COVID-19 in Moria: The Tinderbox that Caught Fire

The COVID-19 pandemic has seemingly spared no facet of everyday life for the American public; granted, much uncertainty that once plagued the nation has largely dissipated with time. From breakthroughs in curbing the spread of COVID-19, amongst them mask-wearing and a developing vaccine, the current understanding of the virus has given the public a sense of security: there is seemingly an end in sight to the pandemic. Notably, there has been a large decline in more frantic concerns regarding life during a pandemic; while toilet paper once flew off supermarkets shelves amidst fears of scarcity, many have now found some way to adapt to life under COVID-19. But this beginning stage of frantic fear in the face of uncertainty parallels a story of far more dire consequences, one far from the reality of many Americans. For migrants seeking asylum across the globe, many of whom flee to camps where destitution runs rampant, scarcity is a lived reality rather than an isolated period. Uncertainty and fear cannot be marked by the beginning and end of the pandemic. Rather, refugee hardships are caused by forces far deeper than these new challenges. In Moria, a refugee camp located on the Greek island of Lesbos, the poor living conditions of thousands of refugees fostered an incredibly pressing challenge to curb the spread of COVID-19. Beyond bringing new challenges to refugee healthcare, the advent of COVID-19 has exacerbated a public health crisis that has persisted since long before the pandemic.


Once the largest refugee camp in Europe, Moria was first founded on the Greek Island of Lesbos in 2015 to provide refuge for a maximum of 2,200 migrants seeking asylum in Europe, arriving largely through harrowing boat journeys from Afghanistan and Syria, among other nations. However, over its four years of operation, the camp and its surrounding olive groves have held almost ten times this capacity [1]. This congestion resulted in an extreme scarcity of resources for asylum seekers living in and around the camp; by mid-March of 2020, each water station hosted over 1,300 refugees, with each toilet used by upwards of 160 refugees [2]. There were also minimal resources for hygiene, with open sewage often flowing through the camp combined with insufficient soap and running water [3]. The camp’s social dynamics also often grew violent and hostile; fights often broke out in long lines for food or access to other resources. Beyond purely physical threats to refugee health, physicians on the ground in Moria have observed a mental health disaster among refugees, with psychological stress from fleeing violence only intensified by the camp’s desolate environment. Psychiatrist Alessandro Barbierio from Médecins Sans Frontières remarked in a statement on the camp’s conditions that “in all of my years of medical practice, I have never witnessed such overwhelming numbers of people suffering from serious mental health conditions, as I am witnessing now amongst refugees on the island of Lesbos.” [4].


The spread of communicable diseases was not a new concern for health officials observing Moria. Combined with poor sanitation, past poor prevention against endemic diseases and differing rates of vaccination among refugees fostered enduring concerns for the spread of infectious disease [5]. Additionally, already high rates of respiratory problems among refugees presented potential comorbidities [3]. Alongside lockdowns in many other European nations, Moria had technically been in semi-lockdown since midMarch, with restrictions imposed on who can leave the camp and new arrivals to be medically screened before entry [6]. Early in the pandemic, human rights groups called for the decongestion of Moria, citing overcrowding as a major obstacle to tackling spread if the virus were to reach the camp [2]. In early September, the first confirmed positive case of COVID-19 was found in Moria. Authorities placed the camp in a mandatory 14-day quarantine, not permitting any new entries into the camp with the exception of security personnel. This decision drew contention from aid groups who called the quarantine ineffective in controlling COVID-19 spread without adequate sanitation and social distancing among refugees. With over 200 refugees “whose age and underlying health conditions put them at even greater risk if they contract COVID-19”, the spread of COVID-19 would have been devastating [7].


Days after this first case was announced, 35 additional migrants tested positive for COVID-19. While these asylum seekers were segregated from the rest of the camp, tensions began to rise over the tightening lockdown. Soon after the announcement of this lockdown, on the night of September 8, large fires broke out that spread rapidly throughout the camp, completely destroying its infrastructure and leaving upwards of 12,000 refugees homeless. The whereabouts of the 35 positive refugees were unclear after the fire, and their migration onto the neighboring streets to Moria in the days following the fire was disastrous for containing the virus [1].


In response to these fires, with thousands of refugees boxed in by police checkpoints on a stretch of road neighboring what was once Moria, Greek officials began planning a new temporary camp on a former military base on the island. Upon arrival to the new camp, over 240 asylum seekers tested positive for COVID-19 of the 7,000 tests conducted by late September, and many of the remaining displaced refugees were reluctant to return to a new camp in fear of similar conditions [8].


Weeks into the camp’s operation, these fears grew, as refugees were faced with continued limited access to healthcare and a lack of running water or sewage systems, among similar issues to the camp’s predecessor [9]. Effectively, refugees of the island of Lesbos face a comparable predicament that they faced with Moria, living in continued poor conditions where the spread of COVID-19 would have similarly devastating effects.


Today, Moria no longer exists, but it is crucial to remember that the conditions that birthed it still fester deep in contemporary global health systems. Health inequity still manifests, in the most destructive sense, for the millions of refugees in and beyond Lesbos. For refugees, the effects of COVID-19 have gone far beyond viral infection; rather, the COVID-19 pandemic has exposed severe institutional flaws in refugee health care, creating the perfect storm for tensions to break. Moria may be gone, but its asylum seekers, migrants, and refugees still live on having to bear the brunt of a flawed refugee health system. Though the fire that destroyed Moria has long been physically extinguished, a more dire blaze still has yet to be addressed.


References:

1. Godin, G. (2020, September 10). Blaze That Destroyed Greece's Moria Refugee Camp Symbolizes Breakdown in E.U. Over Future of Migrants. Time. https://time.com/5887085/greecemoria-refugee-camp-blaze/

2. Schülke-Gill, B. (2020, March 18). MSF: Moria refugee camp 'an ideal breeding ground for

a rapid spread' of coronavirus. Deutsche Welle.

https://www.dw.com/en/msf-moria-refugeecamp-an-ideal-breeding-ground-for-a-rapid-spread-ofcoronavirus/a-52824830

3. Hume, T. (2020, March 13). No Soap, Little Water, and No Way Out: Refugee Camps Brace for Coronavirus. Vice. https://www.vice.com/en/article/v74q3b/no-soap-littlewater-and-no-way-out-refugee-camps-brace-forcoronavirus

4. Nutting, T. (2019). Headaches in Moria: a reflection on mental healthcare in the refugee camp population of Lesbos. BJPsych international, 16(4), 96–98. https://doi.org/10.1192/bji.2019.2

5. Altare, C., Kahi, V., Ngwa, M., Goldsmith, A., Hering, H., Burton, A., & Spiegel, P. (2019). Infectious disease epidemics in refugee camps: a retrospective analysis of UNHCR data (2009- 2017). Journal of Global Health Reports, 3. https://doi.org/10.29392/joghr.3.e2019064

6. Greek islands migrant camps: new restrictions to contain coronavirus. (2020, March 17). InfoMigrants. https://www.infomigrants.net/en/post/23496/greek-islandsmigrant-camps-new-restrictions-to-contain-coronavirus

7. Andrea, L. (2020, September 9). Lockdown in Moria Refugee Camp Raises Questions of Migrant Freedoms During Coronavirus. Pulitzer Center. https://pulitzercenter.org/reporting/lockdown-moriarefugee-camp-raises-questions-migrant-freedoms-duringcoronavirus

8. Lesbos: Hundreds test positive for Covid-19 after migrant camp fire. (2020, September 21). BBC. https://www.bbc.com/news/world-europe-54239446

9. A month after Moria fires, UNHCR warns of worsening conditions ahead of winter. (2020, October 9). UNHCR. https://www.unhcr.org/enus/news/briefing/2020/10/5f80111c4/month-moria-firesunhcr-warns-worsening-conditions-ahead-winter.html

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