EVACUATE. MORIA. NOW

Open letter to the European Commission and the European Emergency Response Coordinator

Kayvan Bozorgmehr, Louise Biddle, Rosa Jahn, Katharina Wahedi, & Martin McKee on behalf of 3,373 signatories


As the coronavirus (SARS-CoV-2) pandemic hits the European Union, 446 million citizens are encouraged to follow social distancing and individual protection measures. At Europe's border on the Greek islands (Chios, Kos, Leros, Lesvos, and Samos), however, more than 42,000 children, women and men are contained, and left deprived of such protection measures and basic humanitarian needs (clean water, sanitation, electricity, security, and access to health services) in overcrowded camps set up for 6000 individuals.1 While no cases have yet been confirmed among residents according to Médecins Sans Frontières, the disastrous humanitarian situation could turn camps into epidemic hotspots as the virus hits an ill-nourished, strained population, including children with chronic morbidities, elderly, new-borns and pregnant women. An outbreak could turn into an unmitigated disaster, also affecting residents on the islands, the Greek mainland, and ultimately Europe as a whole.

Now, more than ever, is the time for evacuating Moria and other camps on the Greek islands, where human rights, humanitarian principles, health security and pandemic control measures converge in unprecedented urgency. As public health professionals and scientists concerned with migration, public health, humanitarian aid, and infectious disease control, we call upon the European Commission and the European Emergency Response Coordinator to take urgent action to mobilise all required resources to evacuate Moria and the camps in Chios, Kos, Leros, and Samos. This is a public health imperative.

We suggest a two-tiered action plan: first, build capacities on the Greek mainland, providing decent shelters or provisional housing so that self-isolation and social distancing measures are possible. This is not currently possible on the island camps, especially since the fires on 16 March 2020, which have further reduced Moria's capacity. Second, relocate camp residents to EU countries from the islands' respective airports, especially children, those with special needs, chronic morbidities, and the elderly. On Tuesday (25 March 2020), the EU called for an evacuation of camps and a distribution of refugees elsewhere in Greece.2 However, given that capacities are already stretched locally, we demand a truly European solution in the light of the current situation. Relocation failed previously due to political resistance of member states;3 however given the urgency of the current situation, now there is no alternative to European solidarity. The total number of asylum seekers to be relocated to individual member states is moderate to miniscule given proportional distribution quotas (Fig 1 A).

Practically, evacuation is possible with well-conducted pre-departure symptomatic screening, using core camp spaces to ensure quarantine conditions4 for those not fit to travel. Sufficient protection during travel, quarantine conditions and health security measures upon arrival minimise the risk of infection. Upon arrival, daily symptomatic screening and strict quarantine could be applied. Alternatively, systematic testing for SARS-CoV-2, combined with short-term isolation during the test period and quarantine of those tested positive according to international guidelines (two negative tests at least 24 hours apart or 14 days after symptoms have completely resolved5) could be carried out. The required testing and quarantine capacity will be higher the later evacuation starts (Fig 1 B). In a scenario of 300 persons being evacuated per day, and assuming a conservative SARS-CoV-2 prevalence of 1%, less than 100 person-months of quarantine during evacuation would be required in most receiving countries, but the capacities would nearly triple when prevalence rises up to 30% - a situation which is not unrealistic given exponential transmission in an unprotected population. Since the beginning of the SARS-CoV-2 outbreak, the European Emergency Response Center has evacuated more than 1400 EU citizens from Wuhan, Japan, Oakland, Morocco, Tunisia and Georgia,6 showing that evacuation is technically feasible if there is political will.

On behalf of 3,373 of signatories from 53 countries, we call upon the European Commission and the European Emergency Response Coordinator: give back dignity to Europe and to the humans in need of international protection at Europe's border, and EVACUATE. MORIA. AND ALL CAMPS ON GREEK ISLANDS. NOW.

Figure 1: Number of asylum seekers relocated across EU-27 countries under a complete evacuation scenario of Greek islands, N=42,000 asylum seekers (A) and quarantine and isolation capacities required in receiving countries by Sars-CoV-2 prevalence (B)
Legend: A: Number of asylum seekers per country calculated according to population size of receiving countries relative to the population in EU-27 (Source for population data: Eurostat). B: Required quarantine and isolation capacities calculated under a scenario of 300 persons being evacuated per day (2 days isolation for all asylum seekers received per country until test results are available, and additional 14 days for those tested positive for Sars-CoV-2 , i.e. 2 day for those tested negative, 16 for those tested positive). Quarantine and isolation capacities in person-months refer to the complete evacuation time until the numbers in A are received by each country (example: Germany needs to provide a quarantine capacity of 560 person-months to receive 7800 persons over 25 days (i.e. 300 per day) under a 1% scenario for the prevalence of Sars-CoV-2.

Author details / *Corresponding author

Prof. Dr. Kayvan Bozorgmehr (MD, MSc)*
Head, Dept. of Population Medicine and Health Services Research
School of Public Health, Bielefeld University
P.o. Box 10 01 31, D- 33501 Bielefeld, Germany
&
Social Determinants, Equity & Migration Group
Dept. of General Practice & Health Services Research
Heidelberg University Hospital | Im Neuenheimer Feld 130.3 | 69120 Heidelberg, Germany

Louise Biddle (MPH)
Research associate
Social Determinants, Equity & Migration Group
Dept. of General Practice & Health Services Research Heidelberg University Hospital | Im Neuenheimer Feld 130.3 | 69120 Heidelberg, Germany

Rosa Jahn
Research associate
Social Determinants, Equity & Migration Group
Dept. of General Practice & Health Services Research
Heidelberg University Hospital | Im Neuenheimer Feld 130.3 | 69120 Heidelberg, Germany

Katharina Wahedi (MD)
Social Determinants, Equity & Migration Group
Dept. of General Practice & Health Services Research
Heidelberg University Hospital | Im Neuenheimer Feld 130.3 | 69120 Heidelberg, Germany

Prof. Dr. Martin McKee (MD, MSc)
Professor of European Public Health
London School of Hygiene and Tropical Medicine
15-17 Tavistock Place, London, WC1H 9SH, United Kingdom

References

  1. Orcutt M, Mussa R, Hiam L, et al. EU migration policies drive health crisis on Greek islands. The Lancet 2020; 395(10225): 668-70.
  2. Baczynska G. EU asks Greece to move migrants most at risk from coronavirus out of crowded camps. Reuters World News. 2020.
  3. Bozorgmehr K, Wahedi K. Reframing solidarity in Europe: Frontex, frontiers, and the fallacy of refugee quota. Lancet Public Health 2017; 2(1):
  4. e10-e1.
  5. WHO. Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19). Geneva, 2020.
  6. WHO. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts. Geneva, 2020.
  7. European Commission. Crisis Management. 2020. https://ec.europa.eu/info/live-work-travel-eu/health/coronavirus-response/crisis-management_en (accessed 22 March 2020).