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Medical and Psychological Care in Detention
A mental health counselling session at Venna detention centre, Rodopi, northern Greece.
Toward the end of 2010, the situation for migrants in detention in Greece became critical. Cells in border police stations and detention centres in the region of Evros, on the border with Turkey, were exceeding capacity two- or threefold. Men, women and children were obliged to share facilities, with 100 people typically having access to just two toilets. Detainees were not being allowed outside.
What we witness every day inside the detention facilities is not easy to describe”,said Ioanna Pertsinidou, Médecins Sans Frontières’ emergency coordinator, in December. “In Soufli police station, which has space for 80 people, there are days when more than 140 migrants are detained there. In Tychero, with a capacity of 45, we counted 130 people. In Feres, with a capacity of 35, last night we distributed sleeping bags to 115 detained migrants. One woman, who had a serious gynaecological problem, told us there was no space to sleep and she had no other option but to sleep in the toilets.” The MSF team distributed sleeping bags and hygiene kits, and worked to improve sanitation. In Soufli and Tychero police stations, two MSF doctors treated patients who were mainly suffering from respiratory and skin infections as a result of the harsh living conditions. Where detention is an instrument of migration policy, the rights to medical care,humane treatment and respect for dignity are often ignored. In 2010, MSF provided humanitarian assistance and medical care in detention centres or prisons in Cambodia, the Democratic Republic of the Congo,Greece, Kyrgyzstan, Malta and Myanmar. “Our role is to provide emergency support and medical care to help detainees survive”,says Dr Apostolos Veizis, MSF head of programmes support. The conditions of detention, even detention itself, have a significant impact on people’s health, but MSF cannot take on the responsibilities of immigration authorities or the Ministry of Health. As an emergency medical organisation,
MSF brings assistance to people in urgent need. But also, as Dr Veizis says, “We push the authorities to improve conditions by showing the positive impact of our activities and by speaking out on what we witness in these centres.” MSF lobbies hard to ensure the provision of acceptable living conditions and adequate healthcare for detainees. In Malta, MSF staff had been providing medical care to detained migrants and asylum seekers since 2008, but in 2009 the team temporarily suspended activities when it became clear that living conditions were compromising the care and treatment that staff were providing. After persistent lobbying, authorities began to improve living conditions and the availability of healthcare. MSF resumed its activities in June 2009, and in October 2010 staff handed over responsibilities to the Ministry of Health. The ministry had also started to recruit cultural mediators to help remove language and cultural barriers between medical staff and migrant patients in health centres and hospitals.
Despite feeling forced to leave their homes in order to survive, enduring painful and traumatic journeys, and experiencing overcrowding, lack of food, lack of exercise and insanitary conditions in the places where they end up, the single most important complaint for most migrants is the mere fact of their detention. Three per cent of migrants who received care in Greek detention centres attempted suicide or self-harm, 39 per cent of detainees showed signs of anxiety, and 31 per cent had symptoms of depression. MSF offered psychosocial support to detainees in Malta and Greece, providing individual and group counselling to help migrants cope after their traumatic experiences. But in an emergency intervention staff have little time to gain the trust that is necessary for the provision of quality medical care, particularly mental healthcare. MSF’s principle of independence is therefore crucial to our work in places of detention. Teams working in detention centres make it clear to everyone that although they are present with the consent of the authorities, their activities are carried out independently. Confident of MSF’s independence, trust can be built with the detainees more quickly. According to Dr Veizis, MSF staff members are “some of the few people detainees can talk with”. Tuberculosis care in prisons Prisoners are also often in need of assistance, and MSF provides medical care in a number of penitentiary facilities. In Kyrgyzstan, MSF has been collaborating with the Ministry of Health, prison authorities and international organisations such as the International Committtee of the Red Cross (ICRC) to support the treatment of tuberculosis (TB) in prisons. TB is 20 to 30 times more prevalent among prisoners than among the general population. Patients diagnosed with TB are referred to treatment facilities in three prisons in and around the capital Bishkek. Overcrowding and poor ventilation are key factors in facilitating the spread of the disease, so MSF staff have refurbished the medical rooms in the prisons and TB patients’ cells. Prisoners with TB are often transferred or released before completing their treatment, and former inmates often struggle for the bare necessities of life. They do not consider the continuation of their medication to be their highest priority. The disruption of TB treatment not only risks the patient’s recovery, but also the development of drug-resistant TB, which involves a much longer and more difficult treatment regime. In 2007 MSF staff began providing counselling, food, and money for transport to help ex-prisoners in Kyrgyzstan continue their treatment. Improving conditions In 2010, a successful collaboration with the government and the ICRC in the Democratic Republic of the Congo (DRC) ensured a long-term improvement in prison conditions in Bunia, eastern DRC. When 17 prisoners died of malnutrition at the hospital in Bunia in just two months, an MSF team visited the prison. The team found 540 men, women and children living in a structure with a capacity for 100. There was no guaranteed food supply and no safe water. MSF immediately began treating malnourished patients with ready-to-use food and organised medical consultations. A safe water supply was installed, the sanitary block was renovated, and a reliable food supply was assured. The government allocated extra funding to the prison and in March 2010 MSF handed over its activities to the government and the ICRC.