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Providing mental health care lets refugees in Greece ‘feel seen again’

Asylum seekers have endured torture and other trauma at home and en route to Europe, where they are then isolated and fall through the cracks.

A refugee at the anchor of a ship in the port of Piraeus. (CREDIT: Wassilios Aswestopoulos/NurPhoto/via Getty Images)
A refugee at the anchor of a ship in the port of Piraeus. (CREDIT: Wassilios Aswestopoulos/NurPhoto/via Getty Images)

ATHENS, GREECE — This storied European capital city is a version of hell for asylum seekers dealing with trauma and mental illness. In some neighborhoods, such as the Exarcheia, an anarchist stronghold with a long history of counterculture, men from Iraq, Afghanistan, Syria, and Iran hang out in parks and squares, sometimes drunk, sometimes high, sometimes neither, but clearly in a deteriorating state, staring off into space and wandering around.

At a neighborhood park and nearby Omonia Square, a major metro hub surrounded by shabby motels, teenage Afghan boys sell themselves for 10 Euro — 20, tops — enough for a couple of meager meals.

While many of these asylum seekers might have a spot in some kind of camp or housing, some are too traumatized to live there, opting to take their chances on the streets rather than continue to live either in camps on one of the Greek islands or in isolated residences.

“The main problem of asylum seekers, in general is that because they don’t have a permit to stay, they feel like they don’t exist. They’re like ghosts living in this city…they are invisible in this rich European capital.”

“The biggest issue we have in Athens is the problem of accommodation,” said Christina Popontopoulou, a psychologist treating torture victims at a clinic run by Doctors without Borders (known by its French acronym MSF).

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For about two years, the Greek government has been enacting geographic restrictions on arrivals in order to decentralize the population. Roughly 13,000 refugees have been stuck in camps on the Greek islands, not being allowed on the mainland. On Wednesday, a Greek court announced that new asylum-seekers will be free to leave the islands while their asylum claims are being considered.

But the Greek Ministry of Migration hasn’t exactly embraced the order, which doesn’t apply to asylum-seekers who have already arrived anyway. For those asylum-seekers, the camps on the islands are overpopulated, and the ones on the mainland are somewhat isolated, with extremely limited access to services.

“Sometimes, we hear of a camp where one doctor from a hospital somewhere else is supposed to go to the camp every two weeks to do checkups for 400 people — it’s impossible,” said Rosaria Gatta, field coordinator at the MSF clinic in central Athens.

A large number of asylum seekers have mental health issues often associated with the traumas they are fleeing in their countries (with drawn out conflicts, as in Syria, Iraq, and Afghanistan). A number of them have suffered torture and by the time they reach Greece, they have also reached their breaking point.

Many simply leave the camps or accommodations because they can’t take it anymore, and they go to Athens, hoping they can find help.

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“When they leave these camps, they lose their status as asylum seekers, so even if they aren’t prisoners, they are prisoners… so when they come here, without accommodations, without food, without asylum, they have to start from the beginning,” said Gatta.

Providing asylum seekers with mental health, medical care, and access to a social worker,” said Gatta, “makes people feel seen.”

“The main problem of asylum seekers, in general is that because they don’t have a permit to stay, they feel like they don’t exist. They’re like ghosts living in this city…they are invisible in this rich European capital,” she added.

But help can be very hard to find, especially for someone who doesn’t speak the language, understand the system and is dealing with an almost bone-crushing sense of fear, alienation and hopelessness.

“The city of Athens is very active [in this respect] but is not equipped to deal with all the issues, so we are partnering up with NGOs and organizations and we try our best,” said Lefteris Papagiannakis, the vice mayor in Athens for Migrants, Refugees and Municipal Decentralization.

“But the lack of specialized accommodations and services provisions for cases of mental health issues, trauma, etc. etc. it’s up to the government,” he told ThinkProgress. “In some cases we are late, and other cases we are poorly equipped.”

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Papagiannakis lives in Exarcheia, and highlights the fact that the city government has been very active in trying work with the asylum seekers. But, he said, when a member of the municipal council complained about underage sex trafficking in a park in the neighborhood, the police were sent in and said that they didn’t find anything.

“Because in order to [make successful arrests] you have to run an operation, you can’t just walk in, in the open,” he said. The police, it should be noted, are generally not welcome in Exarcheia.

Stuck between fear and pain

Compounding all the trauma and hardships asylum seekers have been through is the long wait as they battle the system and try to get refugee status — which can take months, if not years.

“This limbo phase is the biggest moment — it’s the moment when most of our patients show most of their vulnerabilities… In this moment of eternal waiting, they get lost,” said Gatta.

Popontopoulou said some people describe the situation by saying, “It’s like the past has a lot of pain and the future has a lot of fear. So now, they are in the middle of pain and fear.” And compounding this is the fact that they have no idea how long they’ll be stuck in this state.

Acceptance and integration seem so far away from them that they don’t even think about it, said Popontopoulou — they’re much more focused on the immediate. They want to survive these months and maybe be able to move on to northern Europe, where some have families or communities waiting for them — and where, potentially, they could get more long-term, stable help.

The heavily bureaucratic asylum process has a way of making the newcomers feel less than welcome as they wait (and wait, and wait) for basic services.

This tent, pitched on the slope of a muddy hill outside the Moria camp on the island of Lesbos, is home to eight men who could no longer tolerate the conditions inside the camp, opting to move out into the informal camp dubbed the Olive Grove. CREDIT: D. Parvaz/ThinkProgress.
This tent, pitched on the slope of a muddy hill outside the Moria camp on the island of Lesbos, is home to eight men who could no longer tolerate the conditions inside the camp, opting to move out into the informal camp dubbed the Olive Grove. CREDIT: D. Parvaz/ThinkProgress.

But the Geneva Convention is clear, said Popontopoulou.

“These people should have rights to be here, to be accepted, to have accommodation, to have access to health system for free, completely. The governments of all these [European] countries should provide all this, by law. But practically speaking, it does not happen,” she added.

Denying access to treatment constitutes another violation of asylum seeker’s human rights. “This person cannot function, cannot be a good mother or good father. It’s destructive, not just on a personal level but on a community level,” said Popontopoulou.

This destruction can happen in Greece or wherever the asylum seekers are sent — to Turkey or their home countries.

By law, victims of torture should be prioritized, but in these over-crowded camps, it’s difficult to recognize individual vulnerabilities — and even the NGOs working within the camps often don’t have access to speak to the asylum seekers openly, so it becomes impossible to identify and treat them or even flag them to authorities.

Indeed, Gatta said she’s seen asylum seekers experience better mental health at the point of origins, where they couldn’t eat, they didn’t have money, and they had no electricity.

Here, in Greece, they stop seeing a future for themselves.

“When we ask them what they want to do tomorrow — like, actually tomorrow, not the future — they don’t know,” said Gatta. “They see no future for themselves at all.”

A lesson Europe refuses to learn

Clearly, what’s driving policy in the European Union is a numbers game: How many make it to Greece, Italy, or Spain? Are those numbers continuing to drop under the 2016 E.U. – Turkey deal (that sees Turkey getting paid billions of Euros to keep refugees from crossing over, and accepting many of them back when they are deported from the E.U.)? Which political party in which country can claim this as a victory? The rabidly anti-immigrant parties (such as Hungarian Prime Minister Victor Orban’s Fidesz party), or more moderate ones (such as French President Emmanuel Macron’s En Marche! party) that are still cracking down on immigration?

“Over and over again, we’ve documented people with various conditions — whether it’s a child with kidney problems or a person with depression — who can’t access a doctor,” said Emina Ćerimović, Human Rights Watch’s researcher on disability rights.

Ćerimović acknowledges that Greece has had financial issues, but points out that the European Union has invested a huge amount of money in helping refugees, but somehow, their health needs — that includes mental health — are not addressed.

“We keep highlighting this at the European Parliament — we can’t say that it’s lack of resources,” she said. It’s taken a massive amount of effort to even get reporting on how resources are being used for asylum seekers with physical or mental disabilities.

“That’s a step forward,” she said, “But people are washing their hands of the responsibility they have,” Ćerimović said.

Ćerimović, herself a Bosnian refugee, fled the conflict in 1994 with her mother and sister, and ended up in Sweden (her father was killed).

Her sister had jaundice and Ćerimović herself was “literally vomiting worms because I didn’t have access to clean water and food.”

Bleak Farsi graffiti in the over-crowded Moria camp in Lesbos speaks to endless cycle of misery seen by asylum seekers trapped in the system. It reads: Others left and we've remained. We will leave so others will remain. CREDIT: D. Parvaz/ThinkProgress
Bleak Farsi graffiti in the over-crowded Moria camp in Lesbos speaks to endless cycle of misery seen by asylum seekers trapped in the system. It reads: Others left and we've remained. We will leave so others will remain. CREDIT: D. Parvaz/ThinkProgress

Her aunt, who lived in Sweden, arranged for smugglers to bring the family there with fake Croatian passports with Christian names because Muslims wouldn’t be able to pass through Croatia to Western Europe.

“It’s shocking for me that 20 years later, I’m in a forest in Serbia, speaking to a family who has fled Syria, telling me they could only leave with the help of smugglers, and how they’re being mistreated,” she said.

“It’s unbelievable that Europe is not working towards ending encampments, because we know that encampments are hostile, insecure, create mental health conditions,” she added.

The way we see refugees, how racist people are — she says people are routinely shocked when they meet her, realize that she’s white, European, and a Muslim, and a refugee.

“There’s so much fear, so much hate speech,” she said, “And not just from people, but from leaders. It’s unbelievable.”

This is the third and final part of a series of reported pieces on life as a refugee in Greece.