The impact of detention practice on

migrants’ health and wellbeing: the

experience of Médecins Sans Frontières
in Greece.
 MSF and migration
• MSF has a long history working with refugees and internally
displaced, since the 1970’s. In addition, since the late 1990s, MSF has
intervened in host countries (Spain, Belgium, France, Italy, Greece)
and “transit” countries (Morocco, Yemen, Egypt, Mexico) to
address vulnerabilities caused by increasingly restrictive
immigration policies.

• As a humanitarian organisation MSF responds to human beings in

need of assistance irrespective of their legal status. MSF’s commitment
to assisting populations on the move stems from their accummulated
vulnerability at different stages of the migration process. This is
considered by MSF a crisis where life, health and human dignity
are being put at risk.
 Restrictive immigration policies
• A wide range of restrictive immigration policies have increasingly
been put in place in Europe over the last decade. These include stricter
border controls and interception measures; cooperation and
readmission agreements with countries of origin and transit; increased
and prolonged use of detention.

• EU Return Directive increased the maximum detention period at 18

months (for foreigners subject to return).

• However several European countries apply systematically the

practice of immigration detention not only for migrants “subject to
return” but also for migrants and asylum seekers upon arrival.
 MSF interventions
• Since 2004, MSF has provided medical and
psychological support to migrants in detention centres
across Europe: in Greece (2008– now), Malta (2008-
2010), Belgium (2004-2007), and Italy (2012).

• The medical and humanitarian situation of migrants in

detention is worrying across settings: Serious barriers to
access healthcare, including mental healthcare,
overcrowded living conditions, combined with inadequate
sanitation facilities, lack of provisions for vulnerable
groups.
 MSF interventions in Greece
• Medical care
MSF intervention in Greece
2008- up to now • Psychological support
• Identification of vulnerable
cases
• Humanitarian assistance
(provision of personal hygiene
and other emergency items)
• Awareness and advocacy
activities/Lobbying authorities
to ensure acceptable detention
conditions and medical services.
 Medical Emergency Project in Border
Police Stations (Dec.2010- Apr.2011)
• 1,809 patients – 32 referrals to secondary care
• In addition 75 patients received psychological support
in 122 individual mental health sessions – 11 referrals
to psychiatric care
• Patients: 89% male of whom 5.9% minors, 11%
female
• Main countries of origin: Afghanistan, Iran, Iraq
Pakistan, Baglandesh Somalia, Northern Africa
 Impact of detention on
physical health
• Upper respiratory tract infection (18.7%), lower
respiratory tract infection (7%), non-bloody diarrhoea
(8.3%), musculoskeletal condition (10.9%), skin
infections (5.3%), headaches (4%).

• 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.
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.
 Mental health projects in Evros and
Rodopi immigration detention centers
(Aug. 2009-Apr. 2010)

• 305 patients seen in 381 individual consultations.

• 79 group sessions and 258 play therapy sessions.
• Patients: 89% male of whom 12% minors, 11%
female
• Main countries of origin: Afghanistan, Iran, Iraq
Pakistan, Somalia, Palestine, Baglandesh.
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
previous experience 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.
 Impact of detention on mental health

• For the majority of MSF patients detention was the

single most important cause of stress and frustration.
• Many expected some kind of humanitarian assistance and
protection on arrival in Europe. As a result, detention and
the feeling of being treated as criminals was experienced
as particularly cruel and unjust.
• Difficult living conditions, overcrowding, constant noise,
lack of activities, dependence on other people’s decisions,
the length and uncertainty of the period of detention and
the ever present threat of forced return all contributed to
feelings of defeat and hopelessness.
“I have never been in detention before. I feel very
insecure and frightened”

“I am constantly crying. I feel very worried about how

long I will have to stay here. Being in detention makes
me feel desperate.”
M.S.S. v. Belgium and Greece
“a similar situation to varying degrees of
gravity [is described]: overcrowding, dirt,
lack of space, lack of ventilation, little or no
possibility of taking a walk, no place to
relax, insufficient mattresses, dirty
mattresses, no free access to toilets,
inadequate sanitary facilities, no privacy,
limited access to care”. European Court for
Human Rights, 2011
 Recent improvements
• MoH medical teams present in DCs and BPS (but not full
capacity and with interruptions).
• Presence (but very limited) of other NGOs (legal aid,
support to unaccompanied minors).
• Minor improvements in some facilities terms of
infrastructure.
• New legislation since 2011 provisioning the set up of a
First Reception Agency and a reformed Asylum Agency.
 Ongoing deficiencies
• Inappropriate facilities (overcrowding, very poor sanitary
conditions).
• Gaps/interruptions in services provision (eg. medical
services).
• Lack of appropriate services for vulnerable groups (eg.
torture victims).
• Understaffing and lack of specialized personnel, such as
interpreters.
• Lack of protocols and procedures for the management of
the facilities and the screening of new arrivals (incl.
medical screening) - No systematic monitoring.
 Ongoing deficiencies
• Limited access to health care.
In accordance to Greek legislations irregular migrants are
only entitled to access the NHS in cases of life-
threatening emergencies and need to cover incurred
costs.
• No follow up of cases once they are released from
detention.
• Very limited reception capacity for vulnerable cases
(only 900 beds available in shelters for the accommodation
of asylum seekers, vulnerable persons, unaccompanied
minors).
 Current MSF activities
• Evros
Poros registration center (since March 2012): Medical care
to newly arriving migrants (triage, first aid).
Filakio and Venna detention centers and border police
stations: humanitarian assistance (eg. personal hygiene
items) to migrants/asylum seekers in detention.

• Lesvos Island: Medical and humanitarian assistance at

arrival and in police stations.
Ioanna Kotsioni, Migration Referent,
Médecins Sans Frontières, Athens

ioanna.kotsioni@athens.msf.org