The refugee crisis/medical angle

With winter fast approaching the refugee crisis could become a medical disaster

This article first appeared on OpenDemocracy

As temperatures drop in eastern Europe, western attitudes to refugees cool. The Paris attacks have hardened many hearts, yet still the migrants arrive, at medical camps and aid agencies.

When ISIS arrived in Mosul, Fatima knew that her son, a policeman, was in mortal danger. With his children they fled to Erbil, the capital of Iraqi Kurdistan, a safer place for now but with little future to offer a displaced family. So Fatima set off on her own, on a tortuous journey in search of a better life for the family.

She flew to Istanbul, then made her way to the Turkish coast, straight into the hands of people smugglers. When the boat she was on reached the Isle of Lesbos there was no beach to land on so she and the other passengers were slung overboard to swim to shore. If it wasn’t for two younger men supporting her as they swam Fatima, in her mid 60s and overweight, says she would surely have drowned.

“I had nothing to lose when I left Iraq”, said Fatima, as she waited anxiously for the ambulance to arrive to take her to hospital. “I am old. I took the risk so that my family can live”.

While arriving in Europe, into the arms of volunteer doctors, is a moment of salvation in the eyes of those who have survived that far, what they don’t know is that further along the trail, the wind has changed.

According to the most recent census, the Greek village of Idomeni has a population of 154. To approach it now is a lesson in how quickly official statistics can become meaningless when events take over.

Less than 200 metres from the border with Macedonia, the village has become one of the busiest flashpoints along a punishing migration route. And with hardening attitudes at this border point and many others in the region, the situation is getting worse.

Every day thousands arrive at the camp before they attempt to get into Macedonia; every day hundreds need medical attention before they can go on. Built by a combined effort of the local authority and MSF and run by a collection of aid agencies and medical volunteers, it’s one of dozens of temporary stations to have sprung up around southern and eastern Europe since the flow of migrants suddenly surged this summer. Stations like Presevo in Serbia 200km north, which has become one of the most strained and congested of all the crossing points.

Wherever you go in the region, the problems are the same: unpredictable migrant flows from each day to the next; a host of medical problems to deal with; delays and security concerns at border crossings; weary and anxious migrants often disorientated and afraid. With winter almost upon us and the political climate changing further down the trail, a perfect storm is amassing.

Already throughout eastern Europe men, women and children sleep rough and exposed, often still wet from ferry crossings and the lashing rain. Some are given waterproof clothing, others are not so lucky. Temperatures in eastern Europe can reach as low as -15°C in the depths of winter and even in the relatively mild autumn just drawing to a close, hypothermia has been a common problem.

Aid agencies like Médecins Sans Frontières? (MSF), Doctors of the World, the International Red Cross, Save the Children, and others are battling to prevent a humanitarian crisis from turning into a medical disaster. Two months ago the ‘camp’ at Idomeni was just a few gazebos and food stalls. Since then the various organisations have been working around the clock to assay the situation, find out what was lacking, to provide a service, and source equipment and supplies.

They have managed to get hold of the basic equipment to treat the most common cases: colds, coughs, hypothermia, dehydration, stress, trauma, exhaustion and worn limbs – the wounds and inflictions from the journey itself. But for the most serious cases the conditions are still parlous; an ambulance takes up to two hours to arrive and without complex equipment the doctors have to make do.

Kiran Cheedella, a British doctor volunteering at Idomeni, says that every day people arrive anxious and traumatised. “I treated one man the other day whose heart rate was very high when he arrived,” he says. “He told me some horrific stories of seeing dead people along the way, and being pushed into small fuel containers by smugglers; stories of brutality by the smugglers. People tell me they see boats sinking every day and people dying as a result”.

MSF reports a “significant increase” in the incidents of people suffering panic attacks and attempting to self-harm, which it says is a direct result of the trauma of the trip. And while arriving in Europe, into the arms of volunteer doctors, is a moment of salvation in the eyes of the people who have survived that far, what they don’t know is that further along the trail, the wind has changed.

“Politicians in the west like David Cameron have been using humiliating adjectives and language to describe migrants and this only results in fuelling racism and stigmatization.”

Even before the wave of attacks in Paris on November 13, borders throughout Europe were closing and fences were going up. Two of the biggest recipients of refugees, Germany and Sweden, had already shifted their positions to restrict the number of refugees permitted to enter the country, and Slovenia, a key entry point, has erected a series of “temporary technical obstacles” – aka razor wire fences – along the its border.

With the horrors of that night in Paris still raw, very quickly fear turned to resentment, and suspicion. Reports of a revenge arson attack on the refugee camp in Calais turned out to be false, but were all too believable.

Across Europe far-right groups are calling for a halt to all immigration from the Middle East, and right-wing politicians are exploiting the situation to maximum effect. If this wave continues and borders are sealed off for good, as more people flee the region, key pressure points like Idomeni and Presevo could be overwhelmed.

In the last few weeks the governments of Serbia, Slovenia, Croatia and Macedonia have all placed restrictions on the migrants allowed over their borders. Which suits their own needs politically, but does nothing for the migrants still arriving or for the doctors out in the field trying to treat them.

Cheedella says this is the worst thing that can happen to the teams trying to cope with the medical situation. He says: “If the borders close down and we start getting these pileups where the camps are filled with 5,000 to 10,000 people then the risks of this becoming a medical emergency is going to increase. This could turn into a huge camp where people stay for days, then the medical needs will change and the risks of emergency are going to increase.

“If that happens overnight it will be very stressful for us because we will be dealing with a whole new range of medical problems and will need to increase the capacity very quickly”.

The changing attitudes in countries like Germany and Sweden are alarming. But they follow months of those countries accepting migrants – the bulk of the 800,000 estimated to have entered Europe this year. Elsewhere on the continent, far less has been done. There are even reports of “systematic” human rights violations going on in some countries, according to the UN.

And, as a source inside Doctors of the World’s mission in Greek tells me, the other approach, of “keeping people in their place” by discouraging them from leaving the Middle East, has been just as debilitating when it comes to any kind of solution.

He says: “Politicians in the west like David Cameron have been using humiliating adjectives and language to describe migrants and this only results in fuelling racism and stigmatization. They are wrong when they say that this way of funding is going to stop people from coming; we can see that very well and very clearly here, it will not stop people”.

While western leaders twist and turn in the changing political winds, the gruelling business of keeping the refugees alive goes on. Organisations like Doctors of the World are demanding real concerted action from political leaders to keep hope alive for refugees and provide safe passage out of conflict zones.

The policy of taking in minimal refugees has won leaders like David Cameron quiet support at home and pushed their own political problems back; but it has done very little to ease the situation on the ground. And with this inaction, my source tells me, he is afraid for what the next weeks and months have in store. “Winter is coming and it’s going to be really tough,” he says. “These people will keep moving”.

Aidan Hehir, reader in International Relations at the Department of Politics and International Relations at the University of Westminster, says that Britain’s contribution to the crisis has been “paltry”, with the figure that Prime Minister David Cameron committed to, of 20,000 people over five years, equating to each UK city taking in five refugees per month.

It’s also worth bearing in mind that Europe as a whole has only taken in 5% of all the refugees having fled conflict zones – the remaining 95% going to surrounding countries.

It’s worth bearing in mind that Europe as a whole has only taken in 5% of all the refugees having fled conflict zones – the remaining 95% going to surrounding countries.

Whether Fatima made it to a safe place, and in what state of health, the doctors at Idomeni will never know. The number of people like her fleeing Iraq and Syria is on the rise, and showing no sign of slowing down. Every day the people smugglers send men, women and children out into the choppy waters of the Mediterranean; every day some of them drown.

With winter approaching just as the political climate becomes much colder, the plight of a desperate people becomes more bleak every day. A further hardening of attitudes to refugees in the wake of the Paris attacks could leave aid camps dangerously overcrowded and unmanageable for the organisations operating there, and ultimately leave more people stuck in the Middle East within the clutches of ISIS.

To prevent a medical crisis unfolding this winter, coordinated political action needs to happen. Western governments must honour their commitments in the 1951 Refugee Convention; safe passage out of conflict zones must be enabled; people must not be denied their basic human rights to medical aid and shelter; and a pernicious right-wing movement that seeks to exploit the tragedies in Paris to cut refugees off from safety must not be allowed to prevail.

And through it all, medical agencies and other aid organisations need the maximum support from western governments and populations. If they don’t get it a desperate situation could become steadily worse, as the long hard winter rolls on.


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