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HUMAN RIGHTS WATCH
Pregnant Women, Others ‘At-Risk’ Lack Health Care, Support
(Athens) – Thousands of migrants and asylum seekers in northern Greece have been subject to appalling reception and detention conditions, with at-risk groups lacking necessary protection, Human Rights Watch said today. Greece has failed to ensure minimum standards for pregnant women, new mothers, and others arriving via the land-border with Turkey in the Evros region, many of whom are fleeing violence or repression in countries including Syria, Afghanistan, and Iraq.
HUMAN RIGHTS WATCH
Pregnant Women, Others ‘At-Risk’ Lack Health Care, Support
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Migrants that crossed the land border between Greece and Turkey are seen at the Pre-Removal Detention Center in the village of Fylakio, Northern Greece, February 24, 2017.
© 2017 Alexandros Avramidis /Reuters |
(Athens) – Thousands of migrants and asylum seekers in northern Greece have been subject to appalling reception and detention conditions, with at-risk groups lacking necessary protection, Human Rights Watch said today. Greece has failed to ensure minimum standards for pregnant women, new mothers, and others arriving via the land-border with Turkey in the Evros region, many of whom are fleeing violence or repression in countries including Syria, Afghanistan, and Iraq.
During visits to three government-run
centers holding asylum-seekers and migrants in May 2018, Human Rights Watch
found living conditions that do not meet international standards. All three
facilities lacked adequate access to health care, including mental health care,
and support for at-risk people, including women traveling alone, pregnant
women, new mothers, and survivors of sexual violence. The lack of interpreters
hindered essential communication. Asylum seekers and migrants said they did not
know why they were being held. Interviewees reported verbal abuse by police,
and two said they witnessed police physically abusing others.
“People told us they were being treated
so poorly in these facilities that they felt less than human,” said Hillary Margolis, women’s rights researcher at Human Rights Watch.
“Greece has a responsibility to uphold basic standards of care for everyone in
its custody, regardless of their immigration status.”
Human Rights Watch interviewed 49 asylum
seekers and migrants in the three facilities, as well as Greek authorities and
facility personnel. Conditions were especially poor at the Fylakio pre-removal
detention center, where Human Rights Watch researchers witnessed asylum seekers
being held in dark, dank cells, with overpowering odors in the corridors.
Female asylum seekers and migrants were being held with unrelated males at both
the pre-removal center and the reception and identification center at
Fylakio, where housing failed to meet
such basic standards as having toilets and locking doors. People working at
both centers in Fylakio confirmed in late July conditions remain the same. At
the time of Human Rights Watch’s visit to the Diavata open camp, asylum seekers
and migrant families were housed together in crowded rooms, and some in tents,
including pregnant women and new mothers.
A surge in arrivals over Greece’s
northern land border with Turkey in the spring of 2018, peaking in April,
slowed reception and identification procedures, leading to overcrowding and lengthier stays in
detention facilities. However, this does not absolve the Greek government of
obligations to uphold the rights of all asylum seekers and migrants, including
by providing decent living standards and health care.
Pending completion of reception and
identification procedures, Greek authorities hold newly arrived irregular
migrants and those seeking international protection in northern Greece in one
or more of the following facilities: border police stations in the Evros
region; the Fylakio pre-removal detention center, run by the Hellenic Police;
and the Fylakio reception and identification center, run by the Ministry for Migration Policy. Some
are then transferred to open camps, including the Diavata camp in Thessaloniki,
run by the Migration Policy Ministry, and others to accommodations supported by
the UN refugee agency. Some remain in detention pending examination of asylum
claims, deportation, or voluntary return.
Human Rights Watch wrote to the Hellenic
Police and the Migration Policy Ministry in June to seek comment on the findings.
The head of the Hellenic Police replied on July 4 acknowledging increased arrivals had
put pressure on facilities, but said conditions were improving. The Migration
Ministry had not responded at time of writing.
Government reception and identification procedures are supposed to include medical checks and screening
for vulnerable people including pregnant women and new mothers, people with
medical or mental health conditions, people with disabilities, and
unaccompanied or separated children. However, Human Rights Watch found these
procedures are not conducted systematically. Most asylum seekers and migrants
interviewed said they had not been screened by medical personnel or asked about
vulnerabilities, including pregnancy or health conditions.
Four pregnant women said they had not
been able to get adequate prenatal care even after requesting it. A 31-year-old
woman from Iraq who was four months pregnant said she had not been screened in
the four days since she had arrived at the reception center.
“I am very afraid because I don’t feel
the baby moving,” she said, adding that she had severe leg pain. Her husband,
40, said he had explained his wife’s situation to staff and requested a doctor.
“But there’s no doctor here,” he said. “They said we can see a doctor when we
go to Thessaloniki after release from the reception center.”
Asylum seekers and migrants said lack of
medical personnel, poor treatment by available personnel, long waits, and lack
of interpreters hindered access to physical and mental health care. The lack of
female doctors and interpreters creates additional barriers for women and
girls.
Ten people said police verbally abused
or otherwise mistreated them in the Fylakio centers. Three said police refer to
them as “malaka,”
a Greek insult meaning cowardly, worthless, or stupid. Two said they saw police
hit other asylum seekers with plastic batons. Human Rights Watch researchers
heard police at both facilities make derogatory comments about asylum seekers
and migrants and address them aggressively.
National and European law and international standards require treating asylum seekers and migrants
with dignity and providing them with decent living conditions, including timely
access to health care. Greek authorities should take immediate steps to ensure
migrant reception and detention facilities comply with international and
national law.
“A decent standard of living and humane
treatment for asylum seekers and migrants are not optional extras,” Margolis
said. “Regardless of the number of arrivals, the Greek government can’t shirk
its legal obligation to prevent abusive conditions and help those most
at-risk.”
Please note, all names of migrants and
asylum seekers have been changed to protect their privacy.
Accounts by Asylum Seekers, Migrants
Living Conditions
Human Rights Watch found substandard
conditions at all three facilities: the Fylakio pre-removal detention center,
the Fylakio reception and identification center, and the Diavata open camp in
Thessaloniki. Conditions at the Fylakio pre-removal detention center could amount
to inhuman and degrading treatment.
The surge of arrivals over northern
Greece’s land border with Turkey strained reception and identification
processing in the Evros region, but when Human Rights Watch visited in late
May, authorities said both centers in Fylakio were under capacity. On May 19,
authorities at the pre-removal detention center, with a capacity of 374, said
it was housing 172 people. On May 21, authorities at the reception and
identification center, which has a capacity of 240, said it was housing 196.
Diavata camp was housing over 1,000 people with an official capacity of around
900.
Nadir, 21, from Syria, said he and his
6-year-old niece were held at the pre-removal center for four days in a cell
with about 40 young men. “The toilet had no light and no running water,” he
said. “I was afraid for my family. There were people from other nationalities
[in the cell] – they were strangers…. We didn’t have any bedsheets or pillows.
There was a bed and a sponge mattress but no covers.… [W]e didn’t shower for
four days, and we used the sink to drink water…. The toilets had no locks; even
the walls between the toilets were not totally closed off.”
Muhammed, 18, from Afghanistan, said
police had not allowed him outside for two days, although international
standards require daily time outdoors. “Sometimes [the police] let us out in
the morning and in the afternoon, but sometimes we might not go out at all for
two to three days,” Muhammed said. “Last time I went out was two days ago, and
today they let us out only for five minutes in the corridor.”
Human Rights Watch interviewed 15 asylum
seekers in Diavata open camp, including three pregnant women. Four Afghan and
four Syrian families were housed on a building’s second floor in a large room
with broken windows, accessed via another room housing at least 10 additional
families. People slept on blankets on the floor, and the rooms were extremely
hot.
Others were housed in tents in open
areas, which authorities said was due to overcrowding following increased
arrivals. Some, including pregnant women and mothers with infants, said they
had been living in tents for up to 20 days. According to the latest available site management report, the population of Diavata reached nearly 1,500
in June, with 500 people accommodated in tents.
At all three facilities, women and girls
said they felt unsafe using toilets and showers, which are difficult to reach
and lack privacy. “There are four showers for all the women in this camp,” said
Farida, from Afghanistan, in Diavata. “If you go to take a shower at 9 a.m.,
your turn may come at 1 p.m. They’re far away and if you want to go there at
night, you can’t. For a woman to feel safe, a man needs to accompany her.”
Halah, 27, from Syria and seven months
pregnant, said distances to toilets posed particular difficulties for pregnant
women. The June site management report states the number of separate toilets
and showers for women are “insufficient.”
Rasha, 15, from Syria, had been in the
Fylakio reception and identification center with her 18-year-old sister for
three weeks, living in a pre-fabricated container in a fenced-in, enclosed
section with unrelated men and boys. “Our container is the only one with no
toilet,” she said. “We have to go inside a container with people I don’t know,
so I worry that someone can come inside and see me. There is no lock in the
bathroom. I don’t feel very safe here because many people come and go and there
are many boys.”
Human Rights Watch also documented inadequate
toilet and bathing facilities for women in cells with unrelated men at the
Fylakio pre-removal detention center, and women said they had been harassed
while using the facilities.
In the letter to Human Rights Watch,
Hellenic Police Director Georgios Kossioris said, due to strain on the
reception and identification center following the surge in asylum seekers and
migrants arriving over the Greece-Turkey border, authorities held some people
at the pre-removal center before completing reception and identification
proceedings. He said this was to meet basic needs for food, health care,
housing, and sanitation, even if gaps remained in meeting these needs. He also
said living conditions at the center had improved following a reduction in
arrivals and “measures taken,” but did not specify these measures.
Regardless of the number of arrivals,
the Greek government has a responsibility to comply with international, national and European law, and international standards for treatment and detention of asylum seekers
and migrants. They require a decent standard of living and necessary physical
and mental health care during completion of procedures. Authorities have an
obligation to inform those held in reception and identification facilities
about their status and circumstances in a language they understand.
The authorities are also obligated to
protect women and children and to identify and support people with
“vulnerabilities,” including pregnant women, new mothers, and sexual violence
survivors. The European Union should support Greece’s government in ensuring
humane treatment for all arrivals.
Identifying At-Risk People
Under Greek law, third country
nationals or stateless people who arrive irregularly should undergo procedures
in a reception and identification center, including medical screening and
identification of at-risk (“vulnerable”) people. This includes pregnant women
and new mothers, unaccompanied children, single parents with children, people
with disabilities, and victims of torture, rape, or other significant physical,
psychological, or sexual violence. Reception and identification center staff
should, by law, refer those identified as vulnerable to services and prioritize
them for asylum processes. Those needing medical care should be referred for
treatment.
When Human Rights Watch visited, no
doctor was on staff at the Fylakio reception center. Authorities there said
nurses screen new arrivals and border police often signal known vulnerabilities
to staff, but there appeared to be no systematic process for identifying
vulnerabilities. Many of the asylum seekers and migrants interviewed said they
had not seen medical personnel or been asked about potential vulnerabilities.
The nongovernmental organization Doctors Without Borders (Médecins Sans
Frontières, MSF) is reportedly considering providing some services provision at
the reception and identification center but would not be authorized to screen
for vulnerability. Greek policy requires screening by government agencies.
Human Rights Watch interviewed women
with recognizable vulnerabilities – including some who were obviously pregnant
or mothers of infants – who said they had not received any assistance. People
with hidden vulnerabilities, such as mental health conditions, psychosocial
disabilities, or who have experienced sexual violence are less likely to be
identified or assisted. The Ministry of Migration did not respond to a request
for information about vulnerability screening at the Fylakio reception and
identification center.
Staff at all stages – including in
border police stations and pre-removal centers – have a duty under Greek law to
ensure appropriate care for people with identifiable vulnerabilities, as well
as access to essential physical and mental health care and decent living
conditions. The deputy commander at the Fylakio pre-removal detention center
said staff give vulnerable people priority for transfer to the reception and
identification center, but both he and the doctor acknowledged not all arrivals
see medical staff or the psychologist.
Access to Medical Care
Asylum seekers and migrants at all three
facilities said they had difficulty getting medical and mental health care,
citing long waits, poor or no response by personnel, and a lack of
interpreters.
Nurses are at the reception and
identification center daily from 7:30 a.m. to 11:30 p.m., but, the deputy
commander and a nurse said, they cannot examine patients or provide medication
and must transfer people to facilities 30 to 45 minutes away for treatment.
They said the lack of an on-site doctor was a critical gap. “I can’t do
anything,” the nurse said. “I can’t give any medicine. People have to suffer
and wait.”
Maysa, 18, from Iraq, who had been at
the reception center with her husband and in-laws for close to three weeks,
said she sought medical care for her 8-month-old daughter. “Her mouth has
looked like it’s rotten and white for a week now,” she said. “Nobody took us to
the doctor. I asked, but the nurse brought cotton and chamomile tea to clean
the baby’s mouth – that’s the medicine she gave us.”
A male doctor is on-site weekdays at the
Fylakio pre-removal detention center. “Ideally, everyone should be examined,”
he said of new arrivals. However, he said he medically screens “most” new
arrivals and tries to identify serious cases for transfer to a hospital. The
doctor said he lacks necessary equipment and services, including medications
and interpreters.
Nurses are on-site daily at the Fylakio
pre-removal center, but the doctor said, as at the reception and identification
center, they cannot examine or treat patients without a doctor’s orders. When
an asylum seeker fell ill during the Human Rights Watch visit on a Sunday, a
nurse said she could only give emergency first aid. She did not approach,
touch, or communicate directly with the young woman, who had vomited,
complained of severe headache, and appeared too weak to sit up.
Eight people interviewed said they had
difficulty getting medical care at the pre-removal center.
Suha, 20, from Morocco, said she sought
help because she had not menstruated in two months. “It took five days of
begging the doctor [at the center] to go to the hospital,” she said. She said
that after a negative pregnancy test, the doctor gave her tablets he said would
induce her period. She said she had severe abdominal pain and vomiting after
taking them. “I was crying all night from the pain,” she said. “When I told the
doctor he just said to hold on – ‘in two days you will have your period.’”
Ten days later, she said her period had
not started and she had ongoing pain “like knives” in her abdomen, which led
her to cut her inner forearms with a broken mirror; she showed the interviewers
the scars. She said that when the doctor returned on Monday she would plead for
more tests to determine her condition.
Muhammed said he developed a skin
condition at the Fylakio pre-removal center but was unable to get treatment.
“I’ve asked to see a doctor, but [the police] curse at me,” he said. “I’m very
itchy during the night and I’ve asked many times to see a doctor, but they
haven’t allowed me to see one.” Six other people described itching or rashes
they believed were caused or exacerbated by unsanitary conditions in the
center.
People at Diavata, including pregnant
women, said they were often unable to get care. “There is still one doctor in
the whole camp,” said Bashira, 26, from Afghanistan, who gave birth to her
second son during her two years there. “You have to sit waiting from morning to
night to see the doctor.”
Authorities, medical personnel, and
asylum seekers and migrants said a lack of female doctors creates additional
barriers for women. “Most of the doctors are men,” said Bashira. “It is hard
[for a woman] to tell them how you are feeling.”
The reply from the Hellenic Police
director states “primary health care is provided for everyone without
exceptions” at the pre-removal center, including necessary medical care and
referrals to hospitals or other appropriate facilities. The Ministry of
Migration did not respond to Human Rights Watch regarding provision of health
care at the RIC and at Diavata camp.
Access to Psychological Support
Many of the asylum seekers and migrants
interviewed said they were experiencing symptoms of emotional or psychological
distress but had not received psychosocial support.
No psychological support was available
on-site at the reception and identification center when Human Rights Watch
visited. People requiring mental health care were being referred to a medical
center about 20 minutes away by car. A nurse at the center said the wait for an
appointment is usually about a week. A Greek nongovernmental organization has
since reportedly begun providing psychosocial and legal support, as well as
recreational activities, for children, giving priority to unaccompanied
children. However, no on-site psychosocial support is available for adults.
The nurse and deputy commander at the
reception and identification center said it needs an on-site mental health care
specialist. Eight asylum seekers and migrants interviewed there said they or a
family member were experiencing symptoms such as sleeplessness, anxiety, crying
bouts, and hair loss.
Suraya, in her twenties (nationality withheld),
had been there for five months. She said she did not receive help she requested
after another asylum seeker sexually assaulted her. “I’m losing my hair and I
want to see a doctor,” Suraya said. “From the very first month [here] I asked
for a psychologist, but they never brought one.”
Nadir, at the center with his 6-year-old
niece, Abra, said they both have skin conditions and Abra is unable to sleep or
eat. When asked whether she had received psychological support, Nadir said, “We
haven’t even seen a doctor for our skin. I don’t think we’ll see a
psychologist.”
Lack of information and interpreters
means detainees are sometimes unaware of available care. Staff said a
psychologist and a social worker are at the Fylakio pre-removal center on
weekdays, but only two of six people who described experiencing psychological
distress said they were offered assistance. Muhammed had been at the
pre-removal center for 26 days. “I’m not well psychologically,” he said. “My
thoughts are confused. Everything I’ve been through makes me suffer.” He did
not know the facility had a psychologist or social worker.
The reply from the Hellenic Police
director said medical care provided includes “necessary health care and
psychosocial diagnosis and support.”
Human Rights Watch previously reported on
confinement of women and girls with unknown men at the Fylakio centers, which
they said caused or contributed to their psychological and emotional distress,
including sleeplessness, anxiety, inability to eat, and crying. Two women at
the pre-removal detention center said they had suicidal thoughts.
Pregnant Women and New Mothers
Human Rights Watch interviewed three
pregnant women at Diavata camp, one who had given birth there and one with an
infant, and two pregnant women and one with an infant at the reception and
identification center.
International standards on detention of asylum seekers, migrants, and
refugees state: “as a
general rule, pregnant women and nursing mothers, who both have special needs,
should not be detained,” and alternative measures should be sought. International guidelines on detention of women also call for
“gender-specific health care,” and for providing pregnant and lactating women
with appropriate health and dietary support. Emergency obstetric and newborn
care should be accessible in humanitarian crises, in line with international standards.
Greek law calls for reception and
identification procedures to screen for and give priority to vulnerable people,
including pregnant women and new mothers. Farah, 31, from Iraq and four months
pregnant, said she had been unable to see a doctor at either of the centers in
the Fylakio center. “I asked them to provide me with a doctor, but they said,
‘When you go to the reception and identification center, you will find one,’”
she said. “[At the reception center] they said the doctor is coming, but he never
showed up.”
Leila, 24, from Syria and seven months
pregnant, had been at Diavata camp for four weeks with her husband and
2-year-old son. “Sometimes I feel like my stomach is tough and hard,” she said.
“I desperately need to go to the doctor to see how my baby is, but the doctor
here said, ‘When you move to another camp, you’ll see a doctor there.’”
Leila and another pregnant woman at
Diavata said a doctor checked their babies’ heartbeats but did not perform an
ultrasound or explain why not. World Health Organization guidelines call for an
ultrasound during the first 24 weeks of pregnancy to determine gestational age,
and to aid in identifying and managing higher-risk pregnancies.
Pregnant and lactating women at Diavata
also said they did not have adequate living conditions. Amina, 23, from Syria
and six months pregnant, had been there for 20 days with her husband, parents,
and 18-month-old son. “We are living in a tent and it’s raining all the time,”
she said. “Whatever we can find – blankets and so forth – we sleep on. We have
been asking various organizations [working in the camp] to help us but they
say, ‘There are many pregnant women here, so you have to wait.’”
A woman from Syria had been living in a
tent at Diavata for about 10 days with her husband and infant, who was less
than two months old. Another woman who had given birth to her 11-month-old son
at Diavata said she lived in a tent through her sixth month of pregnancy.
International humanitarian standards
call for providing vulnerable people, including pregnant and lactating women,
with additional bedding and clothing, as well as food or nutritional supplements in line with their needs.
Lack of Interpreters and Training
Even when care is available, lack of
interpreters hinders access. There were no interpreters at the Fylakio
pre-removal center at the time of Human Rights Watch’s visit. The deputy
commander there said a Health Ministry program should provide interpreters, but
the positions are considered undesirable and are difficult to fill. “At the
moment we don’t have any interpreters and we are figuring it out with other
detainees,” he said. “The lack of interpreters is a problem, especially with
increased arrivals.” Someone working at the center said one Arabic interpreter
has recently been employed there.
Abdullah, 21, from Afghanistan, said he
had seen the doctor at the pre-removal center several times for a rash and a
throat problem. “The doctor sometimes uses one of the other detainees as an
interpreter, and other times I try to communicate with signs [hand gestures]
when there’s no interpreter,” he said.
Authorities at the reception and
identification center said they have five interpreters funded by the European
Asylum Support Office and the Dutch government, but this does not meet the
facility’s needs, leaving staff to rely on other asylum seekers for
translation. “If [an asylum seeker or migrant] speaks English, we can
understand some things,” said the nurse there. “Otherwise we try to get an
interpreter, or else we use someone else living in [the asylum seeker’s or
migrant’s] section.” She said interpreters are often unavailable or not on-site
when nurses need them.
Suraya said the lack of female
interpreters compounds the problem for women and girls. “[People who speak with
us at the reception and identification center] usually don't have an
interpreter,” she said. “And even if you talk to them about a confidential
women’s issue, the interpreter will be a man.” Samira, 18, from Syria, at the
center for three weeks with her 15-year-old sister, said she had to use hand
gestures to communicate she had her period and needed sanitary pads. “There was
no interpreter, so I used sign language with the [medical staff],” she said.
Relying on other asylum seekers or
migrants to interpret can compromise the quality of information transmitted,
and violates privacy and confidentiality standards for medical and mental
health care provision and for registration, identification, and processing of
asylum seekers and migrants. Lack of trained interpreters – including women –
can also hinder identification of survivors of sexual and gender-based
violence, torture, or other abuse.
Detainees who were or had previously
been held at the pre-removal center said their distress was compounded by a
lack of information and communication about why they were being held and the
status of their asylum process.
The reply from the Hellenic Police
director said all detainees are “systematically informed” about reasons for
their detention and their rights, including their right to contact representatives
from external organizations. He said “relevant brochures have been posted in
prominent spots” and detainees are given “information sheets,” but did not
specify languages in which such documents are available.
Health professionals interviewed at both
Fylakio centers said they had no specialized training in working with asylum
seekers and migrants or in detention facilities, and sometimes no prior related
experience. International standards call for all staff working in immigration
detention to be trained in identifying symptoms of trauma or stress, as well as
on sexual and gender-based violence, human rights requirements, and standards for
detaining asylum seekers. The reply from the Hellenic Police director said the
Health Ministry is now responsible for providing doctors, nurses, psychosocial
support staff, and interpreters to facilities for migrants and asylum seekers.
Abuse and Mistreatment by Police
Ten asylum seekers and migrants said
police at the Fylakio pre-removal detention center and reception and
identification center mistreated them, including through verbal abuse,
humiliation, and violation of privacy. Two said they witnessed police hit other
people being held in the facilities.
People interviewed at both sites said
police used derogatory terms and shouted and laughed at them. “Police call us ‘malaka,’” said Fatima, 24,
from Algeria, about the pre-removal center. People in the reception and
identification center said police there used the same insult. “One thing they
always say is ‘malaka,’”
said Suraya. She also said she witnessed police at the reception center beat
children twice, once in front of her 9-year-old nephew. “My nephew was in front
of the police when they beat the kids with kicks, slaps, and plastic batons,”
she said.
Muhammed, from Afghanistan, said he had
seen police at the pre-removal center hit detainees with plastic batons the
previous day. He also said police treated asylum seekers and migrants of
differently according to nationality. “Policemen are nice to Turks and Syrians,
but not to Pakistanis and Afghans,” he said.
Four asylum seekers, including a woman,
a girl, and two men with young nieces, said police at the reception and
identification center regularly entered their containers unannounced. “The
doors [to the containers and rooms] don’t lock,” said Nadir at the reception
center with his 6-year-old niece. “Every night the police just come in to count
us.”
The reply from the Hellenic Police
director said his office has received no complaints of mistreatment by police
and requested details of incidents reported to Human Rights Watch. The reply
said authorities have “zero tolerance for human rights abuses” and impose
“severe disciplinary sanctions” on those who fail to adhere to orders to
protect life, respect human dignity, and prohibit torture, inhuman or degrading
treatment.
International rights bodies have criticized Greece in
the past for failing to address allegations of police abuse and have called for
complaints mechanisms to investigate abuse allegations. Under the European
Convention on Human Rights, the UN Convention against Torture, the EU Charter
on Fundamental Rights, and other treaties to which Greece is a party, the
government is bound by the absolute prohibition on torture and inhuman and
degrading treatment, including in detention and reception facilities.
27/7/2018
