Covid-19 pandemic and refugees, asylum seekers and migrants in Greece: a public-health necessity to prioritize their comprehensive care
Dear Editor
Douglas M. et al correctly suggest that refugees, asylum seekers and migrants are more vulnerable to epidemics.(1) Social distancing in overcrowded places where they commonly reside is in most cases impossible, while early detection of infected individuals is difficult due to the exclusion of these population groups from national health coverage schemes and healthcare services. Local outbreaks among displaced population groups living under these conditions are expected during epidemics, outbreaks that in many cases might go unchecked or even concealed.(2)
During the Covid-19 pandemic WHO, UNHCR and IOM have repeatedly recommended that national healthcare plans and disease surveillance systems should integrate all refugees/migrants. Concrete decongestion plans of camps or reception centers need to be prioritized, while most vulnerable displaced individuals need to be immediately released from places of detention and moved to safe accommodation.(2),(3)
In Greece more than 60,000 refugees and migrants reside in 36 reception centers and camps, most of which run beyond their capacity, overcrowded, lacking basic infrastructure and offering poor hygiene living conditions, ideal environments for the spreading of SARS-CoV2.4 Early calls from Civil Society Organisations for the immediate decongestion of these camps have remained unresponded to by the Greek authorities.(4)
From February 23rd (3 days before the onset of the Covid-19 epidemic in Greece) the operating epidemiological surveillance system in these 36 points of care for refugees/migrants has been interrupted and weekly disease reports are no longer publicized in the National Public Health Organisation’s website.(5)
From April 2nd to April 21st (6th to 9th week of the Covid-19 epidemic in Greece) three cases of local outbreaks in refugee camps and reception centers in Greek mainland have occured,(6) in all cases detection of Covid-19 clusters was accidental and late.
Planning and management of covid-19 cases in refugee/asylum seekers/migrant camps remains under the jurisdiction of the Greek Ministry of Migration and Asylum instead of the Ministry of Health. Early on, and lacking any evidence, refugees/migrants were stigmatized by government authorities as possible carriers of SARS-CoV2, increasing public hostility and paving the way for the ongoing operational plan, that foresees the preventive lockdown of all refugee/migrant camps in Greece and the onsite quarantine and self-isolation of any confirmed or suspected cases, offering limited only access to clinical services.
The early introduction of non-pharmaceutical interventions has successfully delayed and controlled the first wave of the Covid-19 epidemic for the time being in Greece.(6) Immediate decongestion of refugee camps, full integration of refugee care in the national healthcare plan, and effective epidemiological surveillance and contact tracing systems for the entire population (including displaced population groups) are public-health prerequisites for sustaining this success.
Declaration of conflicts of interest: all authors (EK, KP, AV, CP, AB) declare that have no conflicts of interest
References:
(1). Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ. 2020;m1557.
(2). World Health Organization. Interim guidance: preparedness, prevention and control of coronavirus disease (Covid-19) for refugees and migrants in non-camp settings. Geneva: World Health Organization; 17th April 2020.
(3). IFRC, IOM, UNHCR, WHO. Interim guidance: scaling-up Covid-19 outbreak readiness and response operations in humanitarian situations, including camps and camp-like settings. Version 1.1. Geneva: Inter-Agency Standing Committee (IASC) secretariat; 17th March 2020.
(4). Hargreaves S, Kumar BN, McKee M, Jones L, Veizis A. Europe’s migrant containment policies threaten the response to covid-19. BMJ. 2020;m1213.
(5). National Public Health Organization. Epidemiological surveillance in points of care for refugees/migrants weekly report: week 8/2020 (17/02 to 23/02). Athens: Ministry of Health; 2020.
(6). Kondilis E, Pantoularis I, Makridou E, Rotulo A, Seretis S, Benos A. Critical assessment of preparedness and policy responses to SARS-CoV2 pandemic: international and Greek experience. CEHP Report 2020.2. Thessaloniki: CEHP - Centre for Research and Education in Public Health, Health Policy and Primary Health Care; 2020. Available at https://www.healthpolicycenter.gr (accessed 10th May 2020)
Competing interests:
No competing interests
11 May 2020
Elias Kondilis
Associate Professor of Health Policy
Karl Puchner (Department of Medicine, National Kapodistrian University of Athens), Apostolos Veizis (Medical Operational Support Unit, Medecins Sans Frontieres) Christos Papatheodorou (Department of Social Policy, Panteion University) and Alexis Benos (Department of Medicine, Aristotle University of Thessaloniki)
Department of Medicine, Aristotle University of Thessaloniki
Aristotle University of Thessaloniki, P.O. Box 1689, P.C. 54006
Rapid Response:
Covid-19 pandemic and refugees, asylum seekers and migrants in Greece: a public-health necessity to prioritize their comprehensive care
Dear Editor
Douglas M. et al correctly suggest that refugees, asylum seekers and migrants are more vulnerable to epidemics.(1) Social distancing in overcrowded places where they commonly reside is in most cases impossible, while early detection of infected individuals is difficult due to the exclusion of these population groups from national health coverage schemes and healthcare services. Local outbreaks among displaced population groups living under these conditions are expected during epidemics, outbreaks that in many cases might go unchecked or even concealed.(2)
During the Covid-19 pandemic WHO, UNHCR and IOM have repeatedly recommended that national healthcare plans and disease surveillance systems should integrate all refugees/migrants. Concrete decongestion plans of camps or reception centers need to be prioritized, while most vulnerable displaced individuals need to be immediately released from places of detention and moved to safe accommodation.(2),(3)
In Greece more than 60,000 refugees and migrants reside in 36 reception centers and camps, most of which run beyond their capacity, overcrowded, lacking basic infrastructure and offering poor hygiene living conditions, ideal environments for the spreading of SARS-CoV2.4 Early calls from Civil Society Organisations for the immediate decongestion of these camps have remained unresponded to by the Greek authorities.(4)
From February 23rd (3 days before the onset of the Covid-19 epidemic in Greece) the operating epidemiological surveillance system in these 36 points of care for refugees/migrants has been interrupted and weekly disease reports are no longer publicized in the National Public Health Organisation’s website.(5)
From April 2nd to April 21st (6th to 9th week of the Covid-19 epidemic in Greece) three cases of local outbreaks in refugee camps and reception centers in Greek mainland have occured,(6) in all cases detection of Covid-19 clusters was accidental and late.
Planning and management of covid-19 cases in refugee/asylum seekers/migrant camps remains under the jurisdiction of the Greek Ministry of Migration and Asylum instead of the Ministry of Health. Early on, and lacking any evidence, refugees/migrants were stigmatized by government authorities as possible carriers of SARS-CoV2, increasing public hostility and paving the way for the ongoing operational plan, that foresees the preventive lockdown of all refugee/migrant camps in Greece and the onsite quarantine and self-isolation of any confirmed or suspected cases, offering limited only access to clinical services.
The early introduction of non-pharmaceutical interventions has successfully delayed and controlled the first wave of the Covid-19 epidemic for the time being in Greece.(6) Immediate decongestion of refugee camps, full integration of refugee care in the national healthcare plan, and effective epidemiological surveillance and contact tracing systems for the entire population (including displaced population groups) are public-health prerequisites for sustaining this success.
Declaration of conflicts of interest: all authors (EK, KP, AV, CP, AB) declare that have no conflicts of interest
References:
(1). Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ. 2020;m1557.
(2). World Health Organization. Interim guidance: preparedness, prevention and control of coronavirus disease (Covid-19) for refugees and migrants in non-camp settings. Geneva: World Health Organization; 17th April 2020.
(3). IFRC, IOM, UNHCR, WHO. Interim guidance: scaling-up Covid-19 outbreak readiness and response operations in humanitarian situations, including camps and camp-like settings. Version 1.1. Geneva: Inter-Agency Standing Committee (IASC) secretariat; 17th March 2020.
(4). Hargreaves S, Kumar BN, McKee M, Jones L, Veizis A. Europe’s migrant containment policies threaten the response to covid-19. BMJ. 2020;m1213.
(5). National Public Health Organization. Epidemiological surveillance in points of care for refugees/migrants weekly report: week 8/2020 (17/02 to 23/02). Athens: Ministry of Health; 2020.
(6). Kondilis E, Pantoularis I, Makridou E, Rotulo A, Seretis S, Benos A. Critical assessment of preparedness and policy responses to SARS-CoV2 pandemic: international and Greek experience. CEHP Report 2020.2. Thessaloniki: CEHP - Centre for Research and Education in Public Health, Health Policy and Primary Health Care; 2020. Available at https://www.healthpolicycenter.gr (accessed 10th May 2020)
Competing interests: No competing interests