce tide of emotions hit me all at once. Guilt, that the piece of folded card and paper held in my hand, which says nothing of my worth as a human being, guarantees me freedom, safety, and a home. Anger, because I knew I had done nothing to earn the privilege and power that this object bestows on me. Most of all, numbness, because I knew that in contrast to those I had left behind, I could simply step through those sliding glass doors with no questions asked. No interviews, no detention centres, no freezing in tents, no deaths at sea, no recurring nightmares recounting the horrors of what brought me here.
The emergence of ‘hot spots’
What is driving the problem on the Greek Islands? The EU-Turkey deal was made in March 2016 with the aim of sending refugees from the Greek islands back to Turkey, relying on a decision that declared Turkey safe for refugees. As a solution to what Europe calls the ‘refugee crisis’, this deal represents a cruel twist in which collective responsibility has been cast aside, making numbers look good on paper while bartering with human lives to push the problem away from European shores. The deal has resulted in the emergence of hot spots, of which Moria is one of the most notorious. This is because the flow of refugees into mainland Greece and Europe has been halted, so that camps on the islands, originally set up as reception or detention areas, have become holding areas where people may wait for years for decisions to be made about their asylum claims or deportation. Essentially, the EU has decided that outsourcing the management of refugees to Turkey and Greece is an appropriate step forward. In the words of Dimitris Christopoulos, head of the International Federation for Human Rights, what we are doing is ‘charging the poor to keep the poorest’. He states:
‘If we refuse the persecuted the right to knock on the door of Europe – and this is what the EU-Turkey deal does – because we are afraid that fascists will come, then we are simply becoming the beast we are supposedly fighting against. We end up saying exactly what the far right believes. And they are more convincing, more original and passionate than the EU bureaucracy. This, not refugees, is the real problem Europe faces.’
Regard for basic human rights is scarce in such places as Moria. Almost 6,000 people (at the time of writing) are crammed into a camp built for just under 2,000, and hundreds more arrive by boats every week. It is a true humanitarian crisis. Naturally, this has led to many problems. The camp is not safe – especially for women and children at night-time, when there have been reports of violence and rape. However, the rates of violence and the incidence of riots are not nearly as high as might be expected in such a situation. I believe this can in large part be attributed to the strong family and community values entrenched in the cultures to which the refugees belong, and to the glimmer of hope that kept them fighting, made them run and is now helping them to survive in the camp.
I knew conditions were very bad at the camp, but the reality of what I saw on my first day went far beyond anything I had imagined. Thousands of people, waiting. Waiting to be received. Waiting to be processed. Waiting to be interviewed. Waiting in a food queue. Waiting for bottles of water. Waiting to use a toilet. Waiting for running water. Waiting to see a doctor. Waiting to find out if they will be separated from their families. Waiting for others to stop screaming in the night so that they can sleep. Waiting in detention centres. Waiting to be transferred. Waiting to be deported. Waiting for days, weeks, months and even years.
When you arrive in Moria, you are no longer a school teacher from Afghanistan, a student from the Democratic Republic of Congo, or a human rights activist from Syria. You are a number on a piece of paper that you must now cherish, because without it you are nothing. Dates of birth on the registration documents are for the most part assigned, with young refugees given dental checks upon arrival to determine their age. All that remains to you of your identity is that single piece of paper, for the most part tattered and nearing disintegration after months of being folded and unfolded to prove that you are human. The refugees carry these everywhere with them, in a plastic sheet if they are fortunate enough to possess one. For documentation purposes, we ask to see these papers when patients come to the clinic. There is just about enough ink left to show a name and a grainy black and white photograph. In the photographs the residents are smiling; they were newly arrived in the camp, in Europe, ready to start their lives again. You look at the paper and back at them, and see in front of you a much thinner, older version of the person in the photograph. It hits you every time.
After fleeing conflict, torture and extreme loss, you might expect that claiming asylum would be fairly straightforward, but unfortunately this is not the case. The administrative system is extremely complex, and requires that you tell your story repeatedly to various panels of officials, located within gated and guarded complexes which closely resemble the prisons that many of the refugees endured on their way to Greece. Often, the acute anxiety attacks we dealt with in the clinic happened outside these very complexes. Older children are given medical examinations to determine their age – this is common practice in many European countries, despite being contested on legal and ethical grounds by human rights groups. If they are deemed to be under eighteen, they are marked as vulnerable and placed in a safer part of the camp. Many unaccompanied minors make the journey to Greece alone. You can see with your own eyes how much older these young teenagers look after fending for themselves for the months or years of their journey to Greece, being passed on from one agent to another, walking for days on end without food, and suffering imprisonment under deplorable conditions on the way. It is likely that many minors are living in these camps, lacking the most basic protection and safeguards; bear in mind also that those who are now eighteen may have been as young as sixteen when they set off on their journey.
There are families and children in Moria – and babies continue to be born in the camp. Most of the residents, however, are young men (currently 52% are men, 21% women and 27% children). Refugees who are deemed more vulnerable – single women and families – have a better chance of being moved on to another camp or to the mainland. If you are a young man unfortunate enough to be judged to be eighteen or over, you are likely to be split up from your mother and younger siblings on registration. This will affect where you live in the camp and your vulnerability status, meaning that if the chance arises for your family to move on from Moria, you may be left behind. Many of the conflicts from which people are fleeing result in the death or disappearance of fathers, leaving young teenagers to step up and fulfil the role of protector and provider for the family. The grief that ensues within the community when these kind of family splits occur is unimaginable, and clearly affects the residents’ mental health.
Most of our work in the camp was primary care: treating the infections that spread through the camp as a result of the poor hygiene facilities, managing diabetes, blood pressure and wounds caused by recent injuries. We also dealt with pain and ongoing problems related to major injuries incurred in areas of conflict, or suffered en route to Greece. Many patients required dental work; we could only offer pain relief, and advise that a volunteer dentist would visit the camp in due course. A small number of emergencies required admission to the local hospital, and some acute trauma resulted from violence within the camp.
But the most common presentations we encountered were, by far, those related to mental health. When refugees first arrived on the island, they experienced a sense of shock, but also one of relief that they had, at last, arrived in Europe. Over time, after endless waiting in the camps on the islands, their sense of hope had begun, gradually, to diminish.
Many patients asked me to help them forget the horrors that constantly haunted them. In particular, they needed something to help them sleep; they were simply asking for a way to continue existing. I couldn’t offer anything. Medications for insomnia, anxiety and depression cannot be routinely used in a camp like Moria. This is partly due to the extremely high risk of intentional overdose, but also because desperation in the camp is so severe that the availability of such medications would probably drive a black market, leading to violence. Luckily, inspirational work is being done by small NGOs, such as the provision of classes – English and Greek, IT, stress relief, and many more – as well as hosting events and activities to encourage integration and well-being for the refugees on the island. Everyone working in the clinic promoted these programs heavily, and we found that the benefits were remarkable.
It is worth considering, though, what a huge ask it is to suggest to someone who is suffering severe depressive symptoms or crippling anxiety – someone who may have only just turned eighteen, and who is alone in a camp, sleeping in a communal tent packed with a hundred strangers – to pick themselves up, take exercise, and attend a class to learn a new language. The fact that they manage to do this is inspiring, a testament to the power of hope. When patients asked me to help them deal with their trauma, all I could do was signpost them to projects I deeply believed could change their lives, and to remind them that having survived extreme suffering, left their home, travelled torturous and dangerous journeys and finally made it to Greece, they had more to teach me about coping and healing than I would ever understand.
It was amazing to discover how, even through their despair, the kindness of the refugees in Moria shone through like a beacon. They go to great lengths to help us and each other. Many residents spend their time in the camp translating and advocating for others who are unable to do these things for themselves. Others volunteer in the clothes donation warehouse or help with community projects. A vast range of different groups from a variety of cultures is crammed together in extremely harsh conditions. I truly believe, however, that if given the opportunities that would arise from improved living conditions, the provision of building materials and the enabling of some form of productivity, their collective power to create something amazing would surely put us all to shame. From within the desolation of the camp, moments of true beauty rise up in the form of teamwork, respect, and care for one another. It was a real privilege to provide medical care for some of the strongest and most resilient people I have ever encountered, and I am lucky to have been able to use to my skills to help a community that deserves to be treated with humanity.
Fights did break out outside the clinic, and incidents of violence were brought on by the frustration and anxiety of yet another waiting line. To add to the problem, some who were waiting were in pain, or suffering with their mental health. However, for the most part, the gratitude we received from patients was deeply humbling, even though the help we could offer was extremely limited, and, due to the sheer volume of patients, they invariably had to wait for hours to see a doctor. The real destruction caused by camps like Moria is that it brings out the very worst in people, turning them against each other. I can only imagine the frustration of finding yourself pushed to the point of losing your integrity, when this may be all you have left. It was therefore humbling, though not surprising, that patients who became aggressive outside the clinic or during consultations were often quick to express regret and to apologise once the dust had settled.
A lasting impact
There is a small airport in Lesbos situated along the coastline. My last day on the island was sunny, and I sat on the rocks outside the airport watching the crystal blue waters peacefully stroking the pebbles beneath. I had not seen the sea so calm since I arrived. At night we could usually hear the waves crashing onto the shore in the pitch darkness. On such a clear day if you just look out to sea, straight ahead, you can see Turkey. And you know that just across the water, eight kilometres away, hundreds of men, women and children are hiding the forest, waiting in sheer terror, about to embark on the most frightening part of their journey to safety. They must secure a place on an overcrowded dinghy, set off in the dead of night, survive a dangerous passage – in 2017, 3,100 people are believed to have lost their lives at sea while travelling to Europe – avoid interception by Turkish coastguards and make it into Greek waters for even a glimpse of a chance to stop running at last, and to restart their lives.
As of 2015, the number of forcibly displaced people in the world – more than 65 million – has reached its highest since the end of the second world war. Through sheer good fortune, most of us will never know how it feels to live in fear, or to be forced to flee our homes and everything we know in search of safety. The poem ‘Home’ by Warsan Shire begins with ‘no one leaves home unless home is the mouth of a shark’ – and so let me say to those who have asked me if the solution is to ‘just let anyone in’: please think. Think about your question, about your situation, and then think about theirs. Think about the fact that the only difference between you and a refugee is the piece of land you were born in. Had history followed a different course, it could have been any one of us behind those fences, trying to get in. We, as individuals, can do little to change the incredibly complex situations in Syria and the rest of the world, but I think that our attitude – our sense of entitlement and our lack of gratitude for what we have – is something we can and should be prepared to challenge. We live in one of the richest and most developed countries in the world, yet we lack the collective responsibility and sense of community to end homelessness, to care for our elderly population, or to stop teaching our children that success is measured in personal achievement, fame, or money.
The refugees I met in the camp have such beautiful qualities that we would be privileged to have them living amongst us. It is tragic that these people, who could teach us so much about the value of family and community, and about strength, kindness and hope, are trapped in a horrifying limbo created for them by Europe.
For an insight into the story of one refugee, which echoes the stories of a million others, I would strongly recommend reading Gulwali Passarlay’s book ‘The Lightless Sky’, which describes his experiences escaping from Afghanistan as a child refugee.
For anyone who is interested in volunteering in Greece, there are many opportunities for medics and non medics to get involved – I have included links below to some inspiring projects and organizations on the ground in Lesbos.
There are also many opportunities to help refugees in the UK navigate the asylum process and integrate into the community – a quick google search will help you find projects in your area.
Finally, I will take this opportunity to announce that myself and a group of likeminded doctors I met in Lesbos are currently in the process of setting up a charity connecting volunteers and doctors to organisations that work on the ground in crisis zones. We are starting with the refugee camps in Greece, and plan to launch in the very near future.
Some organisations operating in Lesbos
Further reading on topics discussed above
Medical age tests for refugee minors