Dr Laura Clapham / ACCS CT1 / North Wales
Dr Laura Clapham shares her experiences and reflects on the challenges of working in Moria Refugee Camp. People continue to make a treacherous journey across the Mediterranean Sea and Laura highlights considerations for those interested in volunteering along with the agencies who are active today.
Moria Refugee Camp is situated on the Greek island of Lesvos, just five miles off the coast of Turkey. It was Europe’s largest refugee camp until it was destroyed by a huge fire in September 2020. It has now been replaced by “Moria 2.0”, called Mavrovouni, built next to the sea on a disused military shooting range.
During my “F5” year, I spent five weeks from November to December 2019 volunteering in a medical clinic with the Dutch NGO, Boat Refugee Foundation(BRF). In that short time, the number of residents grew from 14,700 to over 17,000, including 1,100 unaccompanied minors, in a camp designed for 3,000. The vast majority came from Afghanistan and others from Syria, Iran, Iraq, Cameroon, Congo, Somalia and Eritrea.
BRF was established in 2015 in response to the European migrant crisis and the reports of people dying daily in the Mediterranean Sea. The two arms of their mission are emergency medical care and psychosocial support. Since the fire, they have re-situated the medical clinic inside a large container on the back of a lorry.
Day to day in Moria
Whilst I was there, the medical clinic consisted of a prefabricated box (similar to a shipping container) and a caged area, situated next to the camp police station and registration centre. The police were often called upon to break up fights, especially if there were patients from different gangs in the clinic at the same time. During the day, Kitrinos Healthcare ran a clinic from 8am until 4pm, staffed by GPs focusing primarily on chronic conditions. From 4pm until midnight, BRF ran a clinic offering acute and emergency care with a small team of doctors, nurses, psychologists, translators and support crew . Other medical actors in the camp included Médecins Sans Frontières (paediatric, antenatal and psychiatric clinics), Rowing Together (Obstetrics and Gynaecology) and occasionally a dentist and optometrist.
We saw between 150 and 220 patients per shift in the four consultation spaces, three triage areas and a dressings area. Ages ranged from infants to late 60s and I was impressed by both the physical and mental resilience of those I encountered. I often met older people who had severe osteoarthritis of hips and knees and yet still managed to hike through mountain ranges to reach safety. A consultation with a 19-year-old woman particularly stands out. She arrived with her 17-day-old baby who had been born in Turkey on the journey from Somalia. Despite the obvious difficulties of bringing a newborn into this harsh environment, it was heartwarming to see her cooing over her baby, just as any adoring mother would do.
Limitations
Although patients presented with all manner of complaints, including emergencies, the clinic had limited resources. Oral medications for most primary care complaints and minor injuries were available along with a small, select pharmacy of acute intravenous and intramuscular medications. There were two crash bags and an automated external defibrillator, cylinders of oxygen, a nebuliser, an ECG machine, and a basic ultrasound. However, perhaps unsurprisingly, at times it felt like the most useful items were the huge bags of salt and sugar used to prepare oral rehydration solution for gastroenteritis, as well as a large pot of honey to decant into smaller pots to soothe sore throats for the colloquially-termed “Moria flu”.
Common presentations
Common minor problems were coughs and colds (pre-COVID-19), gastroenteritis, fevers, scabies, lice, wound infections and miscarriages. The cases which had the biggest impact on me were patients with psychological presentations – panic attacks and conversion disorder – and trauma patients with injuries from fights in the camp.
Every person I treated had experienced trauma of some kind, having fled their country in fear for their lives. This trauma was compounded not only by a distressing journey from their home country, but also by the appalling conditions in the camp: inadequate shelter, food, warmth, running water or sanitation. Parents brought in their children with night terrors, mutism or developmental regression. Panic attacks were common and sometimes extreme. They would manifest in all sorts of ways. Some patients presented in a seizure-like state, others with stroke symptoms or dissociation (conversion disorder). I learned a little from the psychologists trained in trauma techniques about ways to help bring the patients out of re-experiencing and into the present moment through engaging their senses. We used ice blocks, elastic bands and the scent of hand sanitiser.
Stabbings from gang violence were frequent and would often occur in clusters. One of the most memorable examples was treating a 19-year-old man from Afghanistan. When I was called to help, I remember thinking that he was within minutes of dying. His eyes were glazed, his oxygen saturations were 72% on air and his systolic blood pressure was 80mmHg. He had subcutaneous emphysema on his back surrounding the stab wound, and no breath sounds on one side. My hands were shaking as I inserted a cannula to decompress a suspected tension pneumothorax. Upon hearing a ‘hiss’ I sucked out air through a 50mL syringe. Remarkably, his saturations recovered to 97% on oxygen, and blood pressure normalised. As we carried him on a stretcher to the ambulance, he was talking and almost chuckling through his oxygen mask. Sadly I never saw this patient again; I sincerely hope that he received his chest drain in hospital and made a full recovery.
On reflection, if the kit had been available, this man should have had a thoracostomy. NICE guidelines for ‘Major Trauma in the Pre-hospital Setting’ (current at the time of publication) are to “use open thoracostomy instead of needle decompression if the expertise is available, followed by a chest drain via the thoracostomy in patients who are breathing spontaneously.” This example highlights the difference between practising pre-hospital emergency medicine in a low-resource setting to an Emergency Department with the appropriate expertise, equipment, and ongoing care.
Personal Reflection
I learned a huge amount in the short time I volunteered in Moria. My skills as a doctor were challenged and honed. I became more adept at distinguishing epileptic from non-epileptic seizures, suturing, recognising sick neonates, and using skills learnt for psychological first aid. Non-technical skills were also essential when communicating with the police, paramedics and other NGOs, who came together as teams speaking different languages and from different cultures. I loved working and becoming friends with the translators; all of them refugees themselves with their own harrowing narratives to tell. Their dedication to the role was truly admirable.
I have heard so many refugees recount what drove their perilous journeys to such a difficult place as Moria, and I am left with a deep and enduring conviction that, had the lottery of our birthplaces been drawn differently, I could easily have been in their position and they in mine.
For those considering work within European refugee camps
Things to consider before applying:
What are your skills/specialty?
Have you had prior experience in a low-resource setting?
Can you safely operate relatively independently or with indirect supervision?
How much time can you give? It can take a while to settle in and learn the ropes.
Where is your time and money best focused?
What are your own motivations for going?
How is your own support network and own mental health? Will you need to schedule in time afterwards to decompress and reflect? Do you have a strong support network at home with whom you could discuss what you have experienced and how you have been affected?
Further reading and up to date information:
‘The New Odyssey’ – Patrick Kingsley
An insightful and emotive read whereby Kingsley, The Guardian’s former Migration Correspondent, alternates chapters between a factual chronology of where and why the European migrant crisis began with one man’s harrowing story of his journey across Europe looking for safety and security.
‘The Aegean Boat Report’
An official social media account ‘on the ground’ tracking and publishing accurate data on the migrant arrivals, pushbacks, and illegal deportations on the Greek islands.
‘A Doctor’s story: Inside the living hell of Moria refugee camp’
Published in the Guardian in 2020 – another medical report of time spent volunteering in Lesvos.
‘Choose Love’
An international charity providing a reliable and sustainable platform to donate to help refugees worldwide.
‘Lawlessness at the border mars Greece’s reputation over migration’
A recent publication in Aljazeera describes the current policy and politics towards refugees arriving in Greece.
‘Border violence.eu’
Border Violence Monitoring Network (BVMN) is an independent network of NGOs and associations that monitors human rights violations at the external borders of the European Union. They list the NGOs working in each border region and advocate to stop violence to people on the move.
Medical actors on Lesvos
Boat Refugee Foundation
BRF were a really positive NGO to volunteer with. They fostered teamwork and strong morale, were supportive and incredibly organised. Within Lesvos they provide emergency medical care from 1700-0000 every day.
BRF are in the process of setting up a clinic on the border of Ukraine and are always looking for both medical and non-medical volunteers.
Kitrinos
A Greek NGO providing acute care from 0000-0800 every night.
Medical Volunteers International
A German NGO providing acute and chronic care from 0800-1700 every day.
Medecins Sans Frontieres
An international organisation providing paediatric and specialist obstetric care in Lesvos. They also work on other Greek Islands.
Crisis Management Association
Set up in response to the fires in September 2020, CMA coordinates and provides healthcare in Mavrovouni.
Seeds of Humanity (Dentists for All)
Palestinian organisation who work in Athens, providing healthcare and education, and in Lesvos providing healthcare, specifically dentistry.
Non-medical NGOs on the Greek Islands
One Happy Family (Lesvos)
A vibrant community centre offering a safe, pleasant space for refugees – opportunities to play sport, use computers, enjoy the cafe, repair items and mend bikes, garden, etc.
Movement on the Ground
NGO focusing on making the refugee camp/reception centre safe through infrastructure support (building, sanitation, etc.) and supporting unaccompanied minors.
Still I rise (Samos)
An educational centre “Mazi” for refugee children aged 11-17 years.
Better Days (Lesvos)
A multi-faceted organisation providing education, legal aid, sports, gardening, and support for unaccompanied minors.
Because We Carry
Dutch NGO in Lesvos providing support and food to refugees, particularly mothers and families.
Attika Human Support
Distribution centre in Lesvos and Athens providing essential items.
Fenix Aid (Lesvos)
Holistic legal aid, including advocacy and mental health support.
Update on the situation – March 2022
There are currently 3,000 residents in Mavrovouni and the clinic now sees mainly acute healthcare complaints and psychological problems. The pandemic has meant that more refugees have been transferred to the mainland to reduce some of the pressure on island healthcare systems. While BRF’s mission in Lesvos is now much smaller than it once was, BRF are looking at supporting similar work in Samos (a neighbouring Greek island) in the coming months and still require medical support to run their clinics.
