Supplement material to: Letter to the editor: Healthcare and disease burden among refugees in long-stay refugee camps at Lesbos, Greece
Supplement 1
Camp Moria
Camp Moria, a former army barrack with high fences topped with razor wire located at Moria, Lesbos, Greece. Set up as a so called ‘hotspot’ transit camp for the high volume of refugees, Camp Moria has slowly transferred into a long-stay refugee camp. Refugees are only allowed to leave the camp during the day after living there for at least 25 days. There is little to do (almost no sports, games, cultural activities), but waiting for asylum interviews. Nationalities are grouped together, so as families and unaccompanied minors. All those who do not live in the ‘family area’ have to stand in line for hours for breakfast, lunch and dinner. People get frustrated, sometimes resulting in riots. Camp Moria suffered from several fires, often started out of protest for feelings of displeasure. During our study period, Camp Moria was overcrowded, housing approximately 2100 persons while it was originally designed to accommodate 800 people. Currently (dec 2016) Lesbos island houses approximately 6 391 refugees while there is only capacity for 3 988 persons. Shelter conditions have become worse due to winter conditions and several reports of suicide attempts and deceased refugees (due to hypothermia) have been published in the last couple of months. It is estimated that many refugees will stay here until their asylum application has been approved, a process that could easily take up to one year.
Supplement 2 – Health services at Camp Moria
Health services for refugees on Lesbos were examined using standards of the Sphere Project.[5]These standards were designed to inform on the most important minimum standard health services needed in a humanitarian setting. Healthcare at both Camp Moria and Caritas Hotel was provided on site by NGOs, which could refer patients to existing health facilities on the island such as the local hospital. In Camp Moria, the Boat Refugee Foundation provided health services (daily from 16.00h until 9.00h) as well as Médicines du Monde (weekdays 9.00h until 22.00h, weekends 9.00h until 16.00h). In Caritas Hotel, only the Boat Refugee Foundation worked as a medical NGO (daily from 11.00h until 13.00h). Medical services of the Boat Refugee Foundation consisted of first aid and acute medical health care (with the option of referring to the Emergency Department of the local Greek hospital by ambulance). Medical services of Medicins du Monde consisted of vulnerability screening (to consider relocation of vulnerable refugees to a better shelter), chronic health care (with the possibility of using public services for investigations such as lab and radiology) and to a much lesser extent, first aid and acute medical health care. When needed, chronic medical cases were referred by the Boat Refugee Foundation to Medicins du Monde. Regarding human resources, the Boat Refugee Foundation worked with medical volunteers (mostly, but not limited to general practitioners) from all over the world, whilst Medicins du Monde worked with paid Greek medical staff. Drugs and medical supplies of both the Boat Refugee Foundation and Medicins du Monde were funded by donations. Health services provided by the Boat Refugee Foundation and Medicins du Monde were free of charge, as well as health care provided in the hospital. However, if a patient was discharged from the hospital with prescription medication, this medication was not free of charge. Boat Refugee Foundation and Medicins du Monde had their own health information system, although shortly after our study period a universal medical record was developed to improve collaboration and patient care. Coordination of health services was established in weekly health meetings and informal communication between Boat Refugee Foundation and Medicins du Monde.
Supplement 3 List of diagnoses
List of diagnoses*Circulatory / n / % / Musculoskeletal / n / %
Angina Pectoris (stable and unstable) / 6 / 0.6 / (Lower)Back pain / 26 / 2.6
Cardiac patient management / 3 / 0.3 / Broken ankle / 2 / 0.2
Heart failure / 1 / 0.1 / Broken hand / 1 / 0.1
Blood pressure regulation / 14 / 1.4 / Contusion / 17 / 1.7
Myocardial infarction / 2 / 0.2 / Congenital leg abnormality / 1 / 0.1
No diagnosis / 4 / 0.4 / Decubitus / 1 / 0.1
Palpitations / 1 / 0.1 / Dislocation finger / 1 / 0.1
Missing / 4 / 0.4 / Flat feet / 1 / 0.1
Total / 35 / 3.4 / Infection (superficial) / 2 / 0.2
Myalgia / 14 / 1.4
Dentistry / No diagnosis / 10 / 1.0
Allergy and allergic rash / 1 / 0.1 / Other / 1 / 0.1
Caries, broken teeth, dental pain / 30 / 3.0 / Musculoskeletal pain / 21 / 2.1
Infected teeth / 20 / 2.0 / Rheumatoid arthritis / 1 / 0.1
Missing / 1 / 0.1 / Sprain / 18 / 1.8
Total / 52 / 5.1 / Tendinitis / 1 / 0.1
Missing / 1 / 0.1
Dermatology / Total / 119 / 11.6
Acne / 5 / 0.5
Allergy and allergic rash / 15 / 1.5 / Neurology
Blister / 5 / 0.5 / Contusion cerebri / 2 / 0.2
Burn wound / 2 / 0.2 / Seizure (e.g. epileptic or febrile) / 4 / 0.4
Chicken pox / 1 / 0.1 / Headache / 16 / 1.6
Eczema / 6 / 0.6 / Meningitis / 1 / 0.1
Folliculitis / 2 / 0.2 / Migraine / 3 / 0.3
Mycosis / 5 / 0.5 / No diagnosis / 1 / 0.1
Boil / 1 / 0.1 / Syncope / 2 / 0.2
Herpes / 2 / 0.2 / Total / 29 / 2.9
Impetigo / 1 / 0.1
Infection (superficial) / 2 / 0.2 / Ophthalmology
Louse, mosquito bite / 2 / 0.2 / Blepharitis, swelling eye, trauma eye / 4 / 0.4
No diagnosis / 4 / 0.4 / Chalazion / 1 / 0.1
Other / 1 / 0.1 / Conjunctivitis / 5 / 0.5
Pruritus / 7 / 0.7 / Corpus alienum eye / 2 / 0.2
Scabies / 3 / 0.3 / Dry eyes / 2 / 0.2
Sunburn / 2 / 0.2 / Infection (superficial) / 1 / 0.1
Missing / 2 / 0.2 / No diagnosis / 6 / 0.6
Total / 68 / 6.6 / Missing / 5 / 0.5
Total / 26 / 2.5
Gastrointestinal / n / % / Other / n / %
Abdominal pain eci / 5 / 0.5 / Dehydration / 3 / 0.3
Allergy and allergic rash / 1 / 0.1 / Fever / 6 / 0.6
Celiac disease / 1 / 0.1 / Hypothermia / 1 / 0.1
Obstipation / 21 / 2.1 / No diagnosis / 32 / 3.2
Dehydration / 2 / 0.2 / Other / 2 / 0.2
Food poisoning / 2 / 0.2 / Overuse medication / 1 / 0.1
Gastric bleeding / 1 / 0.1 / Sepsis / 1 / 0.1
Gastritis / 6 / 0.6 / Side effect medication / 1 / 0.1
Gastroenteritis / 22 / 2.2 / Vaccination / 1 / 0.1
Hepatitis C / 1 / 0.1 / Missing / 8 / 0.8
Melena / 1 / 0.1 / Total / 56 / 5.5
No diagnosis / 7 / 0.7
Nausea / 1 / 0.1 / Psychology
Other / 1 / 0.1 / Anger attack / 1 / 0.1
Pyrosis / 15 / 1.5 / Anxiety/Panic attack / 8 / 0.8
Thrush / 1 / 0.1 / Depression / 2 / 0.2
Viral infection / 2 / 0.2 / Detoxification and addiction / 13 / 1.3
Worms / 1 / 0.1 / No diagnosis / 1 / 0.1
Missing / 2 / 0.2 / Not eating / 1 / 0.1
Total / 93 / 9.1 / Psychologic complaint(somatic) / 21 / 2.1
Post-traumatic stress disorder / 4 / 0.4
Endocrine / Suicide and self-mutilation / 4 / 0.4
Diabetes mellitus / 4 / 0.4 / Syncope (psychologic) / 1 / 0.1
Hyperthyroidism / 1 / 0.1 / Total / 56 / 5.5
Other / 1 / 0.1
Total / 6 / 0.6 / Respiratory
Allergy and allergic rash / 3 / 0.3
Otorhinolaryngology / Asthma / 6 / 0.6
Allergy and allergic rash / 2 / 0.2 / Asthma exacerbation / 11 / 1.1
Epistaxis / 3 / 0.3 / Bronchiolitis / 2 / 0.2
Cerumen, corpus alienum ear / 2 / 0.2 / Lower respiratory tract infection / 17 / 1.7
Pharyngitis / 78 / 7.7 / COPD (exacerbation) / 2 / 0.2
Insult (febrile seizure) / 1 / 0.1 / Corpus alienum airways / 1 / 0.1
Hay fever / 6 / 0.6 / Influenza / 49 / 4.8
Otitis media with effusion / 2 / 0.2 / Infection (superficial) / 1 / 0.1
No diagnosis / 4 / 0.4 / No diagnosis / 14 / 1.4
Otitis media acuta / 21 / 2.1 / Other / 1 / 0.1
Other / 1 / 0.1 / Overuse asthma medication / 2 / 0.2
Otitis externa / 4 / 0.4 / Pertussis / 1 / 0.1
(Rhino)sinusitis / 4 / 0.4 / Common cold / 113 / 11.2
Tonsillitis / 15 / 1.5 / Missing / 1 / 0.1
Trauma eardrum / 1 / 0.1 / Total / 224 / 21.8
Viral infection / 1 / 0.1
Total / 145 / 14.1
Gynaecology / n / % / Surgery / n / %
Anticonception request / 1 / 0.1 / Appendicitis / 1 / 0.1
Candida (urogenital) / 3 / 0.3 / Infection (superficial) / 3 / 0.3
Breastfeeding supply down (dehydration) / 1 / 0.1 / Lipoma / 1 / 0.1
Mycosis / 3 / 0.3 / Trauma / 5 / 0.5
Hormonal dysregulation / 1 / 0.1 / Wart, corn, splinter / 5 / 0.5
Menstrual complains / 6 / 0.6 / Wound / 29 / 2.9
No diagnosis / 7 / 0.7 / Total / 44 / 4.3
Pregnancy related problems / 5 / 0.5
Preterm birth / 1 / 0.1 / Urogenital
Sexual transmitted disease / 2 / 0.2 / Bed peeing / 1 / 0.1
Missing / 1 / 0.1 / Haematuria / 1 / 0.1
Total / 31 / 3.0 / Candida (urogenital) / 1 / 0.1
Nocturnal emission / 2 / 0.2
Haematology / Incontinence / 1 / 0.1
Anaemia / 4 / 0.4 / Kidney disease / 1 / 0.1
B-Cell Lymphoma (already present) / 1 / 0.1 / No diagnosis / 4 / 0.4
Leukaemia (already present) / 1 / 0.1 / Nephrolithiasis / 4 / 0.4
Missing / 1 / 0.1 / Other / 1 / 0.1
Total / 7 / 0.7 / Phimosis / 1 / 0.1
Pelvic inflammatory disease / 1 / 0.1
Cystitis, pyelonephritis / 12 / 1.2
Sexual transmitted disease / 2 / 0.2
Varicocele / 1 / 0.1
Missing / 2 / 0.2
Total / 35 / 3.4
*All first, second and third consultations, diagnosis was missing when no information was available from the patient form (although, tract was often reported).