Addressing health vulnerabilities of migrants and refugees in large migration flows: The Greek experience and National Action Plan Yiannis Baskozos April 18, 2016 General Secretary of Public Health Greek Ministry of Health

Source: (17/4/16)

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Source: MSF - (17/4/2016) Main healthcare needs are due to 5 conditions 1.Trauma 2.Respiratory tract infections 3.Chronic diseases 4.Gastrointestinal maladies 5.Skin maladies Most of the disease burden is due to the journey and the inappropriate living conditions There is no alarm in terms of Public Health! Constant healthcare provision and emergency treatment are needed, together with an attempt to improve living conditions in the refugee spots

Source: (17/4/2016)

Core values of the Action Plan Refugees are human beings and need to be treated accordingly Every European country has a duty to provide appropriate healthcare standards to all human beings in its territory The refugee population currently present in Greece has specific needs in terms of healthcare

1.Facilitate the assurance of appropriate living conditions 2.Ensure the adequacy of a living environment that deters the spread of infectious diseases and obeys to the rules of public health 3.Develop a healthcare system that serves the medical needs of the refugee population with quality and appropriate standards 4.Apply a holistic approach to the healthcare issues of the refugees currently present in Greece 5.Respect, protect and fulfill human rights Core elements of action

1. Facilitate the assurance of appropriate living conditions Shelter Water and sanitation Food provision and quality assurance 2. Ensure the adequacy of a living environment that deters the spread of infectious diseases and obeys to the rules of public health Vector control Rubbish disposal Cleaning and maintenance 3. Develop a healthcare system that serves the medical needs of the refugee population with quality and appropriate standards Deal with healthcare emergencies Develop a primary healthcare system Monitoring for contagious diseases, early detection and reporting Vaccination campaigns and preventive medicine Health promotion Provision of mental health services Develop a recording system Network the healthcare services Management and coordination of the healthcare services Provide training and education to healthcare workers

4. Apply a holistic approach to the healthcare issues of the refugees currently present in Greece Special care for the social background of refugees Management of vulnerable social groups Network of social services 5. Respect, protect and fulfill human rights Ensure a human rights approach in the provision of services Early detection of human rights violations and management

SHORT-TERM PRIORITIES Deal with healthcare emergencies Shelter Water & sanitation Food provision & quality assurance Rubbish disposal Cleaning and maintenance Monitoring for contagious diseases, early detection and reporting Vaccination campaigns and preventive medicine Develop a recording system Management of vulnerable social groups Management and coordination of the healthcare services Ensure a human rights approach in the provision of services LONG-TERM PRIORITIES Vector control Develop a primary healthcare system Health promotion Provision of mental health services Provide training and education to healthcare workers Special care for the social background of refugees Early detection of human rights violations and management

Source: (17/4/16) Rescuing and reception

Effective rescue Availability of rescuers Authority to rescue Training of rescuers Referrals Referral units (ΕΚΑΒ) Standardized referral procedure Reference points (hospitals, health centers etc) Emergency healthcare Basic Life Support Advanced Life Support Training of professionals Psychological first aid Triage Assessment & primary health evaluation Team of professionals Standardized assessment procedure Personal Operational Plan Goal setting Portable healthcare units Screening Intercultural mediation

Public health measures Source: (17/4/16)

Early warning systems Location of the camps and settings Access to the camps Shelter Electricity Communications Mosquitoes & vector control Water Sanitation and hygiene Rubbish disposal Food & diet Monitoring for contagious diseases Burial of the deceased

Vaccination Source: (17/4/16)

Vaccination campaign with mass vaccination of children currently living in the camps AND Inclusion of vaccinations in the primary healthcare services to be developed MMR DTaP + Polio Pneumoniococcus BCG (newborns)

Epidemiological monitoring Source: (17/4/16)

Reinforcement of the already existent system for compulsory reporting of specific diseases AND Sentinel system for epidemiological monitoring of symptoms and syndromes

Partners National Organizations (superintended by the Ministry of Health and others) National Center for Healthcare Interventions (coordinating authority) National School of Public Health Hellenic Center for Disease Control and Prevention NGOs International (Global and European) Organizations WHO IOM UNCHR ECDC MDM MSF NGOs

Primary healthcare Source: (17/4/16)

Services to be provided by the primary healthcare system Vaccination Treatment of chronic diseases Mental health services Health promotion Mother and child health Treatment of vulnerable social groups (persons with disabilities, unaccompanied children etc)

Characteristics of the primary healthcare system Specific structure to serve the emerging healthcare needs timely and adequately Location of the primary healthcare surgeries Rules of function and operation timetable Human resources Administration and coordination Referrals and connection to the already existent primary healthcare units

Governing Source: thenextweb.com (17/4/16)thenextweb.com

Administration General Secretariat for Public Health (Ministry of Health) Sub-ministry for Migration Policy (Ministry of Internal Affairs) Regional Healthcare Officials Local Healthcare Officials National Center for Healthcare Interventions (ΕΚΕPΥ)

Referral system – NON emergency Local primary healthcare units Regional healthcare units Health centers 2 nd grade hospitals Urban healthcare units 3 rd and 4 th grade hospitals

Referral system – Emergency Local primary healthcare units Regional healthcare units Health centers 2 nd grade hospitals Urban healthcare units 3 rd and 4 th grade hospitals Rescue team ** Transportation of patients is enabled via the National First Aid Center (ΕΚΑΒ) and includes ambulances, ships and/or aircrafts

Access to the healthcare system The rest of the incoming population has access to the national healthcare system ONLY in case of emergency. Registered asylum seekers and refugees enjoy full access to the national healthcare system. Currently… Law changes need take place in the direction of providing free access to healthcare for every individual that has crossed the Greek-Turkey border

In an ever changing environment Versatility Alertness Modification of priorities