The Cruelty Of Containment

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The Cruelty ofContainmentThe Mental Health Toll of the EU’s‘Hotspot’ Approach on the Greek IslandsInternational Rescue Committee December 2020

2The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek IslandsContentsExecutive summary3Introduction4Report methodology6Section 1: A damaging context for mental health:humanitarian, political and COVID-19a) Steadily worsening humanitarian situation on Greek Islands7b) Deteriorating political environment9c) Perfect storm: Impact of the COVID-19 pandemic10Section 2: The severe toll of containment policieson people’s mental healtha) The IRC mental health and psychosocial support programme:data and findings12b) Impact of gaps in access to medical services,particularly mental healthcare17c) Impact of gaps in access to protection, essential servicesand an effective asylum systemi) Unsafe past: Lack of protection19ii) Undignified present: Basic needs unmet21iii) Uncertain futures: Lack of information, legal supportand early integration22Section 3: The EU’s new Pact on Migration and AsylumPreventing past mistakes to guarantee a fresh start25a) New pre-screening and border procedures: the need to guaranteesafeguards and a fair process26b) No more Morias? The need for dignified reception conditions27c) A fresh start: The need for meaningful solidarityand s31References34AcknowledgementsWritten by Martha Roussou and NiamhNic Carthaigh, with special thanks toVictor Beaume.With thanks also to Dimitra Kalogeropoulou,Georgia Karoutzou, Georgia Berlemi,Dimitra Mantzari, Kiki Michailidou, GiorgosPapadimitriou, Dukas Protogiros, Irini Serafim,Beth Farmer, Lena Donner and ImogenSudbery and all the IRC mental healthprogramme staff on Lesvos, Chios & Samos.Particular thanks in addition to the peopleattending IRC mental health services whoshared their stories and experiences withus. Also thanks to the local and centralgovernment representatives, governmentaland intergovernmental agencies’ officials andthe numerous medical, legal and protectionNGOs working on the ground, who agreedto be interviewed for this report.Illustrations by Jocie Juritz/IRC.

The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek IslandsExecutive summaryAlmost five years on from the establishment of fiveEU-funded Reception and Identification Centres(RICs) or ‘hotspots’1 on the Greek islands, nearly15,000 people2 remain stranded in these camps.Having survived harrowing journeys to Europe, theyfind themselves trapped in dangerous, overcrowded andinhumane living conditions for months, and many for aslong as two years. People who came in search of safetyare instead further traumatised by their present andanxious about their future.In September 2018, the International Rescue Committee(IRC) published ‘Unprotected, Unsupported, Uncertain’.3This report detailed the shortcomings at the heart of theEU’s asylum and migration policies and their detrimentalimpact on the mental health of asylum-seekers living inMoria camp on the Greek island of Lesvos. Two years later,this new IRC report finds that the situation has worsenedsignificantly. It draws on fresh data spanning two anda half years to October 2020. The data was collectedfrom 904 people supported by the IRC’s mental healthprogrammes on the islands of Lesvos, Chios and Samos,and is backed up by testimonies and interviews. This reportsets out proposals for immediate action to improve the direconditions they endure.The IRC’s research reveals consistent accounts of severemental health conditions, including depression, posttraumatic stress disorder (PTSD) and self-harm amongpeople of all ages and backgrounds. As many as threeout of four of the people the IRC has assisted throughits mental health programme on the three islandsreported experiencing symptoms such as sleepingproblems, depression and anxiety. At least two out offive people reported symptoms of PTSD and nearly onein ten had psychotic symptoms and were self-harming.One in three people reported suicidal thoughts, while onein five reported having made attempts to take their lives.The research demonstrates how the onset of theCOVID-19 pandemic further exacerbated the sufferingof already vulnerable asylum-seekers and exposed themany flaws in Europe’s asylum and reception system. Thedata reveals a marked deterioration in the mental healthof people in the camps following the initial COVID-19lockdown measures and movement restrictions, whichwere stricter than those applied to the rest of thepopulation in Greece. There was an alarming spike inthe number of people who disclosed psychotic symptoms,jumping from one in seven (14%) to almost one in four(24%). There was also a sharp rise in people reportingsymptoms of PTSD, which climbed from close to halfI’ve never lived this type of life because imagine, you sleepoutside in tents, with rats. It was very difficult.”Baimba, 24-year old man from Sierra Leone.VIAL camp, Chios island, Greece. October 2020.3

4The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek Islands(47%) of people beforehand to almost two in threepeople (63%) and in disclosures of self-harm, whichjumped by 66%.At the roots of this crisis are longstanding and unresolvedpolitical and policy failures at both the Greek and EUlevels. EU member states’ inability to agree on a fairsystem of shared responsibility has been compounded bythe prioritisation of deterrence and border control aboveupholding the right to seek asylum and the human rights,dignity and wellbeing of those in search of protection.Policies of containment put in place to implement theEU-Turkey Statement, coupled with persistent gaps in theGreek state response to provide adequate reception andaccommodation and effectively process asylum claims,are clearly harming asylum-seekers arriving at Greekshores.4 This approach is also taking a serioustoll on local communities. Increasingly frustrated withthe deteriorating situation on their islands, people oncehailed for their warm welcome and support, have begunto target those seeking asylum and those who assistthem, often actively encouraged by far-right activists.5Urgent action is required. After several years of deadlock,the forthcoming negotiations following the publicationof the EU’s Pact on Asylum and Migration are Europe’slast window of opportunity to put in place a fair andsustainable system that works in the interests of bothnew arrivals and local communities. Announcing the Pact,Commission President Von der Leyen pledged to achievea balance between solidarity and responsibility and toensure that Europe manages migration in a humaneand effective way. There is some way to go to makethis a reality.The Pact includes some positive steps forward, butthere are also elements that risk taking us in the oppositedirection. New screening procedures before an asylumclaim can be lodged could mean longer waiting times forpeople at processing centres, while increased groundsfor detention could allow such centres to becomeclosed camps. There continues to be a strong focuson preventing people from arriving in Europe throughirregular channels, but very little on establishing safe andlegal pathways. Critically, the absence of an automaticrelocation mechanism means large numbers of peoplewill continue to be trapped in Greece. The currentconstruction of new compounds on the Greek islandsin partnership with the EU, coupled with the proposalsabove, all suggest a continuation of the current containmentmodel. Indeed, mandatory border screening could meanmore camps on Europe’s borders – not less.The inhumane facilities on the Greek islands shouldnever have existed and must not be the blueprint forthe EU’s future approach to forced migration. TheEuropean Commission’s vocal acknowledgementof the crisis at Europe’s borders is welcome, but refugeesand asylum-seekers trapped in dreadful conditions needmore than words. They need protection that includesthe enforcement of existing legal provisions by statesthat receive them. They need to be treated with dignity,whatever the outcome of their asylum claim. They alsoneed safe and legal routes to reach Europe. Without this,women, men and children, of all ages and backgrounds,will continue to suffer needlessly, with their resiliencediminished and their mental health harmed as a resultof Europe’s response to forced migration.This year, 495 unaccompanied children from the Greekislands were successfully relocated to EU member statesfollowing the onset of the pandemic. Efforts were alsomade to transfer people following the fires that rippedthrough Moria camp.6 These measures are proof thatpolitical will and coordinated action can transform thelives of people held in the island camps. As negotiationson the Pact begin, the stories in this report that testifyto the ongoing cruelty of containment should give pausefor renewed reflection on the need for true solidarity andresponsibility-sharing in Europe.

The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek IslandsIntroductionThe only way to improve our life here is toclose this camp. It’s horrible. It’s terrible thathuman beings are forced to live like this. Itmakes me very sad to see women and childrenin these conditions.”Fariba, 32 year-old woman from Afghanistan.Vathy camp, Samos island, Greece. September 2020.The ‘hotspot’ approach, introduced by the EU’sAgenda on Migration in April 2015, has long beena contested element of Europe’s response toforced migration.7It was put in place to coordinate the reception andidentification of people seeking asylum at the EU’ssouthern borders. In practice this has resulted in thecontainment of many thousands of people in countries ofarrival for months, even years. Placing disproportionateresponsibility on a small number of EU countries, it hasalso revealed striking gaps in intra-European solidarity.In September 2018, the International Rescue Committee(IRC) published ‘Unprotected, Unsupported, Uncertain’,a report detailing the serious impact of EU migrationpolicies on the mental health of asylum-seekers livingin the Moria camp on the Greek island of Lesvos. Twoyears later, this new IRC report examines the furtherdeterioration and harsh realities facing those forcedto live in limbo on three different islands. It calls forimmediate action to improve the dire conditions thesepeople endure.An obvious mental health and protection crisis hasbeen unfolding since the establishment of the hotspots.However, in March 2020, the onset of the COVID-19pandemic further exacerbated the suffering of alreadyvulnerable asylum-seekers in the Greek island camps.It also exposed the many flaws in Europe’s asylum andreception system. In Section 1, this report details severalkey political realities at both the Greek and EU levelsthat have contributed to the current emergency. It alsooutlines the deteriorating humanitarian situation. Livingin severely overcrowded conditions, with limited accessto water, sanitation and healthcare, including mentalhealthcare, people in the three island camps live inhigh-risk, congested settings. Yet they continue tohave limited access to essential services or to effectivemeans to protect themselves and their loved onesduring the pandemic.Section 2 of the report draws on data spanning twoand a half years, collected from 904 people supportedby the IRC’s mental health programmes on the islandsof Lesvos, Chios and Samos. It provides a shockingsnapshot of the catastrophic impact that the modelof containment has on the mental health and wellbeingof people in search of safety and protection. Additionalinterviews and testimonies were collected from dozensof people supported by the IRC’s mental healthprogramme and from IRC staff members. Thesefurther reinforce the findings from the data: peopleare experiencing high levels of trauma, psychologicaldistress and damage to their mental health as a resultof their time in the Greek island camps.Section 3 explores some of the key proposals in theEU’s new Pact on Migration and Asylum, before movingforward with recommendations to both the EU and theGreek government. As negotiations on the Pact begin,we hope this report will cause co-legislators to reflectagain on the need for true solidarity and responsibilitysharing in Europe to address the mental health damagecaused by current policy and political practice. The IRCtrusts that this report will also help propel increasedefforts by Greek and EU authorities to better assist thepeople who bear the brunt of the hotspot approach, andwhose stories from life in the hotspots are testamentto the ongoing cruelty of containment.5

6The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek IslandsReport methodologyThe findings in this report are based on quantitativeand qualitative data gathered by the IRC across aperiod of two and a half years, from March 2018 toOctober 2020. Interviews with people who attendedthe IRC’s mental health programme were conductedin order to place the experiences and voices of thoseaffected by daily life in the Greek island hotspotsand by the EU’s containment policies at the centreof the IRC’s research.DataThe quantitative data was collected from the IRC’smental health programme on the three islands of Lesvos,Chios and Samos (hereafter ‘the three islands’) betweenMarch 2018 and October 2020, with programmesstarting on these islands at different times. It includesthe anonymous records of 904 people who were referredto therapy and received counselling from the IRC.The 904 records were collected by IRC staff duringthe initial mental health assessment made before routinecounselling services. People were informed that the IRCwas collecting the anonymous quantitative data duringthe assessment interview, and that the IRC would useit to adapt and improve programming and in reporting. Thetotal records include 603 people from Lesvos betweenMarch 2018 and October 2020; 225 from Chiosbetween April 2018 and October 2020; and 76 fromSamos between November 2019 and October 2020.InterviewsThe IRC gathered qualitative data on the three islandsbetween August to October 2020. Semi-structuredindividual interviews were conducted with 55 people,including 21 IRC beneficiaries in addition to IRC staffand key informants involved in the refugee response inGreece, namely state employees and staff working forinternational organisations and NGOs.Interviews were carried out in English or native languagesthrough an interpreter, ensuring gender and culturalsensitivity. All people interviewed gave informed verbalor written consent. They were advised of the purposeof the research, of the voluntary nature of the interview,and that they could refuse to be interviewed, decline toanswer any questions, or terminate the interview at anypoint. The names of interviewees have all been changedto pseudonyms to protect their privacy and security.Limitations— In certain places in this report, the small sample size insome subsets of data analysed increases the probabilitythat those findings were influenced by chance.— It is important to note that the IRC’s data only accountsfor people who were able to overcome obstacles toreach care or who were referred to care in the IRC’smental health programme, and is therefore likely tobe an underestimate of the extent of the mental healthconditions facing people in the three camps.— It should also be noted that the mental health needsoutstrip the availability of services on the islands. TheIRC’s mental health programme has limited capacityin terms of the numbers of people it can assist. As aresult, it explicitly focuses on the most urgent referrals,and prioritises people with severe or critical mentalhealth symptoms. This is reflected in IRC data, andcould therefore lead to an overestimation of theseverity of the mental health conditions facingthe whole camp populations.— The quantitative data gathered was limited to thepeople the IRC assists through its mental healthprogrammes. Consequently, based on the datafrom the three islands, the IRC makes no statisticalclaims regarding prevalence and severity of mentalhealth conditions among the overall population livingin the camps.While the results cannot be extrapolated for the entirecamp populations, the view from the IRC’s three mentalhealth centres nevertheless provides an alarmingsnapshot of the severity and range of mental healthproblems and psychological distress that people face.It is essential and urgent that more detailed researchon the genuine harms and mental health impacts ofpolicies at the EU’s borders takes place, to ensurea better response is mounted to support and addresspeople’s needs. Critically, this will also be needed toguarantee that further discussions and policy decisionsat the EU, national and local levels are evidence-basedand result in responses that are fit-for-purpose,effective and humane.

The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek Islands1 A damaging context for mental health:humanitarian, political and COVID-19a) Steadily worsening humanitariansituation on Greek IslandsOver the last three years, the reality facing asylumseekers and refugees on the Aegean islands has steadilyworsened. This reached a new breaking point at the startof 2020, as severe overcrowding and related dangers forthose living in camps escalated. This occurred amid risingfrustration from the local population at the lack of viablegovernment alternatives to the island camps and growingresistance to their presence. 8The dire conditions facing refugees and asylum-seekersin 2020 are the result of a long-term deteriorationin the political and social context. As the year began,the combined camps were at more than six times theircapacity, with at least 38,601 refugees and asylumseekers living in the Aegean island RICs9 in facilitiesmade for 6,178 (see box, left). In January, extremeovercrowding in the depths of winter overstretchedthe services, forcing people to survive in unacceptableconditions in great distress, with limited access to food,water and sanitation.10Overcrowding in the Reception and Identification Centresacross the five Aegean islands, 2 January 2020OverallCapacity: 38,601Occupancy: 6,178Overcrowding: 624%GREECETURKEYLesvosCapacity: 2,840Occupancy: 18,806Overcrowding: 662%ChiosCapacity: 1,014Occupancy: 5,781Overcrowding: 570%SamosCapacity: 648Occupancy: 7,766Overcrowding: 1,198%LerosCapacity: 860Occupancy: 2,461Overcrowding: 286%By September, the numbers of peopleresiding in the island camps had reduceddue to sizeable efforts by the Greekgovernment to try to decongest thecamps, especially from late March, as adirect response to the threat posed by thepandemic, substandard camp conditions,and the lack of access to services.The lower number was also connectedto the COVID-19 related closures ofglobal borders and increasingly reportedpushbacks of people in boats coming fromTurkey that were prevented from arrivingin Greece.11,12 Despite the reduction inarrivals, 7,000 more people were livingin the three camps in September 2020when compared to the same time twoyears earlier when the IRC launched itsprevious report (rising from 14,167 to21,206). (See box below)By November 2020, 15,000 people stillliving in the hotspots remained subjectto pandemic lockdown measures.13 Themajority of these people had fled conflictand insecurity, with close to half (46%)hailing from Afghanistan, almost one infive (19%) from Syria and another onein 14 (7%) from the Democratic RepublicKosCapacity: 816Occupancy: 3,787Overcrowding: 464%Source: Greek governmentHotspot population in September 2018 and September 2020No. of refugees:2018, September12,7672020, SeptemberSource: Greek government8,1613,8173,6434,796Capacity 2,9672,189Capacity 1,014Capacity 648Vial (Chios)Vathy (Samos)Moria

NGOs working on the ground, who agreed to be interviewed for this report. Illustrations by Jocie Juritz/IRC. Acknowledgements . The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek Islands The Cruelty of Containment: The Mental Health Toll of the EU’s ‘Hotspot’ Approach on the Greek Islands .

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