Winter is Coming

Published on December 16, 2015
Autumn turns to a winter that few of Europe’s beleaguered asylum seekers have ever experienced. Dr. Keith Raymond gives a front-line physician’s perspective from Vienna.

Syrian refugees camp in tents on the Slovenian border with Croatia.

Vienna is the city where East meets West, a city where spies have secret rendezvous in coffee houses. It is a city of intrigue, romance and fine music. The Westbahnhof (the western train station) has become a staging site for asylum seekers. In the small town of Nickelsdorf at the east Austrian border, 4,000 to 10,000 refugees enter daily from Hungary. In the Salzburg Banhof near the western border, the underground parking garage has been turned into a transient camp, housing three thousand refugees daily awaiting trains to Germany. Summer has given way to Autumn, and the bloom is off the rose.

Despite the EU taking swift action on behalf of the asylum seekers, frustration is growing amongst them. Old prejudices between Afghans and Syrians have led to brawls in refugee camps in Hamburg. Some 370 Albanians and Pakistanis clashed in a shelter in the German region of Hessen after a dispute over distribution of food. German nationals burned a Sport Hall in Wertheim that was being prepared to receive more refugees. A small village in Bavaria that had a hundred people, mostly retired, has seen its population swell by a thousand refugees, that are now sheltered in an old military Kaserne (base). As a result, German authorities are slowly applying the brakes to refugees entering from Austria.

To put things in perspective, Austria has a population of about nine million, similar to New York City. Germany has a population of about 81 million, and in this year alone six hundred thousand refugees have arrived from Africa and the Middle East. The inevitable build up along the border has slowly increased tempers. Meanwhile ‘Gut menschen’ (do-gooder Church volunteers) are performing charitable deeds, everything from distributing backpacks with socks and coats to organizing soccer games. The weather is beautiful when it is not raining or cold.

Medically, I have seen a huge upsurge in allergic rhinitis and atopic dermatitis, primarily due to exposure to allergens these folks have never previously encountered. Here, the antihistamines must be prescribed, as Claritin and Zyrtec are not over the counter. Additionally, dental problems are coming to light, as some of the refugees have never seen a dentist in their life. I saw one man whose teeth were almost entirely rotted out, and in need of removal. Sadly, dentures were not covered. On top of this, dietary restrictions and changes amongst the refugees point to future nutritional deficiencies, particularly in the children.

Still there is optimism for the most part. This may change as winter sets in. The nut trees and berry bushes have been exceedingly generous this autumn. The bees have stored rich honey. Both are indicators of heavy snow and a long winter. A winter that few if any of the asylum seekers have experienced before.

To date, the EU has not mandated medical screening exams for asylum seekers. This may change as endemics arise in the camps. The language barrier remains stark. Recently, I reviewed a patient’s medications and found she had been taking vaginal tablets orally. She was embarrassed when I noted and clarified her treatment. Still, this happens even when there is not a language barrier. Pressured practices and the inability of the patient to read instructions not in Arabic contributed. Fortunately, she suffered no ill effects.

I sense a growing sense of expectation – sometimes entitlement – from the refugees. Back in Afghanistan, Syria, Nigeria, Iran, and other countries, these citizens were not offered the same privileges from their governments. Housing, food, and funds were not volunteered. In Austria, asylum seekers are given 45 Euros a month, while in Germany that figure is triple. But these funds come from limited resources, and as a result Austria is considering the possibility of taxing incarcerated prisoners. While it may not offset the short fall, it provides an indication of the times.

The Hungarians have recently closed their Croatian and Serbian borders, so the tide of asylum seekers are shifting toward Slovenia, after which they will travel north into Austria, and the city of Linz will become the next staging site, with Spielberg on the Slovenia border being the choke point. While my wife and I were vacationing in Italy, traveling by rail, many Americans traveling along with us, voiced their frustration that they had been diverted to Linz, as the Salzburg rail station had been closed to all but asylum seekers. I merely shrugged and shook my head. Clearly the misperception that a vacation trumps asylum was fixed in their minds. Perhaps such luxuries will be indulged in the future, perhaps not.

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