RIGHT TO CARE - EUROPEAN REFUGEE CRISIS Dr Alexander van...

RIGHT TO CARE - EUROPEAN REFUGEE CRISIS

Dr Alexander van Tulleken

Dr Anders Björkman

Dr David Montes Bentura

Dr Hanna M. Ingelman-Sundberg

Doctors of the World International Network

Médecins du Monde

Doctors of the World

• Europe is currently

experiencing the largest

global displacement since

the Second World War.

• MdM has > 430 programs

in > 80 countries

• 15 countries which run

domestic programs and

international programs

@ Giorgos MOUTAFIS

Turkey/Syria

Iraq

Lebanon

Jordan

Greece

Albania

Bulgaria

Czech Republic

Croatia

France

Netherlands

Norway

Spain

Sweden

Germany

Belgium

Slovenia

UK

MdM and Partners

End 2014: 59.5 million displaced people in the world (UNHCR)

Over 1 million migrant arrivals in 2015 from the Mediterranean

In 2016 so far;

172,130 refugees/migrants arrived from the sea in Europe / 152,152 in Greece alone

35% children, 20% women, 45% men

711 deaths

90% from countries that have experienced conflict and war

49% from Syria

26% from Afghanistan

16% from Iraq

84% of patients

experienced physical,

psychological or

institutional

violence

Violence a recurring theme on their

journey from the conflicts they have

fled, experiences in transit and in

“host” countries

Médecins du Monde – At all the main entry, transit and exit points

LESBOS

• 59% of new arrivals came to Lesbos

• Providing access to healthcare, Mental

Health and Psychosocial support in

reception centre, the port & mobile unit

@Guillaume Pinon

• 23% of arrivals come to

Chios

• Primary healthcare and

Mental health and

psychosocial support for

refugees at Souda Camp,

Vial, port, mobile unit

MdM in CHIOS – Mobile Unit (now in Larissa)

FERRY PROJECT – Health in Transit

• 10 hours to make a difference

• Identify and provide support for those with

vulnerabilities in health via social worker

and psychologist with the aid of interpreters

• Provide access to primary healthcare

(Nurse and doctor)

• 3 – 4 emergencies per crossing

ATHENS – Health in Transit

• MdM is operational at

Elliniko, the old Athens airport

(around 8,000 refugees), and

all other camps around Attiki

• Open polyclinics in Athens,

Perama, Patras,

Pireus,Thessaloniki, Chania,

Kavala & mobile units to

villages & islands: GPs,

specialists, mental health

support and medicines

MdM clinic in Elliniko

IDOMENI – Border with Macedonia

• Despite the difficulties of working in

ever-changing conditions on the

ground, they continue to provide

healthcare and bear witness to

the crisis.

• Conditions seen over last 6 months

•Respiratory tract infections 41%

•Diarrhoea & Vomiting 20%

•Skin Diseases 12%

•Trauma 23%

SAR - Search and Rescue in Central Mediterranean

The Search and Rescue team of SOS Méditerranée

with a medical team from Médecins du

monde/Doctors of the World rescue refugees

between Libya & Italy

CALAIS • Psychologist, Art therapy, child

friendly psychosocial tent

• Community outreach and support

to families following deaths

• Socio-legal-medical support for

victims of violence

DUNKIRK• Mobile unit with 2 doctors twice a

week

• Partnership with MSF who

provide medical consultation the

other days

Trauma experienced in country of origin:

• The direct and indirect effects of conflict

• Conflict-related wounds & associated complications with wound healing

• Torture

Trauma sustained in transit:

• Accidental injuries

• Hypothermia

• Dehydration

• Burns

• Death of friends & family members

HEALTH NEEDS - Trauma

Children in MdM consultationsBetween 58% and 66% were not immunised

against MMR, whooping cough, hepatitis B or

tetanus

39% of parents did not know where to go to

have their children immunised

Around 90% of the EU children have completed

their immunisation (general population)

Pregnant Women in MdM consultationsMore than half of pregnant women had no

access to antenatal care before they came to

MdM

80% of pregnant women had no health coverage

in the EU

Health Status23% of patients perceived their physical health as bad or very bad. 27% when it comes to mental

health.

70% had not received medical attention before going to MdM consultations.

10% of patients with a chronic condition knew their diagnosis before going to MdM consultations.

10% report having been victims of violence after arrival in Europe

Doctor on the frontline in Chios, Greece

Dr David Montes Bentura, MdM Spain

What are the survivors feelings ?

Happiness? Greatfulness?

Anger?

Sadness?

Fear?

Anxiety?

Mersinidi

Souda

Tabakika

i

Nobel

Peace

Prize

2015

Secar la ropa

Get some rest

Dry clothes

Contact with the family

Medical attention

from international

team of Doctors,

Nurses and

Interpreters.

Children

Children

Pregnant women

Chronic disease

• Chronic disease

registration

• Diabetes

• HTA

• Heart disease

• Oncology

• Treatment

• Acute illness

No more Humanitarian aid.... Chios has become a detention camp

MDM RESPONSE TO THE REFUGEE ARRIVAL IN SWEDEN

Dr Hanna Ingelman-Sundberg – Doctors of the World Sweden

MdM Sweden – Läkare i VärldenSverige

• Founded in 1991, volunteer medicalclinic since 1995

• Initially medical service for undocumented migrants without access to health care

• Facilitates access to regular health care access for undocumented migrants since new legislation in 2013. Currently provides medical care for EU citizens without health insurance

• Legal advice and psychological support for undocumented migrants

The medical clinic in Stockholm

• 3 nurses, 4 dctors, 1 dentist, 1 physiotherapist

• 20-25 patients per evening

• Many patients lack proper housing

Arrival of the European refugees in Sweden

• The first trains arrived September 11th

2015

• No reliable data on the number of arrivals - many continued to neighbouring countries without registration

• > 114.000 asylum applications fromSeptember to December 2015

Dagens Nyheter 2015-11-13 Photo: Nicklas Thegerström

First mission for MdM Sweden: Information

• Many volunteers from other NGOs and “spontaneous volunteers” at StockholmCentral Station

• Disinformation about legal right to health care for asylum seekers and undocumented migrants

• MdM Sweden distributed a leaflet with correct information to >1000 people within 24 hours after the first arrivals

• Further spread through social media

Aftonbladet 2015-09-08, Photo: Robin Lorentz-Allard

Main challenge: identify immediate needs

• Similar to refugee camps in the rest of Europe, people with life-threatening or other emergent conditions needed to be identified

• MdM Sweden set up a team of mobile medical staff to visit the arrival points and preliminary refugee shelters for primary surveys

• Patients with serious conditions could be taken to hospital immediately, lighter conditions were treated on the spot

Organisation of the mobile team

• Based in the Stockholm Mosque, being one of the biggest temporary refugee shelters

• Initially only using an emergency bag, later a better equipped car

• Communication with the main refugee shelters by phone to relocate medical volunteers to where they were needed

Sweden closes its borders in 2016

• The Swedish Government decided on temporary border controlsfrom January 4th 2016

• All travellers need to show valid documents and proof of identity

• The numbers of arriving refugees has drastically dropped

• In total, only 9000 asylum applications from January to March

The Mobile Clinic from 2016

• Re-located to night shelters for EU citizens without proper housing

• Able to assist newly arrived refugees if needed, after communication withthe shelters

• Seeing around 10 people per night

The way forward

• MdM Sweden has raised great concern about newly suggested changes to Swedish legislation, severely impairing asylum rights

• Preparations for handling an increasing number of undocumentedmigrants

• “Watchdog function” to report how impaired rights to affect healthof humans already under pressure

• New campaign: Don´t stay silent!

THANK YOU!

Solidarity & care instead of fences – Thank you@ Olmo Calvo