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Mental Health and refugees in Greece: from the management of the crisis to the need for long-term actions to strengthen rights, assistance and social integration

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Stelios Stylianidis Panagiotis Chondros Stelios Farsaliotis

 


1. Introduction



We are living the greatest displacement of people in history, with 65 million dislocated people since World War II. The crisis of the world's refugees is no longer an emergency, a technocratic problem to be solved, but a crisis of human rights. A crisis that is testing the values that underpin the European Union and also a problem of democracy (Gionakis & Stylianidis, 2016).
The European Union's institutional framework is solid; what is needed is to promote a systematic collaboration, integration policies and the implementation of laws and policies. The fact that the number of refugees arriving in Europe is 3 per 1000 individuals of the population and that the UK spends more financial resources for refugees of the United Nations, where the latter are responsibile for the management of 10 million refugees, shows that this is not a technical problem of resources, but essentially a European political issue. (FRA, 2016A).


2. On the subject of refugees and migrants in Greece.


The International Organization for Migration, pointed out that research in Europe is fragmented, lacking in coordination among the various agencies and funding mechanisms, and also between member States and European Institutions. This leads to fragmented and inadequate results, characteristic only of the regions taken into consideration and not the whole of Europe. In general, a great waste of effort and resources are observed (IOM, 2009). Greece was already in difficulty since 2007, with regard to the reception and integration of people on the move, and it
has been said that its politics on immigration are insufficient. (Gionakis & Stylianidis, 2016; World Bank 2011)


3. The refugee crisis


According to the Agency of Fundamental Rights of the European Union (FRA) (2016B), more than a milion people sought asylum in the EU in 2015 - a number five times greater than in 2014. The competent department of the United Nations asks for support for Greece because of the continual deterioration of living conditions for refugees (UNHCR, 16/06/2015). For example, in 2015 (MdM, 2016), on the island of Lesbos, which has a population of 90,000 inhabitants, 525,635 refugees arrived. The number of people coming from Turkey by sea during the period 2005-2014 was 89,994; in 2015, it reached 847,930 (Hellenic Coast Guard Union, 2016).
After the closure of the borders with the Republic of Macedonia, 47,000 people lived in camps for more than 6 months, as pointed out in a joint report by 12 national and international organizations, who are rallying in Greece (ActionAid et al., 2016). Particular attention should be paid to the issue of unaccompanied minors. 2,248 minors were recorded in 2015 and 3,574 during the first 8 months of 2016 (The Guardian, 2016/10/09). According to Human Rights Watch, these minors are held, even for an entire month, in police stations, undergoing a series of violations of their human rights.
The risk factors for refugees in Greece are identified as follows:
l) Pre-existing conditions: health and mental health problems and other social problems before the beginning of the war or before making the decision to leave their country.
ll) Trauma: a large percentage of refugees and asylum seekers have experienced traumatic situations (war, torture, persecution).
lll) Separation from the family.
lV) The uncertainty caused by the prolonged period of time spent in Greece, the fear of expulsion and mass deportations to another country. All the suicide attempts reported in the media, speak of a protest against the conditions of detention and the threat of deportation (Chondros, 2016).
At state level, the General Secretariat for reception (of refugees) of the Ministry of Immigration issued for the period from April to September 2016 a project that includes 23 actions that have affected the legal and institutional framework, coordination, monitoring and assessment of the organizations involved - local, national and international - along with actions for the creation of infrastructures and alimentation.
Unfortunately, a large part of these actions have not been put into effect because of institutional, organizational and policy problems with the General Secretariat of the Policy for Migration. According to the ex-general minister who has resigned, the rate of absorption of the available funds was only 28%, while there were also problems in estimating the number of refugees in the country.


4. The insufficiency of the health services and social and mental health protection in Greece.


The management of the refugee problem in Greece takes place in the context of a deep economic, social and political crisis, to which is added the refusal of some European countries to share responsibility (ActionAid et al, 2016 Stylianidis, Chondros e Lavdas, 2016). In Greece, the percentage of people who claim that their medical needs are not covered has increased from 4% to 6% during the years of the crisis (between 2008 and 2011); it has reached 11% among those with lower incomes (OCSE, 2014). As regards the social protection system in Greece, we can observe the increase in unemployment passing from 10% in 2010 to 27% in 2014. In 2015, this rate reached 25,7%; the respective rates among young people aged between 15 and 24 years old was 52% (the highest in Europe). Public spending has fallen from 16.1 million in 2009 to 9.3 million in 2013 (UNHCR, 2016). 27.7% of the total population is without health insurance. It must be added that the long-term unemployed in Greece lose 96% of their gross income (compared to 49% in Portugal), this rate indicates a significant lack of support mechanisms.
The mental health system in Greece, according to the latest ex-post evaluation of Maudlsey International and CMT Prooptiki for the Ministry of Health, can be described as fragmented, inefficient, uncoordinated, without allocation of a system of responsibility (Ministry of Health, 2013; Loukidou et al, 2013).
The state budget for mental health has been cut by 45% in recent years. As for the use of services, only 32% among those who have presented a common mental disorder last year turned to a specialist. (Skapinakis et al., 2013). The number of new cases in non-public hospitals has risen by
39,8% with regard to children and 25,5% for adolescents. As a result, the waiting time for services for children and adolescents has tripled, reaching up to a year (Anagnostopoulos & Soumaki 2013). Finally, among the systems of 30 countries studied in a comparative research by the Economist Intelligence Unit, that examined 18 criteria for distribution in the following categories: i) Environment (provision of stable housing and existence of support for family life), ii) access to health services, iii) opportunities (employment and educational opportunities) iv) Administration (stigma reduction policies and public awareness), the greek system was ranked in the 28th place (Stylianidis, 2015).


5. Actions to support the mental health of refugees


These actions must be organized on three levels: local, national, interstate. It is possible to distinguish two aspects:
(i) first reception and response to urgent needs.
(II) actions for social integration.
As regards the first reception, we must emphasize the need to:
- Give initial aid on a psychological level. The "Babel" Day Centre for migrants has translated and already applies the guide of the WHO. Treatment is provided so far by a non-specialized staff, making training necessary.
- Clinical supervision and support to staff (professionals and/or volunteers) who welcome and take care of refugees, to reduce the frequent phenomena of burn-out caused by the exorbitant amount of work and the lack of necessary resources on the ground.
- Assessment of clinical needs with instruments that will be adapted, at a European level, to the emergency situation, so any medium and long-term action is prepared on the basis of the diagnosed needs. As for the evaluation of cultural factors, the contribution of specialists from the countries of origin of the refugees and the cooperation with the organizations of the hosting countries would be of decisive importance. (WHO, 2012).
- Ensure continuity of medical care. As part of a pilot project, a health card was created by a municipality. It is important that people who need medical care can continue to receive it even after their departure from Greece to other countries of destination.
- Develop models of crisis management, but also of the resulting situations, through collaboration between the organizations of the European countries, the organizations of the refugees' countries of origin and other bodies involved.
- Develop digital tools to support populations in movement (for example, access to information through Internet, support for depression or suicidal thoughts). Digital tools are sometimes the only means of keeping in touch with relatives (eg photos), but they can also pose a threat (possibility of localization of persecuted individuals, unreliable information from harmful sources). The transmission of reliable data, is not only fundamental for refugees, but it increases the effectiveness of organizations providing support operations (Akl e al., 2015).
For individuals whose period of stay is long:
- Training of non-specialized people (police, teachers, health workers, etc..) on issues related to social and cultural integration.
- Possibility of representation of refugee-users: participation in the development and implementation of measures for integration (Greek Council for Refugees, 2016).
- Actions to combat xenophobic rhetoric of hate and fear (information activities, cultural actions) in local communities, outside the host country of the refugees.
- Services designed for specific groups of the population, such as women and children, who are often victims of violence, on the basis of a management model of the cases and intervention teams (home interventions, flying squad) where there is experienced-based knowledge.
- Reintegration of children in the educational process since long-term absence can have serious consequences on their cognitive and socio-emotional development. (ActionAid et al, 2016).
- Actions for the integration of refugees into the labour market - as intended by Law No
4375/2016. The exploration of the skills of refugees can promote local solutions tailored to the specific conditions of each host municipality, as has been demonstrated through good examples (in Crete, for example).
- Actions for the support of volunteers, faced with significant challenges due to the high rate of migration (see, for example, New York Times, 17/08/2016).
In Greece, local and regional autorities can be crucial for the implementation of integration policies and respect for otherness. As the Department of the UN High Commissioner for Refugees pointed out, in Greece, (2012: 14) "A holistic approach to address the issue of migration requires, first, the recognition of the complexity of the issues involved and the acceptance of the fact that there are no quick and easy solutions. No single measure can constitute, in itself, a "solution". On the contrary, a whole series of complementary measures are required to address different aspects and different groups among the citizens of third countries according to their present situation."


6. In conclusion


This unprecedented situation for Europe and Greece should not be perceived by European policy makers as an exceptional state of emergency, but as a permanent situation which demands the development of a long-term political project together with technical tools and means made available to the countries, for the realization of this. In other words, we must "abrogate" the politics, the ideology and the culture of urgency, promoted by the European Commission.
As pointed out by Prof. D. Christopoulos, president of the International Federation for Human Rights, in a recent interview (25/01/2016), "We must rethink Greece on respect for human rights, the economic and the refugee crisis in its European context and the relevant politics pursued in the greek government. "It seems to us that the European Union uses Greek shortcomings as an excuse to load the country with more responsibility than it deserves." In particular, Christopoulos continues, "the European Union can not be proud of its performance with regard to the refugee crisis: the Member States have not said openly to the population that this crisis is not a "bad moment" of our recent history, but a situation that we must learn to live with."


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