A child in the Moria “hotspot” camp on the Greek island of Lesbos, December 2017. Parents in the camp said their children cannot access adequate healthcare. © Bill Van Esveld / Human Rights Watch, 2017.

(Athens) – Bureaucratic delays and obstruction by Greek authorities have left some asylum-seeking children confined to the Aegean islands without access to necessary medical care.

Greece enforces a policy, backed by the EU, to keep asylum seekers on the islands until their asylum claims are adjudicated. Authorities can allow people with urgent medical needs that cannot be treated on the islands to travel temporarily to the Greek mainland for specialized care, but several families said that asylum officials either failed to help or acted too slowly, causing dangerous, agonizing delays in access to urgently needed health care.

“No child’s health should be left to deteriorate because of deliberate obstruction of access to health care,” said Bill Van Esveld, senior children’s rights researcher at Human Rights Watch. “It’s hard to avoid the conclusion that Greek authorities are prioritizing deterring asylum seekers from coming to Europe over their duty to make sure children get the medical care they need.”

Human Rights Watch interviewed six families in June 2018. Two, whose legal and medical records Human Rights Watch reviewed with their consent, said that their seriously ill children had been referred for medical treatment not available on the islands but had been stuck there for months. The others said medical care for their children had been inadequate.

The process of approving transfers to the mainland for medical treatment is extremely cumbersome. The Greek Center for Disease Control and Prevention assesses asylum seekers arriving on the islands from Turkey. If staff determine that they have urgent medical needs for which treatment is not available on the islands, the Greek police may recommend allowing them to move to the mainland. The Regional Asylum Office of the Greek asylum service must confirm the decision to lift the restriction to the islands. The authorities reassess the situation monthly, returning the asylum seekers to the islands if the case is no longer considered urgent.

But in the cases Human Rights Watch documented, either the first assessment failed to identify children with urgent medical needs, or officials did not share the assessments with the asylum authorities for months. Even then, the authorities refused to lift restrictions keeping children and their families on the islands.

In that case, the family must wait for an interview with the European Asylum Support Office or the Greek asylum authorities’ Regional Asylum Office, which can lift the restriction. But a lawyer supporting asylum cases on Lesbos told Human Rights Watch in June that some people assessed as highly vulnerable – and who should be allowed to move to the mainland on that basis – are being scheduled for these interviews as late as April 2019.

In one case reviewed, of an Afghan family that arrived in November 2017, the father, who had been tortured by the Taliban, was given a “medium vulnerability” assessment, which was applied to the whole family. But their 16-year-old son, who had been injured when an unexploded hand grenade detonated in his school a year ago, with shrapnel piercing his throat, and saw two classmates die, was not assessed. His father said he has insomnia, nightmares, unpredictable aggression, and loss of consciousness, has repeatedly injured himself requiring hospitalization, and has wandered out of his camp at night.

Child psychologists on the islands twice referred him for pediatric psychiatric treatment on the mainland, and a hospital on the islands submitted a statement in February that the treatment is not available on the islands. European asylum officials interviewed the family in March.

The officials, to whom the family provided the boy’s initial medical assessment, stopped the asylum interview after asking about the boy’s mental health condition to reassess the family’s vulnerability, a lawyer acting for the family said. In May, however, asylum authorities renewed the family’s restriction to the islands, the father and the lawyer said. They were still waiting for their interview with the Greek Asylum Service in June, and the boy has still not received treatment.

In another case, a 12-year-old girl from Iraq has a severe, undiagnosed disorder that causes frequent convulsions and makes it extremely painful for her to eat. Within days of the family’s arrival on the islands in March, a doctor referred her to the mainland for care, and she was assessed as “high vulnerability” during her initial medical screening. But the screening authorities did not transmit the assessment to asylum authorities until May, by which point the family was stuck in a lengthy asylum procedure on the islands. “My daughter is dying in front of my eyes and I can do nothing,” her father said. In the meantime, she contracted an eye disease requiring surgery that is also only available on the mainland, an ophthalmologist on the islands told the family.

Greek asylum authorities repeatedly obstructed treatment. They initially told her father that only he and the girl could leave for her treatment on the mainland, and then rejected a lawyer’s request to allow the whole family to move, said a volunteer lawyer supporting their case. In May, the family obtained their “high vulnerability” assessment and a certified statement from a hospital referring the girl to treatment in Athens, and the Greek police gave permission, but the asylum service again refused. The asylum service also refused the lawyer’s request to speed up the family’s asylum interview date. In early June, the asylum service said the family could leave only if the girl had an appointment with a pediatric specialist at a hospital in Athens, which cannot be scheduled remotely, her lawyer said. Asylum authorities finally lifted the restriction temporarily in mid-June.

Asylum-seeking children in the Moria refugee camp on Lesbos also need unavailable medical treatment. A father from Afghanistan said he had to beg medical workers to take his 2-year-old daughter who had been “extremely sick for three days” to a hospital. Her condition had been deteriorating for a week but “the camp doctors just told me she should drink water,” he said.

One mother from Syria said her five surviving children refuse to go outside after witnessing an airstrike that killed their oldest brother, and that her 12-year-old daughter demonstrates “severe psychological distress,” cutting and hitting herself. They had been waiting for more than a month to see a psychologist.

A 6-year-old Syrian boy developed a severe speech impediment and psychological distress after witnessing attacks during the conflict, but had received “no real care, just painkillers” during three months in Moria camp, his father said: “He goes wandering. Last month the police found him three kilometers outside the camp and told me they’d take him away from me if I ever let him out again. I said I was willing to pay for a private doctor, but the hospital said there aren’t any here and I have to go to Athens.”

Human Rights Watch previously documented the mental health crisis among children in the overcrowded “hotspot” camps on the islands, which have a capacity of 6,300 residents but were warehousing 14,500 as of mid-July. More than 30 percent of asylum seekers on the islands are children.

Doctors Without Borders, which runs a medical clinic immediately adjacent to the camp, reported in May that the demand for pediatric services at its clinic doubled over two months and that they lacked the capacity to treat everyone who needed care, while the only public hospital on Lesbos was “overwhelmed and understaffed.” In July the group reported that conditions in the camp were retraumatizing children and an increasing number were demonstrating “intense panic attacks, suicidal ideations and suicide attempts.”

“Greece should end the perverse system of incentives that leads asylum officials to ignore the needs of traumatized children,” Van Esveld said. “To truly cut through the bureaucracy and make sure children get the treatment and care they need, Greece needs to scrap its policy of containing asylum seekers on the islands.”