Refugee crisis in Europe: health status, life experiences, and mental health problems of transiting refugees and

migrants on the Balkan route in 2015

Iro Evlampidou, C. Baruzzi, C.Peruzzo, A. Meimaridou, E. Loyens, E. Faga, A. Ponthieu, ME. Ingres,

S. Moissaing, F. Zamatto, N. Severy, S. Argenziano, M. Van Herp, JP. Jemmy, C. Montaldo

Médecins Sans Frontières – Operational Centre Brussels

@MSF/Achilleas Zavallis

Refugee crisis in Europe, 2015

Source: UNHCR, http://data.unhcr.org/mediterranean/regional.php

0

50 000

100 000

150 000

200 000

250 000Monthly arrivals to Europe, 2014-2015

1,015,078 total arrivals to Europe in 2015 3,771 Deaths in 2015

Source: IOM, http://doe.iom.int/docs/Flows%20Compilation%202015%20Overview.pdf

Response: agencies, NGOs, volunteers, governments

MSF Operations • Primary health care (PHC) – Referral - Health

promotion

– Chronic diseases

• Mental health care (individual & group)

• Victims of torture

• Food & Non-Food Item (NFI)

• Transportation, Shelter, Water & Sanitation

• Search & Rescue

• Vulnerable groups: identification & referral

• Advocacy

@MSF/Vicky Marcolefa @MSF/Alex Yallop

@MSF/Alessandro Penso

@MSF/Alessandro Penso

@MSF

@MSF

Objective

In 2015, among transiting refugees/migrants in Greece & Serbia we aimed to determine the:

• Socio-demographic characteristics and vulnerabilities

• Physical and mental health status

• Traumatic life-events

In order to better understand their needs and guide interventions

Methods

• Primary health care: Jan-Dec 2015

• Mental Health: May-Dec 2015

• Referral (self-/NGOs), MH group sessions, medical consultations, patients’ social networks

• Cultural mediators

• Anonymous program data

Vulnerable groups

• Pregnant women

• Children <5yrs

• Unaccompanied minors

• Single parents with minor children

• Elderly (>65yrs)

• Disabled

• Chronic physical or mental health illness

@MSF/Vicky Marcolefa

@MSF/Guillaume Binet

@MSF/Alex Yallop

@MSF/Anna Surinyach

PHC consultations, Greece (N=43,619) & Serbia (N=38,249), 2015

0

2 000

4 000

6 000

8 000

10 000

12 000

14 000

16 000

18 000

20 000

nb

of

con

sult

atio

ns

Greece Serbia

Socio-demographics: Primary health care

Socio-demographics: Mental health

Vulnerabilities: Primary health care & mental health sessions

Primary health care Mental Health

sessions (N=1064)

N n % n %

Vulnerable group 81,868 12,796 16 326 31

Under 5yrs 81,595 9,443 12 6 1

Pregnant woman 16,583 1,523 9 34 3

Unaccompanied minor 22,165 1,118 5 41 4

Elderly (>65) 81,592 440 <1 10 1

Disabled 81,732 136 <1 39 4

Single parent with child of minor age 81,868 136 <1 59 6

Chronic physical illness 81,868 4,564 6 75 7

Chronic mental health illness - - - 48 5

Primary health care: Medical consultations

@MSF/Alex Yallop

Health status by country (N=81,868)

• 93%: symptom onset during the migration trip

Chronic diseases & referrals (N=81,868)

Chronic diseases (4564; 6%) • Cardiovascular (26%) • Diabetes (25%) • Chronic lung disease (15%) • Epilepsy (3%)

→ 11% (77/681) referral refused

• Gynaeco-obstetric (n=21)

• Respiratory (n=12)

Referrals (681; 1%)

• Trauma (20%)

• Respiratory (14%)

• Gyneco-obstetric (12%)

@MSF/Achilleas Zavallis

Individual mental health sessions

@MSF

Traumatic life events before & during the journey (N=1064)

97%

56%

0%

20%

40%

60%

80%

100%

before journey during journey

0 events ≥1 events

Self-reported traumatic life events

Self-reported intentional violence

7%

12%

10%

7%

0% 5% 10% 15% 20% 25%

Sexual violence

Ill-treatment

Physical violence

State authorities Community/smugglers

@MSF/Juan Carlos Tomasi

Mental health symptoms (78%; 830/1064)

Challenges • Overwhelming numbers of people

• Multiple actors: Coordination - collaboration

• Cultural mediation:

– Many languages

– Not enough

• Patients on the move

– Quality care

– Refusal of referrals

– Follow-up – continuity of care

@MSF/Anna Surinyach

@MSF/Jodi Hilton

Conclusion • Increased vulnerability

• Multiple traumatic life-events

• Physical & Mental health needs – chronic diseases

• Transit population: difficult to follow-up – continuity of care

@MSF/Alessandro Penso @MSF/Achilleas Zavallis @MSF @MSF/Florian Lems

Recommendations

At transit and destination countries in EUROPE:

Authorities need to assume their humanitarian and legal responsibility & take action:

Safety – living conditions – early vulnerability screening

Free, easy access to healthcare (physical/MH care)

– Preventive (screening, perinatal, vaccinations)

– Curative (acute/chronic)

– Cultural mediation

Innovative ways for continuity of care & follow-up

@MSF

Thank you

Acknowledgements • Patients

• Field & coordination teams

• Refugee Task Force members

• Cell 2 – Roma

• HQ staff

• Luxor team

@MSF/Florian Asis Schulz

Organizations responding to the crisis in the Balkans

A21 ActionAid Apostoli Caritas CRI DRC Serbia DRC First Reception Service GCI Greek Asylum Service HCG Hellenic Police HRC Human Appeal ICMC

IOM IRC Islamic Relief IsraAID MdM Mercy Corps METAction - METAdrasi MMTF MoI Greece MoI Italy MSF NetHope NRC OXFAM PRAKSIS

Pro Asyl Samaritan's Purse SCI Save the Children ShelterBox Solidarity Now TSF UNHCR Europe Bureau UNHCR - Italy UNHCR - Greece UNHCR - MENA bureau UNHCR -Africa bureau UNHCR Malta UNHCR SMI UNHCR fYR Macedonia

UNHCR Serbia UNHCR Croatia UNHCR Slovenia UNHCR Austria UNHCR Hungary UNHCR - Spain UNICEF WAHA

Source: UNHCR:

http://data.unhcr.org/mediterrane

an/partnerlist.php#

Mental Health: Group sessions • 2,464 group sessions (Greece: 2,098 (85%), Serbia: 366 (15%))

– 75% “Other psychosocial”

– 13% psycho-education

– 6% therapeutic groups

– 4% distraction

– 3% therapeutic play

• 24,901 total participants

• Languages

– 59% Arabic, 20% Farsi, 10% English, 7% Dari, 7% Urdu, 3% Pashto, 1% Kurdish, 1% French, 0.6% Spanish

Proportion of MSF-OCB consultations out of total arrivals, Greece, 2015

0 0

3

9

6 6

4 4 4 4

6

8

0

50 000

100 000

150 000

200 000

250 000

0

1

2

3

4

5

6

7

8

9

10

%

Total arrivals in Greece Total MSF-OCB consultations Greece % consultations out of total arrivals

10% 9%

15% 12%

0%

10%

20%

30%

40%

50%

Respiratory tract Trauma GI tract Skin

Female Male

Proportionate morbidity by sex

Proportionate morbidity by age group

0%

10%

20%

30%

40%

50%

60%

70%

Respiratory tract Trauma GI tract Skin

<5 years 5-17 years 18-44 years 45-64 years 65+ years

47% 32%

56% 44% 39%

28% 37%

12%

17%

10%

12% 14%

20% 14%

13%

10%

9% 11%

10% 5%

11%

9%

10%

6% 9%

11% 27% 12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Afghanistan Africa Iran Iraq Other Pakistan Syria

Respiratory tract Trauma GI tract Skin

Proportionate morbidity by nationality

*Numbers do not add up to 100 due to multiple diagnoses

Trauma cases by country and epidemiological week, Greece & Serbia, 2015

0%

10%

20%

30%

40%

50%

60%

70%

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Greece Serbia Linear (Greece) Linear (Serbia)

Self-reported traumatic life events (1)

Self-reported traumatic life events (2)

0 2 4 6 8 10

ProstitutionFamily separation

Sexual violence by authoritiesSexual violence

Sexual violence by community membersCombat experience

Child abuse/ill-treatmentTorture

Accident (land or sea)Marital violence/intrafamily conflict

Incarceration/kidnapping/hostageSaw dead bodies/corpses

Ill treatment by authoritiesDeath of family memberSevere illness/handicap

Physical violence by communityDiscrimination/racism/exclusion

%