By Marissa Michaels

MORIA, Greece — Migrants who survived the perilous sea journey from Turkey to Lesbos sit on small blue benches in the Reception and Identification Center (RIC) upon arriving at Moria, the most infamous and crowded refugee camp in Greece. Volunteers hand out snacks and search luggage. Translators tell migrants about the asylum process. Migrants enter a room to be screened, fingerprinted and legally registered.

Next comes the crucial part: medical examinations, including psychological components if necessary, to determine which refugees are vulnerable enough to be put on a priority list for transfer to Kara Tepe, a nearby camp, or the mainland camps, where conditions are generally better. This exam, run by the Ministry of Health’s Centre for Disease Control and Prevention, more commonly known by its Greek acronym, KEELPNO, tests for conditions like pregnancy and AIDS.

But KEELPNO is desperately understaffed and asylum rules change regularly. About 700 names are on a wait list to be transferred from the first reception center at Moria to camps on mainland Greece. People in wheelchairs and those riddled with psychotic disorders remain stuck in Moria, a refugee camp that is improving but is still unsafe and unstable for occupants. The limited capacity in well-run camps on the mainland makes the vulnerability assessment a crucial determinant of a refugee’s future.

In January 2019, an international nonprofit group called Oxfam released a report on the condition of vulnerability assessments in Greece called “Vulnerable and abandoned,” which outlines the failures of the reception system.

A woman in a wheelchair outside of Moria. Photo by Marissa Michaels.

Oxfam reported that “For many months, there was just one doctor employed by KEELPNO to assess the health conditions of, at times, as many as 11,000 people seeking asylum in Lesvos, and as many as 2,000 new arrivals in one month.”

For over a month in 2018, there was no appointed camp doctor.

“The medical and mental health screening is a big issue in the camp,” Sonia Andreu, manager at the ‘Bashira Centre’ for migrant women is quoted saying in the report. “People have to wait for months before they can see a doctor or a psychologist who will determine if you are considered vulnerable or not, and this is affecting their asylum procedure.”

In an interview, Médecins Sans Frontières psychiatrist Alessandro Barberio agreed. “You have to wait sometimes one week, sometimes one month” for a medical examination, he said.

Barberio could not provide more information about the vulnerability assessment because he was unsure of the process. According to him, the assessment rules change frequently, even monthly, making it difficult for volunteers to coordinate their procedures and for authorities to improve the system.

A man with a crutch and his arm in a sling sits outside of Moria. Photo by Marissa Michaels.

Oxfam reported, “In Lesvos, the procedure of screening and classifying people according to their specific vulnerability has changed three times in the past year alone, creating uncertainty, confusion and further increasing the huge delay for people to be officially recognised as vulnerable.”

The Oxfam report introduces a refugee named Joysin from Cameroon who described his process. “They only asked me if I had had any operations recently and I said no. That was the only medical ‘check’ they did before putting me in Moria’s prison. There are too many people dealing with mental problems and for all of them there is just one psychologist available. He does not have enough time to treat you.” The prison he mentions is Moria’s detainment center. Others agree that the medical examination is superficial and only acknowledges the most severe of cases.

Though it is unclear exactly what happens in this examination, there are distinct guidelines for the vulnerabilities that authorities look for.

According to Article 14(8) L 4375/2016 in Greek law, the following groups are considered vulnerable: “a) Unaccompanied minors, b) Persons who have a disability or suffering from an incurable or serious illness, c) The elderly, d) Women in pregnancy or having recently given birth, e) Single parents with minor children, f) Victims of torture, rape or other serious forms of psychological, physical or sexual violence or exploitation, persons with a post-traumatic disorder, in particularly survivors and relatives of victims of ship-wrecks, g) Victims of trafficking in human beings.”

These people are identified as vulnerable because they need conditions better than those in Moria in order to survive.

But in reality, the simple act of staying in the camps causes its own distress. Moria currently houses 5,500 refugees even though its capacity is closer to 3,300. And the camp does not provide psychological services. Rather, it depends on NGOs to assist those in need. And conditions there only exacerbate problems.

Eurorelief’s camp manager for Moria, Daniel Garnett, explained that 50 out of 170 air conditioners did not work last month in Greece’s sweltering heat. There is not enough access to toilets and showers. People must wait hours in line to receive food. Moreover, refugees in Moria are living in a state of limbo, unsure what result their asylum application will produce.

Barberio explained, “The persons we are following – all of them are living during this unstable phase of registration, asylum seeker. It’s very complicated.”

Oxfam says, “In some cases, asylum seekers develop mental health problems after arriving in Moria because of the squalid living conditions, overcrowding, and the long wait for their asylum claim to be processed.”

Throughout their stay in Moria, many become psychologically vulnerable, but with KEELPNO seeing only severe cases, most people go without help.

A November 2018 briefing by the United Nations refugee agency reported that “Vulnerable asylum-seekers – including some 200 unaccompanied children, over 60 pregnant women, the disabled and survivors of sexual violence – are left at risk in the RIC as alternative accommodation places on the island are taken.”

Further complicating the medical assessment, some refugees will fake vulnerabilities in an attempt to go to mainland Greece.

Patric Mansour, an aid worker who is deputy camp manager of Moria, explained that people sometimes falsely claim that they are unaccompanied minors in attempts to be transferred to the mainland. For this reason, the medical assessment might include examinations of teeth to determine if self-identified minors truly are underage.

He even claims that women will lie about being victims of sexual or gender-based violence in order to be considered vulnerable cases, highlighting the desperation of migrants stranded in Moria.

As Ali Beddin, who manages an informal camp site for migrants adjacent to Moria, said, “Of course, nobody wants to stay here.”