(Athens) – Greek authorities have not done enough to address the acute overcrowding and lack of health care, access to adequate water, sanitation, and hygiene products to limit the spread of Covid-19 in camps for asylum seekers, Human Rights Watch said today. Greece’s government should immediately take measures to protect those most at risk of Covid-19 in the island camps to avert a public health crisis.
“While the Greek government is working to stop the spread of the virus, the images of the squalid conditions in camps on the islands make clear that it’s not complying with minimum preventive and protective measures against Covid-19 there,” said Belkis Wille, senior Crisis and Conflict researcher at Human Rights Watch. “Even handwashing and social distancing are impossible in these circumstances.”
Human Rights Watch interviewed 11 male asylum seekers from Afghanistan, Palestine, Somalia, and Syria by phone in English and Arabic between April 6 and 16, 2020, and 9 aid workers on Chios, Leros, Lesbos, and Samos islands. Human Rights Watch also analyzed photos and video footage showing the conditions in the camps.
2,401 Covid-19 cases and 121 deaths have been reported on mainland Greece as of April 20, and 11 cases in the local population on the islands, according to reports from the media. No cases have yet been identified in the island camps, known as Reception and Identification Centers. Yet as one aid worker put it, “it is very unlikely that Covid-19 will never come to Moria [the Lesbos camp]. The only solution, if we want to minimize casualties, is to decongest before it comes.”
The authorities should urgently identify people in the camps at greater risk of serious illness and death from Covid-19, including older people and people with chronic diseases and serious underlying medical conditions, and other especially at-risk groups, as well as unaccompanied children, people with disabilities, pregnant women, and women who have recently given birth.
They and their families should be safely transported to alternative and accessible accommodation such as hotels, apartments, and other housing units, where they should have access to food, water, sanitation, health care, and other basic necessities. These facilities should be spacious enough and equipped to make social distancing possible, and the authorities should provide information about how and why social distancing works.
Soon after the first Covid-19 cases were reported in Greece, the government announced measures on March 17 to prevent an outbreak in the island camps. The measures included strict limits on leaving the camps other than for buying necessities, suspending activities including informal schools, and prohibiting access to visitors except those providing essential services. Authorities extended measures in the camps until May 10. On March 22, Prime Minister Kyriakos Mitsotakis announced a nationwide lockdown, restricting people’s movements beyond essential activities.
Everyone interviewed described extreme overcrowding in the camps and adjacent sites and extremely poor water and sanitation conditions. They said that there is no way to maintain social distancing while waiting in line – often for hours or even days – to get food, see a doctor, wash or use the toilet, or get permission to leave the site. Camp residents have no access to masks or gloves, except on Lesbos where volunteer seamstresses sewed cloth masks for residents. Interviewees said that testing for Covid-19 is not available in any of the camps as far as they know.
All said they regularly hear guidance from authorities and aid workers on measures they can take to protect themselves, but as a 63-year-old Syrian man living in the Samos camp said about social distancing, “I spend around 3 hours in line every day to get food.… If we are 200 people waiting for food, the camp is not even big enough for all of us to be able to wait and keep that distance between each other.”
The European Union’s home affairs commissioner announced on April 2 that part of its €350 million financial assistance package for Greece would cover temporary accommodation for migrants and asylum seekers on the islands, including in holiday homes and hotels on the islands and through an increase in the reception capacity on the mainland. In response, Greek authorities developed a plan to decongest the island camps following “triage” of the migrants and asylum seekers, giving transfer priority to people over 60, those with “specific medical conditions,” and their immediate family members.
The plan will shield some people most at risk from the virus, but as an April 16 Ministry of Migrations statement indicates, the number transferred will only be 2,380 – not enough to relieve the severe overcrowding, Human Rights Watch said. The plan also does not address the continued gaps in water, sanitation, hygiene products, and health care – nor the lack of accessibility for people with disabilities – in the camps and adjacent overspill sites for those who will remain.
Public information about the plan does not specify what medical conditions qualify for priority transfers or whether priority groups will include unaccompanied children, pregnant women, and new mothers.
Human Rights Watch sent questions about these issues to the Greek authorities on April 15 but has received no response.
The authorities should supply adequate sanitary and hygiene products and ensure accessible continuous running water so that camp residents can follow the guidelines of the National Public Health Organization (EODY) and the World Health Organization (WHO) for protection from Covid-19. They should also ensure frequent disinfection of common areas, bathrooms, and toilets, as well as the timely collection and removal of waste.
The European Commission should ensure that its emergency support leads to the rapid decongestion of the camps by developing with the Greek authorities a time-bound plan to lower the population within their actual capacities and ensure that social distancing can be practiced. The commission should also ensure that any new facilities, particularly any new island camps, do not contribute to an increase in abusive detention of migrants.
EU member states should support these efforts, including by setting up a permanent system for sharing responsibility for receiving asylum seekers, processing their asylum applications, and speeding up family reunification to alleviate the burden on Greece.
Ultimately Greece, with the support of EU institutions and countries, should end its inhumane containment policy and facilitate the transfer of asylum seekers from the Aegean islands on a regular basis and provide them with fair and efficient asylum procedures.
“Covid-19 exposes that the lack of EU solidarity on addressing the congestion in the Greek islands has not only made the situation worse but is now putting thousands of lives at risk,” Wille said. “The Greek government and the EU should show they can win this race against the clock while addressing in a humane way the massive overcrowding that has been a problem for years.”
The Greek Island Camps
As of April 15, 34.875 migrants and asylum seekers lived in the Reception and Identification Centers on the Greek Aegean islands of Chios, Kos, Leros, Lesbos, and Samos. The camps’ total capacity is 6,095 people. The situation on the islands has grown more acute due to a spike in arrivals since July 2019 leading to extreme overcrowding, compounded by the Greek authorities’ containment policy, which has blocked transfers to the mainland. The islands are also home to an estimated 212,600 Greeks as of the last census, in 2011.
The lack of basic protection measures in the camps leaves women and girls particularly at risk of sexual harassment and assault and afraid to use facilities including toilets and showers, which often lack locking doors and adequate lighting. Sanitation and washing facilities are difficult for some people with disabilities to access. Thousands living in adjacent overspill sites on Chios, Leros, Lesbos, and Samos, where people set up their own tents for shelter, face even greater problems. The Greek authorities largely failed to carry out plans, announced in November, to relocate 20,000 asylum seekers to the mainland by early 2020.
In a March 27 submission to the European Court of Human Rights (ECHR), the Greek government listed a range of measures it had taken in the camps to address the pandemic. They include permitting only one person per family to leave to go shopping between 7 a.m. and 7 p.m., limiting the total number of people who can leave at any given time, limiting the entry of aid workers and visitors, closing down education services, and suspending indoor activities.
The government said indoor and common spaces would be cleaned daily, including with disinfectants, and door handles in common areas would frequently be disinfected. It said the EODY would establish appropriate quarantine areas and that the government would use informative posters in relevant languages and written or oral information in a language the residents can understand, about all the measures being imposed.
The government did not provide details on existing stocks of masks, gloves, and disinfectants available at the camps. It also did not say how it would make information about protection, testing, and treatment accessible to people with various disabilities, including blindness or deafness.
In mid-April, the head of the public health organization visited Lesbos and pledged to install a mobile unit to conduct Covid-19 testing on the island in early May.
Everyone interviewed said that standing in congested lines with dozens of other people is a fact of daily life. They said that because of the lockdown and the limited ability to buy goods, the food line, which had always been long, has become even longer. With the exception of residents of Leros – who said lines were not so long, though they still could not spread out enough – those interviewed said they wait in line between an hour and a half and five hours per meal.
On Samos, the situation has been exacerbated by the decision to serve two meals a day instead of three, so people would only need to wait in line twice a day. But two residents said that has made food lines even longer because in the past, someone might have skipped one of the three meals, but now no one is skipping the two meals.
Everyone interviewed said they also wait in long lines for health care. A Lesbos resident said that there is only 1 clinic in the camp serving 20,000 people. Residents need a referral from the clinic to seek health care outside the camp. He said there are always on average 100 to 200 people waiting close together to see doctors between 8:30 a.m. and 3:30 p.m. Aid workers confirmed this. On Samos, 2 residents said that they usually wait for up to 3 days to see a doctor.
Human Rights Watch has documented repeatedly over the years that people living in the camps have to line up for hours or days to get medical care, often with no success, and that access to specialized care, including pre and postnatal care, is extremely limited. In addition, because of the new restrictions, people wanting to get out of the camps are waiting for hours in congested lines to get permission from the police to leave. The aid worker and a resident on Chios said they both witnessed police fining some residents €150 for leaving the camps, even if they had permission.
Residents of the Lesbos and Samos camps and an aid worker in Chios said residents shower as little as once a week to avoid the three-hour wait in a long, crowded line. Those on Leros said that the lines are shorter, about 20 minutes. One man with a young child said he fills up water bottles and washes his baby inside his tent to avoid the lines. Residents of Lesbos and Samos said that they also often wait in long lines to wash dishes, clothes, or their hands, or to use the toilet.
The March 27 government submission stated that authorities had put up instructions on hygiene precautions at 10 of the most crowded locations, including instructions on standing in line with enough distance between people. The government said the authorities announced instructions and measures by loudspeaker every two to three hours, as well as by SMS to residents’ cell phones and in the safe spaces for unaccompanied children.
Everyone interviewed said that daily, they hear loudspeakers announcing the lockdown measures in various languages and other announcements about hygiene standards and the need to limit movements and socially distance inside the camp.
The residents interviewed live in tents or containers of varying sizes, some by themselves, others only with their immediate family, and some in shipping containers housing multiple families and up to 25 people. “I live in a 3 by 4-meter container with my family of 6 people, and another family of 6. Tell me, how on earth could I practice isolation if I get sick?” said a Chios camp resident.
Health Care and Potential Isolation Policies
All of the residents interviewed said they have not been tested for Covid-19 and do not know anyone who has been tested or how they can request a test. They all assumed they will need to go to their camp clinic, which would entail waiting in a long line. They said that some health care workers have taken residents’ temperatures when requested. Leros residents said that doctors are no longer coming to the clinic because of the lockdown, and so if someone gets sick, the police need to agree to call an ambulance, but only in critical cases. There are no clear provisions to provide health care to people with pre-existing medical conditions, pregnant women, or women who go into labor.
The government said in its ECHR submission that the Samos camp had established a special shelter “for the hospitalization and isolation of any coronavirus case.” However, three migrants and one aid worker interviewed on Samos said that they have not seen any new special shelter or received any information about it. A second aid worker on Samos said that there are up to 7 containers that could be used to isolate 2 people each, but that given a population of around 7,000, the ability to isolate 14 people is unlikely to be sufficient if the virus entered the camp. A container reportedly set up at the Samos hospital to deal with virus cases was vandalized on April 15.
Four residents on Lesbos said that in the last month, the authorities had placed a new container at the camp entrance. None of them had interacted with the few health care workers stationed there, who they said are wearing masks and gloves, nor have they seen anyone else being taken to the facility. They said over the last month, they believed authorities had set up one or more containers that might have a link to Covid-19 isolation measures but have not seen them in use and have not been given any information about them.
A Chios resident said that the authorities have set up two new containers, one with three beds inside it, that they said was intended to isolate anyone that contracted the virus. A Leros resident said he heard that authorities will be setting up quarantine containers in mid-April but have not done so yet.
In April, authorities quarantined two camps holding migrants and asylum-seekers on the Greek mainland because people inside the camps had tested positive for Covid-19, not letting anyone in or out. They took those steps without taking measures for robust contact tracing and to isolate those with the virus within the camps, said two aid workers and a camp resident. In a third case, authorities locked down the camp without any evidence of the virus inside, merely because they suspected camp residents had contact with a nearby community where people had tested positive for the virus. In a fourth case, authorities quarantined a hotel in the Peloponese, housing 470 asylum seekers, after a pregnant woman tested positive. On April 21, over 100 people in the hotel tested positive.
One aid worker said:
As outrageous as it sounds, the approach of the authorities when they suspect there might be a virus case in a camp is simply to lock up everyone in the camp, potentially thousands of people, some very vulnerable, and throw away the key, without taking the proper measures to contact trace and isolate the specific affected individuals.
Three aid workers said that on Lesbos there are 6 beds in the single hospital’s ICU, in Chios there are 3 beds, and in Samos there are 2. Two aid workers said that there is no ICU on Leros or Kos.
The Lesbos residents said that a group of volunteers sewed enough reusable cloth masks for about 80 percent of the migrant population, but no one has access to gloves. None of the people on the other islands have access to masks or gloves.
Water, Hygiene, and Sanitation
Residents of the Lesbos and Chios camps said they do not have consistent access to water to wash or adequate drinking water. Four Lesbos residents said that they only get about 2 hours of water in the morning, 2 hours in the afternoon, and 30 minutes at night for all their washing needs. The Chios resident said they only had two hours of water a day for washing hands and themselves. The Chios aid worker said water had become so limited in some areas that some camp residents have started digging their own wells. She shared photos.
The majority of asylum seekers on the islands are forced to live in informal settlements adjacent to the camps due to severe overcrowding. Residents said they have to get water from inside the camps and bring it back in water bottles, so they have less ability to keep clean. A resident of the adjacent overspill site on Samos said his water supply runs out daily by noon.
Samos and Leros residents said they don’t have enough soap. All of the migrants and aid workers said that since the outbreak of the virus, the government temporarily stopped transferring funds onto their cash cards in an effort to stop people from shopping outside the camps, so they had been unable to buy soap or other goods including food even from stores inside the camp, which also increased the length of the food lines.
None of those interviewed have seen any disinfecting in the camps.
One resident of Lesbos said that some camp residents helping the catering team prepare meals in recent weeks have been doing so without any gloves or masks, as far as he has seen.
Available evidence has shown that older people are more likely to experience serious and life-threatening complications from Covid-19. The 63-year-old Syrian man in the Samos camp said he was extremely worried about contracting the virus. He said he knew that it affected older people more, and was listening to the advice authorities have been giving daily, but said that there were no specific, shorter lines for older people or people with disabilities to get food, medical attention, bathrooms, showers, or to leave the camp.
Some people with disabilities may be at higher risk if they contract Covid-19, particularly those who have underlying health conditions that are recognized to make people more susceptible to disease if exposed. For others, having a disability does not by itself put them at higher risk, but they are at risk due to discrimination and barriers in accessing information, sanitation, and washing facilities. A Syrian man with a physical disability who uses crutches in Moria said that washing and waiting in long lines was especially difficult for him and others with disabilities. He said he had to ask friends to help him wash, as there are no sanitation facilities adaptable and accessible for those with disabilities.
Human Rights Watch research in 2016 and 2017 found that asylum seekers and refugees with disabilities were not properly identified in Greece, had difficulties getting basic services such as shelter, sanitation, and medical care, and, like other at-risk migrants, had limited access to mental health care.
The WHO has said that while there is no evidence yet that pregnant women are at higher risk of severe illness than the general population, due to changes in their bodies and immune systems, pregnant women can be badly affected by some respiratory infections. Human Rights Watch research in 2017 and 2019 found that pregnant women and new mothers in Moria camp lacked access to comprehensive medical care, including prenatal care for high-risk pregnancies, and to adequate nutrition, food, and bedding to meet their needs and in line with international standards. The Chios resident said he had to sneak out to buy vitamins and medications for his pregnant wife because local police refused to grant him permission to leave the camp.