A doctor’s story: inside the ‘living hell’ of Moria refugee camp
On the Greek island of Lesbos is the Moria refugee camp, constructed for 3,100 people but now with a population of more than 20,000 men, women and children. It has become a place of violence, deprivation, suffering and despair. I am a doctor from London and I have just spent three weeks working for the Boat Refugee Foundation (BRF). This was my third time there – and my most shocking.
BRF is the only emergency medical provider for the entire camp between the evening hours of four and 11. These thousands of vulnerable people spill out into the surrounding olive groves in makeshift tents, which are elevated on wooden palettes to try to prevent the cold from the freezing ground seeping into their tired, aching bodies. Most of them have made a treacherous journey to come to this unsafe place; 40% of them are children. Without BRF, I know many would have died every day in the three short weeks I was there: adults – both men and women – from violent stabbings that are stabilised by medics trained briefly in “stop the bleed”; children from a new outbreak of meningitis whose fevers spike at night in their tents; vulnerable women in labour; four-day-old babies sleeping in freezing tents.
I kept a diary of the cases I saw, thinking it would be cathartic after the chaos to read through one or two major incidents, for personal processing purposes. Little did I know how much the events from just one day would catch in my throat on re-reading. And the next day, and the next. I want to tell you about one dayin the life of the little portable cabin clinic where I worked. I am the narrator of the stories of the people still there; this is not about me.
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People queue outside the wirefenced cabin for hours before the clinic opens at four, hoping to be able to speak to a doctor about their child’s rash, their pregnancy-related abdominal pains, their hallucinations and flashbacks from witnessed violence, their sleep disturbance, their itch from having to wear nappies at night for fear of having to go to the toilet in the pitchblack camp. There has been no reliable electricity in the camp for more than two-and-a-half months now (with 20,000 people trying to use a grid made for 3,000, it constantly trips and cannot be relied upon for any period of time), and the threat of violence and sexual violence is incredibly high. Women and minors largely choose to wear nappies to avoid having to leave their tents after the sun goes down.
They come with infected wounds that need cleaning and bandaging; they have minimal access to clean water out in the olive grove areas. They come with the infamous “Moria flu” and a whole range of chronic problems one would normally expect in a population of this size. Any chronic problems are advised to come back to doctors working in the daytime: this clinic is for acute care only, for emergencies only. And we work at full capacity.
Patients can only enter with their police papers, known as their ausweis, which contain their photograph, name and number. They are triaged at the door by one medic alongside a translator in Farsi and Arabic. “Green” patients need urgent care; “yellow” patients are severely unwell with abnormal vital signs and require a full examination on a bed; “red” emergency patients usually suffer from major panic attacks, extreme pain, collapses and, increasingly, life-threatening stab wounds or the results of other violence.
We are a team from across the world – when I was on Lesbos there was a mix of Dutch, French, English, American and Spanish doctors, nurses and support crew. We work together with our translators (refugees living in the camp themselves, volunteering daily in return for bus tickets, phone credit, education and dinner as they are not able to stand in the food queue while working with us) from Afghanistan, Syria, Iran, Somalia and the Congo. We make up the clinic team, and respond together as the crowds enter.
The names of patients to be seen are written on a whiteboard in order of priority and we call them inside
one by one. The clinic has two rooms, split into four consultation areas. It is basic but functional. We have boxes with the essentials for consultations – oxygen saturation probes, blood pressure cuffs, thermometers and ophthalmoscopes. The thermometers and SATs probes [oxygen measure] often stop working for the triage doctor outside the clinic as night draws in and temperatures drop, so throughout the shift we swap them with those inside. There are four beds against the walls that can be pulled out in case of emergencies to allow access around the entire patient. We carry crash bags and emergency drugs to the clinic every day in rucksacks and have them in A1 – the emergency care room – where any “red” patients are taken for emergencies that day. On any given day, we can see 180 to 250 patients during clinic hours. Here are their stories.
A mother comes in with her fouryear-old child who has a very high fever, and who hasn’t been eating, drinking or responding to her properly for hours. To get to the cabin, she has had to walk through the camp on the side of a steep hill, weaving between UNHCR and makeshift tents, past the falafel store, the Wave of Hope for the Future school with its new library, past the barbers and people doing their washing, past the rubbish that hasn’t been cleared for a month, past the gang of wild dogs barking and running after her. She has waited patiently in line in the cold. When the gate is unlocked there is a rush of people, each shouting that they are an emergency, waving their ausweis.
I call the febrile child in. The mother is crying and the father looks ashenfaced as he explains through the Farsi translator that they are worried as the child won’t drink and looks tired. He has heard that another child from a nearby tent is now in hospital in Athens with a brain infection. He looks at the floor, apologises for attending, but asks for help.
Just as I start examining the child, I can hear shouting and the sound of someone being dragged along the gravel outside. The support crew member on the back door shouts “red patient” and I move the febrile child into the back space of the cabin, pulling the bed out and making space for the emergency. He is a young man in his teens, unconscious, dragged in a dark grey blanket by four people from the surrounding tents. He was seen to be shouting and screaming and then collapsed, breathing very heavily and not waking up. The men have been running with him unconscious in the blanket for 10 minutes to reach the medical area.
I start the tests on him. As I go to inflate the blood pressure cuff, he opens his eyes and screams – a long, sustained scream, followed by extreme hyperventilation and rigidity in his arms. This is a classic picture of a panic attack associated with PTSD (post-traumatic stress disorder), and a common presentation to the clinic. We are fortunate to have a psychiatric nurse in our team, and once any more sinister pathology is excluded, we move the man to a back room to rest and be reviewed by her, to plan onward referral and care.
In terms of mental health help for refugees, there are currently two referral pathways for the more severe end of the spectrum, but each takes time and depends on exposure to violence, sexual violence, and previous history. In the acute phase we provide emergency care for these patients and their friends, relatives and tent-mates, who listen to them cry at night, and drag them to the clinic in blankets when they have attacks.
Despite seeing multiple patients suffering with panic attacks every day, the sound of the screams still shocks and chills me as I wonder: what have you seen? What are you still seeing? I can’t comprehend it. And when we send them back to their tents, I feel ashamed.
I call the child back to my clinic space for a full assessment. By midway through my second week in the camp, we have had three confirmed cases of meningococcal meningitis and are considering a camp-wide vaccination programme. This child is persistently hot and lethargic, and has a concerning rash. We give him intramuscular ceftriaxone antibiotic and request a taxi to take him to hospital. With only two ambulances on the island despite a rapid 25% increase in the population, the service is not fit for purpose, and we are increasingly using taxis to transport patients to hospital.
I continue, with the help of my translator, to see patients in the “yellow” queue, mostly children with fevers, adults with abdominal pain, pregnant women, minors with scabies. We are busy today, as we are every day; there are a lot of people to see. As the sun goes down, I always feel the atmosphere at triage and inside the clinic changes. I get a sense of desperation and hostility, not usually played out, but always at the back of my mind. Because there is no electricity in the camp, the darkness outside is engulfing. Our clinic runs on the grid, regularly tripping out, and we carry out our consultations by the glow of head torches and battery-operated lights.
An entire family is dragged in, two of the four children unconscious and the father appearing confused, shouting about “fire”. Apparently they went to a neighbour’s tent where a fire was lit for warmth after sundown, and have been exposed to carbon monoxide for a sustained period of time. We start oxygen from our transported cylinders on the children who are not responding, wrap them in emergency blankets, and call the ambulance, while checking over the others. We have only two oxygen tanks so rotate them in response to clinical need. The ambulance will not drive up to the clinic (a short distance from the front gate of the camp) for safety reasons after dark unless in extreme emergencies, so we run the children down to the ambulance when it arrives, connecting their masks to the oxygen in the ambulance and sending them on their way. They have started responding by the time they are in the ambulance, and we know they will be OK.
The hubbub created by another “red” patient draws close and echoes around outside the clinic. This time two young men from the sections for unaccompanied minors are dragged in between friends, gasping and covered in blood. Both have been stabbed in the chest. One stabbing like this in London would receive emergency trauma care from a highly trained team, probably in a major trauma centre. In Moria, this is not the case.
I call all five doctors and the emergency nurse to the cabin and we split into teams, with two translators at each bedside. The majority of doctors are not used to dealing with acute stabbings: BRF has not actively recruited for emergency doctors previously, as we were offering more clinic-based urgent care. We had gone through some team pre-hospital trauma care earlier in the week and have had daily exposure to stabbings by now, so we get to work putting in lines and assessing each patient. We now have only one oxygen tank as we used the other on the children with carbon monoxide poisoning.
We prioritise the boy with the central chest stab as he appears to be having repeated apnoeic episodes. As we wait for the ambulance to arrive, the other one starts to gargle and choke. One of his lungs is filling up with air and blood where he has been stabbed. We switch the oxygen tank to him, while stabilising the other boy’s bleeding, and plan how to extricate both on stretchers from the tiny clinic room. We put in an emergency needle to decompress the damaged lung. It works for a few minutes, then fills with blood again. We decide to decompress that side of his chest with a cut to his chest wall. The tension is released, for now. The translators – non-medical but now accustomed to this type of emergency – grab oxygen masks, gauze and cannula dressings, and squeeze in fluid like members of a trained trauma team. Their resilience and care for their fellow refugees nearly chokes me.
As the ambulance arrives, we beg them to come down to the clinic gates to minimise the time transferring the boys in the freezing cold. They agree and also agree to take both boys at the same time – a rare occurrence, but last week a young man died from a stab wound and we work together in the dark shadow of this memory. We take the boys out in emergency blankets, with fluids and lines in place, on stretchers, in front of the patients waiting to be seen in the cold, gravel-floored cage that is the waiting room. I go back to debrief the team; the translators are already cleaning the blood from the floor, beds and walls.
We see the next patients. We keep going. People keep arriving and we continue to try to keep them safe in whatever capacity we can.
At the end of our clinic time, the responsibility for the medical care of patients in the camp is down to a lone “army doctor”, who cannot be accessed by patients unless the police deem them to have a serious enough medical problem. Unless there is a life-threatening emergency, they will wait until the day clinic opens at nine. People queue in the dark from 6:30 to try to get help.
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This is not abnormal. This is daily. The next day we had a 16-year-old boy, again from the supposedly protected sections, fall through the back doors of the clinic with a knife still in his back. On the last night I was working we saw four life-threatening stabbings, including a stabbed neck and an open chest. We assessed and stabilised them all and got them to hospital. As far as I’m aware, all of these patients are still alive.
There has been no electricity in the camp now for two and a half months. We know about the direct correlation between light and crime – people have been requesting an end to this darkness. It has not come.
The sections for unaccompanied minors and vulnerable women consist of fenced areas with sleeping cabins inside, locked in a secure area near to the police and new arrivals areas. They are understaffed. Guardians work hard to keep the most vulnerable safe, but with boredom and violence still prevalent, and staff often not speaking the same language as the refugees, monitoring and care is stretched, and problems continue to spiral. With finite space and an infinite number of increasingly vulnerable people arriving, many minors and women are living alone outside the sections, at risk of abuse, violence, and systemic failings.
The boredom in the camp is maddening and the asylum process is opaque. Even those of us with contacts in other NGOs and with lawyers cannot work it out. During my time there, one of our most calm, loyal, and impressive translators was arrested after a second rejection and deported without papers, and without a lawyer. We have still not been able to contact him. We do not know where he is and we do not know the details of his rejection. We know he will not be safe back in Afghanistan. This kind of thing reaches through the camp, adding to the feeling of resignation and hopelessness. And the madness continues.
The suffering is palpable, the hopelessness is insidious, the feeling of abandonment is all-consuming. I have not done a special job here. I have gone to volunteer, as many have before me and many continue to do while I return to my home, where I have central heating, regular food I can choose, and my freedom – and all of these afforded to me only by my luck at birth.
Moria refugee camp is at breaking point; the situation is about to implode. This will happen inwardly, harming some of the most vulnerable people in the world. The implosion will probably cause a tiny ripple of outward explosion, and then be forgotten. The world continues to turn its back. We must open the conversation once more, we must consider taking responsibility for our fellow humans. I have no solution, but I want to give a voice to these silenced people, and hope there is a willing audience prepared to begin to listen.
What have you seen? What are you still seeing? I can’t comprehend it. And when we send them back to their tents, I feel ashamed