ASSESSMENT REPORT: The Health Situation at EU Southern Borders - Migrant Health, Occupational Health, and Public Health GREECE Field work 6–15 November 2013 The information and views set out in this report are those of the author and do not necessarily reflect an official opinion of the EC or IOM. Neither they nor any person acting on their behalf may be therefore held responsible for any use of the information contained therein. Reproduction is authorized provided the source is acknowledged. This document is based on the Assessment undertaken by the International Organization for Migration (IOM) within the framework of the project “Fostering health provision for migrants, the Roma and other vulnerable groups” (Equi-Health). The Equi-Health project is co-financed under the 2012 work plan, within the second programme of Community action in the field of health (2008– 2013), by a direct grant awarded to IOM from the European Commission’s DG for Health and Food Safety (SANTE), through the Consumers, Health, Agriculture and Food Executive Agency (Chafea). The Equi-Health project is designed and managed by the International Organization for Migration Regional Office Brussels, Migration Health Division (MHD). The methodology of the field work and analysis, based on the prior Increasing Public Health Safety alongside the New Eastern European Border Line project (PHBLM) EC co-funded IOM project experience, was developed by IOM with additional support from the Andalusian School of Public Health (EASP). The Assessment Report was drafted under IOM MHD, RO Brussels guidance by Dr. Chrisoula Botsi and Panayiotis Damaskos, and benefitted from peer reviews by Marina Rota and an anonymous reviewer. It was edited and consecutively revised and complemented by Marina Rota, Mariya Samuilova, Isabelle Beauclercq and Alexandra Bousiou. We thank DJ Krastev for his copy-editing, proofreading, and general editing assistance. IOM is grateful to local and project implementation partners involved during the field visit as well as in the National Consultative Committees (held in July 2013 and November 2014), for their personal and technical support. In particular we thank staff and representatives of: Ministry of Public Order and Citizen Protection, Hellenic Centre for Diseases Control and Prevention, Ministry of Labour, Social Insurance Welfare, National Centre for Health Operations, Ministry of Health, Council of Europe, Ministry of Interior, Municipality of Lesvos, Prefecture of East Macedonia and Thrace, Prefecture of North Aegean Region, Hellenic Coast Guard, FRONTEX, Act up Hellas, NGO Agkalia, Pakistani Hellenic Cultural Welfare Society, Doctors of the World (MDM), Red Cross, Doctors without Borders (MSF), the North Aegean Centre for Social Welfare, NGO Siniparksi kai Epikinwnia sto Aigaio, NGO Arsis, Praksis Policlinic, NGO Metadrasi, Association for Repatriated and Migrants Argo, Sotiria hospital for chest diseases (Athens) Children’s hospital Agia Sofia (Athens), Vostaneion general hospital (Lesvos), general hospital of Alexandroupolis. IOM would also like to convey thanks to the Greek Ministry of Public Order and Citizen Protection; for providing allowing access to the detention centres, as well as to the Greek Ministry of Health for the authorization to visit the hospitals mentioned in this report. We are grateful to the NGOs, local authorities and all stakeholders consulted during the field trip for their time and support during the assessment. A particular vote of thanks is due to national and international team members who carried out the field visits with great enthusiasm and professionalism, and who provided valuable insights in the process: Dr Chrisoula Botsi, Panayiotis Damaskos, and Marina Rota (national experts); Marcus Jaeger and Lucas Ritter (Council of Europe); Dr Silvia Bino (Institute of Public Health – Tirana, Albania); and IOM MHD team Roumyana Benedict, Mariya Samuilova, and Milen Petrov. The assessment would not have been possible without the support and efforts of IOM Athens and especially Andromachi Lazaridi, Kelly Namia, and Rena Simopoulou, who took care of all the logistical details surrounding the field visit and organization of multiple meetings in Greece. 1 CONTENTS ACRONYMS ................................................................................................................................ 4 EXECUTIVE SUMMARY ............................................................................................................... 5 1. INTRODUCTION .................................................................................................................... 10 2. BACKGROUND INFORMATION .............................................................................................. 12 2.1. Irregular migration to Greece ..................................................................................................... 13 2.2. Regularization programmes ........................................................................................................ 14 2.3. Number of asylum applications and main countries of origin.................................................... 15 3. METHODOLOGY ................................................................................................................... 17 3.1. Overview of data collection ........................................................................................................ 17 3.2. Limitations ................................................................................................................................... 18 4. FIELD WORK ......................................................................................................................... 22 I. POLICY AND LEGAL FRAMEWORK .......................................................................................... 22 I.I International, EU, and national/local legislative framework on interception/reception/rescue at sea/green border ............................................................ 22 I.II Legislative and financial framework of open/closed centres ........................................... 23 I.III Entitlements to health care; health service provisions ................................................... 27 I.IV Discussion Section – I .................................................................................................... 31 II. PARTNERSHIPS, NETWORKS AND MULTI-COUNTRY FRAMEWORKS ....................................... 34 II.I Description of the reception process and coordination ................................................... 34 II.II Public health in border communities ............................................................................. 38 II.III Discussion Section – II .................................................................................................. 40 III. MONITORING MIGRANT HEALTH ......................................................................................... 42 III.I Migrant health .............................................................................................................. 42 III.II Provision of health care and social services .................................................................. 43 III.III Data collection ............................................................................................................ 50 III.IV Discussion Section – III ................................................................................................ 53 IV. MIGRANT-SENSITIVE HEALTH SYSTEM ................................................................................. 55 IV.I Infrastructure and physical conditions .......................................................................... 55 IV.II Occupational health of staff ......................................................................................... 62 IV.III Health knowledge, attitudes, and practices ................................................................. 64 IV.IV Discussion Section – IV ............................................................................................... 68 5. CONCLUSIONS AND RECOMMENDATIONS ............................................................................ 70 2 V.I Conclusions ......................................................................................................................... 70 V.II Recommendations ............................................................................................................. 71 REFERENCES ............................................................................................................................. 75 ANNEXES.................................................................................................................................. 80 3 ACRONYMS ART Antiretroviral Therapy CPT European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment ECDC European Centre for Disease Prevention and Control EWRS Early Warning Response System FRA Fundamental Rights Agency FRC First Reception Centre GG Government Gazette HCDCP Hellenic Centre for Diseases Control and Prevention HIV Human Immunodeficiency Virus IDU Intravenous Drug User IHR International Health Regulations MDM Médecins Du Monde (Doctors of the World) MED IN MEDical Intervention (Greek NGO) MDR TB Multidrug resistant Tuberculosis MoH Ministry of Health MSF Médecins Sans Frontières (Doctors without Borders) NaHOC National Health Operations Centre NGO Non-Governmental Organization NHS National Health System RABIT Rapid