7. Health 42 Given the precarious conditions, as regards hygiene and safety, within the facilities, and the non-prevention of disease transmission, both detainees and employees are at high risk of becoming sick. »I was sleeping for two months among two people who had Hepatitis. Now they are released.«133 7.3 Insufficient number of specialised medical staff, inadequate medical infrastructure, insufficient medication and lack of co-ordination on the part of the authorities There is not enough medical staff. The provided medical staff can neither adequately meet the needs of basic healthcare examination for all detainees, nor does it suffice for securing a proper medication. The latter entails tremendous health risks for detainees who depend on their medication, e.g. when they had severe traumatic experiences and are in need of psycho-pharmacy, or if they have undergone operation or suffer from serious congenital heart defects. The lack of medical staff particularly for night shifts and weekends further curtails detainees’ access to doctors and proper medical treatment. The distribution of medicines during night is assigned to the guards, who are not trained for carrying out this task. Furthermore, regional hospitals are unable to examine the high number of newcomers. The medical staff is not trained in migration issues, and they do not know how to deal with victims of torture, violence or rape. There are not enough interpreters. The lack of interpreters in detention centres and in hospitals makes medical screening, examination and treatment impossible. Doctors, psychologists and nurses cannot treat detainees adequately, lacking medical equipment, medication and proper examination rooms. The management and co-ordination of detainees’ medical treatment is dysfunctional. In scheduling the examination of a patient, doctors depend on the police who have a different assignment and therefore different priorities. Means of transport and guards to accompany hospital transfers are generally insufficient. As borderguard officers told us in various occasions, for the transportation of a detainee to hospital, one police car and two police officers are needed. Another problem in co-ordination is the transfer or release of detainees without informing neither the treating doctor nor the patient. The patient leaves the detention centre without his/her medical files, without his/her medication and without referral for further therapy or treatment. A medical follow-up is impossible. 7.4. Access to and communication with doctors Access to health care (medical and psychological treatment) is not always guaranteed, and sometimes guards arbitrarily discourage the detainees from calling the medical staff or refuse to refer them to the staff. »I had been asking for a doctor for many days. I had a bad cold. He never came, but one day the police took me out and beat me so I didn’t ask for the doctor again!«135 »You can call for a doctor 100 times if you want them to react even once!«136 »Once a man fainted inside the cell. We were afraid he would die. We called the officers, but they did not react.«137 A minor told us: »If somebody needs a doctor, we need to make a lot of noise and shout. The sick person has to be lying on the floor, unconscious, for them to take you seriously.«138 Detainees who were ill-treated by the police, told us that they were not allowed to see the doctor. Detention facilities do neither offer appropriate examination rooms, nor isolation room for cases of suspectedly contagious diseases. »The doctor gives us pills of four different colors to treat our sickness. None of them help«.134 During our missions, we saw doctors examining detainees through the bars (Feres, October 2011), in inappropriate examination rooms (i.e Tychero) or in places lacking privacy (Feres, Fylakio). Detainees systematically complained to the mission’s team about difficulties in communication, resulting in inadequate medical care. During the team’s missions, the doctors (except for the MSF mission) were working even without any interpreter or with few. The absence of external and professional interpreters compromises the quality of the delivered health care, as well as the patient’s confidence, especially in cases where other detained migrants are used as interpreters. Detainees complained to us that, even when there was a psychologist, they did not want to speak with him/her, because there was no interpreter and 133 A.F. from Iran; December 18, 2010 – Feres 134 S.Q. from Iran; October 13, 2011 – Ferres 135 D.F. from Turkey; December 19, 2010 – Soufli 136 B.M. from Iran; December 19, 2010 – Soufli 137 F.S. from Iran; December 20, 2010 – Fylakio 138 A.T.M. from Afghanistan; October 11, 2011 – Fylakio