Παρασκευή 29 Ιουλίου 2016

Recommendation by the Ministry of Health Control and Disease Prevention Centre (KEELPNO) delivered to the Ministry of Migration Policy, to the Ministry of National Defense and to the Ministry of Health about the situation at the refugee hosting facilities from the viewpoint of public health after their on-the-ground visits

21 July 2016 

Recommendation by the Ministry of Health Control and Disease Prevention Centre (KEELPNO) delivered to the Ministry of Migration Policy, to the Ministry of National Defense and to the Ministry of Health about the situation at the refugee hosting facilities from the viewpoint of public health after their on-the-ground visits. 

On KEELPNO's initiative and in the context of the ministerial decision for assessing the state of public health at "accommodation centres" in the Central Macedonia Region, an excellent joint inspection crew was created in cooperation with the Health Department. Inspection took place at 16 refugee reception centres during July 4, 2016 to July 8, 2016. Reports for each of the centres inspected were sent to the Office of the Head of KEELPNO. The recommendation is based on the analysis of these summarized reports resulting in specific proposals. In reference to living conditions, refugees are being accommodated inside warehouses in disuse after industrial use. In all areas there is over-crowding of hundreds of people in combined spaces without adequate ventilation, with litter accumulation and waste, poor hygiene conditions, inadequate provision of potable water and fluctuations in quality and quantity of food. The past uses of these warehouses multiply the exposure potential of these populations to known or unknown risk factors. In the warehouse for example at the Karamanlis Tannery, water from the well and in the surrounding area, that is used for washing, has been estimated high in concentrations of heavy metals (the Greek Army's Veterinary Hospital has been requested to aid in measurements). Also, there are semi-damaged asbestos plates on the roof of the warehouse burdening inhaled air with asbestos fibres. The biggest problem is that all the centres are in close range, both to major breeding grounds of the Anopheles mosquito (Thessaloniki rice paddies, the Galliko River estuary bed, the Kalochori lagoon), every year consistently capturing a very significant flourishing population of the Anopheles as well as to smaller breeding grounds adjacent which are highly productive.  

From the perspective of Public Health, the overall picture of the hosting centres is particularly worrying. Their selection and placement took place without even requesting the opinion of health services. Long-term residence of these primarily healthy populations in such conditions multiplies the chances of the occurrence of foodborne and waterborne epidemics as well as transmittable by disease transmitters (mosquitos), burdens the overall level of bio-psychosocial health of the population and exposes it to a series of risk factors. Operation of the "accommodation centres", not only due to current organizational and coordination weaknesses, but mainly as a strategic approach (entrenchment of populations outside the urban web with burdened living conditions), should be firstly discontinued for the protection of Public Health. Given the international political framework in addressing the refugee stream, it is clear that it is useless and dangerous for Public Health to treat this as a "crisis of a few months." To recognize this reality also highlights the urgent need to immediately launch the final closure of accommodation centres and the gradual integration of refugees into society. It is proposed to decide for the total closure of the "accommodation centres". Obviously this process should be designed based on their gradual closure and keeping in mind the burden of risk factors (such as at eg. the Karamanlis Tannery and the camps in the fields of rice paddies of Thessaloniki). 

Vice President of the Board  
Alexis Benos 
Professor of Hygiene, Social Medicine and Primary Health Care 

Read the original report at www.keelpno.gr

We thank Angela Vismaya Psarrou for the translation 

Σάββατο 2 Ιουλίου 2016


Elliniko Emergency Reception Sites
A Report on Living Conditions
Based on information available on June 30, 2016

Table of Contents

1          General

1.1     Introduction

The document describes the living conditions in Elliniko refugee camp in Attica region, Greece.

1.2     Terminology


1.3     References

Document location
Practical Guide to the Systematic Use of Standards & Indicators in UNHCR Operations
UNHCR Site Profiles, 29 June 2016
UNHCR Sites in Greece, 29 June 2016

1.4     Disclaimer

Unless otherwise specified, the document reports information available on June 30, 2016.
Due to rapidly changing circumstances, the limited availability of official data and inconsistencies identified across a multiplicity of (unofficial) sources, data accuracy and completeness may not be guaranteed. However, all information is reported to the best knowledge of the author, given in good faith, and selected across sources (including onsite witnesses) and media deemed reliable.

2          Living Conditions at Elliniko Reception Sites

2.1     General

The denomination Elliniko identifies three emergency reception sites in Elliniko municipality, in Attica region of Greece.
The sites are located South East of Athens, along the coast and can be reached by tram or bus from the two Athens metro stations Faliro and Elliniko.
One overall coordinator is assigned to the three sites, in addition to a volunteer coordinator each. The three camps are open and residents may freely exit, which they normally do to go shopping for food and groceries.
The management across the three sites differ. Access procedures across the three sites have been reported to differ greatly depending on the respective coordinator in charge, with consequences on services’ availability and provisioning as well as volunteers’ teams composition, size and spirit.
According to official reports, the site is planned for evacuation/closure in the short term to return the site to the Elliniko municipality. Evacuation of Elliniko terminal started around April 20, 2016, when the three sites hosted 3,529 people. Initially, residents were being transferred by buses to Malakasa camp. It is unclear whether the evacuation continues. However, the total number of residents (as reported by UNHCR [3] has now increased to 3,627. Surveys among local teams of volunteers highlighted the following:
  • Many people transferred to new camps returned to Elliniko due to poorer living conditions faced at the new camps
  • Elliniko has recently absorbed residents from a camp in Larissa region which was closed.

2.1.1 Elliniko Olympic Hockey Stadium

Referred to by UNHCR documentation as Elliniko I.
According to UNHCR [2], Elliniko I opened on September 28, 2016.

2.1.2 Elliniko Olympic Centre/Airport Terminal

Referred to by UNHCR documentation as Elliniko II.
According to UNHCR [2], Elliniko I opened in late February 2016.

2.1.3 Elliniko Olympic Baseball Stadium

Referred to by UNHCR documentation as Elliniko III.

2.2     Capacity and Number of Residents

The predominant nationality at the three sites is Afghani (90-93% of the total).
Approximately 25% of the total number are children and 35% are women.
No information available regarding age distribution or the number of people with special needs, such as elderly, disabled, or pregnant women.

2.2.1 Elliniko Olympic Hockey Stadium

According to UNHCR [3], capacity is 1,400 and the current number of residents is 1,280.

2.2.2 Elliniko Olympic Centre/Airport Terminal

According to UNHCR [3], capacity is 1,400 and the current number of residents is 1,371.

2.2.3 Elliniko Olympic Baseball Stadium

According to UNHCR [3], capacity is 1,300 and the current number of residents is 976.

2.3     Shelter

At Elliniko terminal, people sleep in camping tents on the floor of the airport building’s first floor, in sleeping bags (previously owned) or over blankets (received onsite) placed on the ground. Tents at the airport terminal were donated (one per family) by an Afghani business man resident in the Netherlands. There is no living space in between tents and people access their tents via narrow paths.
A large number of camping tents hosting families surround the fenced area of the airport terminal. Some of them are Yazidis.
The situation at Elliniko baseball and hockey stadium is similar (with people occupying the building in camping tents) except for the additional presence of outdoor rub halls hosting 10-12+ people each.
Tents, bath towels, clean laundry neatly piled up, family’s children’s drawings. Elliniko airport terminal.
Crowded tents inside Elliniko airport terminal.
Numerous families (including Yazidis) live in camping tents in the area surrounding Elliniko airport terminal. They have occasional, limited or no access to the camp’s services.
Large UNHCR tents hosting people at Elliniko baseball stadium. Tents are outdoor exposed to the sun all day where temperatures may exceed 40 degrees Centigrade.

2.4     Environment and Safety

The buildings offer no heating and no air conditioning. Elliniko terminal, characterized by the presence of large, fixed windows, has been very hot since April, with no oxygen, unbreathable air and temperatures higher than the external temperature by 5 degrees Centigrade or more. Many spend the daytime sleeping since virtually no activity may be carried out in such environment.
Walls and ceilings are in poor state. Large holes are present in the terminal walls, especially along the staircase accessing the first floor. They are occasionally “covered” with wooden pallets placed vertically in front of the apertures, which in many cases remain uncovered in large portions. Children play explorers entering the broken walls.
In the area immediately surrounding the sites there are unsafe areas (including lower ground levels) unrestricted or accessible through broken metal fences as well as hazardous discarded materials and debris. Children roam and play around in those areas and in the garbage within the fenced area, climbing enormous rubbish containers (2+ metres high) to retrieve tools and materials to play, including cardboard boxes. They are also seen playing with rocks and engaging in dangerous and potentially hazardous activities towards each other. Children have no safe, dedicated place to play and, except for very small ones, they are mostly unsupervised.
The first floor’s terrace is not protected by fence (horizontal, parallel railing tubes with very large gaps in between) and small children are at risk of falling. At least one incident of such kind (child falling from the first floor) was reported in early April 2016.
There is a highly trafficked highway in front of the terminal. Vehicles drive at very high speed (estimated 90kmh at least). Pedestrian traffic lights to cross the highway and reach the tram stops in both directions are not responsive. People are forced to wait 5 minutes or more to cross.
Numerous holes in the ceiling and in the building’s walls of Elliniko airport terminal
Numerous holes in the ceiling and in the building’s walls of Elliniko airport terminal
Efforts of the families to make the environment more reassuring and hospitable for children.
Discarded, hazardous material (large window glasses) on the terrace at the first floor of Elliniko airport terminal
On the road connecting the three Elliniko reception sites
Trees are used to hang wet laundry. There are no facilities for doing or drying laundry onsite.
The unprotected fence of the first floor terrace of Elliniko airport terminal. Incidents of children falling to the ground floor were reported.
Unfenced dangerous sites (lower ground level) within the area of Elliniko airport terminal. Garbage and hazardous materials are widespread.
Children play in the area surrounding Elliniko airport terminal, next to the highway
Children climb in the high garbage container in front of Elliniko terminal in search of tools and objects to play
Discarded materials and debris at Elliniko airport terminal.

2.5     Sanitation

According to UNHCR [2], each site should be equipped with 1 toilet per 20 individuals, 1 shower per 50 individuals, 1 water tap per 250 individuals, 1 hygiene promoter per 1000 individuals.
The following statistics and facts refer to Elliniko Airport terminal. Similar situations apply to both Hockey and Baseball stadiums though actual numbers are unverified (UNHCR data only available).
Tap water is drinkable. Bottled water is generally not provided. There are 12 taps in total, 6 in the men’s room, 6 in the women’s room.
There are 5 indoor’s men’s toilets, 5 indoor’s women’s toilets, 6-8 outdoor’s toilets (undivided for men/women), altogether largely insufficient for the needs of 1,300 people (1 toilet every 72 people). The outdoor toilets are often filthy and unusable. The stench surrounding them is unbearable even at a distance and when all doors are closed. Children are seen playing in the vicinities and small children are exposed to overflown and scattered excrements with consequent high risk of infections.
There are 4 cold showers for men and 4 cold showers for women (1 shower every 162 people). They are all indoor and result in queues of hours to take a shower. The only time when queues shrink is at night, however that results in disturbance and quarrels in the living area because of the constant noise and loud speaking (and singing!) in an area that hosts many sleeping children.
Facilities are not suitable or accessible to disabled people.
The terminal is infested with cockroaches appearing especially at night time.        Cleaning

It is worth noticing that indoor living spaces, toilets, restrooms and showers (normally found in proper state) are cleaned on a regular shift rota by residents, while the outdoor facilities are care of the camp’s management.
Separate facilities for men and women are indoor only
Indoor men’s showers. Holes in the wall are everywhere in the building’s terminal. Cleaning is organized by residents on a daily rota, twice a day.
Outdoor toilets. Cleaning is care of the camp’s management. Children are at risk of infections while playing. In area surrounding the outdoor toilets, the stench is unbearable.
Outdoor showers. Cleaning is care of the camp’s management.
”Throw it in the bin”. Educating children to keep the site tidy. Elliniko’s child resident’s drawing.
Debris, garbage and hazardous discarded materials at Elliniko airport terminal site.

2.6     Services

2.6.1 Electricity

According to UNHCR, electricity is available all day.
On average, there are 40 plugs (some of which hardly accessible) for 1,300 people. Residents report unannounced, daily interruptions of power supply, suggesting planned intermittent supply in addition to incidents possibly triggered by consumption’s peaks.
Access to power plugs. Elliniko airport terminal.

2.6.2 Food

According to UNHCR, 3 or more meals per day are distributed and cover 100% of the people.
Three meals per day are distributed (breakfast, lunch, dinner). For approximately a week around March the food was very good. The situation then changed suddenly (changed catering service for unclear reasons) and the food became insufficient in quantity and of poor quality. Breakfast includes a slice of bread, a juice and jam/cream; lunch and dinner both include (as main ingredient) one of the following: rice, beans, spaghetti pasta.
Distribution of baby food is reported insufficient. Secial needs (allergies and food intolerances) are entirely neglected.        Baby Food

It is constantly reported that not enough baby food (including milk) is distributed. The situation has worsened since the evacuation started. The local warehouse is now nearly empty and the distribution of goods and baby food is more irregular than ever. Parents refer to the not-for-profit organization running the medical services also for the provisioning of baby food.

2.6.3 Health

According to UNHCR, there should be a health facility onsite or less than 5km away from each reception site.
The three sites have no official camp’s doctor appointed. Medical services (including paediatrician and OBGYN. Midwife once a week) are delivered daily (approximately: 10:00-11:00, 14:00-15:00, 16:00-20:00) by not-for-profit organizations and NGOs operating onsite: Fair Planet, Doctors of the world, WAHA. Although there are objective difficulties in accessing personal hygiene detergents on a regular basis and there is supply of cold water only, medical personnel report that children are in general very clean.
Despite efforts, women’s health and hygiene needs remain a sensitive topic. Female medical doctors may not be always available. In the waiting room, translation services are normally provided my male volunteers among the refugees.
During gestation, women undergo no regular visits or exams and the risk of miscarriages and birth complications remains high.
In the first trimester of 2016, a baby died of birth complications because no assistance was provided despite several requests raised by volunteers to take the woman in labour to the hospital.
Vaccination praxis undergone by new-born children is unclear and in appearance inconsistent. For babies born at the hospital, some of the vaccines may be delivered immediately after birth and others may be planned on a personal vaccination record card. However, this could not be confirmed. In general, children’s access to compulsory vaccinations remains uncertain and poses serious reasons for concern.
Highly specialized medical services may not be provided at the sites’ premises. More difficult cases are therefore referred to local hospitals in Athens. Those include documented cases of children suffering of heart conditions and epilepsy. Access to drugs and medicaments in those scenarios may be problematic due to both availability and inherent costs.
The average wait for an ambulance is one hour. Patients are taken to the nearest adults’ hospital or to one of the two nearest children’s hospital.

2.6.4 Services for Children

Entertainment activities for children is limited to: 1) the initiatives of the Dutch Boat Refugee organization, 2) daily projection of movies (evening) by a Shanghai-based organization, 3) occasional activities organized by volunteers. Children are bored and their learning abilities are affected. Furthermore, there are known cases of teenagers wanting to learn Greek who were denied the possibility (by the volunteer coordinator) despite the availability of volunteer teachers.
There is no playground, no safe area for playing, no schooling.
Some children spend time inside the terminal teaching themselves the English alphabet or drawing. Their potential is left to the goodwill and the skills of parents or the occasional volunteer.
Many children become alienated or develop aggressiveness or dysfunctional social interaction behaviour, including bullying and beating. Due to the absence of adult’s supervision, bad practices find fertile ground to grow, spread and consolidate.
See also section 2.4 for further information regarding the environment unsuitability and children’s unsupervised activities.
Drawing by a child at Elliniko
One volunteer playing with children at Elliniko airport terminal
Children self-teaching the English alphabet at Elliniko airport terminal
Portrait by a 10-year-old Afghan child at Elliniko airport terminal. The drawing portrays his father.
On a sunny afternoon, a volunteer met the eyes of a kid. They liked each other right away and started to play hide-and-seek and peeking out the world from inside cardboard boxes. The child was giggling and the mother was looking at them from a distance. She
approached and smiled to the volunteer, “I had not seen my child laughing for so long.” The number of children grew fast. A circle formed on the asphalt in front of Elliniko airport terminal, each child sitting in one cardboard box, passing around a small ball and, when a bully ran away with the ball, rolling a tiny toy-car tier.
Playing soccer at Elliniko hockey stadium
Children playing in the area surrounding the fence of Elliniko airport terminal

2.6.5 Internet

According to UNHCR, WiFi Internet access is available.
There is no WiFi Internet provided at the sites. Although a free network occasionally appears among the available networks, a connection fails to be established. Often the network disappears while attempting its selection. This has prevented the camps’ residents from accessing the skype service to attempt to contact EASO.

2.6.6 Legal Advice and Access to Asylum Procedures

According to UNHCR [3], a mobile UNHCR team is assigned to the camp.
At Elliniko airport terminal, UNHCR has an office on the first floor of the building. Officially, personnel is available daily between 10:00 and 15:00 and between 16:00 and 20:00, however both the number of UNHCR representatives and the actual opening times appear to be irregular (personnel generally available in the morning, 1-2 workers with translator). There is no mediator assigned to the camp on a stable basis. Before the evacuation started, assistance was reported provided for the following cases only: 1) applying for asylum in Greece, 2) applying for family reunification in other countries.
During the second mid of June, pre-registration procedures started at Elliniko. It could not be verified whether this has affected the regular provision of UNHCR services or their contents.
Clear information is provided with regards to self-deportation to the applicant’s country of origin.
Ads at Elliniko reception sites
Various information regarding support services, including humanitarian assistance, legal assistance, asylum service office
IOM’s assisted voluntary return and reintegration programme
Hellenic Red Cross restoring family links and tracing service
 Hellenic Red Cross restoring family links and tracing service

2.6.7 Warehouse and Goods Distribution

Elliniko basketball stadium used to be employed as the main warehouse of the three sites. In addition, the ground floor of Elliniko airport terminal was used as storage of various goods, including food, personal hygiene items and clothes. According to volunteers’ reports, baseball and hockey stadiums too each had a local warehouse.
Before the evacuation started, the distribution of items was approximately scheduled as follows,
  • Clothes, once daily allowing access to the warehouse to 5-10 people at a time for about 5 minutes. However, many were the reports of insufficient or inadequate clothes/shoes due to the too short time window for the selection. Many reported to have been able to access the service only once over two months. Many were the children with broken shoes or wearing adults’ shoes. Resistance from volunteer coordinators was faced to handle exceptions.
  • Personal hygiene, twice a month.
  • Cleaning products and detergents, upon need and handed directly to the representative of the camp’s residents (and elected by them) in charge also for coordinating the cleaning shifts and gathering general needs and requests.
Since the evacuation started, the warehouses have been progressively emptied. There are reports of insufficient baby food being distributed. People refer to the local medical ambulatory, managed by independent not-for-profit organizations, for baby food and, often, personal hygiene items including specialized children shampoo for lice control.

2.6.8 Security

According to UNHCR [3], security is provided by Hellenic Police.
However, officials’ presence is limited to 2 officials (not 24-7) and occasional riots and fights are unhandled or left to the potential intervention of witnesses with risks for all the involved: camps’ residents, workers, and volunteers. Witnessing women and children appear to be especially impacted by the incidents.        Yazidi Minority

Yazidi families live outside of the fenced perimetral areas of camps, in camping tents mounted on the asphalt, in the near proximity of the highway, among debris and in the radius of 100-200metres away from the terminal. They do not have access to any of the three camps’ services and do not join lines for food or items’ distribution. They make contacts with volunteers to ask for help to arrange independent deliveries of food by local charities. There are no established processes and no formal support. It is expected that access to food, hygiene items, clothes, blankets, water, sanitation has largely to do with occasional help of volunteers and luck.

2.7     Photo Credits

Photo credits: Simona Bonardi.