We are treating the medical consequences of the journey, including hypothermia and dehydration, but also acute conditions requiring medical evacuation such as septic shock, pneumonia and wounds inflicted by abuse and violence. We are trying to improve living conditions for people stranded in Greece, Italy, FYROM and Serbia. But all of our work amounts to filling the gaps left by states unwilling or unable to fulfil their responsibilities.

Many people are fleeing war, oppression and torture. Others are fleeing poverty, persecution and human rights violations. All want a safer and better life. But their exit routes are growing scarcer, while refugee hosting countries such as Lebanon, Turkey and Jordan become more overburdened. The world is faced with the worst displacement crisis since World War II. The conflict in Syria shows no sign of abating. Yet Europe is closing its borders.

Categorisations of ’migrants; , ’refugees’ or ’asylum seekers’ do not adequately or fairly describe the reality that pushes people to embark on long and dangerous journeys. Every person has a story to tell about why they were forced to risk their lives to reach Europe. When people need medical care, food, water and shelter, they should receive this assistance regardless of their legal status.

When your ministers gather this Monday for yet another summit on the so-called ‘migration crisis’, bear in mind that the decisions adopted in previous summits have so far largely failed to improve the situation. Some measures have made the situation worse: fences and forced fingerprinting only push people to choose more clandestine and dangerous routes. Lives continue to be lost at sea, in the back of lorries and in make shift camps where people live in unacceptable conditions in the heart of the European Union. It is time to put an end to these policies of deterrence. They have turned a foreseeable and manageable influx of people fleeing for survival into a policy-made human tragedy on Europe’s beaches, borders, train platforms and motorways. They are jeopardising the right to seek asylum. The current approach of ’non-reception’ and closed borders is causing death, injury and chaos.

Europe is faced with an increasing number of people seeking assistance and protection. These people are only a small portion of the millions who are fleeing intolerable suffering. No matter the obstacles, they will continue to come. They have no other choice. The current policies are untenable in the face of this situation. The only way Europe can prevent a worsening crisis on its territory is to replace the smugglers by providing a safe, legal and free alternative. We ask you to provide safe passage. Legal crossing of sea and land borders must be authorised for asylum seekers into and inside the EU. All forms of legal avenues allowing refugees to reach Europe must be put in place urgently. Efficient solutions to relocate asylum seekers from one EU member state to another must be found. Effective access to coherent asylum procedures and assistance should be provided at entry points, throughout Europe and along migratory routes. Swift registration and access to temporary protection should be provided upon arrival. Legal migration pathways must be created. Dignified reception conditions must be offered to all.

Make this life vest redundant. Provide humane, dignified and safe alternatives.

Sincerely,

Dr. Joanne Liu

International President

Médecins Sans Frontières

According to the authorities, this year more than 14,000 people – of whom more than 90 percent are fleeing war-torn Syria – have made the perilous journey in small boats across the Aegean sea from Turkey to the Dodecanese islands, in search of protection. With too few suitable facilities to host them, many refugees find themselves forced for days at a time to sleep outside in the cold and rain or in badly overcrowded police station cells while waiting to be transferred to the Greek mainland.

“Over the past four months, we have seen no will to improve the reception system,” says Kostas Georgakas, MSF field coordinator. “No medical screening is provided for the arrivals and, more importantly, vulnerable people are neglected. Recently a group of doctors from the Ministry of Health was sent to screen refugees for Ebola – despite the fact that most refugees come from Syria and Afghanistan, not from West Africa. But those suffering cardiovascular problems or diabetes receive nothing.”

The Greek authorities have a responsibility to conduct vulnerability screenings and provide adapted care for these people, yet a lack of resources and political will means little concrete action has been taken on the ground.

“We have seen intolerable overcrowding, with 53 people crammed into a cell meant for six,” says Georgakas. “These conditions are unbearable for even one night, especially for people already suffering physically and psychologically from fleeing war. What little they are offered after such a grueling journey is shameful, and is dangerous for their health.”

As a result of the deplorable reception conditions, an MSF mobile team has launched two emergency operations in the Dodecanese islands since late August. In that time, the team has provided medical care to more than 350 refugees and distributed more than 3,000 kits of essential relief items including sleeping bags, soap and other hygiene items.

Patients have told MSF teams that they were pushed back to Turkey before eventually being able to reach Greek shores. Greece has the obligation to honor the fundamental rights of all persons under its jurisdiction, regardless of nationality. States must, at all times, guarantee the non-refoulement of refugees and asylum seekers from territorial lands and waters, and ensure that those persons receive decent treatment upon arrival, including access to an efficient and equitable asylum procedure.

“Greece closed its land borders and now it must respond to the flow of refugees arriving on the Aegean islands with the dignity and respect that these people deserve,” says Manu Moncada, MSF’s operations coordinator for migration. “Higher fences and inhumane living conditions on the islands will not deter the desperate, who will be forced to take ever more dangerous routes in search of safety, with many losing their lives in the process.”

Since 2008, MSF has responded to the urgent medical and humanitarian needs of newly arrived migrants in Greece, as well as to asylum seekers and migrants in administrative detention. In collaboration with two Greek organisations, MSF is also providing medical rehabilitation for victims of torture in Athens.