BackgroundIn 2015 and early 2016, close to 1 million migrants transited through Greece, on their way to Western Europe. In early 2016, the closure of the “Balkan-route” and the EU/Turkey-deal led to a drastic reduction in the flow of migrants arriving to the Greek islands. The islands became open detention centers, where people would spend months or years under the constant fear of being returned to Turkey.Syrians were generally granted refugee status in Greece and those arrived before the 20th of March 2016 had the option of being relocated to other European countries. Afghans had some chances of being granted asylum in Greece, whilst most migrants from the Democratic Republic of Congo were refused asylum.In a clinic run by Médecins sans Frontières on Lesbos Island, psychologists observed a deterioration of the migrant’s mental health (MH) since March 2016. In order to understand the MH needs for this stranded population it was essential to explore how, and by what factors, their mental health (MH) has been affected on Lesbos Island due to the EU/Turkey-deal.MethodsThis was a qualitative study in which eight service providers’ interviews and 12 focus group discussions with male and female Syrian, Afghan and Congolese migrants in two refugee camps on Lesbos Island. Thematic-content analysis was manually applied and triangulation of findings was undertaken to enhance the interpretation of data.ResultsThree main themes were generated: 1) Institutional abuse, 2) Continuous traumatic stress (CTS) and 3) MH service provision. Institutional abuse was expressed by inhumane living conditions, lack of information in order to make future decisions, humiliation and depersonalization. This led to CTS that was expressed through being in a state of permanent emergency under lack of protective measures. Delays in appointments, lack of psychiatric care and differences in MH perceptions amongst migrants highlighted the provision of MH services.ConclusionThe EU/Turkey-deal reduced migrant flows at a very high price. Decongestion of the camps and the elimination of institutional abuse is urgently needed to reduce CTS and improve migrants’ MH.

Background Social support is a core determinant of health and plays a key role in the healing process of people with mental health problems and those who have been exposed to torture or other traumatic events. At the same time, social support is particularly challenging to build in such populations, as self-isolation and social withdrawal are common consequences of traumatic incidents. Defining social support is also challenging as there is no globally adequate definition. Our aim was to explore how social support was understood by Médecins Sans Frontières (MSF) beneficiaries, and how they perceived their needs on Lesvos Island, Greece to be met. Methods This was a qualitative study, based on exploratory free-listing interviews that explored how MSF beneficiaries on Lesvos understood and defined social support, followed by a series of in-depth interviews through which participants explained how they perceived their needs to be met. The study was conducted over a period of two weeks in August 2018, with 32 migrants and asylum seekers (22 male, 10 female) enrolled in the mental health services of MSF on Lesvos Island. The majority of interviewees were single men of African origin who had resided in Moria camp between 2 months and 2.5 years. Countries of origin include Syria, Afghanistan, Cameroon, Democratic Republic of Congo (DRC), Iraq, Iran, Nigeria, Senegal and other West African countries. Results Participants defined social support as the practical, informational and emotional support that people receive from organisations, friends and family members. Results revealed a lack of community links, isolation, tensions and conflict, insufficient amenities and limited orientation to services that lead to and amplify isolation, discrimination and tension. Most of the participants received little or no support both formally from organisations and informally from other migrants and asylum seekers in the camp. Conclusions Functional support networks are urgently required to overcome the consequences of restrictive policies which force people into containment and remove their support systems. Actors who are involved in providing social support, including MSF, are strongly encouraged to engage in activities that work towards building and strengthening peer support networks and creating a sense of community.

Introduction: On-going conflict and political instability in the Democratic Republic of Congo (DRC) has led to increasing numbers of people fleeing their country for Europe. Many need rehabilitation services upon arrival in Greece after experiencing torture in DRC.  The scarcity of state resources and the limited capacity of non-governmental organisations to assist survivors of torture means many needs remain unmet. This study explored the experiences of rehabilitation for male Congolese survivors of torture living in Athens, as well as the potential role of the wider Congolese community in Athens in supporting rehabilitation.  Methods: This qualitative study included in-depth interviews with survivors of torture attending a rehabilitation clinic and key informant interviews with representatives of the wider Congolese community in Athens. Data was thematically analysed to construct and develop codes and themes. Results: 19 survivors and 10 key informants were interviewed. For many survivors, rehabilitation was an unclear concept. Despite the appreciation for services received at the clinic and the amelioration of physical and psychological symptoms, survivors felt rehabilitation was incomplete as it did not meet their accommodation needs nor provide stability through granting refugee status. Survivors were wary of trusting other Congolese people after experiencing torture and did not always associate themselves with the local Congolese community. The role of local Congolese leaders and organisations was not seen as replacing the clinical element of rehabilitation but aiding in practical issues such as information sharing and integration, especially in partnership with other organisations. Discussion: Systemic shortcomings in Greece, including poor access to accommodation and insecure asylum status, impeded processes of rehabilitation. Many participants found themselves navigating an unstable and unpredictable landscape in their journey towards “feeling whole again.” The role of the wider Congolese community in Athens in supporting rehabilitation remains complex and a lack of trust threatens social cohesion. Nonetheless, the willingness of the community to be more proactive should not be ignored by organisations and policy-makers.

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