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This is an excerpt from MSF's 2013 International Activity Report, published annually looking back on our work in the previous year.

The sudden increase in refugee numbers in Bulgaria in 2013 led to overcrowding in accommodation centers, and a shortage of adequate healthcare.

More than 8,000 refugees, 70 percent of them Syrians, crossed into Bulgaria this year and were transferred to various detention and reception centers. In November, MSF began working in these centers, in close collaboration with the State Agency for Refugees, to respond to the humanitarian needs of the refugees. MSF has not worked in Bulgaria since 2005.

The influx of refugees resulted in pressure on the state system and a dramatic drop in standards of healthcare and hygiene at the centers. Vulnerable groups, including pregnant and breastfeeding women, children under five, patients with chronic diseases or mental health issues, disabled people, and the elderly, needed to be identified on arrival and fast-tracked in order to guarantee them access to specialized care, food and suitable accommodation. During the cold winter months, MSF teams witnessed a lack of accommodation, electricity, bedding, and sanitation facilities. Medical care was also insufficient, with only emergency ambulance referrals to hospitals available. Consultations were provided on an ad hoc basis and there was no consistent supply of drugs.

Responding to the gaps in care, MSF started working in the Vrezdevna and Voenna Rampa centers in Sofia, and in Harmanli camp close to the Turkish border. Basic healthcare was provided, including antenatal care and midwifery. Mental health consultations were organized for those showing symptoms of psychological distress. Tools and procedures for medical and vulnerability screening were introduced, a system of access to healthcare was implemented and critical work to improve hygiene and sanitation was undertaken. MSF also ensured that services were available for those asylum seekers living outside the Vrezdevna and Voenna Rampa centers. 

MSF first worked in the country in 1981.

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