“ “ They told us we would be safe in Europe but I don’t feel safe. I am scared that if I receive a second rejection [on my asylum claim], the police will arrest me. […] Sometimes people come back from the police station with a broken arm or leg, and with their face swollen. My friend was pushed on the floor and they stepped on his head. 31-year-old man victim of torture from Syria, Samos, September 2017 As of late September 2017, an estimated 15 000 asylum seekers remained stranded on the Greek islands, including on Lesvos and Samos. MSF medical teams based there have witnessed a worrying prevalence of violence affecting our patients. In Samos, close to a quarter (23.1%) of people surveyed had experienced violence in Greece. Half of that violence was described as beatings, 45% of which was committed by the police or army. The survey found that people who had arrived on Samos after the EU-Turkey deal reported more violence in Greece than people on the mainland who had arrived in Greece before the deal.9 In recent months, our patients in Samos have spoken about a growing concern for their safety, and reported increased tensions over the summer. General insecurity and police violence are regularly brought up during mental health consultations as a great source of anguish. “ “ We were complaining because there were too many people in our tent. I walked out and they [the police] took me to their office. […] They handcuffed me and pushed my head down in their car. In their office, they kept pressing my head down and they switched the light off. They tightened the handcuffs until my wrists were bleeding [shows scars] and they jumped on my back and kicked me. They broke my ribs and I have an X-Ray proving it. […]I came to seek asylum because I was in danger back home, but now I am in danger again. Police here are like Syrian security. They come with sticks and beat people up. This is not humane. I feel like a prisoner of war, not a refugee. 30-year-old man from Syria, Samos, September 2017 In Lesvos, our psychologists have also reported patients being increasingly concerned for their safety – both because of the general lack of security in Moria, and linked to police violence. On 18 July 2017, clashes between the police and protesting asylum seekers took place in Lesvos’ Moria camp, following the detention of an asylum seeker. 35 people were arrested that day by the police – and MSF visited 14 of them on 21 July. All 14 people treated by MSF had experienced violence, yet none had been able to access medical care before our arrival. Most of these were previous patients of MSF, and included patients who were victims of torture and had severe mental health conditions. Their acute injuries ranged from bruises to broken bones and one victim of torture patient sustained internal organ damage as a result of the violence. “ “ Last Monday, there were many policemen [in Moria]. I was walking […] and a policeman wearing a helmet with dark blue clothes hit me on the head with his baton. He started to put handcuffs on me when four more policemen came. One of them kicked me in the belly. I then fainted and when I woke up, I was in the hospital wearing different clothes. Since then I have difficulty to urinate and in the night I cannot sleep. […] I feel my life is in danger inside Moria and that I might become a victim of retaliations. 37-year-old man victim of torture from Senegal, Lesvos, July 2017 A dramatic mental health emergency THE OVERWHELMING SCALE AND INCREDIBLE DEPTH OF PEOPLE’S SUFFERING In Greece, and in particular on the islands, our medical teams face a dramatic mental health emergency. Both the scale of the needs for mental health care and the severity of the patients treated by our psychologists and psychiatrists have overwhelmed the capacity of our mental health services. In late 2016 and early 2017, three quarters of the people surveyed by the MSF and Epicentre team showed as positive with the anxiety disorder screening tool.10 This percentage rose to 97% for people held on Samos. On Lesvos, our psychologists have to prioritise mental health care to patients with severe symptoms. Yet, despite being this selective, our medical team still receives an ever growing number of referrals from other actors. 110 patients were added to our waiting list between early July and 21 August 2017 – which represents a 50% increase as compared to the period AprilJune 2017. Over the summer, an average of six to seven patients per week presented to our clinic with acute mental health needs, such as suicidal attempts, self-harm, and psychotic episodes. In late August, the MSF Lesvos clinic had to stop taking new referrals, except for emergencies, as its waiting list had reached 146 people. However large the number, we unfortunately know the true need is far greater still. As well as the extremely high demand for our mental health services on Samos and Lesvos, a number of medical indicators point to the worsening of people’s mental health condition. On Lesvos, the percentage of our mental health patients that need to be referred to a psychiatrist increased from just over a third of our 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 patients in August 2017 (22 out of 30 patients in a period of one month). In the last quarter of 2016, 4 of our patients with severe psychological disorders had self-harmed or seriously considered/attempted suicide (11% of those patients). This increased to 19 patients in the single month of August 2017 (86% of patients with severe psychological problems during that month). This included patients that had recently arrived on the island, as well as people who had been there for many months (range of 6 to 20 months). “ My daughter is five. She barely talks anymore. And my husband no longer sleeps. I stay up at night thinking about what is going to happen to us, what we should have done differently. Sometimes I shake. The stress, the fear, the sadness. It is too much… 30-year-old woman from Afghanistan, Lesvos, July 2017 “ CONTINUED VIOLENCE IN GREECE |6 Syrian man losing hope about his future, Samos Reception & Identification Center. © Mohammad Ghannam/MSF © Mohammad Ghannam/MSF Another indication of the severity of people’s mental health status relates to the symptoms treated by our psychologists. In late 2016 and in the first half of 2017, the three key symptoms of our mental health patients in Lesvos were depression, anxiety and post-traumatic stress disorder. Yet in August 2017, psychotic symptoms represented a quarter of our patients’ symptoms, which is likely due to a lack of access to care early on, leading to people developing more severe symptoms. A 25-year old Syrian mother with her 20-month old boy. 7|