Intervention of the Secretary General for Public Health Mr Ioannis Baskozos at the IOM Panel entitled “Migration , Human Mobility and Global Health: a matter of Diplomacy and Inter-sector Partnership»

Intervention of the Secretary General for Public Health Mr Ioannis Baskozos at the IOM Panel entitled “Migration , Human Mobility and Global Health: a matter of Diplomacy and Inter-sector Partnership»
(IOM Council 106th Session, Geneva,26/11/2015)

Dear colleagues,
I am extremely honoured to participate in IOM’s high level panel that for the first time brings health in the migration debate and vice versa. The excellent cooperation between the IOM and the WHO is confirmed  by the participation of DG Dr Margaret Chan today in this panel. This, I believe, sets a very good  example of  cooperation and solidarity among countries, which in the last year have been faced with a high number of migratory flows.
The refugee crisis and the dramatic increase of the millions of people moving away from war-torn countries and hunger to Europe, constitute a harsh reality, which reasonably enough has escalated this as a high priority issue in the European political agenda and has been posed as a political priority for an effective response. This panel, organized by the IOM, focuses on the health care of refugees and is an excellent opportunity for a valid and credible evaluation of the countries engaged in this unprecedented humanitarian crisis.
Of course, the overall issue in Summits and High-Level Meetings is to identify specific measures and to agree upon robust policy plans in dealing with this major social problem which preoccupies the whole of the European countries.

In Greece, we do not forget the migration waves of our compatriots in the early 20th century and after the 2nd World War towards developed countries. Neither do we forget that after 1922 Greece received a large wave of refugees from Asia Minor. All the same, Greece has also been in the receiving end, welcoming hundreds of thousands of immigrants after the fall of the Berlin wall. Most of them integrated well in our society. However we have to acknowledge the problems we faced and mistakes made after this  wave of migrants and refugees.

Europe has been built upon the principles of Democracy, Freedom, solidarity, partnership and humanism and ought to guarantee the essential political agreement and common action in front of this tragedy that takes place every day in the Aegean Sea, the Mediterranean Sea and in the overland pathways to Central Europe.

We must also not forget that today other countries in the region as well as the African countries are under huge  pressure from refugee and migration flows.
Presently Greece receives 80% of the refugees and migrants moving to Europe. 70% of these people are identified as refugees (62% from Syria) of which, 25 % are children and 16% women. The social and epidemiological profile of the population has been altered recently since it encompasses mostly families, infants, little children, pregnant women and the elderly. Obviously they do not constitute a “public health bomb” and do not carry communicable  diseases. However, these people are in need of primary health care services and emergent care since they are experiencing tremendous hardship. They are also in need of timely recording and triage and frequently they are in need of immediate referral to our National Health System (hospitals, units of primary health care, medical centres) and evacuations via the National Centre for Emergencies Care.
This panel at the 106th IOM Council comes as a continuation of the very important and successful High- level meeting for the Migration and Health of WHO Europe that took place two days ago at Rome and focused on health care for refugees, and the conclusions arising from the experience of countries in the region until now . At the core of the conclusions is the need for cooperation and solidarity, the need to develop protocols for the prevention and treatment of refugees and migrants .The requirement to find more appropriate ways to exchange data, between the transit countries of refugees and countries of reception ,transit or residence  with respect to human rights and cultural particularities of these people.
Greece, through laws and reforms currently under way is aiming to move closer to universal coverage and achieve equity for the population in its Public Health Services. We believe that, and we work so as this right be acknowledged for the refugees, coming to our country.
Developing policies to adequately deal with the health care needs of the refugees and the relative health inequalities is a great challenge for the Public Health of the member - states of WHO Europe and it is related to the security of health worldwide. Health systems must now cope with the vast surge of refugees, aiming at both the improvement of their health and the avoidance of stigmatization.
The increasing influx of refugees poses challenges to the security as well as public health and the health systems of the member -states of  Europe and specifically the E.U. The immediate and effective management of this issue becomes the responsibility of all countries. We must work to the best of our abilities to take advantage of the great potential. For trans - border exchanges and collaboration, in order to find the best solution to the health problems that arise and absorption of the refugees. This will benefit members- states both socially and financially.
As far as Greece is concerned, we have started to implement our commitment to create hot-spots and the Ministry of Health has completed a plan of action for health coverage of the first reception countries.
Since the beginning of the year, more than 700.000 refugees and migrants have arrived in our country via the Aegean Sea. It is estimated that over 3.500 refugees have lost their lives, while the average  daily rate of arrivals often exceeds 5.000.
This tragic account in human life and the excessive encumbrance imposed on many islands of the Eastern Aegean make it even more imperative to find a permanent and viable solution.
General and indiscriminate access to health is a basic right. For both refugees and migrants as well as a priority for our country. As far as we are concerned we have satisfied the current needs for health coverage without being provided for by the European funds. For this reason we had to give ad hoc solutions using our own means.
About 2000 refugees and migrants have been hospitalized, with costs exceeding the sum of 800.000 €. Furthermore, during the current year, we have recorded an increase by 42% in Emergency and urgent  transportations, compared to 2014, while this increase went over 103% during the period of peak (June to November).
The Ministry of Health has done the following:
1)    The system of diagnosis and prompt detection of patients (triage) is being used at the eastern Aegean points of entry for the evaluation and treatment of medical needs of refugees
2)    Medical units are organized on daily basis at the Pre-Departure –Centers as well as 24 hour operation of medical unit at the Open Hospitality Centres.
3)    Two mobile units of Red Cross have been transferred to Macedonia ,near the concentration refugee centre at the border with FYROM.
4)    The Secretariat General of Public Health has created  a personal travel health report for the refugees in collaboration with the IOM and the European Commission using the immediate information concerning their current needs. This report will be used by all health care providers. The purpose of this action is to contribute to the continuous and unobstructed health care provision, until all refugees have reached their final destination. Alongside we process in collaboration with WHO the registration  of  basic health information of refugees  on a short sheet.
5)    We have secured adequacy in medicines and health products such as vaccines etc and immediate pharmaceutical coverage for refugees, from chronic, non communicable diseases such as diabetes. All the actions for immunization coverage of vulnerable groups, will be taking  place under conditions and in accordance with basic screening immunization protocol.
6)    We have been able to tackle the medical issues of the new coming refugees in a satisfactory way ,despite the fact that this problem is huge. Not to mention the condition that the public structures of our islands are in a situation , which is far from ideal. This is the result of the concerted efforts of the local people ,the medical staff, the NGOs and citizens showing solidarity.

Yet, the major and the most serious health risk is the risk of death which results from the refugees' desperate attempt to cross the sea from the Turkish coast to the Aegean islands.  A comprehensive and direct management of this phenomenon requires an agreement, regarding, identification and registration of all refugees in Turkey so as to stop this death course through the stormy and cold Aegean sea. The need of solidarity and assistance to Turkey is an integral part of this solution. Meanwhile the treatment of hypothermia because of exposure to in the cold water, the treatment of wounds and fractures, the vaccinations based on protocols, the right sanitation conditions related to their hospitality and accommodation at the First Reception Centers, the treatment of chronic diseases, prevention and immediate treatment of infectious diseases, the constant need to provide psychological support are priority for the our health system. Furthermore the need of a prompt assistance from the European mechanisms became an one way road.
However , we commit to the following:
•    The strengthening of primary and secondary health care services at all points of entry with medical staff through the European Fund of Internal Security.
•    The improvement of the coordination between the structures of the public health system, the NGOs and the international organizations also the public sector services between them.
•    The creation of a constitutional frame for the documentation ,supervision and coordination of the NGOs for access to the field and the provision of health services.
•    The documentation and rational allocation of medical products and medicines among the structures of the health system.
•    An important factor is the development of the intercultural mediators and also the health workers who are among refugees – migrants
•    The improvement of the health coverage for all refugees and local communities  while promoting a sense of security for local people.
The recent experience of the visit with the Health Commissioner of the European Union Mr. Andriukaitis at the island of Lesbos was the understanding of the huge flow of refugees which is going on. The Commissioner’s statement confirmed in the best way that understanding and solidarity is the only way to proceed  among the citizens of Europe.
DEVELOPMENT OF EXPERIENCE PROPOSAL FOR COMPLETE HEALTH COVEREGE OF REFUGEES – MIGRANTS
1) Immediate rescue
- Ypothermia - injuries
2) Identification
-Basic health control in hot spots (triage)
3) Prevention
- Vaccinations
- Medical care and pharmaceutical coverage for chronic ,non communicable  diseases - Treatment for all the emergencies (pneumonia).
- Psychological support
Our government proceeded from an attitude of unconstructive negative approach to the logic of humane reception policy. We established the Ministry of Migration policy that coordinates all host operations for refugees and migrants. Under the coordination of the Secretariat General of Public Health established the Committee for health coverage of refugees and immigrants. Also the Secretary General of Public Health is the head of a committee for the National Action Plan of migration and health. Also important is the support of the informal committee of NGOs with the participation of the IOM, WHO and UNHCR .
The refugee issue in the health sector, as in others, tests fundamental human values.  The resulting changes will either help proceed in the direction of further strengthening cooperation, solidarity and humanism, or towards dangerous pathways leading to the closing of borders, xenophobic outbursts and uncontrolled societal reactions. For us the road we must choose is very clear.
Thank you

106th Session of the International Organization for Migration (IOM) Council (Geneva 24-27/11/2015)
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