Leros: MSF started Sea Rescue operations in the South East Aegean Sea on 21 December 2015 to provide dedicated rescue support to prevent tragedies at sea, related to the perilous journey refugees have to undertake in order to reach the broader area of the island of Leros and adjacent islands.

Since the beginning of the project the MSF Rescue Teams have assisted more than 500 people trying to reach Farmakonissi and nearby small islets in unseaworthy boats. MSF Leros Sea Rescue project ceased activities from mid-February as more rescue means are in place.

Lesbos: As of 20 February, 53,617 people have arrived to the island of Lesbos – 90% of whom came from Syria, Iraq or Afghanistan. MSF has been responding on the island since June 2015. In the authority-run registration camp (Moria) MSF is providing medical consultations, mental health support, distributing relief items and conducting water and sanitation activities. In the north of the island, MSF is running rescue activities and organising the transportation of new arrivals between the North and the camps in the South where they must complete their registration, in January MSF transported 10,482 new arrivals. In Kara Tepe, the second authority-run camp, MSF is running a medical clinic and operating a mobile medical clinic in the port.

In Mantamados MSF has established a transit camp for arrivals to the north of the island where we provide shelter, medical and mental health activities, a children’s play area and ‘safe space for mothers’ and distribute food, water, blankets. MSF is offering  first assistance to new arrivals as they travel down to registration sites in the South of the island.

Our teams – that are providing medical care to refugees and migrants in Kara Tepe and Moria camps and at the port of Mytilini, have observed several pathologies related to the winter conditions, such as respiratory tract infections as well as injuries associated with the journey. MSF continues works to improve water and sanitation in Kara Tepe and Moria camps; ensuring cleaning services throughout the camps, installing chemical toilets and providing water points in Moria. MSF is also offering transportation through 14 buses as well as 2 ambulances to new arrivals, transporting an average of 300 people every day so far in 2016, avoiding them being forced to walk for 70 Km to reach the registration centers in the South of the island. For medical referrals of new arrivals we are operating two ambulances on the island as well as a minivan for mild cases or vulnerable families.

The Greek authorities have yet to identify an additional suitable space to the existing reception center in Moria and Kara Tepe camp where people can be offered shelter, food, hygiene facilities and medical screening. As long as this is not done, in the face of chronic mismanagement by the authorities, it is likely that the island will go from crisis situation to crisis situation. MSF negotiates since months with authorities in order to have a space near the harbour where people wait for their ferry in order to put some heated tents at least for children and vulnerable people.

Idomeni:  In Idomeni transit camp, close to the border with FYROM (Former Yugoslav Republic of Macedonia), MSF is running a medical clinic and distributing relief items for those who are continuing their journey to Western Europe. The transit camp now has six heated rub halls, 24 hot showers, wifi, provision for hot food and clean toilets. From 9 December 2015 to 20 January 2016, this camp was closed to refugees and migrants, due to restrictions enforced by the Greek Police, but have since reopened due to ongoing pressure from NGOs and volunteers. The numbers arriving to the north continue to be much higher than the capacity of the transit camp and so, many refugees and migrants travelling to the FYROM border have no option but to spend hours waiting a gas station less than 20km from the camp – often overnight. In response, MSF has established nine 45sqm heated tents at the service station so that people waiting can stay warm and dry. We also run our mobile medical clinic at the site, have set up temporary toilets and distribute food and water.

With 50% of refugees and migrants in Greece now classed as “illegal” – according to Greek authorities – due to expired or illegal papers, it is becoming harder to reach those in need as many have turned to unofficial routes in order to try and continue their journey. In response, we have launched outreach activities in areas we know to be populated by people who have been rejected from FYROM or whom cannot cross. Here, we are providing medical care as well as distributing blankets, food and water. We have seen a considerable increase in smugglers in the area following the restrictions implemented on 19 November only permitting Syrians, Afghans and Iraqi’s to cross out of Greece. In addition, we have consistently heard reports from people who were caught crossing illegally into FYROM and claim to have been beaten by the police – indeed, our medical teams have treated a number of injuries consistent with violent behaviour though we cannot confirm the perpetrators of this violence.

In the last week of January 2016, MSF medical teams conducted 1,462 medical consultations between Idomeni Transit Camp and the Eko Gas Station. The main morbidities are Respiratory tract infections (associated with inadequate shelter) 51% and Gastrointestinal (associated with inadequate access to hygiene facilities) 12%.

Samos: Samos is the second most important island after Lesbos where refugees land when they cross over from Turkey. An MSF team is providing first aid to refugees when they land. Then they transfer them by MSF bus to the city of Vathy where the registration process is taking place in the port area. In Vathy MSF is performing medical and mental health activities at the port where only few nationalities are allowed to be sheltered, mainly Syrians and Iraqis. During weekends, MSF is also running a mobile clinic next to the screening center in the north of Vathy town where the rest of migrants, including Afghans, are waiting for several days/weeks the registration to be completed. MSF is providing NFI and a hot meal to an average of 300 people from the screening center every day. MSF social workers are supporting the referral of vulnerable cases to the hospital and providing translators. MSF started providing a support to local fishermen for research patrols around the island.

Agathonisi: In the island of Agathonisi, close to Samos, MSF team is welcoming new arrivals, providing medical care and shelter to refugees when they land.

Korinthos: In order to provide medical care to the most vulnerable people arriving in Greece, in February, MSF started providing medical care in the Korinthos detention center, where 4,369 people were present. Most of them are coming from Northern Africa and they are stopped in Greece and cannot continue their journey to other European countries. The MSF medical team plans to go to Korinthos twice a week to provide medical consultations in the detention centre.  

Athens: In Athens, MSF launched in October 2014 a project offering medical rehabilitation migrants and asylum seekers who have suffered systematic violence in their country of origin, during their journey or in Greece. The MSF team, in cooperation with two local partners: BABEL mental health day center and Greek Council for Refugees, offers medical assistance, including psychiatric care and physiotherapy, psychological, social and legal support aiming at the rehabilitation of victims of violence. 164 people from 33 countries have received assistance in more than 2,500 individual consultations. The project is in the process of being re-launched with increased capacity for outreach in the urban setting in response to the increased needs resulting from the changing context: more and more migrants and refugees spend longer periods in Athens as access to the “Balkans route” is being restricted.

In order to respond to the increase in migrants’ arrivals in Athens, MSF  has been providing since December 2015 outpatient medical consultations at the Eleonas Hospitality Centre for Refugees. The medical team consisting of one medical doctor, one nurse, one Arabic translator and one Farsi translator is present every day including weekends. Victoria square in the centre of Athens has become an unofficial meeting place for migrants of all nationalities. On 12 February, MSF started providing outpatient medical consultations in a facility next to Victoria Square, where an NGO welcomes and provides social activities to women and children.

SERBIA

Since late 2014, MSF teams have been present at both entry and exit points in Serbia offering medical services, mental health support and distributing NFIs to people transiting through Serbia, onwards towards Croatia. MSF has also conducted mobile clinics at the Bulgarian border and since January 2016 has re-started activities in Belgrade.

The Western Balkan route is fraught with difficulties and danger. It is subject to frequent and confusing changes as state borders open and close with little warning. Since mid-November 2015 a new policy was introduced in Slovenia that only allows people from Syria, Iraq and Afghanistan to apply for asylum. This policy had a domino effect towards the transit countries which meant that it is now implemented all across the Balkan route. This is a deeply concerning and discriminatory practice since asylum is a universal right based on individual claims and not nationality. This has pushed people back into the hands of the smuggling system, increasing their vulnerability and putting them at further risk. Since this policy was put into place, MSF immediately saw an increase in the number of patients who reported having been victims of violence while crossing Macedonia. These reports have come from Non-Syria, Iraq and Afghanistan country nationals who are forced to cross without papers, therefore denied access to public transport, hostels or medical care. As a result, they are also more vulnerable due to the travel out in the open, at night, in rough terrain and without shelter.

Since January, also Croatia has increased restrictions in the screening of people entering the train (only Syrian, Iraqis and Afghanis), that has led to pushbacks of even documented people – between 100-200 daily. MSF has treated patients who alleged having been beaten by Croatian police while being sent back. Since last year, MSF has seen an increase of women, children and disabled people it has treated and in January 2016 official numbers were: 44%; men; 36% children and 20% women.

Presevo: In Presevo, where the registration center is located, hundreds of people are walking through the border in a dirt road which is often muddy. MSF has set up shelters to protect people from rain and rehabilitated a 1,5 Km road to facilitate the crossing of thousands of people in safer conditions and allow for 4×4 to pick up the most vulnerable. MSF also provides primary health care near the registration center and in a transit camp near the border; supports garbage collection, does NFI distribution, set up toilets and showers and offers transport to vulnerable families and people with disability from the border. MSF also set up seven 45m2 heated tents in waiting areas with capacity for 280 people daily. Since January, MSF teams provide 1,816 consultations in Presevo.

In Presevo, non Syrians, Iraqis and Afghans remain in our tents as they are not allowed inside the registration center and denied services as well. MSF has provided medical care and referred to protection actors for solutions but as there is no option for them unless applying for asylum in Serbia (IOM is not present for voluntary returns). Many have already tried to cross to Croatia having been sent back to Macedonia and entered Serbia again and are now waiting indefinitely or arranging for ways to travel onwards with smugglers.

Sid: In Sid, MSF strengthened its regular medical activities by operating 20/7 inside a transit center where refugees have to wait before going to the train in Sid. MSF has also set up 8 large heated tents with a capacity to shelter more than 2000 people from the cold. Since January, MSF teams provide 4786 consultations in Sid.

Belgrade: With the new policy allowing only certain nationalities to enter in Balkan countries, MSF has seen an increase of the number of people staying again in Belgrade parks, sleeping in the street or at train station with low temperatures and lack of support at night (shelter, food, medical, legal, etc.).

MSF started operating in Belgrade with a mobile clinic during the night, providing primary health care and distributing NFIs. Unaccompanied minors represent 5% of medical consultations in Belgrade (while the proportion is 1% in Presevo, and 0.8% in Sid). In addition MSF has been advocating for shelter and protection solutions for this vulnerable population which often reaches us after having crossed Bulgaria or Macedonia walking for days with no assistance and pray to violence from criminal groups, police and smugglers. This is also a population that often has tried to pass to Croatia and has been denied access on the train or has been pushed back by police. Although MSF has not witnessed these events and can’t identify perpetrators, we have treated cases consistent with the stories told by our patients – coming from Croatia, Bulgaria or Macedonia.

SLOVENIA

MSF is monitoring the situation in Slovenia.

FRANCE

Calais: Around 4,000 refugees and migrants are living in Calais on the so called Jungle site. Calais is the city located near the Channel tunnel linking France and the United Kingdom and for several years migrants have been trying to reach the UK on trucks via the Channel Tunnel. A lot of non-profit organizations and local charitable initiatives are offering assistance to the population of the camp.  MSF teams provide around 120 consultations every day in the clinic set up in the camp. These include medical consultations, nursing care, physiotherapy and psychological support. The diseases treated – respiratory and ENT infections and some cases of scabies – are mainly due to the conditions patients are subject to. Tensions are growing between migrants and the police. And we receive now at the Outpatient clinic around three victims of violence every day. Measles cases were reported in the camp and it was decided with the local health authorities to conduct a vaccination campaign for the people older than six months. The target population is estimated at 4,000 people. From 28 January to February 5,2082 people were immunized against measles by different medical actors, including MSF.