Furthermore, as the issuance of PAAYPA requires the full registration of an asylum application, delays in accessing asylum, particularly in mainland Greece, also lead to de facto delays with respect to applicants’ acquisition of this document and in turn delays in their actual ability to access healthcare. Based on GCR’s observations, after the deployment of EUAA personnel in Kos. Yet, even for those with an active PAYPA number, the isolated nature of accommodation (i.e., camps in remote areas) in the Greek reception system hinders applicants’ effective access to healthcare, including psychosocial support.1115 This challenge was also noted by the UN High Commissioner for Refugees, Filippo Grandi, during a two-day visit to Greece in early 2024.1116 In 2024, asylum seekers in Greece faced serious challenges in accessing medical care, given that on the one hand there was not adequate nor full-time medical staff available in all facilities nor available interpretation for most of the year. Well documented issues1117 of “on and off” healthcare service provision with PHILOS II (project implemented by EODY) persisted until July, when officially IPPOKRATIS project started with MoMA’s implementing partner being IOM.1118 In July 2024, IPPOKRATIS started with the former EODY as a transition personnel and by September 1st 2024, it was implemented by a private sector entity (Omilos Iatrikou Athinon) and Doctors without Borders NGO. According to MoMA’s Minister’s answer to the Greek parliament, this programme concerns the provision of medical and psychosocial services, including prevention, health education, diagnosis and treatment to third-country nationals who live in RICs, CCACs, CAFTAAS and includes: (a) the treatment of urgent cases - screening, (b) the identification of vulnerable persons, and (c) the provision of a comprehensive approach to the provision of health care services c) taking a medical history - registration, d) clinical physical examination, e) referral to a medical service, f) identification of vulnerable groups (e) referral to further care (secondary/tertiary) and also, the provision of psychosocial care to residents within the facilities by specialised staff. This programme has been included in the new multiannual programme of the Asylum, Migration and Integration Fund (AMIF) 2021-2027.1119 IPPOKRATIS project is designed to offer both medical and psychosocial support services together with child protection case management, although in its initial stage of implementation it was challenged by the lack of interpretation services and the difficulty in staffing medical services (especially doctors) in the islands of Dodecanese.1120 More specifically, challenges in accessing healthcare due to the lack of interpreters and cultural mediators in public healthcare facilities (mainly hospitals and health centers) also persisted in 2024. The language barrier was also flagged as by far the primary obstacle to accessing healthcare by asylum applicants (registered or pending registration) surveyed as part of an ongoing monitoring activity carried out between February 2022-March 2024, under the coordination of UNCHR in Greece. This was followed by challenges in acquiring necessary documentation (i.e., social security number). 1121 Especially in 2024, though, this lack of interpretation services from May till the end of 2024 and thus the obstruction communication between asylum seekers and medical staff was at a point that in many cases resulted per se in people being excluded from effective medical care, exposing them to serious risks and significantly 1115 1116 1117 1118 1119 1120 1121 MSF, Greece: The impact of living in limbo on asylum seekers’ mental health, 17 June 2024, available here. UNHCR, UN High Commissioner for Refugees wraps up visit to Greece: welcomes progress on integration and urges continued efforts, 22 February 2024, available at: https://tinyurl.com/bdepjsbh. See Greek Ombudsperson, The Challenge of Migratory Flows and Refugee Protection, April 2024, available here; and European Commission, Letter to civil society organisations, Ares(2024)613054, 26 January 2024 (available upon request), replying to the Joint CSOs Letter “Human Rights, But Not for All: Open Letter on Access to Food and Medical Care in Lesvos Closed Controlled Access Center”, available here. It is noted that in the Commission’s view chronic gaps of PHILOS II are identified “mostly due to the absence of doctors”. See MoMA’s announcement here. Answer to parliamentary question provided on 09 August 2024, available in Greek here. Information shared at a special meeting of IOM and Child Rights Advocacy Network (CRAN) Members in November 2024. UNHCR, Inter-Agency Protection Monitoring for Refugees in Greece: Key findings, available at: https://tinyurl.com/3z6t3y9f, relevant section on health. 227