Emergency Care Workers on Front Lines of Europe’s Refugee Crisis

Published on October 23, 2015
An emergency physician practicing in Vienna gives a first-hand look at Europe’s refugee crisis, and what it will mean for EU healthcare – and society – moving forward.

A teenager pushes his grandfather across the desert in a wheelchair. A thin line of asylum seekers stretches ahead and behind him. A journalist asks the teenager where he is from, and his only response is, “It’s hot. It’s hot.”

Asylum seekers are a leading news story in Europe. In Sicily, the streets are inundated with asylum seekers who loiter, are unemployable, and steal food from the locals, even in the shops. The police are overwhelmed, and the Mafia don’t help (in fact, they encourage asylum as the human smugglers represent a new income stream). As of this writing, several million people are heading toward Europe from the Middle East and Africa. They are escaping war, rape, murder, and genocide motivated by greed, fundamentalist fervor, tribal dispute, and criminal zeal. It is a mass casualty event of epic proportions, and its effects will be felt for generations.

The health and welfare of the asylum seekers are embedded in the politics and social erosion of their homelands. They don’t want to leave their home country, but they must in order to survive. As of now, only the generally healthy are arriving; the exodus is killing off the weak or unfortunate. Their route is through Libya from Africa, or through Hungary via Serbia, and Macedonia from Lebanon. One quarter of the population of Lebanon are transient asylum seekers. Syrians, Kurds, and Afghanis are in the majority, but there are a great many more ethnicities and languages included in the mix.

When they finally come to rest, asylum seekers are not welcomed with open arms. Not only the Neo-Nazis but the average European fears that they will erode their way of life. And not without reason; certain changes will be inevitable. Asylum seekers are driving up taxes that are already extreme for the average worker. Governments are slow to respond, budgets are tight, and NGOs spend more time watching than assisting. Volunteers are few and easily thwarted by rigid restrictions. Physicians who are asylum seekers themselves are not allowed to practice in the refugee camps where they live owing to Medical Boards’ refusal to license them.

As a board certified physician from the United States, I have worked in Afghanistan, in the Middle East, and Africa, from where many of these folks are traveling. Wanting to assist them here in Austria where I currently practice, I decided to approach Doctors Without Borders. Their plan was to send me to South Sudan. Instead, I signed on with the Rotes Kreuz (The Red Cross), and began working with asylum seekers a mere ten-minute ride from my home. Here is what I witnessed.

The language barrier is stark. I speak broken Arabic – as it is common not only to the Arabic natives but to those who speak Farsi, Persian, and Kurdish, as it is the language in which the Quran is read. When my Arabic fails, I speak English, or into smartphones with translation applications. The depth of the conversations is limited both by language and cultural embarrassment.

When the language divide is breached, the healthcare picture is often bleak and complex. Recently, I saw a married 19-year-old Persian woman. She had been incontinent of urine since childhood. Her words: “I grew up in bad condition.” Exam revealed sphincter incompetence, likely from early and frequent sexual abuse. The tall, thin, proud, and beautiful woman changed her clothes six times a day due to soiling. Afterwards, we sat down and she broke down crying, frustrated. We spoke with the Chapter administrator about a urology referral; both practitioners were men, and only accepted private payment. My wife, a nurse, brought her several boxes of female hygiene pads the next day. Her gratitude shone brightly on her face, and she hugged my wife for a long time.

Right now, before major health issues can be addressed, there is the more immediate quagmire of where these families will land. The doors to peaceful Arab states like Saudi Arabia, the Emirates, Bahrain and Qatar has been shut – and even if it opened, refugees would likely find similarly impoverished living conditions from whence they fled. The United States has agreed to accept a mere ten thousand asylum seekers, cherry picked. As of this printing, the EU had agreed to distribute 120,000 migrants across Europe, which, for all its controversy, represented a mere 20 days worth of immigrants.

The long-term economic and social outlook of the migrant crisis in Europe is still unclear. The UK’s Home Office reported in July that the daily cost to UK taxpayers for looking after asylum seekers amounted to nearly £786 million from 2010–2015, with a 46% overall increase occurring during the same period of time. Germany, which has Europe’s largest economy, and has been the favored destination for many of the current migrants, is expected to spend nearly €10 billion on asylum seekers in 2015 alone. In EU countries with far less wealth, however, such as Italy, Hungary, and Greece, there is great concern that absorbing migrants will immediately destabilize public budgets and services already under great strain and, in the long-term, fundamentally alter their way of life.

Right now, there are more questions than answers, and few places is that more clear than on the front lines of emergency medicine, where societal sores are so often laid bare. Check back next issue – and online here at epijournal.com – for personal stories of the refugee experience, and how the decisions being made will affect not only the EU but the world as a whole.

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