Thousands of refugees and migrants in Serbia, stranded by delays at border crossings and registration points across the Balkans, have been exposed to conditions that pose a threat to their health as assistance fails to meet minimum standards. Unless adequate protections are urgently put in place, Doctors Without Bordesr/Médecins Sans Frontières (MSF) warns that thousands of pregnant women, young children, and elderly people will be exposed to extremely harsh conditions this winter with potentially life-threatening implications.
Stranded in Queues
About 1,500 people, including families, children and the elderly, spent the night of October 18 outdoors with no shelter from the cold and rain conditions at the Berkasovo/Bapska transit point from Serbia to Croatia. Due to the absence of proper structures, some people slept under plastic sheets, and babies and children, mainly from Syria and Afghanistan, were forced to sleep in the rain.
Another recent pressure point has been in Presevo, close to the border with the former Yugoslav Republic of Macedonia (FYROM), where an average of 5,000 people pass through every day. Most have been stranded in a queue, sometimes during heavy rainfall, for days at a time with minimal access to food, water, shelter, and toilets. “Over the past weeks we’ve had very young children coming to us for treatment for hypothermia,” said Dr. Alberto Martinez Polis, MSF medical activity manager in Serbia. “They’ve been waiting for hours at a time in the queue with no shelter. [They] are soaked through and shivering but have nowhere to get warm [and] dry or to change their clothes.”
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MSF teams treated 10 people in Presevo who had collapsed. “In some cases, this was been due to the pressure of the crowd, or because people had not eaten, drunk, or slept properly for days," said Martinez Polis. "People tell our doctors that they are scared to leave the queue as they might lose their family or their place in the line. Others have reached their limit and this can have physical consequences. One case in particular could have been serious—the patient was vomiting, unresponsive, and losing consciousness.”
Potentially Deadly Conditions
MSF’s medical teams in Serbia are treating more than 400 patients daily, a figure that has dramatically increased in recent weeks along with the flows of refugees. The majority need treatment for conditions such as coughs, colds, flu, gastrointestinal issues, and skin problems, which are often a direct result of the conditions they have faced on their journeys. Others are treated for chronic medical issues such as diabetes, asthma, and heart problems that have deteriorated without care. The teams also see serious cases that need more advanced treatment. This week patients presented with cancer, lymphoma, and congenital heart defects.
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“Our patients, who include babies as young as two weeks old, elderly people, and women often in very late stages of pregnancy, are already tired and weak when they reach Serbia,” said MSF head of mission Stephane Moissaing. “The lack of basic services to receive them has real consequences. We are extremely concerned that the situation will become far more serious this winter. Already there are more people crossing into Serbia every day than there are places to receive them. Just a couple of days of blockages or delays could leave thousands of people stranded. Unless we see a serious scale up, there is a real threat of thousands of people being exposed to potentially deadly conditions this winter.”
Serbian winters can be bitterly cold, with temperatures dropping as low as five degrees Fahrenheit. Last year MSF’s teams in Serbia treated two people for severe frostbite—one patient lost part of his foot, and others lost layers of skin when they removed their clothing. Though it’s difficult to predict how many people will pass through the area this winter, MSF is preparing for a large number of patients, recruiting more medical staff and increasing its stocks of tents, blankets, raincoats, and winter clothing. Hygiene conditions tend to deteriorate during winter as people cannot easily find places to bathe and wash clothes, leading to an increase in skin diseases and lice infections, so the team is also preparing hygiene kits.
“Although we have seen a positive impact of the organized transit across FYROM and Serbia since July, thousands of vulnerable people continue to be exposed to unnecessary suffering on their journey through the Balkans," says Aurelie Ponthieu, MSF humanitarian advisor on displacement. “The lack of basic services is already having an impact on their health, and the situation will only get worse this winter if adequate shelters, warm food, and hygiene facilities at registration and transportation points are not rapidly provided. We cannot wait for a dramatic event to happen—safe and adequate transit conditions, adapted to the coming low temperatures, need to be guaranteed now.”