1. Who is Empowering Whom?
Jayne Grimes

2. “A Somali man set himself on fire in a Libyan detention centre on Wednesday, according to fellow detainees and the International Organisation for Migration (IOM).
The man, who is in his late 20s, reportedly doused himself in petrol from a generator in the centre and lit it, after telling friends he had lost hope of being relocated to a safe country.”
Irish Times, 25 October 2018

3. European migration policies and their impact on migrants
June 2015 to March 2016, Europe experienced the highest movement of people since the Second world war.
90% of people reaching Europe through Turkey came from countries with the highest degree of violence currently in the world (Syria – 55% ; Afghanistan - 30% ; Iraq - 15%).
Majority of arrivals into Greece through the five eastern Greek islands (Lesbos, Chios, Samos, Leros and Kos)
following closure and high militarization of the land border between Greece and Turkey.

4. Samos-Border of Europe

5. Global deterrence policy
In March 2016 the EU and Turkey came to an agreement-ostensibly to outsource asylum
Turkey was given status by the EU as a ‘safe third country’ where people would be required to apply for asylum, closing the door to Europe.
Majority forced to remain in Turkey, the only way to enter Europe now - illegally with smugglers.
There are dramatic consequences of this policy on people’s health.

6. Arrivals to Greek islands from Turkey
2015: 847, 855
2016: 173, 450
Jan - March 2016:
2016 March: 26,971
2016 April: 3,650
This year
January to August 16, 262

7. MSF on Greek islands: Samos
MSF providing medical services within the refugee ‘hotspot’ since 2014.
In June 2016 in reaction against the EU-Turkey deal they pulled out their medical team.
They commenced a new project in recognition of the continuing crisis, focusing on mental health.
I worked on Samos in as a Mental Health Activity Manager.

8. Rights of Refugees
Under the Geneva Convention Relating to the Status of Refugees all asylum seekers and refugees have a right to
Health,
Adequate housing,
Social assistance,
Education &
Employment

9. Samos
MESSAGE 1 Loss of power in system-impact on MH-makes people more vulnerable
The actual level of provision of these rights is variable in different countries.
In Greece the provision of these services was theoretically provided by the state, supplemented by financial support from the EU through UNHCR. Services supplemented by UN and privately funded NGOs and voluntary organisations
Hotspot
Capacity is officially for 700
In October 2018 this is at over 4000
Between arrivals each week
Living in tents and containers
No electricity, heating, poor lighting
Significant protection issues
Poor access to toilets, showers
No structure, minimal activities
Inter-national conflict. As more people, less space, more conflict between different religious and cultural groups including Syrians, Kurds, Iraqis, North Africans

10. Samos
MSF provides access to specialised mental health care for the population within the hotspot and a shelter outside the hotspot for people suffering from moderate to severe psychological problems

11. What’s been leave behind
95% of people surveyed in Samos said that they had fled from war. They stated that leaving their country was seen as the only possible alternative to avoid death.
Many reported further violence and trauma during their journey to Greece.
45% reported experiencing violence in Turkey. 60% of that violence was beatings, 70% of which was committed by the police or army and 19% by smugglers.
People who had arrived on Samos after the EU-Turkey deal reported more violence in Turkey than people who had arrived before the deal.

12. Aims of MSF in Samos
Decrease morbidity and severity of mental health needs for vulnerable migrants stranded in Samos through provision of a comprehensive model of care
Ensure access to mental health care for moderate and severe cases and endorse engagement in meaningful activities that will help to prevent deterioration
Challenge European migration policies and promote alternative model of reception

13. Mental Health Programme
MH Outreach
Signposting-rights and services
Group model of care
Detention/police station visits
Link with psychosocial activities
Gateway to employment
GCR collaboration
Experienced interpreters
Community engagement
MESSAGE 2 How to empower people when the asylum system rewards vulnerability- Challenge
Stepped up our social services to improve identification of people in the camp with mental health problems. Went tent to tent, directly observe peoples’ situation, and importantly, their reaction to it. We informed other actors about who we were aiming to support.
Changed the model of care from an individually focused one to group model
We offered one to one support only to those who presented with severe symptoms, whose functioning was very poor, capacity to support themselves in this context was very low.
We invited everyone who came to us to ‘signposting’ sessions. Offered legal aid to all through a partnership with a local legal firm.

14. How to empower when the system rewards vulnerability?
Walking the line between supporting the people and supporting the system
Sickness in the system not the person
Medicalising Politics
Psychological support for the ‘normal’ consequences
Provision of ‘Vulnerability’ reports-helping or colluding?
We provided medical reports for people who were unwell
Demand for these reports was very high
Limitations in the medical system locally meant that people with acute conditions who could not access medical care on the island, in extreme cases were moved to mainland Greece. Decision to move a vulnerable person to the mainland for medical care was taken through the medical doctor in the camp and the camp director and transit arranged in conjunction with UNHCR. While MSF was outside of the system, we were the only organisation with a professional psychologist-so we provided medical reports where acute mental health conditions in evidence. Used these reports to advocate for people to leave the island.

15. Challenging the system through advocacy
Giving voice to those in the transit camps in Europe
Strengthening voice of asylum seekers in Europe
3 MESSAGE Empowering ourselves to challenge the system

16. Empowering ourselves to challenge the system
The problem can feel too big, too unwieldy, too complex, too confusing
It is on our doorstep, in our own country…
Go beyond the headlines
Educate ourselves to what is happening in Europe (e.g. IFGH)
Demand more from our politicians –part of the leaders who have signed up to global deterrence policies