Lack of personnel Primary health care in the detention centers is provided by medical personnel appointed either by the local prefecture or by the regional health authority. Our teams observed long delays in allocating a sufficient number of medical personnel. For example, in Pagani detention center, until the end of August 2009, there was not enough medical staff to adequately respond to the needs of the population. In Venna detention center, between the months of September 2009 to April 2010 a medical doctor visited the detention center two days per week at most. The situation has improved recently. Since April 2010 a doctor, a nurse and a psychologist were hired and are regularly present in Venna detention center during weekdays. Moreover between February and April 2010 a medical team from the Greek Centre for Disease Control, responsible for vaccinations, regularly visited the detention centers of Filakio and Venna. In Filakio detention center, a medical doctor is present on a regular basis. However, there was no nurse for several months and a psychologist has not yet been appointed. Additional medical staff is required so that new arrivals could be systematically screened. Medical personnel did not routinely visit the cells. Migrants therefore gathered at the doors of the cells and called out for medical assistance. This may result in the weakest or sickest not being noticed. The absence of interpreters compromises the quality of the delivered health care, as well as patient confidentiality, especially in cases where other detained migrants are used as interpreters. MSF teams who routinely visited the cells would refer migrants with medical complaints to the doctor. Sometimes serious cases would be brought to our attention, such as insulin dependent diabetic patients, asthmatic patients or patients who said they were on psychotropic medication and whose medication had finished some days before. Another concern in all detention centers is the lack of health care during weekends and evenings. For example the distribution of medication is left with police staff that understandably has a hard time carrying out this task. In all detention centers medical doctors had a sufficient stock of medicines at their disposal as well as a medical examination room. Infirmaries and isolation facilities for patients with infectious diseases were not available in all detention centers. In Filakio detention center there is one infirmary. In Pagani detention center there was no infirmary and patients with contagious diseases were isolated in two containers. In Venna there is no infirmary or isolation room for patients. 17 Inadequate response to medical emergencies In the case of medical emergencies when medical personnel is not present in the detention center, a common practice is that police staff contacts the medical doctor who is on call and based on his advice refer the patient to the hospital. However this system offers no guarantees for timely health care delivery in emergency situations. An illustration of the gap in the system of managing medical emergencies is the case of a two year-old child suffering from a concussion in Pagani detention center who was only transferred to a hospital hours after the accident occurred. The transport of patients to the hospital was, at times, an obstacle to timely health care delivery. In Venna and Filakio detention centers security measures are very strict and police accompaniment is necessary to transfer a person to the hospital. Especially during night shifts, when fewer police officers are on duty, the transfer of patients to the hospital might be postponed for the next day. An example was a patient who suffered from kidney colic during the night and was only transferred to the hospital in the afternoon of the following day. Another cause for concern is the lack of a specific procedure to address suicide attempts. It seems that if the attempt does not result in a medical emergency requiring hospitalization, the migrant is not automatically referred to the hospital and/ or the psychiatric service.