COVID-19 (also) in Moria: The deficient handling of the pandemic as an attempt to instrumentalize refugees


Thirteen days after 35 cases of COVID-19 were identified in Moria, the announcement of 243 more cases in the new camp at Kara Tepe, on the island of Lesvos, is not simply testament to the administration’s bad luck, or the unsuitability of a temporary camp that was set up under threat. Rather, it demonstrates the government’s insistence on a “pandemic response plan” in which,  after exposing thousands of people to risk, it subsequently administers a large volume of rapid tests in order to record the outcome.  

Refugee Camp Greece

Lesvos is revealed as the tip of the iceberg: following the complete incineration of the Moria camp, a facility with a capacity for 2,757 people that was hosting 12,589 residents, the latest 21 cases in the already closed Reception and Identification Facility (“hotspot”) of Samos fueled another potential arson on 20.9.2020, just a few months after the April fire. And yet, despite the successive crises it creates, the standard for pandemic response is still the Moria approach. How to explain this obduracy? On 8.9.2020, the Minister of Immigration and Asylum, N. Mitarakis, declared before Parliament his satisfaction on the achievement of the government’s goals: “We have had two priorities since the day of our reinstatement: First, the substantial reduction of migrant flows. Second, the substantial reduction of the impact of the migration crisis on local communities.” The statement was honest: concern for public health was, at least in word, completely absent. 

The failure of the “Agnodiki” Project

The burning of Moria, a place of squalor and misery (like Pagani in Lesvos before it) and death, in reality meant the complete collapse of the government’s “Agnodiki” Project. This was a classified project created by the Ministry of Immigration and Asylum (and not the Ministry of Health or the National Public Health Agency), which reached the Press in a piecemeal manner, through selective leaks: it was completed on March 17, tested on March 23, and its stated goal was to prevent and manage “uprisings and violent incidents, public health threats, and large natural disasters” – not outside, but inside the overcrowded refugee facilities.  

Following the identification of COVID-19 cases in the Moria hotspot, “Agnodiki” was implemented even more strictly inside such facilities. Almost in response to this development, the burned-out Moria camp served as a reminder that the demand for compliance and measurable success in the control and “security” of borders and facilities, especially when it is obviously prioritized over public health goals, may be concealing practices intended to instrumentalize refugees, which breed desperation in the midst of a pandemic.

Controlling arrivals above controlling the pandemic

It is well-known that the pandemic response in Greece was unique, in that it coincided with the arrival, in late February 2020, of several thousand refugees at the EU-Turkey borders. The handling of this unique event showed that the refugee question constitutes, in Greece and Turkey, a means for both sides to apply pressure and an “instrument” for negotiations with the European Union.

From the standpoint of controlling refugee populations, reducing arrivals by 89% compared to 2019 and reducing those staying on the islands by 34% do constitute “measurable successes”, if the priority is to have fewer refugees and asylum seekers in Greece at any cost – even if that includes refoulements, deportations,  and “voluntary” returns. In late June, the UN High Commissioner for Refugees calculated the total number to be 121,000: 90,600 on the mainland and 30,400 on the islands.

From the standpoint of public health, however, success has a different meaning. In attempting to combine public health goals with border control goals, the government has set as the bar for success the absence, so far, of a fatal case of COVID-19 in the hotspots and the containment of cases, during the pandemic’s first wave, at 0.2% of the total population of refugees and asylum seekers. But are these results according to plan? The continuing overcrowding of the island hotspots, which cancels out the ability for effective contact tracing; the abandonment of those arriving from the islands in Victoria Square in Athens; the reduction of available reception spots on the mainland (with the planned closing of all 67 hotels in the European FILOXENIA program in 2020); and the successive outbreaks of cases since August (in Chios, Siteia, Grevena, Kozani, Malakasa, Oinofyta, Schisto, Elaionas and Vyronas), which also include people working at the refugee facilities, show that controlling this pandemic is a much more demanding endeavor than simply citing statistics. This paper attempts to establish the criteria for assessing the pandemic response plan in refugee facilities.

COVID-19 and refugees: what we knew during the first wave of the pandemic

Based on the definition adopted by the World Health Organization (WHO), public health is “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.” The emphasis of this definition on organized society highlights the fact that public health is not a matter of “personal responsibility”, nor (primarily) a medical issue. Especially in a pandemic for which there are no vaccines or pharmaceutical treatments, the prevention measures and emphasis on living and sanitation conditions constitute, by necessity, the cornerstone of any response plan. This should be the starting point of an assessment of health policy for refugee populations.

As such, on 17.3.2020, the Interagency Standing Committee (which includes the WHO, the IOM, the UNHCR and the Red Cross) recommended measures to relieve overcrowding in hotspots to make social distancing possible, as well as the avoidance of discriminatory measures, providing timely information in appropriate languages, pardoning those entering the country without papers (so that asylum seekers could participate in the pandemic response plan), epidemiological monitoring and individual screening at the border, in holding centers and communal areas. On 27.3.2020, the WHO intervened especially for detainees, calling for proportionality in holding measures, the implementation of measures alternative to detention, and timely access to healthcare. On 1.4.2020, the WHO, the UNHCR and the IOM explicitly called for the release of refugees and immigrants “without delay”.

Utilizing its experience from the first stage of pandemic response, the IOM recorded the basic factors that increase the vulnerability of refugees and asylum seekers to COVID-19: inability to observe social distancing measures due to overcrowding; limited access to basic personal hygiene articles and personal protection equipment; failure to establish the right to healthcare; stigmatization; limited space during lockdown; fear of arrest or xenophobic attack; exclusion from programs providing housing and income; inability to maintain the status of legal resident. On 15.6.2020, the European Center for Decease Prevention and Control (ECDC) noted: “While there are no indications that the transmission of SARS-CoV-2 are higher among immigrants and refugees, factors such as overcrowding in Reception and Detention Centers may increase their exposure to the virus [especially] in the absence of appropriate prevention measures.”


COVID-19 prevention measures in refugee populations’ living quarters in Greece: protection of public health or exposure of refugees to risk?

On 29.2.2020, the Greek National Public Health Agency (EODY) published its “Guidelines for screening and management of COVID infections in refugee and immigrant reception centers. According to these guidelines, the EODY field coordinator would ensure that each facility is properly equipped with personal protection equipment and would also appoint a health professional in charge of managing cases and tracing contacts. This health professional would be responsible, among other things, for checking new arrivals for symptoms at the entry points and transporting suspected cases to the hospital. On 21.3.2020 it was decided to broadcast messages in the facilities in languages that the refugees and asylum seekers understand, and on 27.3.2020 it was decided to install containers in the Reception and Identification Centers to isolate infected persons. Finally, the weekly epidemiological surveillance of living quarters continued.

Beyond these measures, however, the Greek government moved in the opposite direction of international recommendations:

* Overcrowding: While social distancing measures were implemented in the general population, in late May of 2020 there were 17,351 people living on Lesvos (in a facility with a capacity for 3,300); 6,554 were living on Samos (in a facility for 1,400); 4,829 were living on Chios (in a facility for 1,756); 2,241 were living on Kos (in a facility for 900); and 1,200 were living in Diavata (in a facility for 1,050). In a briefing note released by the Ministry of Immigration and Asylum (8.9.2020) it was stated explicitly that “the Government’s goal is the equal and fair distribution (1%) of asylum seekers in all of the country’s Regions, with the exception of the points of first reception.” Overcrowding in specific facilities was not due to “emergency circumstances”: compared to 2015, arrivals remain significantly reduced. Overcrowding was – and remains – the result of a calculation, tolerated by the European Commission, so that living conditions do not function as a “pull factor” for new refugees.  

* Establishing the right to healthcare and ensuring timely access to it: Following the elimination of Social Security Numbers (AMKA) for asylum seekers (July 2019), on 1.4.2020 the decision was ratified to assign Provisional Foreigner Insurance and Healthcare Numbers, which were linked to the legal status of the beneficiary so that, in the event that the asylum request was denied, the number would be removed. In many instances, infections were identified by chance. Until 27.5.2020 many refugees reported an absence of tests at their facilities; Samos only had one EODY doctor; in many facilities getting tested by health professionals required waiting in line for several hours or travelling over large distances; and there were very few ICU beds available on the islands (6 on Lesvos, 3 in Chios, 2 on Samos, and none in Kos and Leros). Recent data from the UNHCR showed that 30% of the “beneficiary” asylum seekers under ESTIA I did not have an assigned AMKA or Provisional Foreigner Insurance and Healthcare Number.

* Living and sanitation conditions: Conditions in the living quarters of refugees and asylum seekers are consistent with inhumane and degrading treatment, primarily in Moria: hours-long wait for food, long queues for water, one bathroom for every 200 people, one shower for every 600. These conditions, together with the frequent occurrences of violence (sexual, domestic, ethnically motivated, police) have led repeatedly to hunger strikes: in March in Corinth, in July in Kos, in August in Moria.

* Sufficiency of protective equipment and facilities: In Moria there was a shortage of face masks and refugees had to make their own protective face coverings. In most hotspots, personal health and hygiene products (masks, soap, etc.) are provided by the UNHCR and the IOM. Following the recent cases of infection in Schisto and Elaionas, the Ministry leaked the information that, “where there is limited availability of containers, infected persons will be isolated in the childcare and kindergarten buildings inside the hotspots.” Despite the lack of facilities, in June of 2020 a “Doctors without Borders” facility in Moria was shut down, due to a fine imposed by the municipal authority.

* Protection of vulnerable groups: According to the most recently available data from the UNHCR (1-31.7.2020), of the 4,600 unaccompanied minors, only 1 in 4 had access to suitable accommodation.

* Income provision: On 27.3.2020 the government decided to suspend the monthly monetary allowance granted by the UNHCR. On 6.4.2020, Minister N. Mitarakis announced that fines will be imposed for violations of curfew and that the related amounts will be withheld from the monthly stipend.

* Proportionality of measures: According to the “Agnodiki” Project, parts of which were made public through leaks, facilities where COVID cases are identified will be placed under sanitary lockdown (quarantine), counter to protocols for detained populations, which provide for the removal of suspected and confirmed cases and their housing in secure quarters. In some cases (e.g. Malakasa), despite the “quarantine”, more cases were diagnosed. With the quarantine in Chios and Evros, the operations of NGO programs inside the facilities were suspended, and in facilities under lockdown there are no informal educational activities, psychosocial support and legal counseling are not provided, and children do not attend school. Despite the consequences and ineffectiveness of such “lockdowns”, the government presents the construction of closed facilities (and the conversion of open ones to closed) as an optimal prevention measure. Between 13.3.2020 and 15.5.2020 the Asylum Agency remained closed; as a result, the registration of asylum requests, conducting of interviews and filing of appeals against rejection decisions were suspended – whereas these operations could have been carried out electronically. Finally, instead of limiting detention, the law on “the improvement of immigration legislation” (8.5.2020) stipulated the broader use of detention as the penalty for irregular entry.

* Discriminatory measures: On 21.3.2020, before restrictive measures were implemented for the general population, restrictions on movement were imposed as a temporary measure for persons housed in the Reception and Identification Centers on the islands. The measure was later extended to the Reception and Identification Center of Fylakio in Evros and to the refugee facilities in Ritsona, Malakasa, and Koutsohero in Larisa. Although temporary, the measure was extended even after the restrictions on movement were lifted for the general population (4.5.2020), with successive joint ministerial decisions and until 15.9.2020. In an interview, the minister would admit that the measures imposed on refugees and asylum seekers where stricter compared to the general population. In late April, the prime minister explained: “My priority has always been and remains the life and health of Greek people.”

* Stigmatization and xenophobic attacks: Just like in Europe and in Turkey, the pandemic provided a pretext for stigmatization and attacks against immigrants and refugees, as evidenced by a long list of attacks motivated by racist or anti-immigrant sentiment against employees in facilities and volunteers in solidarity with refugees.

What needs to happen now

The reduction in arrivals – as a result of the joint EU-Turkey Statement and the deterrence policy implemented by Greece – confirms that Greece is not dealing with an “emergency situation” or a “refugee crisis”. The subjecting of refugees and asylum seekers to inhumane and degrading treatment, in the midst of a pandemic, is the result of a protracted crisis of reception, so that the reception system will not function as a “pull factor” for refugees. In the case of Moria, this policy resulted in the complete destruction by fire of the Reception and Identification Center; in other instances, it has resulted in hunger strikes, self-inflicted injuries, violent outbursts. The recent (4.9.2020) hiring of medical and administrative personnel at the Reception and Identification Centers in Lesvos, Chios and Samos, the acquisition of machinery and COVID tests, medical equipment and supplies, with a 300,000 euro grant, was a measure intended to extend the operation of dangerously overcrowded island hotspots.

By maintaining and extending the failed and, in the midst of a pandemic, dangerous model of closed facilities, Greece is disregarding international practices that point in a different direction: this past March, Spain released from detention immigrants and refugees who cannot be returned, Ireland relaxed its punitive policy on refugees without papers who sought healthcare services, and Britain released 350 refugees from detention centers. In the same direction, international organizations and scientists recommend: a) vacating the reception centers, b) transferring refugees to safe housing on the mainland, c) effective epidemiological surveillance, and d) complete integration of health services for refugees and asylum seekers within an enhanced healthcare system, built around primary care, without discrimination. As long as, instead of the above-mentioned practices, there is continued negligence, deficiencies, and instrumentalization, which did not prevent the fire in Moria, in reality we are counting down to the next cases of infection – and the next fire.


This article was originally published in Greek on 22/09/2020 and it is part of the dossier  "COVID-19. Political debates on the pandemic with a European focus"

See also the article Migrants and Refugees in a Time of Pandemic: Access to Healthcare Services in Turkey, originally published the Office of Heinrich Boell Stiftung in Turkey.