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Tag: Idomeni


Strategic Health Planning Amidst Desperation and Uncertainty

By Dr. Bill Dienst

March 25, 2016, Idomeni Greece, just south of the border with Macedonia

We have now been at Idomeni on the Greek side of the Macedonian border for just over a week since leaving Lesbos. The day before we left Lesbos, I attended the Tuesday coordination meeting where we were briefed again by a UNHCR representative. At that point, he predicted that the refugee population on Lesbos would be increasing due to limited accommodations in Athens, Idomeni and other places. He projected that Lesbos would experience a piling up of unregistered refugees. Contingency plans to house expanding numbers of refugees on Lesbos were in the works.

Then three days later, an agreement was signed between the European Union and Turkey. On the fifth day, the entire refugee populations of Moria and Tara Keppe camps on Lesbos were abruptly put on buses, driven to the port, loaded on a giant ferry and sent to internment camps on the Greek mainland, where they await deportation back to Turkey; we think, but we are really not completely sure. It is all speculation. But now there are hardly any refugees left on Lesbos. Elaborate medical and humanitarian operations there that were developed following the boat people crisis thins past fall and winter are now rapidly shutting down.

We really don’t know what in the hell might happen now on the border here at Idomeni, not in the short term; not in the long term either. Will the population at Idomeni a month from now be at 30 thousand, or will it be zero? As medical professionals and humanitarians, we must still do our very best to plan for the future.

DSCN1570The stranded refugee populations here are centered at Idomeni and 3 other smaller camps that have grown up around the local gas stations: Eko, Hara and BP. Some people have given up and are taking buses back to Athens. Other people are still arriving. Campsites are spreading out laterally over wheat fields to reduce clutter and crowding. So it is hard for us to tell right now if the overall population is contracting or expanding. Smoke billows out from continuous campfires, built for both cooking and for keeping people warm. The downside is that we medics are seeing hundreds of people with sore throats, coughs and irritated eyes from chronic smoke exposure. The only respite from this is when it rains, or when the cold winds blow. But then people get muddier and colder.

Our short term purpose is to provide acute and urgent health care through a mobile health van that we have created. We have aligned ourselves with a British group called Off Track Health. They have a Swedish ambulance that is not operating as such, since that would challenge the existing Greek laws about foreigners running an ambulance. So instead, the back end of this ambulance has been outfitted with various medications and other acute care supplies.

We have modified our existing van in similar fashion. On Lesbos, our van was outfitted with more emergency supplies for treating hypothermia from pulling people off overcrowded boats and out of the water. There was risk for mass casualty incidents, drownings and near drownings. Here, we are handling problems, most of which are not immediately life threatening, but which are directly related to present living conditions and overcrowding: Upper respiratory infections, mostly viral, but some with bacterial complications. Vomiting, diarrhea and the like. We are also screening for for more serious conditions, and devising elaborate ways to send people needing hospital care 30 minutes away to the local hospital. If necessary, we manage emergent conditions as best that we can and wait for the Greek ambulance to arrive.

Everyday is a new adventure, as we do our very best to make order out of chaos. We start out at the “medical supply warehouse”, which is really a musty basement where we store donations from around the world. A few days ago, we had to sort through piles of boxes and suitcases full of stuff, some things that are useful to us and some things not. But thanks to a group of German medical students who spent 2 whole days building shelves and sorting meds into alphabetical order by drug name and by category, we can now find what we have and need in a fraction of the time.

Our medications are in English, German and in Greek. There are also some differences between the USA and Europe: e.g. Acetaminophen (Tylenol) is Paracetamol here. Even when we can figure out the generic ingredients in German and in Greek, we often discover that our European colleagues use different preparations for cough and cold than we use in the States, some that we have never heard of.

We have different groups of doctors, nurses and other allied health professionals every day, as many of our volunteers stay for a week or so, and then return home to their host countries. During the past week, I have worked shoulder to shoulder with health care providers from the UK, Ireland, Norway, Sweden, Germany, Switzerland, Austria and Catalonia, The cooperation and collegiality that I have experienced working along side these wonderful brothers and sisters has been inspiring and amazing!

We line up our mobile health van on the edge of camp, with special considerations for crowd control. We try our best to get people to cue up in 2 lines, and send people trying to cut the line back to the end. We have an intake person who pairs with a translator (mostly Arabic, but also Kurdish, Urdu and Pashtu). When we are limited by the number of translators, we employ local people to help with translation so that the lines don’t get too long. Then the patient is seen by a doctor working through the translator, who requests medications from a gofer/pharmacy technician who does her very best to keep order in the van. We typically have seen about 100 patients among 3 doctors in a 3 hour period in this way. Our notations are brief: Patient age, sex, assessment and treatment. We try our best to get specific names if we think follow up or specialty care is needed.

Yesterday, I attended a general medical meeting with the medical director of Medecins San Frontieres (Doctors Without Borders) and the heads of some of the 20 plus NGO’s who are providing health care here in Idomeni. The purpose of this weekly meeting is to do strategic planning and coordination of medical services for the long term. In the next article, I will try and explain what some of the longer term goals are. But our targets keep moving and evolving.

Dr. Bill Dienst is a rural family and emergency room physician from North Central Washington. He has extensive experience in medical exchange programs in Veracruz, Mexico and in the West Bank and Gaza Strip. He is currently on assignment with Salaam Cultural Museum, a Seattle based nonprofit organization doing humanitarian and medical relief work in Lesbos and Idomeni, Greece.


In Arabic: Pardon Me Sir, Is this the Boat to Nowhere . . . or Somewhere?

Tuesday, March 16, 2016 by Dr. Bill Dienst

Aboard the Greek ferry Nisos Mykonos, leaving the Island of Lesvos for the Greek MainlandDSCN1770

During the last days we spent on the North shore of Lesvos, we witnessed the arrival of an armada of NATO naval ships from Germany, Canada and other countries passing in front our our seaside hotel through the straits between Greece and Turkey. There are 15 large warships, at least. As far as we can tell, they are probably heading to the South end of the Island. We think the are here to help stanch the flow of boat refugees that have still been crossing across the wider straits directly into Mytilini. During the past month, crossings have been very few in our area of operations in the North. The Turkish Coast Guard, under pressure from the EU, has effectively blocked most of the crossings.

So now our NGO, Salaam Cultural Museum is deploying much of our assets to the Greek Mainland in areas of crisis and greater need: specifically to the border village of Idomeni, where thousands of refugees are now stranded up against a barbwire fence set up by authorities of the Former Yugoslav Republic of Macedonia (FYROM). This is not to be confused with Macedonia, the region of Northern Greece where we are now setting up our operations. We packed up a large van with all the humanitarian and medical supplies that we could possibly stuff into it; and then we headed to the South of Lesvos, an hour’s drive over a twisty mountainous road, and into the Port of Mytilini.

The scene at the ferry terminal was poignant: A long cue of Syrian refugees, still with hopes in their hearts for a better future. Finally, they have made it across “the straits of death” at $1000 a piece paid to smugglers to get to Lesvos, and Europe. They spent their time in the transitional camps at Moria or Kara Tepe. Now for about $60 each, they can cross in comfort to Kavala on the Greek mainland: An 8 hour voyage with beautiful scenery, and relatively zero risk of drowning. From there, they will make their way to the North.

DSCN1766A Syrian man tells me confidently and triumphantly during our conversation in pidgin Arabic: “ I am going to Germany!” Knowing what I now know, I have my doubts about his ability to succeed, but I do not have the heart, nor the language skills in Arabic to warn him about the harrowing trail ahead, so I just let it go. We take pictures of ourselves together as habibis (good buddies). Another Syrian man tells me his family will stay with friends in Kavala and only head up to the Idomeni if the border opens again. This seems like a much better informed decision.

The Syrians climb the gangway up to the 6th level and are seated at the stern; they are they lucky ones. They are free to move about most areas of the ship, more or less, though there seems to be a dividing line starboard side aft. Forward from there are the second class passengers, mostly Greeks and other Westerners, including us. First Class passengers who do not want to deal with the refugee crisis are conveniently accommodated in the bow.

On the sixth level portside is a coffee shop, complete with WIFI. Forward from that is a roped off area where we are not allowed to go. But we can see a large contingent of Greek policemen, and what appear to be “prisoners” Some are handcuffed. They are mostly men, but there are a few women too. I suspect these are people, who for one reason or another, were unable to get registered. If these unregistered refugees dare to wander off from the internment camps where they are housed, and they get caught, they risk arrest.

Whether one gets registered or not often has to do with nationality: Syrians and sometimes Iraqis are favored and deemed “war refugees”. Afghans, Pakistanis, Moroccans and others are considered “economic refugees” and are less likely to be able to get registered. Of course, the details of each person’s individual case is much more complicated than that, as UNHCR has argued. Places like Afghanistan are hardly at peace. But the Greek Authorities are doing the best they can, trying to sort things out and restore order in the middle of the chaos of this refugee crisis.

To me, the whole process seems political. The Assad regime and ISIS, though on opposite sides of the spectrum, are American and Western European adversaries. The Shiite dominated Iraqi regime, placed in power after the US invasion and overthrow of Saddam Hussein, are supposedly our friends. But ISIS exists there too, so there are friends and enemies there. Afghanistan has another regime placed in power following an American and NATO invasion. They are also “our friends”, but what about the Taliban? To me all I see in front of me are a lot of worn, tired huddled masses yearning to be free from war and to have a better future for their families. It doesn’t seem to matter much to me beyond that.DSCN1760

Then there is a limitation of incarceration facilities on Lesbos, so I suspect these “prisoners” are headed to more secure facilities on the Greek mainland. There, they will probably face more accelerated deportation procedures that try to send them back from wherever they came, or else Turkey. Then they will be Turkey’s problem, not Europe’s.

Above on the 7th deck, port side forward at midship, there are an overflow of Syrians who are allowed to walk outside on the observation decks. We befriend them, share photo shots, and I do my physical comedy schtick with the children and get them laughing. Behind the Syrians port side aft are another group of people guarded by a smaller contingent of Greek policemen.
They have darker complexions than the Syrians and their manner of dress is different. The police do not allow us to interact with them directly. I think they are Afghans or Pakistanis: those who are probably not registered. Their trips to the bathroom are monitored so they do not try and slip away to mix anonymously with the Syrians. When we reach landfall, they are probably headed to another internment camp on the mainland until their disposition is decided.

We disembark in our huge van after the ferry arrives at Kavala. We see several large prison type buses and a lot more Greek policemen waiting to receive the unregistered passengers and prisoners. We drive onward through the night, arriving on the outskirts of the huge encampment of refugees at Idomeni just before midnight.


Predicaments of the Current Refugee Crisis in Greece

Originally posted March 14, 2016

Lesbos Greece, by Dr. Bill Dienst

After being part of an advance team sent to the Greek-Macedonian border this past week to scope out the situation of 20 thousand refugees stranded at the border, we are back in Lesbos for a few days more. Salaam Cultural Museum is now planning to deploy more of its resources to the border at Idomeni.

The situation here on the North Island of Lesbos has cooled down. The Turkish Coast Guard and NATO Naval forces have effectively cut off refugee boat crossings in Zone 1 on the North end of Lesbos where we are assigned. There are still significant numbers of crossings on the South part of the Island near Mytilini, but they are currently well staffed with medical and humanitarian volunteers there. So we will be moving some of our medical operations to the Greek Mainland, to where we can now be put to better use.DSCN1575

Today, I will take this time to reflect on information we received last week from the UN High Commission on Refugees.

Boat arrivals to Lesbos have been down; on March 8th, 20% down from the daily average of 1500 arrivals per day recorded the previous week. In spite of this, the populations in Moria and Tara Kepe Camps near Mytilini are still growing, mainly due to a slowdown on refugees leaving for Athens. The capacity in these camps is being built up to house a population of 6500, up from the current population of 4000.

Tickets for refugees to get to Athens and beyond are now being rationed. There are reports of tickets being scalped and sold at inflated rates. There are also reports of fraudulent counterfeit tickets being sold which have no value; some claiming direct ferry passage to Idomeni. The only problem is that Idomeni is inland from the sea by more than 50 kilometers and no ferry can get there. But refugees who fall for these fraudulent sales do not know that, and more of their remaining meager funds are being squandered by these ripoffs.

DSCN1598UNHCR believes that if the capacity at Moria Camp exceeds the 6500 currently allocated, more ferry tickets will become available and ferry traffic for refugees will be increased, with ticket sales acting as a “spigot” to allow any overflow in refugee populations to Athens.

Meanwhile there are negotiations and proposals between the EU and Turkey to have refugees sent back to Turkey. An agreement on this is pending in the next few days.

There are multiple social problems affecting the refugees that have now become apparent. First of all, the problem of separated families. In many cases, the father of a household left several months ago, arrived in Northern Europe, became somewhat settled, and then called back home to his host country and invited the rest of his family to come. So the wife, children and sometimes the elders set off and after a long ordeal, make it to Turkey or Greece, only to be stranded halfway between their relatives back home and their husband-breadwinner in Northern Europe. We have heard a few tragic stories of family abandonment by the father in Germany in some of these cases.DSCN1583

Then there is the fact that 40% of the current arrivals are children. For many children, there is an absence of a safety net. The ones who are traveling with both parents, or one parent, are relatively lucky. There are also children who are traveling only with extended relatives: aunts, uncles, etc. Then there are children traveling with no direct relatives at all: perhaps only with neighbors or people who are from their same village. Theses situations are being dubbed, “extended-extended families.”

There are teams of pediatricians and social workers in Greece trying to figure out how to handle children who seem to be on their own. In some cases, children are sent to children’s boarding houses in Athens. But these are “open” facilities; that is, these children are free to leave if they choose to do so. This then puts them at risk for predators: human trafficking, sexual enslavement, etc. Children’s rights organizations and Europol are now getting involved in efforts to handle this.


Bottleneck Human Tragedy at #Idomeni

Originally posted March 11, 2016

Idomeni, Greece by Dr. Bill Dienst

The border at the village of Idomeni between Greece and Macedonia was sealed with a barbwire fence about 4 weeks ago. Meanwhile, the refugee population has exploded exponentially. A week ago, there were about 5 thousand people living in tents. Today there are over 15 thousand refugees officially; but some estimates put the number at over 20 thousand lost souls aspiring for a better future free from poverty and war. The future is totally uncertain for these people at this point.

Three days ago, about 500 refugees were allowed to cross into the Republic of Macedonia on their way to Serbia, Slovenia, Austria and ultimately Germany or other locations in Northern Europe. This number of people allowed passage is markedly diminished from the thousands that were crossing daily before. Today, that number is zero. On March 8th, the border was completely sealed for refugees. The EU is putting pressure on Turkey to stem the flow of refugees crossing into the Greek Islands. So now refugees are being stranded in both Turkey and Greece.

According to sources we interviewed here in Idomeni, members of the Greek Army and Police arrived 3 days ago and blocked the highway heading North to the Macedonian border. Afghans were forced out of the area back to Athens and other unknown destinations.



Based on a walk through visit of the Idomeni camps yesterday, we are seeing that the majority of refugees remaining are now Syrians, with a minority from other ethnicities. Current UNHCR reports are that about 60% of the refugees remaining in Idomeni are Syrians, the remaining 40% are split among other ethnicities: Iraqis, Iranians, Pakistanis, Afghans, Moroccans, etc. 63% of the current population are women and children.

According to Spanish journalist Juan Naza who works for a Russian news agency and who has been in the Idomeni area for 10 days, there is a general lack of information among the refugees. Some have been stranded here for over 3 weeks and the majority don’t know what to believe or what to do. Some have the ability to search the internet, but many don’t even know how to go about consulting the UN about how to proceed.

DSCN1537Medecins San Frontiere has erected 8 giant tents that shelter about 250 refugees each. UNHCR is deploying additional tents for families, and about half the remaining refugees are in individual tents scattered haphazardly in different makeshift zones now designated as Areas A, B, C, D and E. The tents generally do not have fly tents, so the rain soaks through. It has been cold and raining very hard for the past few days and so everyone is getting thoroughly muddy and drenched. Many people don’t have tents at all. The railway station at Idomeni is no longer functioning. Trains are being bypassed around Idomeni. Its platform, relatively dry ground, has become completely covered with tents and temporary shelters. The snack bars are still functioning, currently chock full of people trying to stay dry.

UNHCR and MSF have erected feeding tents. People cue for over an hour to receive a sandwich, an orange and water. For many this is the only meal that they receive for the day. Some other volunteer organizations are providing additional hot meals as well. Limitations in food supply are being burdened by rapid expansion in demand, and the fact that MSF and UNHCR are facing multiple refugee crises around the world. Some, like in Sudan, are bigger than here. The EU is also trying to provide additional funds, but that demands a political process between the Left and the Right. In Greece, the far-right party are saying things like: “All of Greece will become like Idomeni if we allow this to go on.”

MSF has erected portable toilets and showers, but the showers only run cold water, so many people are going without bathing, and hygiene is suffering. A large portion of the population are suffering from upper respiratory infections.

The Greek government has also deployed security police, but they too are feeling overwhelmed, with about 40-50 officers for 20 thousand refugees.

There are now moves by the Greek government to set up reception centers along the lines of what we witnessed in Idomeni. (See previous article by Kirsten Senturia, “A day in the Life of a Refugee in Moria Camp.” ) The advantage of these reception centers, often placed on military bases, is that there is more order, and some hygiene measures can be better implemented, but at a cost of personal autonomy for the refugees. But many of these reception centers are located in the middle of nowhere. Some refugees are grudgingly returning to Athens, at a cost of 35 Euros each for bus tickets.

German Chancellor Angela Merkel is now saying that it is a mistake to close the Balkan route to Northern Europe. But solutions to this humanitarian crisis remain murky.