From London to Lesvos: Diary of a Voluteer
Dr Kat volunteered with us in September 2018. Following her stay in Camp Moria, she was kind enough to share her observations with us. Here is one doctor's account of her experience volunteering in one of the world's most notorious refugee camps.
WARNING: Please be aware that the following text discusses FGM, abduction, rape and mutilation, which readers may find distressing.
"I remember being greeted by the warmth of the air upon stepping off the plane. The smell of the arid land hits you as the flight attendant thanks you for choosing their airline. I recall feeling struck by the difference in the journeys other people had endured to get there.
One of my main aims during the time I was in Moria was to learn why people had to leave their homes. Religious, national, social, racial and political persecution are the main issues that refugees face, forcing them to flee their country, seeking a chance of survival. Prejudice and violence in regard to sexual orientation and gender were also common themes, and climate change, destroying people’s homes and livelihoods, is becoming a more prominent issue.
People pay inordinate amounts of money to smugglers in order to be brought over to Lesvos from Turkey on flimsy inflatable rafts. This journey can take anywhere from 8-24 hours and has resulted in thousands of deaths over the years. As there are no NGO rescue boats in the Mediterranean, this number will likely rise. Those who have survived the journey told me that they are now terrified of the ocean and though they live by the sea, the thought of bathing in the water fills them with fear.
When a person arrives in Moria Camp, they are given a police paper which essentially states that they won’t be deported immediately. Until they are processed they are kept in a small area of the camp called “the cage”. Each person is processed one by one and is not allowed to leave this area until they have received their papers. They do not have refugee status with this. They must progress through different administrative levels in order to gain more freedoms. Initially they are confined to the camp only. If they move through to the next tier of the asylum process they receive paperwork that states there is no restriction of movement within the island. If they are extremely lucky, a person may gain full refugee status and asylum allowing them to enter the EU. This is extremely rare and I did not meet anyone who was close to achieving this.
Nestled in the new arrivals section of the overcrowded Camp Moria, Kitrinos works in a small clinic space, which they share with a Greek governmental organisation called KEELPNO. All translators and coordinators are refugees themselves and most live in the camp and work seven days a week. Kitrinos is the only clinic in the camp who can refer patients to specialists at the hospital and order bloods and imaging such as X-rays and ultrasounds. There is only funding for five referrals to specialists per day. This, for a camp of 8,000+ people*, is completely inadequate.
(*Camp Moria held over 8,000 people at the time this was written, but this has since dropped to around 6,000)
My first day gave me a flavour of what to expect from the rest of my time here: unpredictability mixed with a selection of “the usual” - coughs, colds, sore throats, rashes etc. Children presented daily with diarrhoea and vomiting illnesses. In such overcrowded conditions with minimal facilities for personal hygiene this was not wholly unexpected. The main concern was ensuring that the children did not become dehydrated due to the heat (mid 30°C in the height of summer), lack of shade and minimal water allowance of 1 litre per day.
I found trying to manage chronic diseases in this setting particularly challenging. The reasons why people were coming in were things I had encountered daily in the UK – diabetes, high blood pressure, high cholesterol etc - but I found that I was only able to give patients a few days’ worth of medication at a time and it was probably not the same as what they had been taking previously. I couldn't give them a prescription in order to buy their medication as most of the residents of the camp do not have any money.
In the same day, two gentlemen arrived who had both received dialysis three times a week in their own countries. Having travelled for over five days with minimal food and water, they arrived in a poor state. We had to arrange for them to be seen in the hospital the next morning otherwise they would succumb to the consequences of their untreated renal failure.
Throughout my stay in the camp, I found myself increasingly frustrated by a system that was failing these incredibly vulnerable people.
I had been made aware of a 26 year gentleman with a possible diagnosis of Cauda Equina Syndrome (CES) - a rare and particularly serious type of nerve root problem. He was previously fully mobile but was now in a wheelchair, unable to walk or go to the toilet by himself.
CES requires urgent investigation and treatment, usually within the same day, in order to prevent the nerves to the lower limbs, bladder and bowel from becoming permanently damaged. Two months after he was thought to have developed this condition, he had still not been seen by a doctor at the hospital in Lesvos. He had gone to the hospital on multiple occasions and had been turned away every time. His CES would probably have been reversible if it had been treated immediately, but after so long without any intervention, the likelihood was that this damage was now permanent and he would never walk again.
A meeting was held by medical teams from multiple NGOs and he was taken by a doctor, interpreter and coordinator in order to ensure he was properly assessed.
This devastating story highlights the issue of communication between the services in Lesvos. Interpreters translate so that English speaking doctors can understand the patients. If a medical issue is identified then the English speaking doctors have to communicate this to the Greek teams either at KEELPNO or at the hospital. The patient will then have to attend the clinic or the hospital alone, and if there are no interpreters that speak the patient’s language then they are not seen. I wondered also if there were other interpreters to translate the English to Greek for the doctors working in the Lesvos Hospital.
War injuries were not uncommon. There were people who had been exposed to chemical weapons, leaving them blinded and in chronic pain. Patients came in unable to move their arms due to scar tissue tethering their arms to their sides. There were children with permanent catheters after injuries that meant they were no longer able to pass urine normally.
On one day, a 26 year old gentleman came in on mismatched crutches, dragging a seemingly lifeless, severely scarred foot. He had been unable to walk properly since sustaining a shrapnel injury, and there was an open wound which had been there for many months. He explained that he could no longer feel anything in the foot, which meant that he almost certainly had permanent and irreversible nerve damage. I ordered an X-Ray which showed signs of infection in the bone of his ankle. This would usually require many weeks of strong antibiotics intravenously, but we did not have the facility to administer this and the hospital would have turned him away, as he was not systemically unwell. I gave him as many antibiotics I could offer him and explained he needed to take them every day for at least the next few months. I referred him on to a specialist, unsure what they would be able to offer him and fearing that he may end up losing his foot.
It was not only injuries sustained in volatile conflict zones that presented to our clinic. A distressing story of a teenage boy still disturbs me to this day. He explained that he had been drugged and kidnapped in his home country and when he woke up on the street he found that his kidney had been harvested to be sold on the black market.
I spoke to at least two people each day who told me about a horrific experience they had endured and now had to live with.
The amount of sexual and gender based violence (SGBV) people had experienced was astonishing. The most harrowing story I heard was from a couple from the Democratic Republic of Congo (DRC). The woman explained that they had both been drugged and kidnapped in the DRC. When she woke up she found she had been subject to the most disfiguring kind of female genital mutilation (FGM) - infibulation. She and her husband were both forced to watch each other being raped.
Another woman from the DRC also presented with horrific FGM... She had been seen recurrently and had been given multiple courses of antibiotics for the chronic infection, but this hadn't helped. She had been referred twice to a gynaecologist but was turned away both times. I referred her again to a gynaecological specialist and apologised for the months of waiting she had endured and was likely to be subject to again. The number of women who had undergone “the cut” was vast. The complications of this were difficult to manage in a setting with minimal resources.
People would come in begging to leave Camp Moria because they could not survive living there anymore. Others would fabricate symptoms in an attempt to gain vulnerability status. Epilepsy was a common condition residents would try and emulate so a large proportion of the clinic was taken up managing patients with “non-epileptic like” or “pseudo” seizures.
If made a “vulnerable resident” their asylum application would be expedited and some would also be relocated to an area of the camp that is protected with gates and police officers. The geographical restriction of movement may also be lifted because of medical needs, which cannot always be treated in the public hospital of Mytilene. I spoke to people who had already been awarded vulnerability status for quite some time and their asylum hearing date in Athens was due for October 2019 – 14 months away.
Some form of optimism and positivity still remains in Moria despite the hopeless and impassable situation it has found itself in. Even with the uncommon outbursts of violence resulting from build-ups of immense stress and trauma, people really seem to look after each other here.
For me this experience not only raised many medical ethical issues but also complex global and political ethical dilemmas. The gates to Europe are currently firmly closed and there is no movement once people land in Greece. More and more people arrive every day and very few are moving on. Though Camp Moria resides in a European country, even basic human rights were not being met - where does the responsibility lie to ensure they are? No-one seemed to know the answer to this question.
This invaluable experience has compelled me to re-evaluate my understanding of hospitality, compassion, justice, citizenship, borders and migration. It triggered a lot of personal contemplation regarding the ethics of forced displacement and our relationships to, and responsibilities towards not-so-distant others."
- Doctor Kat, Kitrinos Healthcare volunteer, September 2018.