Almost all the refugees at Greek's EU-funded, highly securitized Zervou center are suffering from psychological distress, according to Doctors Without Borders (MSF).

The Paris-based nongovernmental organization said that trying to see a doctor, getting hold of insulin treatment for diabetes, or seeking legal advice prior to an asylum interview are challenges for the refugees, migrants and asylum-seekers stuck at the isolated center.

The Zervou center on the island of Samos is the result of an aggressive EU-funded containment policy to open ‘closed-controlled access centers’ in remote locations on five Aegean islands, where people seeking safety in Greece are placed while their asylum claim is being processed.

Three of these centers opened on Samos, Leros and Kos, with a further two planned to open in 2023 on Lesvos and Chios.

People arriving in Greece are distressed, having fled conflict or persecution in their home countries and many having been exposed to appalling levels of violence during their journeys. However, they are welcomed with double layers of barbed-wire fencing, X-rays and biometric identification at these centers.

"People in Zervou center tell us of having survived trafficking, sexual assault, forced labor and beatings," said MSF head of mission Nicholas Papachrysostomou.

"Some have seen their family members die during previous forced returns or during shipwrecks. The prison-like centers fail to provide for their basic needs and cause preventable harm to their mental and physical health."

Only people with an asylum ID card can enter or leave the Zervou center but registering for an ID card can take 25 days or longer.

All new arrivals are therefore effectively detained, without the freedom to come and go. So far, the center’s management has allowed people without ID cards out for medical or legal appointments, but this could change at any moment.

Inadequate healthcare

"The first glaring gap is people’s lack of access to healthcare," says Sonia Balleron, MSF project coordinator in Samos. "You have to imagine people who have been traveling for quite some time without medical care."

Nevertheless, doctors have only visited the center on occasional days for a few hours at a time since February 2022.

The healthcare provision within centers continues to be problematic with a continuous lack of medical staff and medical supplies.

In response to the dire situation, MSF has run a mobile clinic three times a week since April 2022 at the Zervou center.

Until recently, new arrivals were sent to a closed quarantine for COVID-19, with no access to medical care, which led to preventable deterioration in medical conditions.

Meanwhile, other people in urgent need of specialist medical care unavailable on Samos have faced administrative delays of up to several months for transfers to hospitals on the Greek mainland.

High-security infrastructure

Many people who have previously gone through traumatic experiences find their mental health condition exacerbated by the prison-like conditions, the segregation and the security infrastructure.

Between September 2021 and September 2022, 40% of MSF’s mental health patients on Samos had symptoms related to psychological trauma, according to the MSF.

Over the past year, the NGO has seen high levels of generalized mental health suffering amongst people in the Zervou center and demand for its mental health services has been consistently high.

Elise Loyens, the MSF medical coordinator in Greece, said: "Now everyone is suffering from a basic level of psychological distress, and always with the same symptoms: body pains, dissociation, depression, sleep disorders. People feel humiliated living under these conditions."

She added that patients describe Zervou center as "mental punishment" and rarely leave their room to avoid being confronted by the barbed wire and intrusive police presence.

"Another major stressor for our patients is the lack of clarity around the asylum process," said Balleron.

On Samos and Lesvos, people are often asked to their first interview immediately after leaving quarantine, with too little time to recover from their journey, no understanding of the procedure for claiming asylum, and no chance to seek legal assistance or prepare for the interview.

"The toll on their mental and physical health is undeniable and clearly visible," added Balleron.

Hostile environment

"If we compare Zervou center to previous camps, it’s fair to say that the closed center is an improvement in some ways," says Balleron.

"People stay in containers instead of in tents and there is less overcrowding than in the former camps. However, Zervou center is a hostile environment and fails to receive people in humane and dignified conditions."

Living conditions in the center are poor as a result of infrastructure problems, with stoppages in the water supply and frequent breakdowns of air conditioning and heating.

In addition, Zervou center’s remote location makes it difficult for people to interact with normal society. Buses run several times per day to and from the town of Vathy, but these are unaffordable for most asylum seekers.

The planned closed controlled access center on Lesvos is even more isolated, at 33 kilometers from Mytilene town, adding a significant barrier for services and underlining again the logic of segregation and de-facto detention that underpins these centers.

"Our experiences providing care in Zervou center underline the dangers of closed centers," says Papachrysostomou.

"Asylum seekers need access to quality, timely medical care. Authorities should invest in dignified reception conditions and safe accommodation, such as housing within communities, and set up integration programs."

"People need a safe, supportive and humane environment to register and process their asylum claim without risk of further retraumatization as international, EU and national legislation provide," he added.