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Integrating Refugees Can Strengthen Greece’s Health System

Health focus and funding in Greece needs to shift from an emergency response centered on NGOs, toward building a more comprehensive and inclusive national health system, argues Chatham House’s Lenio Capsaskis.

Written by Lenio Capsaskis Published on Read time Approx. 5 minutes
Vaccination program for young refugees in Athens. (Giorgos Georgiou/NurPhoto)

Some 62,000 asylum seekers and refugees have arrived in Greece since 2015, according to the Greek government, and have not moved to another European country, either because they cannot or choose not to. The U.N. refugee agency (UNHCR) quotes lower figures, saying that approximately 47,000 people remain on the mainland and islands.

Both the government and UNHCR say they are committed to integrating asylum seekers and refugees who will be living in Greece into local society, improving self-reliance and long-term access to services and improving cohesion with the host communities. Considering these figures, the process of moving people from camps to urban centers to improve integration should be a feasible strategy.

Health services are not predominantly featured in the discussion around integration, but health and well-being are integral to new arrivals’ ability to participate in society.

In a country with a struggling health service as a result of years of austerity, and as donors move away from emergency funding for asylum seekers and refugees, this is an important time to focus on strengthening the Greek health system. Integrating asylum seekers and refugees into the public health system can serve as a platform to strengthen these services in general, benefiting asylum seekers, refugees and the host community, and leading to more equitable and inclusive healthcare.

The Greek Ministry of Health has taken steps to highlight and put into practice its political commitment to providing streamlined healthcare for asylum seekers and refugees in the country. As of April 2016, access to healthcare is no longer linked to employment-based health insurance, a move toward universal health coverage across the country. A joint ministerial decision states that asylum seekers and refugees, along with other uninsured populations, are now eligible for free healthcare in the country through the provision of a social security number.

But the long-term structural changes in the health system that are needed do not happen overnight. While the new law goes a long way to ensuring universal healthcare, it is clear that there are still barriers to implementing an integrated approach to this for asylum seekers and refugees.

The financial flows and structural functioning of healthcare in Greece indicate that the European Commission and Greek government still view asylum seeker and refugee health as part of an emergency response, rather than an integral part of health-sector planning that is central to the work of the Health Ministry.

Money for healthcare provided by the European Commission has largely been assigned to nongovernmental organizations providing primary healthcare in clinics in urban areas or in camps and reception centers. Twenty-four million euros ($27.2 million) were awarded by the E.U. emergency support instrument (as of January 2017) to NGOs for emergency primary healthcare. Of the $204 million granted to UNHCR by the European Commission, some healthcare activities such as primary healthcare on the islands, vaccination procurement and coordination were prioritized.

From the $202 million awarded to the Greek government, $27 million has been given to the Health Ministry by the Commission to cover “comprehensive emergency health response for refugees.” As a result, the ministry hired a number of medical staff and cultural mediators on short-term contracts to support existing public health structures, but predominantly to provide primary healthcare in camps – similar to the type of work NGOs have been doing since 2015.

This model was appropriate when the government was unable to manage the high numbers of asylum seekers and refugees in the country and lacked the technical capacity to conduct an emergency response. As the situation in the country has changed and people are now living primarily in urban areas for longer periods of time, this model is inefficient. It can often lead to an increased burden on the health sector through over-referral of patients by NGOs to public health centers and hospitals, often meaning a duplication of efforts.

This model is representative of a focus on short-term solutions for asylum seekers and refugees as a distinct community, which is contrary to the cited political commitment by the Greek government and UNHCR to move toward integrated government-funded and government-run healthcare.

Funding for long-term structural reforms, as opposed to funding NGOs, would mean a move away from emergency response to allow the Health Ministry to address key challenges such as chronic understaffing and a lack of material resources that would improve the healthcare of Greeks as well.

While the existence of NGOs in the country perpetuates the government’s reliance on them, it is not just a matter of all aid agencies pulling out of the country and the Health Ministry taking over; this should be a gradual process in order for the government to develop the capacity for a strong health system that can cater for the needs of populations facing distinct challenges.

Currently, there are no tailored services for asylum seekers and refugees in the mainstream health system; the development of such services needs to be reflected in the funding approach of donors such as the European Commission and collaboration between NGOs and the Health Ministry. Agencies also have a distinct role to play in emergency preparedness and ensuring that mechanisms are in place to respond to a potential increase in arrivals if, for example, the E.U.-Turkey deal were to collapse.

Another challenge is political decision-making and tussles over which government department has the responsibility for asylum seeker and refugee health. Within the Health Ministry, the Secretariat-General for Public Health is responsible, but it is the National Health Operations Center (a body of the ministry intended to address public health crises) that manages the everyday response, further segregating the health of asylum seekers and refugees.

In addition, access to healthcare is dependent on many different ministries. The Ministry of Migration Policy is responsible for the health and well-being of those living within reception and identification centers on the islands, and which until May had been providing funds to NGOs to provide medical and psychosocial care. The Ministry of Labor is responsible for issuing social security numbers, on which a refugee’s ability to access free healthcare within the Greek health service depends. It is imperative that these departments work with the Health Ministry to align their policies and practice and ensure that integration in healthcare on the islands and the mainland is not seen as distinct from the ultimate goal of overall social integration.

Focusing on integrating healthcare services is an important step toward wider social integration and requires strengthening of the health system, streamlined policies by the Health Ministry and other relevant bodies, increased structural funding and a move away from emergency service provision. In order to integrate asylum seekers and refugees, everyone involved needs to ensure that the services provided are appropriate for people who face multiple barriers.

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Refugees Deeply.

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