Cover Photo: Iraqi family staying in the Samos Reception & Identification Center. ©Mohammad Ghannam/MSF Executive summary Asylum seekers held on Greece’s islands are in the midst of a mental health emergency. Many have lived through extreme violence and traumatic events. But it is the conditions they face in Greece, including the continued violence and the lack of appropriate services, which are pushing them into hopelessness and are greatly compounding their mental health suffering. PEOPLE FLEEING WAR AND VIOLENCE… • On Samos, a survey1 conducted by MSF and Epicentre2 in late 2016 and early 2017 found that 95% of the people surveyed had fled from war. • 80% of our new mental health patients treated in July and August 2017 on Lesvos reported experiencing violence3 (47 out of 59 patients), just over a quarter reported experiencing torture (16 out of 59 patients) and 19% reported experiencing sexual violence (11 out of 59 patients). This violence was experienced in people’s country of origin, in transit and in Greece. FACE CONTINUED VIOLENCE... • On Samos, close to half of the people surveyed reported having experienced violence4 while passing through Turkey and close to a quarter said they had experienced violence since arriving in Greece. Half to 70% of that violence was allegedly committed by state authorities. The survey also found that people who arrived on Samos after the EU-Turkey deal reported more violence in Turkey and Greece than people who had arrived before the deal. • Our medical teams on Lesvos have treated the medical and mental health consequences of exposure to violence along people’s journey and in Greece. Following a riot in Moria Reception and Identification Centre (RIC) on 18 July 2017, MSF medical teams treated 14 people for injuries ranging from bruises to broken bones and internal organ damage. All patients reported violence at the hands of the police. • This continued exposure to violence increases the risk that people’s existing mild or moderate mental health symptoms will develop into much more severe ones. AND A DETERIORATION OF THEIR MENTAL HEALTH. • The scale of people's mental health needs is overwhelming: on Lesvos, 110 patients were referred to us by other actors between early July and 21 August 2017 – which represents a 50% increase compared to the period April-June 2017. In addition to that, an average of six to seven people have presented to our clinic each week since July, requiring immediate and urgent care linked to attempted suicide, self-harm, psychosis and other emergencies. • People’s mental health condition is worsening: the percentage of mental health patients on Lesvos that need to be referred to a psychiatrist increased from just over a third of new mental health patients in late 2016 and the first half of 2017 (35 out of 99 patients – in a period of nine months), to close to three quarters of our new mental health patients in August 2017 (22 out of 30 patients – in a period of one month). We are concerned that this deterioration will continue as extremely vulnerable people from formerly besieged areas of Iraq and Syria continue arriving, and as the identification of vulnerable people and the provision of medical, legal and other support are critically lacking. © Konstantinos Tsakalidis MSF CALLS FOR THE FOLLOWING IMMEDIATE ACTION |2 • Asylum seekers arriving on Greek shores must be able to move to the Greek mainland. It is a humanitarian imperative. The EU-Turkey deal’s policy of containing asylum seekers on the islands pending a decision on their fate is untenable and inhumane. Their extreme vulnerability and high needs for protection and specialised care render their processing on the island illusory and dangerous. Refugees in the port of Mytilini staring at the sea. • In parallel, the provision of mental health care, including psychiatric care and other crucial services, must be urgently stepped up on the islands to meet the needs of this extremely traumatised population. 3|