The journey of a refugee is one of endurance, as successive emotional and physical hazards causes yet another blow to their health and wellbeing. It begins in their home countries, where traumatic events stalk them as the risks of travelling to the border can be as great as staying in a bombed neighbourhood.
Once the border is reached, the journey to Europe is an ordeal with an unknown destination that can take months, often involving crossing mountains, seas and risking their lives from drowning, violence and attacks.
Women and girls are vulnerable to sexual abuse and exploitation and routine health care is hard to come by. One doctor providing care on a ferry to Greece reported how a patient had just given birth in the mountains with the help of her five-year-old son and, after delivering the baby, simply stood up and continued walking to make it to the ferry.
Finally, once they arrive, it is time to face the EU and national migration policies, a system which currently prolongs the ordeal they are already suffering. Put simply, the relocation and asylum and reception system is not working.
Experiencing mental anguish and anxiety
Despite the European Commission agreeing to relocate up to 160,000 people through the emergency relocation scheme, only around 7,500 asylum seekers arriving in Italy and Greece had been relocated to other European countries by the end of November 2016.
Doctors working in Greek refugee camps report asylum seekers experiencing mental anguish and anxiety symptoms related to border closures and not knowing whether they will be relocated or granted asylum. And in camps at Calais, Munich, and across Greece, doctors report widespread anxiety symptoms and distress among all groups. A physical representation of this anxiety reported frequently is sudden collapse due to mental exhaustion.
Many refugees also report not wanting to use emergency medical services, even when they need the care, for fear of missing an opportunity to cross a border. But refugees’ need for health services extends beyond mental and emergency health care to cover the whole gamut of routine health care.
The provision and coordination of healthcare services in refugee camps and how these interact with countries’ health systems is a critical policy area. Some countries are facing deteriorating health systems due to the effects of the financial crisis and austerity measures.
And the austerity measures in turn translate into restrictive policies towards migrant populations who are being excluded from accessing services across Europe. And increases in out-of-pocket health expenditure (the amount people have to pay from their own funds, not covered by insurance or a tax based system) for accessing health services means international NGOs have identified the need to provide services not only to refugees but also to the local population.
As well as offering good health services at camps, it is also vital to maintain or restore free health and public health services for migrant populations across Europe, to coordinate organizations working inside refugee camps, and to link their efforts to national healthcare systems, particularly for providing specialised services not available at refugee camps.
At the ground level there is a clear need for better information flow and collaboration between actors, and to shift from an emergency situation to long-term planning, which requires long-term solutions for protecting the rights of refugees.
The 1951 Refugee Convention – signed by 144 states and outlining the rights of the displaced as well as the legal obligations of states to protect them – should be the key document upheld by all member states and EU institutions. In the context of the current migration situation in Europe, this would mean the EU has to step up in its role to ensure refugee rights are respected and protected.
Recent statistics estimate that around 350,000 migrants, asylum seekers and refugees have arrived on the shores of Europe’s Mediterranean coast since the beginning of 2016. And whereas travelling to Greece through Turkey used to be the most popular way in, new restrictions mean the favoured route to Europe is now through the central Mediterranean, via Libya.
This is considered to be the most dangerous passage, and the number of people who have died or gone missing has increased by 30% in just one year. But what these figures really illustrate is that people fleeing conflict or persecution will continue to find ways to reach Europe even if they have to risk more danger to get here.
Now is the time for European governments to face reality and provide a responsible, common, humane and dignified response to refugees who will continue these long journeys in the desperate hope of finding protection and a better life for themselves and their families.
Helena Legido-Quigley is an associate professor at the Saw Swee Hock School of Public Health and has a joint position with the London School of Hygiene and Tropical Medicine.