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Vulnerabilities and endured violence during migrants' journey and in refugee camps in Greece

  • 2017/11/17
  • Réponse aux Urgences
Since 2015, Europe has been facing an unprecedented arrival of refugees and migrants: more than one million people entered via land and sea routes.
During their travels, refugees and migrants often face harsh conditions, forced detention, violence and torture in transit countries. However, there is a lack of epidemiological quantitative evidence on their experiences and the mental health problems they face during their displacement. Here, we present the results of survey among refugees and migrants at 7 sites in Greece documenting the types and levels of violence experienced during their journey and whilst settled and measuring the prevalence of anxiety disorder morbidity.
We conducted a cross-sectional population-based quantitative survey combined with an explanatory qualitative study from November 2016 and February 2017. The survey consisted of a structured questionnaire on experience of violence and an interviewer administered anxiety disorder screening tool (Refugee Health Screener 15). Furthermore we collected data on demographics, health status and access to healthcare, access to legal aid, crossed countries and project of life. The study population consisted of an exhaustive inclusion or random sampling (based on camp size) of individuals living in 7 sites: 4 camps in Ioannina and Attica regions, 1 hotspot in Samos Island, 1 hotel for refugees in Athens and 1 hotel for refugees in Ioannina.
In total, 1293 individuals were included; 60.9% were aged ≥15 years and 7.8% were 0-5 years. Sixty percent were males and 64.4% were from Syria. Depending on sites, 48.7% (37.8-59.8) to 94.7% (90.1-97.2) reported fleeing from war. Twenty four percent (18.3-31.6) to 54.7% (46.6-62.6) reported having experienced at least one violent event, during the journey or in Greece. Access to an appropriate medicine for those who suffered from a chronic disease on sites varied from 38.1% (26.0-51.9) to 83.5%.  Seventy three percent of the population have been screened positive to the anxiety disorder screening tool. Among them, 41.2% refused to be referred to a psychologist. Access to legal assistance and information about asylum procedures are considered as non-existent for the majority of the population. 
The qualitative interviews show the difficult and violent conditions of border crossings and the tense and stressful interactions with smugglers. These experiences together with experiences of war in home country stand out as traumatic experiences for the participants. Recent studies , , ,  have emphasized daily stressors in relation to high rates of psychological distress often found in conflict driven migrants. The study underlines various daily stressors as negatively affecting the mental wellbeing of migrants and refugees in Greece. Lastly, the qualitative part indicates barriers to accessing mental health care.
This survey conducted during a mass refugee crisis in a European Community country provides important data on living experience in different refugee settings and reports high levels of violence experienced by refugees and migrants during their journeys and the high prevalence of anxiety disorders. Similar documentation should be repeated throughout Europe in order to better respond to the needs of this vulnerable population.