application and its validity is extended until the execution of a return decision or until the UAM reaches adulthood.1142 Following these developments, and despite initial delays in the operationalisation of the new system, issuance of the PAAYPA seems to have been increasingly streamlined since early 2021, 1143 at least to the extent that GCR is aware. Notwithstanding, challenges do seem to persist as, indicatively, out of 61 registered asylum applicant households surveyed between 1 January 2023 and 31 December 2023 as part of an ongoing monitoring activity carried out under UNHCR in Greece, 5% of respondents still lacked a PAAYPA number.1144 As explained above (see Access to the Labour Market), a recent legislative development automatically excludes from access to public healthcare beneficiaries of international protection (when one becomes a recognised refugee a PAAYPA needs to be converted to AMKA) who are not yet working or are not able to work because of their health condition or age (e.g. the elderly). Also, the possession of an active AMKA is necessary for access to the benefits of the Agency for Welfare Benefits and Social Solidarity (OPEKA). 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, where during November 2023 waiting periods for registration were reported at 2 months, the registration in 2024 were concluded within a few days (less than 3 on an average). Similarly in Lesvos, the time to register the asylum claim ranged during 2024 from 1 to 3 days on average, according to GCR’s field experience. 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.1145 This challenge was also noted by the UN High Commissioner for Refugees, Filippo Grandi, during a two-day visit to Greece in early 2024.1146 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 issues1147 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.1148 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) 2021-2027.1149 1142 1143 1144 1145 1146 1147 1148 1149 Article 6(6) of Ministerial Decision 605869/2022. For more, see AIDA, Country Report Greece: 2022 Update, June 2023, op.cit, pp. 191-193 and previous relevant reports. UNHCR, Inter-Agency Protection Monitoring for Refugees in Greece: Key findings, available at: https://tinyurl.com/3z6t3y9f, relevant section 2 on documentation. For the data in this paragraph, filters have been used to only include registered asylum applicant households surveyed during 2023 alone. 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. 209