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Acute health problems, public health measures and administration procedures during arrival/transit phase
Apostolos Veizis,M.DDirector of the Medical Support Unit
apostolos.veizis@athens.msf.org
Who is Médecins Sans Frontières(MSF)?MSF was founded by a group of doctors and journalists
in Paris on 20 December 1971 following the Biafran war in
Nigeria.
MSF was founded by a group of doctors and journalists
in Paris on 20 December 1971 following the Biafran war in
Nigeria.
Today, MSF is a worldwide movement of more than 40.000 health professionals, logistical and administrative staff save lives and alleviate suffering in some 70 countries worldwide.
Today, MSF is a worldwide movement of more than 40.000 health professionals, logistical and administrative staff save lives and alleviate suffering in some 70 countries worldwide.
Impartiality
IndependenceNeutrality
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Health is a state of complete physical, mental and social well‐being and not merely the absence of disease or infirmity
The correct bibliographic citation for the definition is:
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19‐22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
The Definition has not been amended since 1948.
WHO definition of Health
Travel medicine or emporiatrics is the branch of medicine that deals with the prevention and management of health problems of international travelers
MSF interventions: Criteria forIntervention - Why
Focus not on the phenomenon of migration but on the impactincreased restrictions and controls on the health and dignity of the persons affected
Within that group, focus on the most vulnerable among the migrants, on their unmet medical and humanitarian needs
Target - Who
Factors to consider/criteria
Cumulative vulnerability
Unmet medical and humanitarian needs
Poor or absent capacity or lack of political will
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MSF’s commitment to assist people on the move stems from their increasing vulnerability at different moments and stages of the migration process.
This is considered by MSF a crisis where life, health and human dignity are being put at risk.
Life, health and human dignityat risk
MSF activities in brief… Medical screening at arrival
Primary Health care and health promotion
Referral/accompaniment to secondary health facilities
SGBV care
Visit of detention and reception centers
Mental health care and psychosocial activities
Detection of vulnerable groups
NFIs distribution at arrival and during transit
Watsan
Individual protection cases referral
Medical certification/Rehabilitation of VoT
Chronic medical conditions and continuity of care
SAR
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ECDC field visit report, 2011
“The main problem is the increased risk for communicable diseases in the detention centers, mainly linked to severe overcrowding, lack of hygiene, lack of basic supplies (e.g. blankets, shoes, soap, etc.), lack of the possibility for outdoor activities and the long duration of detention. The conditions in the centers are below the internationally accepted minimum standards in all visited detention centers. It is well documented that overcrowding increases the risk for communicable diseases spread, such as tuberculosis, diarrhea, upper respiratory infections, etc” European Center for Disease Control, 2011.
Impact of detention on physical health
Upper respiratory tract infection (24,7%), musculoskeletal condition(13,7%),gastointestinal disorders(14,7%), skin infections (8,5%), dental problem (7,9%).
In total 63% of total diagnoses were linked directly or indirectly to the substandard detention conditions: overcrowding, lack of hygiene, water and sanitation problems, lack of ventilation and no possibility to spend time outdoors.
Impact of detention on mental health
39% of patients presented symptoms of anxiety such as constant worry, fear, panic, restlessness.
31% of patients presented symptoms of depression, such as sadness, loss of interest, hopelessness, and thoughts of death.
17.3% of patients sought psychological support due to the previousexperience of traumatic events - PTSD was diagnosed in 9.5% of all patients.
Detention exacerbated existing symptoms, hindered the healing process and contributed to psychological distress.
3.2% of patients had attempted suicide or self-harm during the period of their detention.
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“Migrants and asylum seekers in detention suffer from medical problems caused or aggravated by the substandard conditions, the length of detention, and the lack of consistent or adequate medical assistance. MSF’s experiencedemonstrates that detention is a cause of suffering and is directly linked to themajority of the health problems for which detained migrants require medical attention“
New areas and locations:
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Vulnerable groups
• Pregnant women
• Children <5yrs
• Unaccompanied minors
• Single parents with minor children
• Elderly (>65yrs)• Disabled• Chronic physical or mental health illness
@MSF/Vicky Marcolefa
@MSF/Guillaume Binet
@MSF/Alex Yallop
@MSF/Anna Surinyach
PHC consultations, Greece (N=43,619) & Serbia (N=38,249), 2015
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
nb of consultations
Greece Serbia
Socio-demographics: Primary health care
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Socio-demographics: Mental health Health status by country (N=81,868)
• 93%: symptom onset during the migration trip
Chronic diseases & referrals (N=81,868)
Chronic diseases (4564; 6%)• Cardiovascular (26%)• Diabetes (25%)• Chronic lung disease (15%)• Epilepsy (3%)
→ 11% (77/681) referral refused
• Gynaeco‐obstetric (n=21)
• Respiratory (n=12)
Referrals (681; 1%)
• Trauma (20%)
• Respiratory (14%)
• Gyneco‐obstetric (12%)
@MSF/Achilleas Zavallis
Traumatic life events before & during the journey (N=1064)
Self-reported traumatic life events Self-reported intentional violence
7%
12%
10%
7%
0% 5% 10% 15% 20% 25%
Sexual violence
Ill‐treatment
Physical violence
State authorities Community/smugglers
@MSF/Juan Carlos Tomasi
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Our mental health activityActivities:- Mostly group sessions. Added value: groupcohesion; promote community/cultural resources;address bigger numbers of beneficiaries- Special sessions engaging with children, oftenattracting adults too- Identification of vulnerable cases and of localreferral networks- In individual sessions, the single shot method isused.
Main challenges:- Population in transit: close to impossible tohave any type of follow-up ; difficult to createinterest in our support and sensitize people towhat it is we do- Marked separation between the variouscommunities- Privacy with our beneficiaries
Mental health symptoms (78%; 830/1064)
The kit
Arrivals, 3667
0
50000
100000
150000
200000
250000
Closure of Balkans route
EU – TK Deal
First restriction at Balkans borders
FLOW OF ARRIVALS FROM TURKEY TO GREECE
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People with specific needs
Victims of violence or other forms of ill‐treatment
People with psychiatric disorders
People with physical disabilities
Pregnant women
Children
Dental Care
in late 2016 and early 2017 95% of the people surveyed had fled from war.
80% of our new mental health patients treated in July and August 2017 on Lesvos reported experiencing), just over a quarter reported experiencing torture and 19% reported experiencing sexual violence
This violence was experienced in people’s country of origin, in transit and in Greece
Total participants
Experienced violence
(except in country of
origin)
Arrived before 20th March
Arrived after 20th March
Arrived before 20th March and
experienced violence
Arrived after 20th March and
experienced violence
NB % NB % NB % NB
% from those who arrived before 20th
March
NB
% from those who arrived
after 20th March
Ritsona 310 92 29.7% 228 73.5% 82 26.5% 58 25.4% 34 41.5%
Malakasa 224 66 29.5% 159 71.0% 65 29.0% 50 31.4% 16 24.6%
Katsikas 140 48 34.3% 133 95.0% 7 5.0% 46 34.6% 2 28.6%
Ioannina hotel 122 31 25.4% 119 97.5% 3 2.5% 30 25.2% 1 33.3%
Samos 240 144 60.0% 4 1.7% 236 98.3% 2 50.0% 142 60.2%Soho hotel
(Athens) 141 45 31.9% 116 82.3% 25 17.7% 35 30.2% 10 40.0%
TOTAL 1177 426 36.2% 759 64.5% 418 35.5% 221 29.1% 205 49.0%
SUFFERING FROM STATE BASED VIOLENCE…
Dire Mental Health Situation
The living conditions in the camp
The lack of legal information and assistance
The uncertainty about the future
The feeling of insecurity
The isolation and discrimination
The destruction of the family entity
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0%
5%
10%
15%
20%
25%
30%
35%
40%
January February March April May June July August September October November December
Proportion of most common reasons for MH consultations
Depression PTSD Anxiety
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
Q1 Q2 Q3 Q4
Symptoms of anxiety
Symptoms of depression
Symptoms of PTSD
Symptoms of adjustment/acute reactions
Other
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The scale of people's mental health needs is overwhelming: on Lesvos, between early July and 21 August 2017 – which represents a 50% increase compared to the period April‐June 2017
In addition to that, an average of six to seven people have presented to our clinic each week since July, requiring immediate and urgent care linked to attempted suicide, self‐harm, psychosis and other emergencies
Morbidities by MDs by quarter 2017
80.8%
18.0%10.3% 8.1%
4.0%
25.0%
9.6%7.2%
3.6%
6.3%
3.0%
4.8%
5.7%
33.6%54.0%
5.6%
18.4%
21.3%
17.4%13.2%
14.0%
7.2%16.1%
5.0% 3.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Q1 Q2 Q3 Q4
Other (not NCD) total
Gastro‐intestinal symptoms
musculoskeletal pain
mental health symptoms
headache
Acute Infections
Diagnosed NCDs
Total consultations in number
Proportion % under 5 year
W48 124 52%W49 274 54%W50 215 59%W 51 188 48%
56
135146
488
0
5376
190
0
100
200
300
400
500
600
Q1 Q2 Q3 Q4
Demand for MSF MH Services
New Referrals TO MSF
Screens of urgent cases
Non communicable diseases
Increase of patients suffering from chronical diseases
Adapt our HP strategy according to level of education of the migrants according to counties of origins.
Limited access to protection and care for very vulnerable people
Challenging access to healthcare
A lack of referral pathway to have access to protection and care
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There is a need for capacity building of professionals to develop intercultural understanding and knowledge of the situation and needs of migrants in the country, to avoid misunderstanding of symptoms and diagnosis difficulties, that can ultimately lead to an over-pathologization of what are often normal reactions to abnormal circumstances.
There are great difficulties in finding accommodation/shelters for severe cases or for patients after hospitalization.
MSF 2017-2018
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Human dignity is inviolable. It must be respected and
protected
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