MSF Live from Greece: A virtual visit with our migration projects

Nick Bayer: 

Hello, kaliméra and welcome. Thanks for joining us as we take you on a virtual project tour of our migration projects in Greece. I'm Nick Bayer, the Public Engagement Manager for Doctors Without Borders based in New York. Some of you might know us by our French name, Médecins Sans Frontières or MSF and that's what you'll hear us saying throughout the event today about the organization, MSF. 

Before we start, I have some info to share with you about how the event will work. Today you will see footage that I took earlier this year when I was visiting the MSF teams on the island of Samos and in the city of Athens. Along the way, you'll meet different MSF staff members and get an inside look at our humanitarian operations in Greece. We welcome you to submit questions and comments throughout the event and we will have some time at the end to address your questions. Whether you're watching the livestream on Vimeo, YouTube, LinkedIn, or Twitch, you can submit questions using the chat feature and there are also live captions for this event available here in Vimeo. 

Now it is my pleasure to welcome Nicholas Papachrysostomou, the outgoing Head of Mission for MSF in Greece, who is joining us live, to contextualize the footage you'll see and answer your questions at the end. Nicholas has been in charge of operations in Greece since January of 2022. Since joining MSF in 2013, he completed several assignments in Africa, Asia, and South America. Nicholas has worked in migration settings on a number of occasions including as the head of search and rescue operations aboard an MSF rescue vessel in the Central Mediterranean Sea and during the massive exodus of Rohingya refugees migrating from Myanmar into Bangladesh in search of safety. 

So thanks for joining us, Nicholas. Let's get started. Can you start by telling us more about the situation in Greece and who MSF is helping there? Let's go first to Samos. 

Nicholas Papachrysostomou: 

Good evening, kalimera, everybody, wherever you are, Nicholas here. The beautiful island of Samos, you will see in the map you've seen and you will see more beautiful images. Samos is a small island. It's a beautiful place that is located in between the Turkish and Greek borders and it is a tourist destination. I mean, it's one of those places that all of us would wish to have a house to live on. Unfortunately, the reality is a little more complex than that. So it's one of the gate points of entering Europe. We all know that there are millions of refugees in Turkey. 

You were now looking at the beautiful town of Vathy, the main town of Samos. Look at the beautiful blue waters of Greece. People cross these waters. They cross them in precarious, inflatable boats from Turkey, which if we had a better zoom, you could actually discern the coastline of Turkey. This is how close it is. So, people are finding it fairly easy in their minds to do that. Little do they know that the windy conditions of the North Aegean Sea are quite treacherous and it's not uncommon to have shipwrecks, shipwrecks of people crossing from Turkey to the island of Samos, to the island of Lesbos, to the island of Leros. 

So currently, MSF works on Samos and Lesbos. We have teams on both islands and we offer medical care in the case of Samos in inside the closed camp for refugees. And then we also maintain a small little clinic in town. Another type of service that we will talk a lot more about is medical and psychological first aid that we offer to people arriving on the island. We will explain a little more on that. 

Remember, people are traumatized. They have fled conflict or persecution in their home countries and many are exposed to levels of violence that I'm afraid that you and us could not imagine. All they're asking for is dignified treatment, but we have quite a bit of time to talk about all this. 

The closed access camp as it is known, closed controlled access camp, you will hear me refer to it as CCAC is about an hour walking from the town that you just saw. It is built on purpose to be an hour away from town. The concept of the camp, as you will see, is not to welcome. It is to isolate. It's not to integrate. It's to keep their worlds apart. They are the migrants, the asylum seekers, potentially they're refugees and then there is the community of Samos, the community of the islands, the Greeks. The two worlds are set apart. 

You are now having a frame that shows you the camp from a distance. It's not so easy to go into the camp and in fact the filming has taken place from outside. You will note that there is a very distinct perimeter. They are very high fences and in what is to come, you will be able to discern that there is an excessive, an aggressive security environment. We are talking about NATO-styled military barbed wire. This is not us characterizing the features. These features are actually explained in the government website. 

Turnstiles, you will see them as we speak. We're driving around the perimeter now, multiple barbed wire, entry and exit systems. There is a closed-circuit surveillance, right? There is a smart software capable of giving notifications and images to control what is happening inside the camp. It's a bit strange because we're not talking about criminals. We're talking about people. The residents of the camp are people that are seeking asylum. It's not really people that have committed a crime. And yet the camp is kind of like a punishment set up for people seeking safety. 

It contravenes the recommendations of the European fundamental rights agents. Now you see us here pointing out from a different side of the camp, which is quite extensive. You might have noted. The Fundamental Rights Agency, and I quote speaks of "facilities intended for the first identification and registration of new arrivals should not resemble a prison". Well, unfortunately, this expensive center numbering in millions of taxpayer’s dollars does resemble a prison. They should not be built with barbed wire and prison-like fencing. And this says, "The Fundamental Rights Agency helps to avoid risks of re-traumatizing people who have experienced violence and persecution during their journey." 

So, I mean, what we see here, and it's interesting how this is considered a role model, a flagship of the EU-funded closed controlled access centers. Samos being one of the centers that have been inaugurated first. It's been more than a year, almost a year and a half now since the inauguration of it. 

So I mean, what I'm trying to convey is that in the point, in our opinion as doctors that work also inside the center, I will explain more on that later on. What we see is a place that is normalizing detention. It's basically an extended administrative detention for people who are seeking international protection, also known as asylum. We believe that this is harmful to people's health and well-being. We've seen it in our own people. We've raised the alarm in the past even before the centers were built. So all in all the CCACs are not safe places for seeking asylum. 

Now you will note in the next video some footage over that shows the MSF team setting up a mobile clinic, right? I will explain why this clinic, although it should be a mobile clinic in and out of the camp, is shall we say, set up in the parking lot outside the camp itself. 

Let's just go over what services are actually or should be available inside the Samos Closed Controlled Access Center. And as we speak, you will see that all hands are on deck here from our drivers to our logisticians to set up generators to make sure that between the mechanized mobile clinic and the tents, we have what it takes, what we need in order to welcome patients in our setup and offer primary healthcare services. 

This is the set up of our makeshift clinic just outside the camp. We [will] explain why that is. It’s the first time set up this way, the way we’re looking at it right now. So, this is the preparatory tent here. Which is, shall we say, composed in two compartments. So, the inner compartment is where the patients are actually waiting. It's a pretty cold day as you see. We are cold so you can imagine how the patients feel. And then the outer one is where the nurse actually does the first triage. So, it's where we take the history of the patient. We identify the need. And then, of course, if the need involves a doctor, then it's the patient will actually walk outside escorted by the cultural mediator, who will also interpret for the patient, depending on the language. And then they will enter our mechanized vehicle. That's up here, this is where the doctor is. The patient will go through the consultation. And then will exit, and then they can return to the camp. So, we can walk inside and have a closer look.  

Welcome. So, this is the first compartment where, as you see, we have our health promoters and cultural mediators, French, Arabic. This is where the information of the patient is taken. So, according to what the nurse discovers, they will come here. The nurse will recommend what needs to be done. Some people have prescriptions for medication. So, it's a pretty full primary health care preliminary set up. And then patients will go out from here and they'll go right across. You can see there's some preparations going on by the logistics team here. And then, this is where they enter. And then the patients will go in and then you can see the little baby there waiting for consultations. We have pregnant women, priority is always given to children and their mothers first. And if there are any particular medical incidents they will go in first. Again, the teams are always doubled. So, it's the medical practitioner, but of course, without the cultural mediator, without the interpreter, nothing can be done. Without the health promoter nothing can be done. So, this is a pretty complete team.  

Would you like to walk in? They walk in, we have a double consultation room. We have the doctor. Ah there's two doctors today. Yes, we have two doctors because there’s quite a few patients. You have to remember that the camp of Samos is now numbering about 1,000 residents. The need for daily medical care is very necessary. So, we have a volume. And although it's cold people know that we're outside.  

About this set up, perhaps we need to explain that normally MSF has access and conducts the mobile clinic inside which you see is right there. We're very close, we're actually in the parking lot of the camp. Would you like to walk towards the camp? So, normally our vehicle would enter the camp. We wouldn't have need for generators at this point because we would be supported by the electricity of the camp. But what happens is that in the past weeks we have been facing an access issue, not just MSF, but many NGOs that has to do with the fact that there is a bureaucratic procedure that requires that our staff members individually are registered with the Registry of the Ministry of Migration and Asylum.  

This is a process that takes time, it takes time in a sense of we upload in a platform, they have to go through the right documentation and eventually they would be approved. So, now the approvals are trickling in. We still don't have a complete team that can go inside the camp. Unless they have this approval and have an identification card, they can't. And this is why although normally we would be where the taller administration building is, parked inside, easy access with containers as waiting areas. Now we have to do this in a parking lot. 

Just to add on the tour that you just saw. So just to explain that this is a bit of a shall we say, a bit of a situation we're in. The reason why we have the mobile clinic outside is due to an access issue that has just sprung up, meaning that according to the Ministry of Migration, we should be registered in an NGO registry, a group registry that they keep. It's not enough for MSF to be registered as an organization, but it has to be registered also each and every member of our team that goes inside. The process is lengthy and what happens is that it takes a lot of time to approve the registration. Based on this, the team cannot go inside as of 1st of January 2023. This is a new thing. 

Of course, MSF always finds a way and that's why you saw how we adapted the services. So, we now have a mobile clinic outside and it works very well. The patients are informed, the camp management is informed. Patients come. We have put all the generators, electricity, heating, on the cold days it's pretty windy out there and it works well. 

And one more point that I wanted to make is that the health promoters and the cultural mediators are the two specialties, let's say. Two types of colleagues that we have that are making everything possible. A health promoter is a person who delivers health education to our beneficiaries. They explain to them what they should be looking into in order for them to know if there's something wrong and whether they should come and see the doctor. Sometimes migrant vulnerable populations don't know. A pregnant mother may not be as aware of a mother to-be on what she should be looking into during her antenatal, the pre-pregnancy time. So the health promoters explain to the mothers. They touch upon very sensitive issues such as sexual violence. So there's a number of things. 

And cultural mediators as well as the health promoters are people who come from the community. You will meet some of these people later on in our virtual tour. They come from the community, they speak their language. Without that, it's impossible to see an Afghan patient that speaks Urdu or a Congolese patient that speaks Lingala. So these are the people who know their sensitivities, who know how we should be approaching our patients. It's all very patient-centered. So that's that. 

Now, I would like to take you a little further back. You've seen the camp as it stands currently, but I think it's time to see, and I believe that the video is now rolling. The camp that used to be. Okay, this is the old camp of Vathy. You will see first of all that we're talking about a place that is in the woods. This is inside the town. It's very close to the houses of the people of Samos. There was a certain interaction between migrants and the people and the numbers were very different. I am talking to you now, shall we say, for the years of easily 2020, 2019, 2021 and even before. 

Just to give you an idea what you see now are remnants of the past. Okay? This frame right now shows you the actual camp. This is the actual camp which is within the perimeter. And again, you see barbed wire and whatnot. This camp was built for 648 people. I'd like to ask you, for those of you who have been following the Greek context, how many people do you think were housed inside and around this camp? 

You won't believe but there was a time that we had 8,000 people here back in 2019. Okay? Later on in early 2021, we had in this place where you see now just basically a garbage dump. We had 4,200 people outside the actual camp in the forest living in tents amidst rats. I'll cut to just comment on the graffiti. The graffiti is basically a way of depicting optimism in a place such as this. 

Okay, so back to the numbers. 648 were inside the camp. 4,200 people in early 2021 were outside the camp. This gives you a ratio of one to six. So, for every person residing in the quote-unquote "safety" of the camp, of the reception and identification center, there were more than six other people left in inhumane and precarious conditions as you are able to see on your screens right now. This was a time in 2021's Europe where MSF was providing, hear this, potable water. We were water trucking in Europe for the communities that you see here in 2021. On average we provided about 50 liters per person per day for the thousands of people that I just mentioned. We built about 70 latrines and 30 showers because of course, if you're outside the camp, there are no facilities. And I mean, what you are able to see is now practically a place where time has stopped ticking. 

In late 2020, you may remember some of you that a fire broke out in this makeshift camp. Lives were endangered. Tents were burnt. There were about 4,500 people at the time. This was not an isolated phenomenon. A very similar situation was taking place in Lesbos with the infamous Moria camp. The big fire of late 2020 again left about 13,000 people without shelter back then in Lesbos. So the management of the camps was a precarious situation. 

And with this I would like to just draw a comparison if you allow. So, the hotspot approach, this is the approach of detaining people as soon as they come. It's the approach of deterring people from coming, has been one of extremes. It's either a situation of people abandoned to a state that reminds us of homeless communities living in tents with rats roaming around in prison-like, sorry, in places like this or it's the current situation where you have prison-like extensive facilities, admittedly clean and orderly, but suppressive and inhumane. So, there is no middle ground. It's incredible that there is no middle ground. We have to go from homelessness to prison-like facility. 

Again, I will repeat that the closed controlled access centers is considered to be their model solution. We also recognize some of the advantages of having the protected camp like this because in this place, of course you can imagine that it was insecure to live in this tent and go to the bathroom, for example, for a lady at night through the woods. So, I mean, the question then becomes then should we imprison the people in order for them to feel safe? 

As you see me walking right there, something happened. Seconds after this last frame of the video clip around 1:00 PM, plans changed. I received a phone call from my colleagues in the office and we were informally informed alongside all competent authorities via formal email that we had a new arrival. So people arrived in the northeast part of the island and they had sent an alert, a distress signal. 

So MSF was informed alongside the authorities. And of course you see the team now getting ready back in the office. We rush to the office. We change plans as we often do. We sprang into action and we are now preparing our vehicle with all the material necessary in order to provide aid, medical, psychological, but also non-food items, also food as well as dry clothes, water, all a complete package of aid. 

So now we're driving as soon as we can to a place where supposedly the people are there. Now you see us looking for them. Soon enough you'll see, you'll hear us calling them so on the megaphone. 

How does that work? People send a distress signal to help lines, public help line, public help lines such as administered by formal actors by the High Commission for Refugees of the United Nations. And they send them their location, an approximate location. The help lines either by legal actors or by UNHCR are then communicating with all the competent authorities, Coast Guard, police, camp manager, and the Doctors Without Borders. And they give away, give out, sorry, their phone numbers as well as the location. 

So, we rush to the site because sometimes the information we have from the formal emails speaks of people in distress, truly. In this particular case, I remember we had four pregnant women, seven months [along], five months [along] into pregnancy. We found them hypothermic, dehydrated. 

Guys, this is the Doctors Without Borders, the doctors that came because you sent a message. We know you have five pregnant women and one of them needs help. So can you please tell us where you are so we can find you or come to where you hear the voice. 

Messages are heard in English, in French, in Arabic, whatever we can, we do whatever we can so that people feel comfortable. People do not feel comfortable. I will explain why. People hide. So, we keep driving. We keep readjusting. You see the doctor there with his bag of medical supplies. It takes hours. Sometimes it takes hours and hours to find the people. And sometimes the people walk for miles. They hide. 

Why do they hide? According to the testimonies that we receive from the people, they speak of violence perpetrated against them. They speak of unknown men, sometimes masked who often intercept them and they take them back. They put them on rafts and they tow them out. 

Hello, Doctors Without borders. People, if you can hear us. 

Nicholas Papachrysostomou: 

So, you see all of this is done quite formally with us communicating with the authorities, also. It's a process that takes a lot out of us. 

Just to give you an idea on this particular occasion, there was no more than three degrees Celsius and a windy day. The people that we found, there were 48 of them in total, eventually had to walk as they landed. So, they basically had to walk in the water. They were wet. We found them hours later, many hours later, and eventually late, late into the night, we found a mother with an one-year-old child. I mean, if I was feeling cold, we can imagine how the baby felt. So, it's a bit of a dire situation sometimes and other times we've seen people landing in very bad conditions. They sometimes swim ashore. They are in need of someone to sit down with them and tell them that it's going to be okay. 

Like I said, people hide because they're afraid. They have heard that oftentimes they are intercepted, and they are forced to return. These forced returns and the collective expulsion so that sending a group out before talking to anybody are not in accordance to any law. People seeking asylum should have their claims examined on an individual basis based on the risks that they face in their home country. They can't be sent out from where they came from, assuming that Turkey is a safe country, for example, for them or any other country. 

So, I mean, we communicate with the police once we find the people and we ask the police to provide transport, formal transport to the camp that you saw at the very beginning, that's how we assist. Having triaged, so we screen the patients. Sometimes we refer the patients to the hospital before they can be registered. We've referred many, many mothers, many pregnant women, sorry, mothers-to-be to the hospital. We call the ambulance. The ambulance comes and based on the instructions of our doctor, they take the people to the hospital. Otherwise, if one of the police comes and they take the people to the camp that you saw at the very start where the procedure of registering takes place. 

People know this. They know that they will be subjected to the risk of violence. Their testimonies say so. We have not seen it as MSF, but multiple testimonies speak of this. They know that they will be left in limbo inside a detention-like facility. They know that their future will be uncertain and still they go in onto that inflatable boat and cross to come. This is how much they are in need of fleeing their own reality, risk, security, war, conflict. And yes, there are people also that flee poverty in search of a better life. None of this is a crime. 

The group that we met on this occasion was a lucky group. Just days before there was a very bad shipwreck with a number of casualties. People drowned on the island of Lesbos. And Samos has had its number of shipwrecks as well. Like I said, it's not easy to navigate the North Aegean Sea if you don't know how. A lot of these people have never seen the sea in their lives. 

Now it's no secret that the people who arrived to the islands do not wish to stay on the islands. That's not why they came. I've had this discussion with Nick many times, my co-host and visitor. Nick, I don't know if you would like to ask a few questions. 

Nick Bayer: 

Yeah, of course. No, I mean it's quite intense and thank you for sharing that information and it's good to see all of that. As you mentioned, Nicholas, for most migrants, Samos, Lesbos, when they arrive to Greece, it's not their final destination. I'm wondering, can you tell us what happens to those who manage to have their geographical restriction lifted? What happens to those who after some time are able to leave these camps? 

Nicholas Papachrysostomou: 

And that's an interesting concept, a geographical restriction. So, somebody who comes to Greece and lands on an island does not have the right of free movement. I mean we've seen it with a camp, but it's quite clear, very, very clear that the person does not wish to establish a homestead on Samos. 

So, for those who finally managed to lift, and that's a legal process. And this is why Greece is an atypical mission. We have a lot of legal support that goes to our patients. Those who have managed to succeed in lifting their geographical restrictions, they go to Athens. Some go to Athens, and in good time they find a way to leave again because their destination is the north of Europe or it is the west of Europe. 

And now you see Athens, a sprawling city, a very ancient civilization, a beautiful place, but also a hectic, excuse me, a hectic place, right? Athens hosts an unknown number of undocumented people, people without papers and registered people. See here you see the parliament of the Greeks. It's a place where many different communities coexist and some of the people on the islands come to Athens. Other times, people have arrived to the capitol and stayed there over the years, some never sorting out their status. So, they are a kind of invisible layer, right? Abandoned, no access to healthcare, nothing. They're just undercover, homeless or sharing apartments with many others. Nobody knows. Nobody knows their coping mechanisms. 

And here you see what we do in Athens, the last MSF sticker is the sticker of our Day Care Center, the DCC as we call it. It's a clinic that does not ask questions, it just offers medical care. It doesn't matter whether you have a social security number. It doesn't matter whether you're registered. It doesn't matter whether you're an asylum seeker, doesn't matter if you lost your ID, your papers. And what we do is we try to service the people of the city of Athens, the vulnerable populations in Athens, but also people that are found in camps, much like the camp that you saw, not in that way, other type of structures but facilities in the vicinity of the capital that house thousands of people. 

So, what you're seeing here is the team walking the streets and our clinic is right here as you see right now in the center of the city. So, there is a tedious system of asylum-seeking procedures. There's a platform. You need to book appointments. The platform is often non-functional. Appointments for interviews are not available. So, you could be stuck for a long time, detained in a camp, sometimes away from the city also. 

Imagine what could that mean if you are a diabetic patient in need of constant medication. The second time you're rejected, your social security number ceases to exist. So, you suddenly don't have any access to care. You're an HIV patient, you have no access to ARVs (antiretroviral drugs). There are some issues that raise concerns that are of public health nature because these are communicable diseases. So, it's not as easy. 

And of course, if you are in the camps, it may take up to 25 days to complete registration if you're lucky and receive a card that allows you to go in and out. Before that, you are left shall we say in the mercy of camp services that in terms of health, they are not very adequate. This is why MSF also offers services in the camps in the vicinity of Athens. 

Another issue was that in order to decongest the islands, Athens and the rest of Greece had an accommodation scheme created. It's called ESTIA, which means homestead in Greek. ESTIA is now closed. This year, the authorities, the state decided that they didn't need that. This is a capacity of 20,000 spaces reduced to zero. You can understand that this may cause risks of homelessness if the people are ousted from the apartments managed by ESTIA as asylum seekers. They will be found on the streets or they have to go back into the camps. Some people don't want that. I can't really blame them having seen the camps. 

And this is the risk of migration in Europe. It's the risk of falling through the cracks. Purposely, maybe not registering into the system because you're afraid, not having the papers to register this into the system so not being able to whichever, maybe you don't have the knowledge of all the procedures that exist. So, this is how refugees fall into the cracks of the systems of many European countries. 

In any case, like I said, the Day Care Center of Athens, as my colleague will explain shortly, is a place where we offer a number of basic health care services. And one particular characteristic is that we offer legal support so that the legal status of these people is determined. Because access to health, and this is very important, access to health in Greece and in many other countries is associated with your legal status. If you're an asylum seeker, that's fair. If you're a rejected person, you cease to exist. So, this complex bureaucratic system sometimes has you under some sort of care and other times under no care at all. 

Accommodation, financial aid, all of this, we have legal officers. We have social workers. We have cultural mediators. We have health promoters in order to do this. 

And now let us take a tour. Let's take a tour with the field coordinator of the Athens Day Care Center. My colleague, Ioanna Pertsinidou, the project coordinator, will actually explain the focus of our clinic. Maybe we can move to the next video now. 

Ioanna Pertsinidou: 

Hello and welcome to the Day Care Center (DCC) of Athens. A clinic that MSF is running for the people that do not have access or they are facing a lot of obstacles to access the healthcare system. That means they do not have their papers they are not registered or they have been rejected and still they do not have a paper that allows them or makes them visible to the Greek healthcare system. Even if they do have something, they may have obstacles to access the system itself because of their language [barrier] or other complications of bureaucracy that may exist in the system and are difficult to understand especially if they are in an uncertainty period here in Greece.  

So, my name is Ioanna and I'm trying to let's say drive you through what we do in Athens. So, anybody that wishes and has a health need for any reason will drop in the Day Care Center in Athens, and they will go first through this magic room that is called triage. There a nurse will assess their physical condition. And either will be referring internally to the Day Care Center in Athens, or we try to liaise with other organizations or other sources that can really serve the needs that the person has.  

What we do provide here in the Day Care Center is sexual and reproductive health care, mental health care, and treatment for non-communicable diseases like diabetes, hypertension, and other chronic diseases that affect people. And they are difficult to follow up, especially if you don't have any access to medications, to proper lab exams, and to diagnostics that can support the care.  

So, once the person is somehow triaged by our nurse here, they'll come to our reception and they book their appointment. Now, our receptionist will give them this little card where they will have their unique registered number. And as you see here, the two very well-known kind of pictures is the WhatsApp and Viber connection in different languages. So, in case they need something urgent, they can contact these numbers and we will see what we can do.  

Hello. That was Iota our social worker. This is the waiting area where we stand now and then here is our corner for the children. Because we have patients that do have children and actually, it was always an issue how they can be really have a proper consultation themselves and who will take care of their children while they are in a consultation in the Day Care Center. There's a magic woman that we call "nanny", and she is taking care of the children around here. Welcome to the Sexual and Reproductive Health Department. Here we have our midwives. Hi Anna! 

Anna Karalia: 

Hello! 

Ioanna Pertsinidou: 

Anna is one of them.  

Anna Karalia: 

Midwives.  

Ioanna Pertsinidou: 

I'll pass the floor to her to explain what we do in the sexual health department. 

Anna Karalia: 

Okay. Here we have a consultation room. We examine all the ladies, all the pregnant ones, and non-pregnant. Here we see, all the sexually transmitted diseases. We have machines that we can provide to the patients, some extra samples about the cancer of the uterus and other infections that we cannot detect clinically.  

Also, we give contraceptive methods here to all the population. We inform all the ladies about the delivery, about the postnatal period. We refer them accordingly if we need the hospital's help. We go through all the population and we ask the needs and accordingly we give all the information that they need and the help.  

Ioanna Pertsinidou: 

So, this is the cabinet for non-communicable diseases (NCDs). Normally a doctor and a nurse are taking care of the patients that are suffering from chronic diseases and they need long term follow up. And in the case they decide to leave the country, then they provide them with instructions or the proper medications so they can have coverage until they reach the place of their destination. So, this is what we call the NCD department, standing for non-communicable diseases department. 

Nick Bayer: 

Shall we go? 

Ioanna Pertsinidou: 

Yeah. Another essential component that is usually very... what we call here are the hidden heroes, because they are not in the medical front line as we are used to with medicine with MSF. They are the social workers and the lawyer. At least in this context, their support essentially complements our medical activities in many different ways.  

For example, they are the ones that are identifying needs that may affect their health status, but they are not directly addressed through DCC. So, they will liaise with the community and other sources that are existing in the community, along with the public health sector, to provide, to liase, our patients with the proper support they need in order to really take care of themselves and maintain their health status.  

Essentially in Greece, living in Greece is your legal status as well because it's what actually makes you visible in the system. So, it's an essential component of having access to the healthcare system. And our lawyer is making sure that at least our patients are exhausting their possibilities to really have access and the proper legal status to stay legally in Greece. That's quite an effort and not always successful, unfortunately.  

We are on the floor for the mental health unit, actually. So, we have the psychologists that are addressing the mental health issues. They're doing quite a comprehensive package of 12 sessions to really treat the most urgent matters. And then accordingly, either they liaise with our psychiatrist, where he can provide medication if necessary, or liaise with other sources in the community to get the proper support.  

Here is where they're holding their sessions. And as we may have people that they may benefit from a group session, we have also a room for group sessions as well.  

All these services wouldn't be possible to be provided if we didn't have quite significant group of cultural mediators. And how actually we're able to follow what is going on in the various communities, this is obtained through our team of health promoters that also speak various languages. So, let's say the Day Care Center here in Athens is our core activity, but we still go out there to reach different needs of our patients in different locations. So, that means practically we are operating in five camps all around Attica. And we operate also in different locations within the city of Athens to really see what actually and whom actually we miss in the Day Care Center. 

Nicholas Papachrysostomou: 

I will pick up from where my colleague, Ioanna left. So, there is a clinic in the center of a city with about 3.7 or more million people. Who knows about this clinic is questionable. Do all the people that need us know that we exist? Is it easy for them to reach us if they are far out within Athens? This is a pretty extensive capital. Is it something that they understand? So even if they know that we have a clinic, would they imagine that the door is open for them if they've been rejected by the system so many times? 

And then moreover, during 2022, following the aggressive political discourse of cleaning up Athens of the illegal people, these are illegal people, the undocumented, the unregistered, there is a series of police sweep operations that has been ongoing throughout. So, police is seen everywhere on their mechanized vehicles, on motorcycles. People see them. People wouldn't dare to come even during COVID for the vaccination through MSF, to access MSF services because they know that if they're intercepted, it's quite possible that they will be taken into the detention centers for a detention period of up to 18 months. So, they are careful. 

For these reasons, we have externalized our service. So, we do what we do at the clinic, as we said, mental health, non-communicable diseases, chronic and also sexual and reproductive health. But then we “export” quote-unquote these services, including primary health care, to places that are outside our clinic. We have the five camps. We go to Corinth, for those of you who know about an hour or more away from the city of Athens. We provide a doctor for that camp. Then we go to other camps as well. So, we go to them and if we need to refer them to the National Health System, we do that. 

At the end of the day, this works fairly well, and we have a mobile team that goes, as you've seen them driving, you'll see more of them now. And finally, we also take care of the city itself, of the urban setting. So, the camps are outside, and they are in closed setups, but there's people in the city that will not come to the clinic. So, we have four points in the city. We have a mosque for the Afghani community, at the center of Athens. We have a municipal cabinet. So, we collaborate with a municipality, one of the municipalities of Athens. We also have a recently established NGO hub where we provide health care along other NGOs that provide other services. So, it's kind of like a one stop for all the patients that come there. They may be distributed food and they also have a doctor. So that works out well. 

But I would like to take you to a very special place, and this is a community center run by the Congolese in a vibrant neighborhood of Athens called Kypseli that echos the cultural vibes of many migrant communities coexisting there. In this last video you will see Ioanna again ushering in Sarah, Barshank and Youssouph, three of our health promoters that come from the communities of the people we serve. It's very atypical in the Greek mission. We have staff, MSF staff that are also beneficiaries. They're asylum seekers themselves. They give back to their community just like we take from them information and we understand better. And the idea is to adapt our services to the needs of our patients. 

So, let's hear in the last video, our colleagues explain from their point of view why health promotion and cultural mediation is an added value. We can go to the next video. 

Ioanna Pertsinidou: 

Welcome, now we are in Kypseli. We are actually in the Congolese Cultural Center where they host activities of their own. But they also host our doctor as well. So, they are collaborating with many different communities that are actually living in Kypseli. So, it's really a key place to be in and be able to provide our services for free. And this is where we are holding every Thursday our medical activities. 

Sarah Massay: 

Hello, my name is Sarah. I’m an MSF health promoter at the Day Care Center in Athens. I’m here today in the Congolese community where we are doing our outreach activity with the general doctor. We receive everyone who has a health problem whether they have documentation or not. We welcome people aged 16 and over. We welcome everyone regardless of what language they speak. Thank you all. 

Youssouph: 

Yes, I'm Youssouph. I'm CM (cultural mediator) of Lingala and French. We are here today for our Thursday outreach activity. We come to the Congolese community to see people who are suffering from different kinds of illness. Additionally, we help the whole team, psychologists and psychiatrists with translation. We escort people to the hospital. That's all. 

Barshank Haj Yonnes: 

I can say it in Arabic. Hello, my name is Barshank, I’m a health promoter with Doctors Without Borders. I’m Arab-Kurdish. We are present in Kypseli in the Congolese community area, with the general doctor every Thursday from 3 to 7 pm. We provide our services to immigrants and refugees, with or without IDs or travel documents, with the help of the general doctor. Thank you.  

Sarah Massay: 

First of all, I have a targeted population. So, most of the people I speak with are African. Either they speak English, French or Lingala. I start to say hello to them to hear how they'll respond. If they speak English, they will say hello. If they don't speak English, they will tell me French or Lingala, please, and then I will start my promotion. But I need to ask them to consent to give me some minutes to speak.  

Barshank Haj Yonnes: 

It's the same for me also, with my community. We greet them and we also introduce ourself, “we are health promoters from MSF,” in our language. And we take their time if they have some minutes to talk to them. And then we start promoting our services in DCC and urban outreach.  

Sarah Massay: 

Today when I went to the outreach, I explained to them what they were supposed to do, but I got feedback that they don't have papers and they cannot come to DCC. They are already our patient, but they cannot follow up with the psychologist. They don't have papers, they're afraid to come to Omonia. So, with this kind of feedback I have from the community, I will think about how I can help them. Not only to give them information but to get the feeling too of how they are living, what they are facing. So, this I really like to help my community especially.  

Barshank Haj Yonnes: 

Yeah, for me also, I like to encourage my community. Not only to deliver our services, but also receive their thoughts and their opinion on how we can build trust. What they believe we can improve for the community in medical services. 

Nick Bayer: 

So, we're coming toward the end of our virtual tour event now. I know we've gone over a couple of minutes, but we do want to just answer a couple of the questions that have come in from the audience. 

So, one question first for you, Nicholas, that's come in on LinkedIn from Alessandro. And the question is about how is MSF dealing with external political pressures where migration processes and refugees are very often used to blame these political propagandas rather than focusing on the care that people need and the support that people need when they're on the move? 

Nicholas Papachrysostomou: 

Right so practically we're talking about how many of us are out there helping people. There's not that many medical actors to be honest and not in the way that MSF works. So, we have medical actors in some of the camps. They have their own specialties, shall we say. So, the Red Cross is there. SAMS and other NGO provides medical services. The people are many. The days are many. The complexity of the cases are many. 

So, I think right now and with the advent of latest events where the UN is also withdrawing, some of the programs are passing to the state, all of us, all the hands are needed on deck. All the medical hands are needed on deck. There is quite a bit of marginalization and there is a distinct trend of criminalization of refugees, of asylum seekers, of people who would otherwise profit from rights that are reserved for the citizens. 

Nick, you mentioned some other aspect about the advocacy part, which I think I may have missed. Can you please repeat? 

Nick Bayer: 

Yeah. So, the question is how does MSF respond to these external political pressures that are coming in from the EU or from other places and as you say that are criminalizing people who are in this situation as we talked about. As you talked about earlier in Samos, people are in a dire situation, so they're not choosing this path just because, so there's a real reason for, and how does MSF deal with the greater political pressures there? 

Nicholas Papachrysostomou: 

Right. This is a good question in that sense. I mean 2022 has not been a good year. The discourse has toughened. The political relationship between Turkey and Greece has worsened on many occasions. There is a blame game. There is a distinct tendency to criminalize the act of migrate. Other countries too, it's about building walls. It's about protecting the border. It's not about the rights of the people based on international law, based on EU legislation, based on national legislation. The seeking international protection asylum is a universal right. The right to medical and timely medical care is a universal right. 

So, MSF speaks, speaks out. We have. We have issued briefing notes. We do bilateral advocacy. We speak of the closed controlled access centers. We speak of the testimonies of our patients that mentioned violence at the border, that mentioned forced returns. We become the voice of these patients. 

It's true that the numbers are not the numbers that we used to see, but that doesn't make it right. It doesn't make it right that in today's Europe for the fewer people that still attempt to cross, regardless of the political pressure, we would treat them the way we are. 

So, I think MSF is an actor that makes use of the medical observation and manifests it into advocacy and speaking out. And whether we make a difference is something that needs to be judged in the course of time. But I can assure you that we will continue to do that. 

Nick Bayer: 

Thanks. And maybe one final question from the audience, and thanks again to all those who sent things in via the chats. This one comes from Eleanor on YouTube and the question is related to any medical referrals that MSF might make for a patient. And so, if something is discovered for a patient in the primary care visit, whether it's at the mobile clinic outside of the camp or in the DCC or with the urban outreach team, if a patient needs further care, where is that patient sent and how does MSF make sure that that patient gets the care that they need? 

Nicholas Papachrysostomou: 

An excellent question, perhaps Eleanor is a medical practitioner. Assisted referrals is a big issue whether they are on the island of Samos, whether they are in Athens, through the clinic, whether they are in the camps of Athens and whether they are in the urban points of outreach. These assisted referrals bridge basically the access of the patient between what MSF can offer, understanding that we do not have hospitalized care and the actual specialties hospitals that the state, the national health system can provide and they have the tendency has been an increasing one. 

So, we refer the people. We refer the people. We accompany them with social worker. We accompany them with a cultural mediator depending on the case. We lift their geographical restriction and the idea if need be. And the idea is to provide a continuum of care. So, from the point of arrival, as we've seen on the shore of Samos to the clinic that's inside the camp where we see the patient after having arrived, to the assisted referral, to the hospital of Samos, to the lifting of the geographical restriction, if need be, so that the patient can reach a hospital in Athens. And the same goes in Athens itself. We try to bridge all the gaps in the system. 

However, there are things that nobody can make right. If we have a patient that is rejected, then even if we refer them, they do not have the social security number. So, MSF cannot make the bridge. Some of the bridges are broken. So, we advocate for that. We try to advocate. We speak with the Ministry of Health. We speak with the Ministry of Migration. We try to work on how the social security coverage should never be discontinued. Even if the asylum claim falls, there should be a disassociation of the two: universal right to health care through the referral and their legal status. Easier said than done. 

Nick Bayer: 

Makes sense. Thanks for that answer. And I wonder just as we wrap up and as you finish your assignment leading operations in Greece, do you have any final thoughts for us? What's ahead here? What are the challenges ahead and what do we need to remember? 

Nicholas Papachrysostomou: 

I will, I think voice the key message. The key message is that for MSF, they are not complex. They are based on basic humanity and medical ethics. So just a few points to take away with you as food of thoughts, food for thought to all the people that are with us today, and I thank them from the heart for being here. 

MSF calls out to the European Union, to the Greek authorities to establish a fair and transparent asylum process. This fast-track thing where vulnerability is not taken into consideration, where people are judged based on the concept of a safe country doesn't work. It expedites basically rejections and it's not a fair process. 

We should uphold to the procedural standards. We shouldn't violate the right to asylum and we shouldn't criminalize it either. People need a safe environment, a humane environment to register and process their asylum without the risk of being re-traumatized because they've already been traumatized getting here, right? 

Access to timely medical care, I've said this many times at the risk of repeating myself, I would say that this is a right that should be tailored to people's needs not be tailored to people's legal status. We should invest in a dignified reception and identification system with safe accommodation. The closed controlled access centers that we have seen are not that. Asylum seekers, refugees, migrants, whatever, they should be encouraged to be integrating into the societies not set aside, not set apart. 

They might sound easy, these remarks, but they're not. And I will close with this. You might have seen also videos that have circulated with a number of famous, famous speakers. Seeking safety is really not a crime. Options for safe passage have been put out by MSF throughout. We do this for the Central Mediterranean where we manage search and rescue. And I've been there, and I've seen it. It's people need safe passage. 

If you don't give them safe passage, life will find another way. And unfortunately, this other way is people being exposed to the risks of trafficking and smuggling, risking their own safety to seek out international protection. Family reunion, refugee resettlement, so that the problem is shared within the EU countries, not taken up by the border countries. Humanitarian visas, complimentary protection pathways, all of these are elements that can be integrated into a system. Roots for work and study, there are ways of doing it. It doesn't have to be building walls and keeping people out because people who have real reasons to come to Europe, they will continue to try at the risk of their own safety. Thanks, Nick. 

Nick Bayer: 

Well said and thank you to you. That's all the time we have for today. Thanks everyone for bearing witness, bearing with us. Excuse me. Thank you, Nicholas Papachrysostomou. Efcharistó polý in Greek and thanks to the team who supported the creation of all of these videos and of this event. I know some of you are out there watching so thanks for tuning in with us as well. 

Nicholas, who's finishing his assignment as the head of mission in Greece this week, thank you again for taking the time to be with us here today and just to everyone seeing this work firsthand is quite inspiring and confronting and it's really important work. And so, we appreciate you doing the work and sharing your perspective with us. So, thank you and a huge thanks to all of those who are out there watching with us on the various platforms. We appreciate you being here today. Apologies if we didn't get to your question, but we'll have the questions available in the chat and you can come back here and watch the recording and see the chat as well afterwards. 

Please stay in touch with us as well. You can email us at [email protected]. That information will be posted in the chat for you as well. And for more information, you can visit our website if you're here in the US with me, we're doctorswithoutborders.org and our international website is msf.org. So, you can also follow us on LinkedIn, Instagram, TikTok and beyond on our social media channels. Please stay in touch and thank you. That's all for now. 

Nicholas Papachrysostomou: 

Thanks everybody for being here. Goodbye.