The Day After Russia Attacks
What War in Ukraine Would Look Like—and How America Should Respond
The Elliniko camp, a few miles outside of Athens, sprawls across a complex of old airport buildings and derelict stadiums built for the 2004 Olympic Games. The venues that once hosted baseball and hockey matches now teem with over 3,000 migrants from Afghanistan, Syria, and elsewhere, who are languishing in squalid and violent conditions. In June, one of the camp’s medical volunteers, Aaminah Verity, described the conditions there as “post-apocalyptic.”
Unmarked roads and fenced-off roadways surround the camp, the sole signpost a white sheet strung on a wire fence and spray-painted “Hockey-Baseball-Refugees.” The office of the Greek officials who are the camp’s nominal managers is a small room behind the bleachers in one of the old stadiums. At 4:30 PM on a Thursday in mid-June, there were no officials there nor any signs of their presence: no computers, desks, papers, printers, telephones, or posters on the walls. Instead, there were some haphazardly positioned folding tables and a group of migrant children drawing pictures with donated art supplies.
Outside, in the 90-degree heat, the United Nations High Commissioner for Refugees had set up white tents for shelter in neat rows on the old hockey and baseball fields within the stadiums. But few people were using them. The tents offer little protection from the sun and are nearly a 30-minute walk, through empty parking lots and unmarked ramps, from the main road. Many have opted to colonize the concrete walkways around stadium bleachers and old offices instead, turning the facilities into a sprawling shantytown.
“I can’t name one person here who isn’t losing their mind.”
In these makeshift shelters, made of blankets and sheets, infections spread easily. About three of every four residents in Elliniko suffer gastrointestinal infections, according to Leo Vandenbossche, a doctor with the nongovernmental organization Médecins du Monde (MdM). Scabies—a contagious disease caused by a microscopic mite that burrows under the skin—is also spreading. And as a sense of abandonment settles atop memories of terror and trauma, minds have started to break down. All across Greece, medical NGOs working in the camps have reported a spike in suicides and acute psychiatric illnesses. A volunteer doctor at the Koutsochero camp in Larissa, a city in Greece’s Thessaly region, told me that he has seen psychosis, drug addiction, sexual abuse, and self-mutilation. “I can’t name one person here who isn’t losing their mind,” said Muhamad, a journalist and Koutsochero resident who fled Kabul with his family. Violence is also on the rise. The medical NGOs at Elliniko are sufficiently alarmed that they have supplied the camp with emergency contraception for residents who are raped.
Four months ago, the European Union signed a controversial deal with Turkey to control the waves of migrants from Syria, Afghanistan, and elsewhere washing up on its shores. Under the terms of the deal, the EU would no longer assure refugees international protection—capping the number it would accept at 72,000. The rest would be deported to Turkey, despite the fact that the country has violated international law by forcing refugees back to the war zones they’ve fled. In the meantime, migrants would languish wherever in Europe they’d landed, stranding tens of thousands in Greece.
Now, a public health disaster looms. Over 50,000 undocumented migrants are trapped in inaccessible and often unsanitary government camps across Greece with little access to health care, conditions ripe for an epidemic.
According to the terms of a $94 million EU aid package that followed the EU-Turkey deal and is intended to help Greece meet the needs of migrants, a few NGOs are allowed to provide basic medical services out of containers, tents, and trucks within the camps. But these organizations are ill-equipped to treat the refugees’ more serious ailments: about one in three of MdM’s patients in the camps, for example, has medical problems that are beyond the scope of what can be provided out of a tent or a truck, according to MdM coordinator Geraldine Delestienne.
Such patients require the services of specialists, which means they must access the Greek health-care system. Yet there is no plan in place to provide or pay for their treatment, and Greece’s beleaguered hospitals have been left to pick up the cost. Even obtaining transportation to a hospital is fraught: NGOs risk violating Greece’s smuggling laws if they drive undocumented migrants around. (In early spring, a driver for Médecins Sans Frontières was arrested for doing just that.) Few camp residents can afford taxis or buses, so their only option, even for non-emergency conditions, is to call an ambulance (paid for by the government), which leaves patients stuck at the hospital without a way back to their camps after receiving treatment.
Greece’s hospitals are in poor condition, devastated by years of austerity.
Making matters worse, Greece’s hospitals are in poor condition, devastated by years of austerity. Since the Greek economic crisis began in 2009, the country’s health-care budget has been slashed in half. Twenty thousand Greek physicians have left the country since then, and there is funding to replace only one of every five who retire. At Papageorgiou Hospital in Thessaloniki, Greece’s second-largest city, stents for vascular surgeries are scarce, six out of 14 operating rooms are shuttered, nursing staff on night shifts have been halved, and incubators in the neonatal intensive care unit haven’t been upgraded in 25 years. At Thessaloniki’s Ippokrateio General Hospital, one of the largest public hospitals in Greece, the paint is peeling off pockmarked walls in shards the size of windows, and there is a two-foot-wide hole in the ceiling dripping brown fluid onto the floor of the darkened lobby. The stench of the toilets can be detected from a hundred feet away.
Such hospitals have no provisions for translators for the migrants who seek care there. Nor can medical NGOs afford to sacrifice their scarce translators for the hours-long waits typical of Greek emergency rooms. And although the Greek government has said it will pay for migrants’ emergency care, doctors are not so sure. “The ministry [of health] says we have to offer them care,” Basil Tarlatzis, a professor of obstetrics and gynecology at Papageorgiou, told me in June. “But then we send the bill to the ministry, and they add it to the existing list of unpaid bills.” The government already owes Papageorgiou $220 million. In effect, the health of Greece’s many migrants depends on whether underpaid, overworked hospital clinicians feel like donating their time to attend to patients whose languages they do not speak.
The health of the Greek people has already declined. Between 2008 and 2010, the country’s infant mortality rate increased by more than 40 percent, and new HIV infections among injecting drug users rose from fewer than 50 in 2008–2010 to nearly 800 in 2011–2012. But these trends, and the outbreaks of chickenpox, dysentery, and scabies that medical NGOs have noted in camps such as Elliniko, are probably just the tip of the iceberg. The true impact of the country’s failed health system won’t become clear until a sizable outbreak erupts.
That’s because as the government’s health-care system has deteriorated, so has Greece’s ability to detect the spread of disease. Experts at Greece’s top pulmonary diseases hospital in Athens reported this month that of the more than 300 tuberculosis cases the hospital had treated in 2012, fewer than 60 had been reported to government public health authorities, as is required by Greek law.
A PUBLIC HEALTH DISASTER
The EU’s failure to protect the health of migrants in Greece is a predictable outcome of EU policy. The EU’s migration rules were designed to manage surging xenophobia and a rising far right, not to uphold refugees’ rights to protection and humane treatment. That’s why they allow closed borders and turn a blind eye to Greece’s inability to protect the displaced.
The fact that migrants would be subject to poor hospital care and substandard conditions in Greece was clear for years before the EU-Turkey deal trapped them in that country. Starting in 2010, in exchange for bailout funds, the European Union and the International Monetary Fund demanded the steep cuts that have devastated Greek hospitals to the point that charity drives are needed to help prop them up. These hospitals were obviously ill-equipped to manage the health needs of vulnerable, traumatized refugees at the outset of the migrant crisis.
The Greek government has little political incentive to uphold the rights of people the EU would rather sweep under the rug.
Nor should it be a surprise that Greece has ushered migrants into squalid camps. In 2011, years before EU policy trapped migrants in Greece, the European Court of Human Rights ruled that conditions in asylum centers in the country were so bad that they violated asylum seekers’ fundamental human rights. The Greek government has little political incentive to uphold the rights of people the EU would rather sweep under the rug. Government priorities revolve around concealing migrants’ misery from tourists. While one-third of all residential properties in Greece lie vacant, migrants have been sent to live in abandoned commercial properties such as old warehouses and airport terminals, spaces not designed for long-term human habitation. Meanwhile, the spokesman for the government’s refugee crisis management agency trumpets the heavy burden of caring for migrants to the world, daily tweeting the number of migrants stranded within Greece’s borders.
The tragedy is that migrants generally start off healthier than the populations that host them, a finding that’s called “the healthy migrant effect.” It’s linked to the fact that migration requires resilience, and it is one reason migrants and refugees tend to improve the economies of the host societies that integrate them. It is also why protecting their health is so critical to the future prospects of Afghanistan and Syria, among other war-torn countries. As some of the most resilient and resourceful survivors of war and terror, migrants are among those best positioned to rebuild the broken societies they have fled. But the longer migrants are deprived of legal status and denied integration, the more their health declines. Treatable conditions generate acute health crises, and preventable diseases spread unimpeded. One 2008 study by Dutch researchers, for example, found that Iraqis who had spent more than two years seeking asylum in the Netherlands had more illnesses and mental disorders than Iraqis who had just fled their country. The tens of thousands of people who are now stranded in Greece face the same problem. In the midst of the greatest refugee crisis in history, their deliberate medical neglect, in a part of the world explicitly committed to helping refugees and easily capable of doing so, is a public health disaster that should have been avoided.