Friday, 1 April 2016

The end for now

 I started writing this post from the departure lounge of Athens airport. It was a stunningly beautiful day, 20 degrees, not a cloud in the sky, gentle breeze and I was seeing my husband in a few hours, but my heart was heavy. Heavy because I’m leaving my most excellent colleagues and will miss them dearly, heavy because I loved every minute of working here and want to keep doing it, heavy because I don’t know what will happen to the wonderful people I’ve met and heavy because saying goodbye to someone who’s future is so uncertain is a deeply unsettling thing. What do you say? All the best…good luck… I hope things work out for you…Inshallah.
Some of the team on the last night out

There are still 24 people in Souda camp split into 4 main families and I feel over the past couple of weeks I’ve become their family doctor. Every morning we’ve been spending the first couple of hours in the day in the clinic and those who want to see us in the camp can come for consultations. We’ve been averaging around 8 consultations a day meaning we’re pretty much seeing everyone in the camp every 3 days. Although its been strange to adjust to such slow days after the manic times a few weeks ago, its been really special to get to know some of our patients properly. They’ve been in such good humour, inviting me for coffee in their Ikea houses and showing me photos from their lives back home and making judgements about how many children I should have and when. One woman Rafah, has 4 children and is pregnant with the 5th. She told me that everyone she has met in Souda has been so kind to them and she loved us all dearly, then she hugged me tightly and said that I had entered her heart and would always be there. Saying goodbye to them yesterday was really difficult and I just wanted to scream with the injustice of it all. 

Iman, Rafah and her daughter Khadija

Samar and her 5 beautiful children (and Hamed)
As the new team were doing most of the clinical work this week, I spent a couple of days catching up with some of the patients we had referred to hospital. One man is very unwell following a major abdominal surgery and Hamed and I visited him in hospital. He was so happy to see us but I saw a familiar look of fear in his eyes. As a doctor its something that you see often in your patients who are vulnerable and scared but I can’t imagine how it must feel to be so sick, so far from home and have no idea what will happen to your wife and your unborn child if you don’t make it. We stayed with them for half an hour and he held my hand tightly the entire time. When we left, they prayed for both Hamed and I to have long and happy lives, thanked us so deeply for everything we’d done for them and it took all my strength not to break down in front of them.  

The new team also performed some consultations in a children’s home in the north of Chios, nestled deep in the mountains where 22 unaccompanied minors have been housed by the Greek state. The Ark of the World is a state run care home where there are another 30 Greek children who live their currently. The centre is beautiful and so peaceful but unfortunately the refugees have been completely separated from the Greek children.  Apparently they are waiting relocation to a permanent centre in Athens where there is a plan for them to be integrated into the social system including schooling but at the moment these kids are stuck in limbo.

Every day the Greek children attend half a day of school and then have structured homework time in the afternoon plus extra activities organised by the centre staff. The refugees there are housed, clothed, fed and seem well looked after but there are no organised activities for them. They have literally nothing to do all day except for entertain themselves. They were all desperately bored when the new team went to do medical consultations they begged them to bring books and asked for a teacher so they could occupy their minds. They are all teenagers and mostly very bright and acutely aware of their education passing them by. The next day the 2 translators prepared an afternoon of language lessons for them and they said they had never experienced more attentive class. One thing I think about often is the generation of children wrapped up in this crisis. The Syrians haven’t been to school for 5 years but for the Afghans some have never been to school. They crave stimulation, new experiences and desperately need to be in school. They need for this to be over and for them to have the chance to be children and learn and flourish.

The weather got better this week and the sea between Chios and Turkey looked like a lake most days.  As predicted more people came. Only one or 2 boats a day compared to 30 or 40 a day before the deal, but around 200 people arrived in the past week. Vial was built to have a capacity of 1200. Our latest estimates suggest there are over 1500 refugees contained inside and the situation there is getting more tense. As I was leaving yesterday, I had a strong feeling that things are going to implode soon.

I didn’t have to wait long for my feeling to be justified. I had news this morning that because Vial was too overcrowded they have placed some people into the Port camp without registering them and it is chaos. The MdM team are there to provide medical care but who knows what will happen now. The majority of NGOs that were providing food distribution and clothing have all left to help in Idomeni or Athens so for any new arrivals the situation is terribly precarious. Technically all of these people should be returned to Turkey but under international law all should have their claims for asylum individually assessed. There’s no infrastructure to do it and Greece is failing to meet the demand that grows every day with new arrivals. It seems that the number of new arrivals will continue to increase as the weather continues to improve and the Turkish coastguards fail in their task to keep their borders closed.

There are reports from amnesty international that Turkish border guards have shot dead 16 refugees trying to enter Turkey at the Syrian border. There is video evidence of Turkish coastguards trying to sink refugee boats as they attempt to cross. How can we be complicit in sending refugees back to Turkey claiming it’s a safe country when we hear stories like this? Let alone how badly managed the camps are and the fact that we’re depriving thousands of people of the prospect of a real future.

Its very hard to express just how bad the situation is right now and how much worse it’s going to get. The MdM team in Chios may be moved to another part of Greece where the situation is even worse than Chios. Many of the refugees that had accumulated in Athens and in Idomeni are being relocated to makeshift camps across the country where there is currently no infrastructure and definitely no healthcare. Given we have the mobile unit at our disposal we’re really equipped to respond rapidly in this evolving context. There’s just so much need and the state is failing to meet it on every level. As I said before it’s really not that difficult of a problem if there was political will as the numbers are still under 55,000 in Greece to date, but this new deal has created a complete shit storm.

I’m back in the UK, it’s great to be back with Bob and I’m looking forward to seeing everyone and spending some time decompressing. But I’m ready to go back out before I start GP training again in August and if MdM call for me, I’ll be on the next flight. Chios already feels far away for me having spent 6 weeks there so I understand that people in the UK find it hard to empathise or understand what’s happening. But it’s not far away. This is Europe. This is our problem. This is our responsibility. We have to pressure our governments to act in a humane way and find a workable solution. We have to speak out against the xenophobes and stop them dictating the current political landscape. We have to combat the fear that’s ripping through Europe and humanise the people that have lost everything and are seeking refuge here. We have to have difficult conversations down the pub and with our colleagues and families and fight the culture of fear. I’m trying not to be dramatic but this really is a pivotal moment in our history and we have to be unified to fight for those who need us to most.  

© Guillaume Pinon

Saturday, 26 March 2016

New deal, New disaster

The new deal continues to be enforced. This week we had strong winds and big waves so as far as we know no boats have arrived on Chios. Many of the locals are saying that Tuesday will be D-day as very calm nights are predicted and we know for sure there are many waiting to come. Either they don’t believe the borders are closed, have been lied to by smugglers or are convinced its still better to live in detention in Europe than suffer the conditions in Turkey.

We know someone who’s working with an independent organization in Turkey and she reports around 2000 people hiding in the “jungle” near the coast of Turkey. There is literally nothing there in terms of infrastructure. People are sleeping rough on the floor, no toilets, no food and no shelter. They have to evade the Turkish coastguards and now more than ever so reliant on smugglers to keep them “safe”. One of the Greek municipality workers told me that the smuggling network in Turkey had to date earned billions of euros in profit, much of which is linked to low level corruption of coastguards etc and high level corruption of government officials. Smuggling people to Europe is big business but so is the EU money flooding into Turkey. Turkey needs to simultaneously sustain its smuggling networks whilst showing it is suppressing them to continue to benefit from 2 revenue streams. I’ve never felt more disillusioned in our global political process.

Yesterday was a national holiday in Greece so we were asked by the Greek MdM team to cover their shift in Vial. Vial which used to be the registration centre is now detention centre. Any refugees that arrive “irregularly” are detained here and we have no idea what their fate will be. They are allowed to apply for asylum and family reunification but we have been told that currently Vial can only process 3 asylum claims per day. This poster was put up overnight in the camp and explains that refugees who are awaiting asylum claims will not be allowed to leave Vial.
Sign in Arabic, Farsi and English
Lots of volunteers, and other NGO workers I’d spoken to had said Vial was really awful and before I went to Vial, I was quite nervous about how it would feel to be working inside a militarised detention centre. I think because I’d worked in a heavily militarized context in Slovenia, the camp here in Greece seemed relatively ok to me. Yes, there are many issues and also it’s a completely unsustainably situation but compared to Slovenia I still felt there was some respect for the people detained there. The police and army officials here are still Greek which means they are relaxed about everything. I haven’t seen any guns, and there is a very limited security presence actually inside the camp. In Slovenia, as I explained before you couldn’t move without bumping into a gigantic heavily armed solider wearing a balaclava. At the moment things seem calm but who know what will happen as people become more agitated.

Entrance of Vial
Now don’t get me wrong. The situation is horrific. The exact same population we were seeing before, young families, over 40% are children, disabled people, over 65s are locked inside the camp with little information and no idea when their cases will be processed. The actual structure is pretty horrendous, it’s split into 2 parts, a huge warehouse with a leaky roof and separate shipping containers that house around 10 people in each, most seem to have bunk beds but some just have wooden pallets with foam sheets to sleep on. There is a large fence separating the 2 areas and at night its locked. Food is distributed 3 times a day and seems to be hot meals but it’s done in one location where everyone has to queue. Volunteers have said that refugees are hungry and many aren’t getting fed properly, the old and infirm are reliant on others to get their food for them. There are showers and access to wifi is available and generally the camp is clean from what we saw.

Line for food distributions (you can only see half of the line and this was half way through the distribution) I think it takes over an hour to queue for the food
The administration and health clinics are in the warehouse side so I’m not sure how access to medical services is organised overnight. There is 24/7 cover with medical NGOs providing care and in fact there’s a strange situation of many different health care providers. The MdM clinic is next to a red cross clinic, which is next to a WAHA clinic which is next to a Greek Army medic clinic. All of them work at different times to ensure a 24/7 service but there are often clinics running simultaneously.

One of the issues I saw yesterday was overmedication with patients able to see many different doctors and clinics over and over again. Seeing the doctor is an activity and gives the refugees something to do to counter the boredom and frustration of being locked up for no reason. Many just come to vent and tell their story again. We heard many people repeating their list of health complaints and asking how it was ok for them to be locked up. We also heard many complaints against the organisers of the camp, many people feel they have no route for information. Who do they get clothes, blankets and nappies from? I couldn’t answer these questions and when I tried to find out I felt as lost as the refugees.

Another big problem is the tension between the Syrians and the Afghanis. On Thursday there was a big fight between two groups involving women and children as well. One Syrian came to the clinic to get a wound on his head redressed. He said that they had “made up” but throughout the day we heard everyone complaining about everyone else. The Afghans push in front of the line for food, the Syrians have all the shelters with beds… These people have only been detained for 1 week at the moment and tensions will continue to mount as their situation because more desperate. The WAHA team which works night shifts have had to leave the camp on several occasions because of security concerns when the refugees tried to protest against being detained.
"Locked" entrance Greek style
Working in this context as a doctor is so challenging. I really struggled to discuss people’s cases without being able to offer any solace of when things would be resolved. I had one family come to see me because the father was losing sight in his right eye. He had glaucoma and had already lost sight in the left and over the past 5 months it was progressing rapidly. He was concerned he would leave his 5 children with a blind father. As we talked both him and his wife broke down in tears and begged us to help them leave the centre. It was truly heart-breaking and I have organised for him to see an ophthalmologist next week but he’ll be taken by police escort and marched around like a prisoner. It’s hard not to feel complicit in the system when you’re providing care in this setting.

I also really struggled with another patient. An 8-year-old boy who was brought by his older brother. They had fled the Taliban and had been travelling to Europe in search of answers about the boy’s condition. He was very weak and often fell over and couldn’t stand from sitting. It only took me a few minutes examining him and listening to the story before I realised the boy most likely had muscular dystrophy and my heart fell into my stomach. I thought for a long time how to tell them and explain what could happen and realised there was no solution for them. Anywhere else they’d be urgently referred to a paediatrician for muscle biopsies and genetic tests then put in touch with support networks and physiotherapy, but here all I could do is explain what I thought the diagnosis was. It was the hardest consultation I’ve done in Greece and when both of them started crying I could hardly hold back the tears. I’ve informed UNHCR and all the officials I could find of their situation but no one could give me any concrete steps to take to help them.  

Still nice moments in the clinic, continuing to provide a humanitarian space
I spoke to an EASO official who said once the relocation program starts again we should be ready with a list of vulnerable people to be at the top of the queue. I thought about the patients I’d seen yesterday and couldn’t begin to triage who was most vulnerable. Everyone is fleeing extreme violence or terrible situations. There are so many pregnant women, so many small children, so many disabled people and so many needing urgent follow up in proper hospitals. There’s young men trying to reach their families and make something of their lives which are only just beginning and yet so wrought with tragedy.

Currently, in Souda there’s one family who arrived before the deal who had made it to Athens and registered for relocation but the rest of their family arrived the night after the deal went live. This half have been placed in Vial. The family travelled back to Chios to try and be reunited with them and are now waiting indefinitely to hear news or be able to see their family in Vial.

Wembley stadium has a capacity of 90,000 people. Every weekend 90,000 people go and come back to see football matches and watch concerts. Its not that many people in the grand scheme of things and London’s infrastructure absorbs it easily. Just over half this number of people are stuck in Greece, in makeshifts camps, in squalid conditions, in detention centers and a handful in hospitals and hotels. This is not some unmanageable problem. This is not some scary flood of people banging at the door of England to come claim £75/week in benefits. This is just half a stadium of people that has been forgotten and completely abandoned in their most vulnerable and needy time. This could be managed in a humane and sensible way if the political will was there. Shame on Europe. 

Tuesday, 22 March 2016

The morning after the night before

The events of the past 72 hours have left me lost for words and I haven’t been able to shake a deep unsettled feeling in my stomach. Since my last post at the beginning of last week the context here has turned upside down and we have no idea how it will continue to evolve. We performed 308 consultations from Monday 14th until the 19th, a busy week where we were seeing similar things to what I described in my last post. I was starting to get involved in some exciting talks about improving the public health situation and thinking more broadly about refugee health in the Greek setting as it seemed that refugees would be staying longer and longer in Chios. Then everything changed.

Full camp on saturday with our waiting room being used as a playground
The EU turkey deal was officially signed and went live from midnight on Saturday 19th and when we left the camp we had no idea what we’d return to on Monday. The agreement means that all new refugees that arrived on the island after the 20th will be apprehended and returned to Turkey. For every refugee returned from Greece to Turkey, Turkey will send one SYRIAN (no other refugees are considered for asylum in Europe) directly to a country in Europe as per a system of quotas.

Overnight the camps we work in were emptied completely, everyone was advised to go to Athens that night and those people who had bought ferry tickets for 1 week in advance were encouraged to board the ferries on Saturday evening and Sunday. From over 1500 refugees on the island on Saturday afternoon, there are now only 28 people in Souda camp. The Port and Tabakika are completely empty and closed and those that remain at Souda are mostly the relatives of 2 patients that had surgery and are awaiting discharge from hospital. We have no information about where the refugees that left were taken but informal reports state many sleeping outside in the streets in Athens. Hamed has been in touch with some refugees who have been taken to makeshift army run camps with non heated tents, gravel floor and one sleeping bag per person in north Greece by the Bulgarian border. No one knows what will happen to those 40,000+ left in Greece who arrived before the 20th March. So many of our patients will be amongst them and I think that’s the root of the butterflies in my stomach. All the pregnant women, vomiting children, poorly healing wounds, poorly controlled diabetics, wheezy babies and one nerve gas victim I told to go to Athens and seek further care there. I can’t stop thinking about where they are and if they are ok, if things have got worse of if they went into labour.

Over the weekend and the past 2 days there have continued to be new arrivals to the island but in smaller number than “normal” despite good weather. We have no handle on what the numbers actually are and rely on the volunteers that remain in Vial to tell us from their eyeballing how many they think are there, current estimate is around 1000. The volunteers who used to watch the coast and inform the authorities when a boat was arriving have been told to leave by officials and the whole process has changed. The Greek coastguard is escorting all boats that make it to Greek waters safely to shore. There, refugees are loaded onto buses and taken directly to Vial by police or military escort, there are reports that refugees are being made to pay for this service. Vial is located around 15km inland and is far off the tourist trail, which I doubt is a coincidence. The camp is completely closed and locked with high fences, barbed wire and armed guards. All registration processes and distribution has been taken over by the military and police. We have no information about what will happen now Vial is full. At the moment there is still free movement out of the camp for the 28 refugees in Souda but we do not know for how long, we also don’t know if they will reuse Souda now Vial is full. MdM Greece are still running the clinic in Vial and we’re meeting with them tomorrow to try and understand our role and what we can do going forward.

Empty camp from on top of the castle walls
The past 2 days we have seen the same 6 patients twice. I’m doing some follow up for a patient who had appendicitis and has been discharged but otherwise we have no work. MdM Belgium just received authorization for a new team to arrive so that we could try and meet the need we were seeing across the other camps and they arrived on Saturday evening with no patients to treat. Today we were asked to help refer a patient from Vial to the hospital as we used to do but the police refused to let us take him without a police escort. It took over 3 hours to get everything organized and we have no idea what would have happened if the patient had been sicker. We have asked to be redeployed with the medibus to Athens or Idomeni but we are waiting for negotiations from MdM Greece and Belgium to be settled. I’m supposed to be leaving in 8 days and I have no idea what I’ll be doing in this time or whether I’ll get sent home early. For the new team its incredibly frustrating and I empathise completely with them from my experiences in Slovenia. 

At least there's no queue for the chargers anymore
To me the most incredible thing is the capacity of Greece and Turkish governments to implement this overnight. It was always possible. It was always within Europe’s power to stop children drowning at sea. Now we can see it with our own eyes, that because the political agenda has been set in 12 hours the entire process is changed. Everyone we’ve spoken to is distraught. Some volunteers left on Sunday morning and refused to be complicit in a system that was returning vulnerable people to what they feel is an unsafe country. Some ladies who work for European Asylum Support Office (EASO), who spent the past months convincing people to sign up for the program to be directly sent to one of 24 countries, have been receiving distraught phone calls from refugees trapped in Athens, unable to find EASO officials or being told the program has ended. They are still waiting to hear from their bosses what their job is going to be and if they will stay in Chios or not.

Last night there were demonstrations and a protest held by refugees inside Vial as word spread that they were going to be sent back to Turkey. For the vast majority they’ve invested everything and risked their lives to get to Greece and there is no way they will walk calmly onto a ferry back to Turkey. We are waiting to see how the authorities will manage this and I’m petrified about how things could escalate.

Europe absolutely has the power to find a humane, compassionate and sensible solution to this crisis and yes something had to change but what’s happening all over Greece couldn’t be further from a real solution. Smugglers will continue to find more dangerous routes to avoid coastguards, people will keep coming and Greece will not cope with returning these refugees fast enough. A humanitarian disaster is going to become a catastrophe overnight as overcrowded detention centers treating people fleeing war and persecution as criminals, continue to pop up over Greece. There are already 2 million refugees in Turkey, how many more will they “cater” for? Will they keep saying yes to get more and more EU money and continue the terrible practices we’re hearing refugees flee from? A lady said to me in Turkey she was free from the bombs but risked starvation. Some volunteers told us they have friends in Turkey and the internet is being controlled at the moment, no whatsapp, no facebook, no twitter means no ability to coordinate or organize any humanitarian response outside of the governments own and independent volunteers are being pushed out. The big NGOs are slowly going to Turkey and maybe MdM will follow but for now we know the situation there is terrible.

Its rare that you can say you’re at a turning point in history but I feel this weekend is going to be marked as a shameful time in Europe’s history. And perhaps Europe won’t exist anymore and my kids will laugh at the idea of travelling to France without a passport. Before the solace I could give people in the clinic was to say “when you’re settled you can…” and feeling that I knew they would eventually find something better. Now what can I say? No one knows. Who knows if I’ll even see any more patients.

Monday, 14 March 2016

Closed borders, full island

Leaders of European member states are set to agree a deal this week that will allow Greece to forcibly return refugees arriving to Greece “illegally” back to Turkey. Illegally means anyone who doesn’t have a visa in their passport. Believe it or not that’s everyone who chooses to put their child in an overloaded rubber boat paying smugglers hundreds of euros, rather than just catching a flight straight from the country they’re fleeing.

The boats that smugglers use, often discarded on beaches or around the port
Many of the refugees we’ve spoken to have spent several months in Turkey, sometimes years, trying to earn enough money to pay smugglers to come to Greece. One young man told me he was working in a clothing factory, another told me he was sorting building materials. We’ve seen several people with wounds or chemical burns from working in what I can only assume are unsafe conditions where Turkish business are profiting from having a vulnerable and captive workforce at their fingertips. There are reports of Turkish authorities forcibly pushing refugees back into Syria, in direct contravention of international law. Along with mismanaged camps with little or no sanitation, medical care, unreliable food distribution, as well a punitive policies regarding refugees right to work in Turkey, many refugees say that there simply isn’t any kind of life on offer in Turkey. Amnesty International and other organizations are campaigning to block this decision which will ignore basic human rights and international law. While politicians talk, more and more people are trying to leave Turkey before the borders shut completely.  

This decision will follow the complete closure of the Balkan route which happened abruptly last week without any warning. There are now around 45,000 refugees stranded in Greece. Over 13,000 are in Idomeni at the border between Macedonia (FRYOM) and Greece. The situation there is worse than Calais. A baby was born in a tent last week. Doctors are treating trench foot. There is limited food distribution, difficulty for independent volunteers and NGOs to access people, no sanitation and around 40% of those waiting at the border are children.

When I came out to Chios, I was completely unsure about what I would face when I arrived. I didn’t predict that decisions made at the drop of a hat by small minded politicians would have such direct impact on the situation here. Overnight, last week, the numbers of people needing care have skyrocketed.  We’ve had a really intense time the past couple of weeks which is why the blog has been a bit quiet. Luckily we have a new Farsi translator Fatieh who is a complete badass political refugee from Iran. She worked with the refugee council and women’s aid in England for many years and decided to spend some of her retirement translating in the field! Our coordinator Claire, rewarded us with a full weekend off this weekend and my amazing hubby jetted in with a days notice to be with me for 2 nights! I now I feel totally refreshed and ready to hit the ground running for the last 2 and a half weeks. It seems from all sides things are going to get worse for refugees here and we will have to expand our operation to even try to meet the need.

Resourceful Fatieh making sure she gets a cuppa!
The ferry companies have been extremely limited in the number of tickets they can sell to refugees with some days only 50 people leaving the island. Last weds night 31 boats with around 900 people arrived on Chios in ONE night. At the moment I think there are around 1600 refugees on Chios but that doesn’t take into account any arrivals from the weekend as I haven’t been up to date with the numbers. More and more camps are opening up on Chios to try and accommodate people as they get stranded here, unable to leave to Athens or have any other route off the island. Now the ability for this island to provide adequate housing, sanitation, food distribution and medical care for these people is limited. We are the only team able to provide care outside of Souda and Vial camps which have permanent clinics which are always staffed.  All of the people in the other camps have to wait for us to come with the Medibus (which we cannot predictably time) to see a doctor. The usefulness of the Medibus has really been proven in the past couple of weeks. On weds we saw 95 patients, on thurs 83 and I think the past 7 days we saw over 450 in total. We’ve been opening a bit later in the evenings to try and fulfil the need but it never ends.

We haven’t analysed the data for the past 2 weeks yet but I wouldn’t be surprised if the majority of our consultations were women or children. We asked anyone who wasn’t desperately sick to step aside when we arrived at the other camps and all the young men with coughs and colds dispersed. Consultations are taking longer, people are sicker, they’re staying for more time on Chios so need follow up and I’m seeing the same patients every day and hoping they don’t get sicker. Tensions are rising in the camp and especially between Syrians and Afghanis. I think a lot of Syrians feel that they will have the right to cross the border because their war is still happening and if it weren’t for the numbers of Afghani’s there would be no problem. There’s a high level of denial about the situation amongst all refugees and people just can’t comprehend that Europe would leave people waiting in a field hoping they’ll turn back. Most people still think heading to Athens is their best bet but we’re trying to caution those who have chronic health needs to think about what could happen if they don’t have a spot in the limited camps.

Tabakika camp, an abandonned warehouse essentially open to the elements housing around 400 people
Despite everyone’s best intentions were seeing full dirty nappies with subsequent horrific nappy rash and a lack of clean nappies for Mum’s. We’re seeing impossibly hungry babies whose mother’s breast milk has dried up due to stress or malnutrition. We’re seeing old poorly healed wounds that I never want to ask how they were sustained because I know hearing the story will leave me shaken and find it difficult to treat the next patient. We’re seeing bad pneumonias, bronchiolitic babies and tonnes of diarrhoea and vomiting and I don’t know if they’ll get better or worse. I’m seeing many people without their normal insulin or diabetic medication who are struggling to control their sugars with the erratic eating patterns. I’m seeing SO many pregnant women, most of them in the third trimester and no one had a plan for where they would give birth. We’re seeing many women who feel the baby isn’t moving as much as normal especially after the boat journey, and I can refer them for a scan at the hospital but then what…

Despite all this, I love this island, I love the team I’m working with and I love my patients.  I love the tenacity of a 14 year old boy strolling into my clinic and telling me he has a cough and needs some syrup because he’s keeping everyone awake at night. I love the way that Syrians say no to something, it's like a click of your teeth and move your head upwards in an upside down nod. I love that it costs 2 euros for chicken souvlaki from Nicolas’s. I love the way that when we managed to explain we could only see emergencies all the young men left the queue and made way for pregnant women and children. I love that when it rains 20 minutes later there’s bright sunshine. I loved seeing a desperately sick boy I sent to hospital playing by the beach 2 days later. I love that when I walk into the camp in the morning people run up to me to show me the rash has gone or the cough is better. I love that when it rains everyone gets a poncho and if they’re giving out blue ones its like there’s a camp full of smurfs. I love that a 7 month old smiles at anyone and has no awareness of how bad things are around them. I love that every single Greek person I've met here has been warm and welcoming and thankful for what we're doing here. I love being able to be in the presence of such admirable people who show such bravery and determination to find a better life for themselves and their family.

List of countries refugees can apply to all of them for asylum and will get randomly allocated to one. They then will get direct transfer by flight to this country if asylum is granted. For vulnerable people but many are skeptical and don't want to sign up as they are heading to a country where they are trying to reach family.  

It worries me how seeing a child without shoes has become normal, that seeing kids use piles of life jackets as a playground is funny and walking into the camp feels homely. I asked a bright 11-year-old Syrian girl when was the last time she went to school. She thought for a moment and said “I can’t remember”. This is not acceptable. We all need to think what it means to be European in this time and how we want history to remember our generation. Hold your leaders to account. Express your disgust at this policy made humanitarian disaster and demand Safe Passage Now.

New recruits helping with the workload!

Tuesday, 1 March 2016

All go in Chios

This week I feel like I’ve gotten into the flow of working in the camp despite there being lots of change and lots of patients. Our team has switched around a bit this week and Claire the nurse from the UK finished her contract and Lottie from Holland joined us. A few days later we were joined by another Arabic translator Ahmad.  We have also had visits to the clinic from DFID (our donors), MdM Holland, MdM international and a journalist who took photos of us working all day for MdM Belgium! Some stay a few minutes some stay all day. I’m dreading seeing a hundred unflattering photos of me getting coughed on by small children!

Advocacy in action!
I had a great week in the clinic and I’m mostly really enjoying my time with the patients. But, I’ve definitely been burning the candle at both ends and after a particularly late night on Saturday, being coughed at by 50 people with an upper respiratory tract infection a day, combined with sunbathing and swimming in the sea on Sunday I’m now suffering a bit of a cold. It has made me slow down a bit and I’ve been getting some early nights and looking after myself (don’t worry Mum). I’m now much more empathetic towards everyone coming to the clinic with a sore throat and headache as I know exactly how they feel!
Team photo on night out!
We are unfortunately lacking a Farsi translator this week which has made consultations with Afghani people challenging. Its amazing how many Afghanis we are seeing and I think so many people have forgotten how fragile of a state it still is. Many Afghanis are saying there has been renewed violence or Taliban has taken control in their area recently or they have been in camps in Pakistan for years with no end in sight. Anyway, my finely tuned charade skills with a mixture of Urdu and a few Farsi words I’ve picked up, have allowed me to communicate most of the minor illnesses with people. Also many people are coming from refugee camps within Pakistan so they have reasonable Urdu which is nice to be able to communicate directly without a translator.

The clinic has been busy almost every day this week with us seeing around 50-70 people a day during clinic hours. This week has seen a couple of emergency cases along with the usual raft of minor illnesses. I’ve seen many pregnant women, lots of very young babies and children and a few elderly and disabled people. We made one ambulance transfer to hospital for a young Afghani boy who had a complicated past medical history. He had been diagnosed with heart failure two years ago and was giving himself IV medication through a cannula every other day. He had a packet of X-rays and letters written in Farsi and a bag of all sorts of medications including IV furosemide! On arrival in the clinic he had dangerously low blood pressure so whilst waiting for the ambulance we placed an IV line and gave him urgent fluids. He stayed in the hospital for a number of days and we haven’t seen him again at the clinic, I think he may still be an inpatient or has been transferred directly to Athens.

For the medics reading spot diagnosis!
Yesterday I referred an elderly man who was septic with a bad chest infection. Apparently he was unwell for several days but had got much worse whilst waiting in Turkey to come to Greece. Several people have told me that they have to hide in the “jungle” on the Turkish side with the smugglers and wait for the moment to get on a boat at night. Many are reporting they have nothing to eat or drink during this time so its no wonder some are turning up to Chios in such a bad state.

Another day, I went outside the clinic to see how busy our waiting room was and saw a little boy sat on the floor with his head on his knees. I went over and tried to see if he was ok but he was completely unresponsive. I got a bit worried and quickly lay him down to assess him properly but as I did, I realized he was completely asleep. He woke up with a start as I manhandled him and he just picked himself up and walked off towards the tents. I shouted after him to check he was ok and tried to get a translator to see if he needed anything but I guess he was just completely exhausted and when he sat down fell straight asleep in the middle of the road.

On one afternoon that wasn’t so busy, I saw a young girl about 8 years old called Najmah playing with a ball by herself. So I called out to her to kick me the ball so we could play a bit and she excitedly did so. I immediately, completely uncontrolled, booted the ball over the fence into the restricted area where she wasn’t allowed to go. I ran round with her to the security guard who obligingly let us retrieve the ball. Once the ball was back we realized I had managed to kick it onto the only shard of glass in the entire camp and it was punctured and constantly deflating. I felt so bad and ran back to the clinic to patch up the ball and try and rescue it. Luckily, Najmah forgave me and 2 days later had learnt enough English to come and find me and say hello and introduce me to all of her friends in the camp as Dr Aaminah.

My absolute favourite Jessica!
The kids here are really amazing and whenever you feel like the reality of this crisis is getting too much you see a small kids running around with bubbles or forming little packs and going on missions to get water or nappies for other kids. They are all so beautiful with huge long eyelashes and the Kurdish and Yazidi children are just stunning! They’re so resilient and for most of them its just another day and new place to play and discover. There’s some really great psychosocial activities being provided for kids here both formalized and organized by independent volunteers. Our Medibus was transformed into an open air cinema one night with a film projected onto it. I’ve seen clowns, many many drawings and face painters and the legacy of people handing out whistles and party blowers (which get tiring after 6 days in a row!).

Kids activities in the Red cross kids centre
The current political situation is starting to affect things here in the camp. There are currently over 35,000 refugees stuck in Greece. Last week Macedonia closed its borders to Afghanis and introduced stricter language tests to ensure only Syrians and Iraqis were getting through. I said goodbye to the mother and father of the child who died, I spoke about in my last blog, full of guilt at knowing they were walking into a terrible situation to maybe be stuck at the Greek/Macedonian border indefinitely. I couldn’t believe after all the trauma they had been through they had so much more to bear. I hugged her tightly and in that moment Inshallah (God willing) was the only thing I could say as I said goodbye.

Yesterday Macedonia completely closed its borders and other countries have enforced strict quotas. Austria is only accepting 80 people a day and there is subsequent chaos here in Greece. The islands have had to restrict ticket sales on the ferries headed to Athens as people are accumulating at an alarming rate there. They have had to open up new camps in Athens, including a baseball stadium and there are still so many people sleeping in the streets. There they have little access to food or water let alone medical aid. The impact on the Greek economy, already struggling so desperately to provide for its own population is enormous. Early reservations for the holiday seasons in Kos, Lesbos and other islands are down 60% on the previous year. 

Today in Chios over 900 people are staying in Souda camp and its overflowed into 2 more temporary camps. I think we are going to have to start up evening shifts to provide care at the other temporary camps as there is no medical care at any of these new shelters. And yet still the camp is controlled with gentle calmness. There are two entrances and exits and just one security guard at each. No sign of a gun or an army uniform anywhere near and there is not a hint of disorder. People calmly wait in lines when food is distributed and even when the clinic is heaving we have everyone waiting their turn to be seen.

We have seen a lot more Frontex (international border control) cars and army vehicles driving around but not an increased presence in the camp yet. The people of Chios continue to welcome and find space for all of these people and the cafes are still providing free food. There are now Nato boats patrolling the waters with an aim of “preventing sinking” of any of the smugglers boats but if the boats are found in Turkish waters they are taken back to Turkey. I think its going to be an interesting few weeks as the political situation evolves and refugees pile up on the Greek Islands. I think the medibus is going to be very useful in providing care around the island to those stuck out in temporary camps. We will see how it goes and I’ll be sure to keep you updated!  

Just in case you're jealous, I've not been sunbathing every day

Monday, 22 February 2016

Hello from Greece!

Reading through my previous posts Dobova feels a million years and miles from where I am today! I’m back out with DOTW, this time on the Greek island, Chios. I’m going to be here for the next 6 weeks (if all goes to plan) providing medical care to refugees who have just arrived by boat here.

The organization of DOTW here is a bit complicated. As we all work within a network there’s many different branches involved in responding to the refugee crisis. All of the work in Greece is being coordinated by the Greek branch of doctors of the world. MdM Greece has been providing medical care and support to Greek people for many years and has increased its operations since the financial crisis for those who can no longer afford health insurance. When there was a significant increase in numbers of refugees coming to Greece last year, MdM Greece asked for the support of other members within the network to help manage provision of healthcare for refugees. In coordination with MdM Belgium, UK and Holland a plan has been made to provide human and financial resources to respond to the ongoing needs of refugees as they arrive on Greek Islands, which is how I’ve ended up here!

I’m going to be working as the only doctor this time with one nurse, two translators, our project coordinator, Claire (who I worked with in Slovenia) and Remi our logistician. The plan is very changeable, but at the moment our remit is to provide care as a mobile unit using a Medibus which was specially made for MdM. The aim is to move around the island and travel to other islands to provide care where its needed most outside of the refugee camp setting. Currently, we are providing cover for the Greek MdM clinic, as they set up a new centre, within one of the refugee camps where people await the ferry to Athens.

The Medibus
There are several camps across the island but at the moment there is a plan to open a new “hot spot” where there can be complete registration of refugees on the island rather than only doing registration in Athens. The clinic we are covering runs the same as the Dobova clinic, where its open access and anyone who wants to can see a doctor. There are quite a few organisations providing medical care in the camps and given the unpredictable arrival of refugees, we are working in rotation with a couple of NGOs to provide cover for the clinic 24 hours a day. Luckily we’ve got the day shifts and have Sundays off, if there’s no major disasters.

The medical work is very similar to the clinic in Dobova but the surroundings couldn’t be more different. We don’t have the same set up at the Slovakian team and are operating more at a primary health care level with a small pharmacy and the ability to do dressings and refer to the hospital if needed. Again we are seeing lots of coughs and colds, chronic diseases and this time more injuries as people have been crammed into boats and injured getting to Turkey.

Clinic in Souda Refugee Camp
The camp here is organized by Norwegian Refugee Council and has been completely founded with humanitarian principles at its core. There is no military presence at all. Since I arrived I have not seen a single gun and I cannot describe how differently the refugees are treated. The camp is completely open and refugees are free to come and go as they please. On arrival refugees are issue 
d a coloured wrist band to show they have been registered, after that they are free to leave the camp and walk around the island. They can stay as long our as little as they want although the majority leave on the earliest ferry to Athens. Information is sign posted everywhere to allow people to plan their onward trip.

Information on the route through Europe
Refugees are encouraged to be self sufficient and many of the islanders have opened up their businesses to cater for the refugee population. Free food is being offered by one of the local cafes. The camp itself has free wifi for everyone, charging points for phones, solar powered hot showers and many individual family sized “tents” that can house one extended family.
Temporary "houses" built by UNHCR in collaboration with Ikea

These temporary structures are allocated based on need and families with lots of children are given priority. The larger tents are where the rest of the refugees can sleep and are full of proper camp beds raised off the floor. There is a children’s play area equipped with staff providing activities like arts and crafts, music and an outdoor area to run around in. It is staffed like a nursery so parents can drop their kids off and not worry about them giving them much needed respite. I really couldn’t believe this was the same crisis I was involved in Slovenia and had to keep asking what the rules are about people coming to the clinic and being referred to the hospital despite their being no restrictions on the movement of people for medical needs. The multiple agencies here are working in complete cooperation with a whatsapp group coordinating all the volunteers working on the island and sharing information as much as possible. It’s very surreal driving and walking past big piles of life jackets discarded on the beaches all over the islands in the morning. Punctured rubber boats are washed up on the beaches and collected by diligent volunteers and piled up for weekly collection by the bin men.

Abandonned life jackets
Chios is only 4km from the coast of Turkey and has been hosting the second largest number of refugees arriving from sea after Lesbos. In the first 4 days of this February, Greece saw 7483 arrivals by sea which was more than the entire month of February in 2015. Everyone is predicting as the weather improves the numbers will spike again up to thousands arriving every day as there is no sign of hope that the situation in Syria will improve. Once people make it to Turkey and want to reach the EU they cannot go by normal routes on ferries to Greece as they require visas/passports to buy the tickets. Therefore, they are in the hands of smugglers who charge depending on how dangerous the route is. The most expensive option is to go to the islands closest to Greece thereby minimizing the danger, for those who have less money then there are cheaper options to travel to islands further away such as Kos.  The translators here tell me that people have told them they can pay anywhere from £400- £2000 each to get on these boats.

Today a young Afghani woman visited the clinic and I have to share her story here. Her husband along with her extended family and her 3 small children had paid smugglers to get on a boat made for 45 people. When they arrived at night to take the boat she said 60 people were being pushed onto the boat. They refused to board the boat because they didn’t want to risk their lives and could see it was dangerously overloaded, but they were forced at gunpoint onto the boat. She got separated from her husband in the panic as some people were thrown onto the boat and others were left on the shore. She thought her husband had her youngest child were together and would get the next boat behind her. When they arrived in Greece someone looked in the bottom of the boat to check if there were any bags left and they found a child face down. When they pulled him out she realized it was her youngest child and they were rushed to hospital by the paramedics. She told us when they arrived at the hospital their resuscitation attempts were futile and he was pronounced dead. He was one and half years old and died from suffocation and being crushed at the bottom of an over loaded boat. She came to the clinic complaining of stomach ache but her entire body was reacting to this horrific tragedy. She stayed with me and the Farsi translator Simin and we sat and drank tea and shared in her grief as she told us her story. When we left her with the UNHCR staff and local charities arranging the management of the child’s corpse and reunification of her with her husband she told us she still hadn’t managed to contact her husband who didn’t yet know what tragedy befell them.  

The whole feel of the island and the refugees is in stark contrast to where I was in Slovenia. Despite being surrounded by story after story of immense human suffering, there is a feeling of calm here in Chios. Young men swim in the sea and bask in the sun after being registered. Families wander around and see the sights of the town, enjoy interactions with locals and plan their next steps in contact with their families behind and in front of them. The stress and anxieties that we saw in Slovenia seem to be far less prevalent and when people come to the clinic it’s with specific medical problems rather than for respite. The intense natural beauty of this wonderful island and the outpouring of compassion and love from the local population and volunteer community restores my faith in the goodness of the world and humanity. We will see how soothing they remain after 6 weeks here.

The view from Souda Camp
Claire and I enjoying some lunch in the sun

Beautiful sunset looking out over Chios town

This sign outside a restaurant says: "Salaam, refugees welcome, all food is halal, price is cheap, you can use internet and toilet for free, we speak arabic!" (according to Hamed our translator!)

Happy team on sunday drive around the island

Monday, 28 December 2015

Isme Aaminah Ana Tabeebah

I tried to write this post a couple of times whilst I was still out in Slovenia but I just couldn’t find the time or energy to do it justice. Now I’m home I’m trying to consolidate all the little notes I made to myself and I’m afraid this is going to be a mammoth post about everything I was thinking, feeling and witnessing whilst working the past week in Dobova. Its not the most flowing piece of writing and I hope you can manage to get to the end!

In total we worked the initial shift I already blogged about and then two 24hr shifts with 24 hour rest in between then another 9 hour shift on Christmas day. We saw 319 patients over those shifts with around 100 a day on the 24 hours shifts and a few less on the 9 hour shifts.  Generally, the shifts were much busier in the evenings and our first 24 shift started in a very chaotic way. A train had just arrived at 9pm when our shift began and over 1000 people were coming into the camp. We saw 40 patients in first 2 hours with another 55 in the next 6 hours including 4 very sick patients. On our second 24-hour shift finishing at 9pm on the 24th we ended up staying another hour as the team we were handing over to consisted of just one doctor and when she arrived we had 2 very sick patients plus reports of a third needing to be picked up at the train station.

We noticed quickly that “batches” were much sicker than others and it was linked to which route they had taken and how long they’d be travelling without stopping. Those who had walked across Bulgaria rather than risk the sea were much more exhausted and seemed to have been more neglected health wise. Sometimes the make up of a train was mainly young healthy men and our only consultations for hours would be coughs, colds and headache. Then the next train would arrive and there would be large extended families with many pregnant women, new born babies, young children and old sick grandparents. I was so amazed at the resolve of families to bring along and continue to care for every member of their families including the wheelchair bound grandma with type 2 diabetes, the severely disabled premature baby requiring urgent heart surgery to save his life and the granddad requiring dialysis every 3 days! When we had a group like this, the clinic was crazy and we were running around like mad trying to keep the flow of minor cases moving whilst providing emergency care alongside. Luckily our team gelled really well and we were able to adapt to the situation when the clinic was heaving with sick people. I felt that as the 2 doctors (and I hope Elly agrees) we had a very good mix of complimentary skills and I never felt like we lost control and patients were always safe.  

We saw several cases where people just could no longer keep it together and something snapped. A young girl around 9 years old was rushed into the clinic hysterically screaming in pain and unable to stand. I rapidly assessed her and found she was very tender in her abdomen and was concerned she had acute appendicitis. We checked her vital signs and actually everything was normal. I gave her some simple analgesia (paracetamol and ibuprofen) and after 15 minutes she was up walking around smiling. She couldn’t really explain what had happened and we observed her for another couple of hours and the pain had completely resolved. One thing Elly and I talked about at the end of that shift was the importance of sitting on people like this and waiting to see what happened if it wasn’t immediately apparent there was a life threatening condition. We saw this type of presentation a few times and we could only really explain it as a psychological response to the extreme conditions they were going through and that being seen by a doctor, being reassured and maybe given any pill was enough to build the resilience back up and carry on with the journey. 

Elly and I shared out the task of going to the train station and transferring cases by ambulance to the hospital. Our first referral was a 7-year-old boy who presented with severe exacerbation of asthma. His mum stated he was on inhalers in Syria before they left but all their belongings including his medicine had been thrown into the sea by the smugglers to make the boat lighter as they crossed from Turkey to Greece. He was really unwell but it was a presentation I’m very used to dealing with in A&E in Lewisham and Woolwich. As we had nebulisers and oxygen I was able to give a significant amount of treatment to him in the clinic to see if he responded. Having experience with these kids I knew pretty early on he wasn’t going to respond and would almost definitely need referral to hospital but actually his clinical state was completely irrelevant when negotiating the referral with the family. His extended family were all travelling together and I think in total there were around 20 people linked to the child. Our Arabic Translator Hakim was amazing at mediating between the family and us and explaining the seriousness of the child’s condition. Despite the mother and father realising how unwell he was there was still severe resistance to the family being prevented from continuing with the journey. Many of the extended family wanted to know exactly how many hours they’d be kept in the camp, predictions we just couldn’t make. It was really hard as a doctor to delay referral for a child who was clearly unwell to appease the family until the point that we had everyone on board in order to make sure the family wouldn’t be separated. Even once they had agreed to go we had a hard time from the family every hour or so having to give updates and trying to stop them boarding the next bus in the morning and wait for the kid to come back from hospital. But about 9 hours later the child returned looking almost unrecognisable to when we sent him to hospital and it was one of the really great moments when he came back to the clinic to say goodbye.

Happy Mustafa back from hospital
Another patient I transferred was a desperately sick little baby who was only 2 months old and had been born just before the family left Syria. The child had a respiratory infection and was unable to feed and was in bad respiratory distress. The mum and dad and baby were travelling together with no extended members and we managed to negotiate with the hospital to keep all of them at the hospital together. They had already been admitted in Turkey for a few days during their travel and I think they knew that the child was still unwell. The mum was only 20 years old but she was so strong and really sorted the Dad out when he started talking about missing the next train. The paediatrician I referred to was an amazing old school doctor who had excellent English and was clearly very skilled. Her first action when we brought the baby in after a thorough history and examination was to give the baby a bath! I found it very weird especially as the child needed urgent IV antibiotics in my head! Anyway, she was amazing at reassuring the parents and was very empathetic offering them showers and to wash all their clothes whilst they were in patients. I thought the child would have to be admitted for at least 48 hours and the paediatrician agreed but it was nice to see the family in a safe space and all together.

The other interesting part of the job was going to the train station to collect patients who were extremely unwell. When I went to the train it was an evening train with around 1000 people arriving. The station was crazy and chaotic and there was one doctor on the station with a handful of meds making direct referrals to us in the camp if she was concerned. When I arrived the patient in question was a young man who had a very high temperature and had collapsed on the train. She had to physically take him off the train and was trying to assess what was wrong with him. Whilst I started assessing him someone started pulling my coat and asking me to see someone else. A 9-month pregnant lady was so exhausted she also couldn’t get off the train and was unable to walk. I decided neither was so sick they desperately needed to go straight to hospital and brought them to the camp. Both turned out to be fine after a period rest, observation, IV fluids and some basic meds and didn’t need referring to hospital but the whole visit to the train station gave me a different perspective.

Although it sounds dramatic I couldn’t help but compare it to pictures I’d seen of the holocaust where people were transported on trains and then taken without knowing where they were going to these heavily militarised camps. They were going to be transported to be stored in empty warehouses for an unknown period of time all clutching a handful of personal items with the hope of finally reaching somewhere safe. When I looked in the train on my way out of the station it had clearly been horrendously overcrowded, vomit on the floors and just so dehumanising. When it was suggested to think about providing a clinic on a train I was quite excited about the logistical challenge. However, seeing that situation now I feel it’s so totally inappropriate to provide care in that setting as this would further legitimise the way the crisis was being managed. People have the right to stop, rest, eat, drink, feed their babies, change their clothes, have showers and seek medical care in a calm and controlled environment whilst making this horrendous journey. The priority should not be shuttling people across your country as fast as you can so its someone else’s problem.
Sleeping overnight at the camp
A case that I got really emotionally involved in was a young teenager who had a congenital heart problem that required surgery. I wasn’t really sure why he hadn’t had the surgery as a baby but the family were very keen that he gets to Germany where he could have proper care and follow up. He was brought into the clinic having collapsed whilst waiting in the registration line in the cold. When he came in he was completely blue and short of breath. His oxygen level was 55% (normally >95% in healthy adults) and we put him on oxygen immediately. Within 5 minutes he was much better and once he’d warmed up we decided that his background oxygen level was normally around 75% which he stabilised to. 
Severely clubbed fingers (for the medics)
We worked out that the reason he had decompensated so badly was being made to stand in the cold so we wrote a medical note and went to speak to the police to ask if he could be fast tracked through the queue and not made to wait in line. After an hour or so he wanted to go back with his family and sleep in the main tent until the bus arrived in the morning so we let him go with the note to the police to ensure he wasn’t made to stand outside again. Only 30 mins later he was rushed back in, in the same condition as before. This time we decided the only way to ensure he was warm and ok was to keep him in the clinic. So we identified the whole family and managed to get access to the mother and baby container (run by another charity WAHA) to allow his 23 family members to sleep there where we would collect them from when the morning bus arrived. Early in the morning the police chief came to say him and his family needed to get on the bus now so we started waking everyone up and getting them on the bus. The chaos of trying to wake up and dress 13 children ready with all your belongings for another journey was indescribable. I was so stressed the family would miss the bus I was running around picking children up, putting their shoes and coats on and collecting them together. Even though it was only 15 or 20 minutes I was involved in helping them get on the bus I had totally adopted the stress of the family and felt fully responsible for keeping everyone together. The relief and emotion I felt when I finally got the last kid on the bus and double checked to make sure everyone was there together was a small taster of what the adults in these families must be going through at every stage.
The family in the WAHA container before they went to bed
When we did get a break in the flow of patients we sometimes took a moment to lie down for a couple of hours. It was very disorientating sleeping inside the medical tent where you can hear the movements of everyone else in the camp around. Towards the end of the first shift and definitely in all of the rest of the shifts my brain had shifted to a hyperarousal state. The smallest noise or movement inside or outside the tent and I would wake up immediately expecting a huge flow of people into the clinic. Those who know me well, know I’m prone to sleep talking and predictably I woke up Heather and Elly! One night I shouted out in the middle of the night “When does the next train arrive?!” and would only lie back down once Elly reassured me we were in the hotel I could go to sleep.

Consciously I hadn’t realised that being in a militarised environment was affecting me but I had several dreams about being shot by the soldiers or about the clinic being bombed. I found it really weird that this was my subconscious reaction as my personal interaction with the police and military was mostly very pleasant and respectful. However, we witnessed every day unnecessary shouting and some pushing/shoving the refugees as they were were boarding buses or being registered. I can’t imagine how it must feel to have fled a war zone where your life was actually threatened by militia and then have to spend every day being pushed from pillar to post by more military actors. The entire team spoke about how unnecessary it was for the police and soldiers to be so heavily armed and how just that simple presence of guns changed the entire feeling of the camp. Individual police and soldiers were very pleasant and often when the treatment of refugees was at it worse it turned out that they were being forced to work unpaid overtime or had been drafted to work without notice that morning. The camp did run “efficiently” and the flow of people was managed well but overall it was just so unnecessary to have so many physical barriers and escorting people often children, with huge weapons to just go to the toilet. 
Open access to healthcare....
I have so many more stories of individuals and families that we were privileged enough to share a small part of their journey and feel this post is becoming way too long again! One of our observations I touched on earlier was actually defining the mandate of the clinic. Our team had a very shared ethos where we wanted the clinic to be a humanitarian space and we really wanted the clinic to run as an open access self referral system. This means that if anyone wants to see a doctor they are able to and there should never be any triaging by police or military to decide if your sick “enough” to see the doctor. Trying to define the role of clinic is difficult as defining medical care is not as clear cut in this setting. Providing rest is the treatment to exhaustion, providing nappies and a space to feed the treatment for an irritable baby, rewarming the treatment for hypothermia and play the treatment for kids who have been travelling non stop for days. However, when we had acutely sick people like a lady who was maybe having a heart attack or the boy with severe asthma our clinic suddenly morphed into an A&E majors department and we went from blowing bubbles to cannulas in a heartbeat. Many health actors are stepping in to provide the humanity in this setting and actually there shouldn’t really need to be a “humanitarian space”. The whole camp should be made with humanitarian principles as a priority not the logistical issues. After all these are people fleeing war and persecution not criminals or cattle or cargo.

Another thing we talked about as a group was seeing ordinary Slovenians differentiating themselves from the state and providing that humanity to people. All the food distribution, escorting to and from the clinic and providing of new clothes, nappies etc was being managed by unpaid volunteers working with Slovenian Philanthropy. They were incredibly responsive to our presence and really amazing at trying to improve the position of the people they were helping in whatever ways they could find despite the barriers created by the system. This crisis so far will be remembered for the terrible way our state organised activities have failed these refugees and how ordinary people and voluntary organisations have stepped in to pick up the slack.

One final point I want to make is that I have noticed the softening of the media to the plight of Syrians and there seems to be accepted that Syrians have the right to flee. This is of course welcome news and vital to help apply pressure onto the government to accept more refugees. However, everyone has the right to escape persecution and claim asylum in any state. Because Macedonia’s policy is still in place, where only Syrians, Iraqis and Afghanis (SIA) are allowed to cross the border we only saw people from those countries or pretending to be from SIA countries. This means that anyone who is black is unable to pass for SIA and is returned immediately on arrival. We saw 2 Somali girls who were detained at the camp and sent to a detention centre in Slovenia despite having every right to claim asylum. The Syrians we met sure have every reason to be fleeing, but so do the Afghanis, the Somalis, the Pakistanis pretending to be Afghanis and the Iranians pretending to be Afghanis and everyone else the world over who’s countries are so fragile or poor they have no prospect of a future. People are people and we need to stop making a distinction between those who have the right to flee and those who don’t. No one would put their children and disabled mother in a boat and travel thousands of miles to Europe if there was not the hope that life would be better than where they left.
Best selfie ever.