Syrian refugee children arrested and beaten(tm) forcarrying toy gu.docx

Syrian refugee children arrested and beaten(tm) for
carrying toy guns in Greece
The Independent (London, England)
Five Syrian refugee children have been arrested and detained
in
Greece after they were found carrying plastic toy guns on their
way to
perform in a children's play.
The boys, aged between 12 and 16, were seized "on suspicion
of being members of an armed group", and then allegedly
detained, beaten
and forced to strip naked.
International organisations have since condemned Greek police
over
the alleged misconduct. Amnesty International has accused
Greek officers of
committing human rights violations against children, describing
the incident
as "disturbing", while Save the Children said the incident
served
as a "reminder of the risks child refugees are facing every day
in
Greece".
The children, who were due to perform in a production about
the
Syrian conflict at a local cultural centre, were carrying their
costumes and
toy guns in a carrier bag when they were detained on the
afternoon of 27
September.
They were stopped and searched by four police officers on

motorbikes, who then called more officers for support.The
children were then
taken to Omonoia police station along with two older Syrian
refugees, aged 24
and 21, who had been walking to the cultural centre with them.
The children(tm)s lawyer, Electra Koutra, has given an
account of
how the children said they were ill-treated in custody, verbally
abused and
forced to undress by two police officers.
Ms Kourta wrote in her full account published on Facebook:
"The children were taken to a secluded room by two policemen,
where they
were asked to undress completely. When two of them refused to
remove their
underwear, police exercised physical violence on them, after
which the one
succumbed and removed it, while the other continued to object
and, as a
result, had his underwear forcibly removed.
"A third child also suffered physical violence, was made to
bend while naked and four were asked to turn around
themselves while naked
more than once, so that the policemen would have the chance to
have a good
presentation and look of their child bodies and genitals.
"The last child in the row started crying and asking for his
mother. The others advised him to undress, in order to not get
beaten too.
After that, they were asked to dress and were subsequently
photographed by
use of a policeman(tm)s cellphone, as a group and each one

separately.
"They remained in a state of deprivation of freedom for more
than six hours, amongst adult drug users and criminal abductors.
As for
water, they were advised, when they begged for it, to go drink
directly from
the police station(tm)s toilet which was impossible to approach
because of
the filth and odour. They were not allowed to use their
cellphones for
calling their parents."
After the children were released, volunteers reportedly asked
police how they could report the incident, but were turned
away. Later the
children returned to the police station with their parents and a
lawyer
demanding to lodge a lawsuit.
Following a number of interviews and referrals between
different
services " which Ms Koutra said took several hours " they were
reportedly informed that the Childrens(tm) Department of the
Central Police
Directorate would take over the case.
The minister of public order in Greece said the public
prosecutor
has ordered a criminal investigation into the incident, but said
he would not
"rush to a conclusion" while the investigation is still underway.
In a statement, he said: oeFrom the first moment, orders were
given for details of the case to be submitted to the prosecution.
At the same

time the police started a disciplinary enquiry. The ministry
investigates any
case any breach of law and rules and it is known that I will
show no mercy to
any proven violation. But it won(tm)t rush to conclusion when
the
investigation is still running. It has caused great surprise that
this
allegation has been accepted without question when it(tm)s
under
investigation.
Amnesty International, which has documented numerous
testimonies
of refugees and migrants alleging ill-treatment by the Greek
police in recent
years, has condemned the alleged police conduct and said that if
the
allegations were true the Greek authorities must ensure criminal
and
disciplinary proceedings were taken as appropriate.
John Dalhuisen, Amnesty International(tm)s director for
Europe,
said: oeThe ridiculous elements of this case should not deflect
attention
from the extremely serious and deeply disturbing nature of the
allegations
against Greek police officers, who are accused of committing
human rights
violations against children in their custody during an identity
check.
oeIf these allegations of beating and other ill-treatment are
shown to be true, the Greek authorities must ensure that
criminal and

disciplinary proceedings are taken as appropriate. They should
also look into
whether racial profiling may have played a part in motivating
these officers
to inflict such ill-treatment on children.
Save the Children also condemned the incident, saying it
highlighted the vulnerability of child refugees in Greece and
describing the
present conditions as "unacceptable".
Andreas Ring, Greece humanitarian representative for Save the
Children, told The Independent: oeIt is unacceptable that
children who
survived years of violence and a notoriously dangerous journey
to reach
somewhere safe are now stranded in Greece, in conditions that
are further
traumatising them.
"The reported incident serves as a reminder of the risks
child refugees are facing every day in Greece. Many are
becoming more
vulnerable to exploitation as families use up their resources
while waiting
for a decision on their asylum applications.
"Other children who arrived alone are having to wait in
detention for months while their applications for family
reunification are
processed. In parallel, tensions with local communities are on
the rise
across the country.
"Both hosts and guests are losing patience with the asylum
and national child protection systems that seem to be over-

burdened and
incapable of handling the added caseload of asylum seekers
stranded in
Greece."
Ms Koutra described the incident was a "landmark" case
and concluded that police stops and searches "should be
conducted in
accordance with national and international law prohibiting
discrimination,
including ethnic profiling, ill-treatment, and arbitrary
deprivation of
liberty".
She added that police "should take particular notice of the
vulnerability of children, and safeguard their dignity."
Greek police told Amnesty International on Friday 30
September
they had begun a oedisciplinary inquiry to oedetermine the facts
of the case.
content_
Full Text: COPYRIGHT 2016 Independent Digital News and
Media Limited.
http://www.independent.co.uk
Source Citation:
"Syrian refugee children arrested and
beaten(tm) for carrying toy guns in Greece." Independent

[London, England] 3 Oct. 2016: 23. Business Insights:
Essentials. Web. 3 Mar. 2019.
URL
http://bi.galegroup.com.ezproxy.rit.edu/essentials/article/GALE
%7CA465259523?u=nysl_ro_rrlib
Document Number:
GALE|A465259523
RESEARCH ARTICLE Open Access
Syrian refugees in Greece: experience with
violence, mental health status, and access
to information during the journey and
while in Greece
Jihane Ben Farhat1*, Karl Blanchet2, Pia Juul Bjertrup1,
Apostolos Veizis3, Clément Perrin4, Rebecca M. Coulborn1,
Philippe Mayaud2 and Sandra Cohuet1
Abstract
Background: Since 2015, Europe has been facing an

unprecedented arrival of refugees and migrants: more than
one million people entered via land and sea routes. During their
travels, refugees and migrants often face harsh
conditions, forced detention, and violence in transit countries.
However, there is a lack of epidemiological
quantitative evidence on their experiences and the mental health
problems they face during their displacement.
We aimed to document the types of violence experienced by
migrants and refugees during their journey and
while settled in Greece, and to measure the prevalence of
anxiety disorders and access to legal information and
procedures.
Methods: We conducted a cross-sectional population-based
quantitative survey combined with an explanatory
qualitative study in eight sites (representing the range of
settlements) in Greece during winter 2016/17. The survey
consisted of a structured questionnaire on experience of
violence and an interviewer-administered anxiety disorder
screening tool (Refugee Health Screener).
Results: In total, 1293 refugees were included, of whom 728
were Syrians (41.3% females) of median age 18 years
(interquartile range 7–30). Depending on the site, between 31%
and 77.5% reported having experienced at least
one violent event in Syria, 24.8–57.5% during the journey to
Greece, and 5–8% in their Greek settlement. Over 75%
(up to 92%) of respondents ≥15 years screened positive for
anxiety disorder, which warranted referral for mental
health evaluation, which was only accepted by 69–82% of
participants. Access to legal information and assistance
about asylum procedures were considered poor to non-existent
for the majority, and the uncertainty of their status
exacerbated their anxiety.
Conclusions: This survey, conducted during a mass refugee

crisis in a European Community country, provides
important data on experiences in different refugee settings and
reports the high levels of violence experienced by
Syrian refugees during their journeys, the high prevalence of
anxiety disorders, and the shortcomings of the
international protective response.
Keywords: Refugees, Migrants, Europe, Greece, Syria, Mental
health, Violence, Journey, Access
* Correspondence: [email protected]
1Epicentre, Paris, France
Full list of author information is available at the end of the
article
© The Author(s). 2018 Open Access This article is distributed
under the terms of the Creative Commons Attribution 4.0
International License
(http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate
credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were
made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to
the data made available in this article, unless otherwise stated.
Ben Farhat et al. BMC Medicine (2018) 16:40
https://doi.org/10.1186/s12916-018-1028-4
http://crossmark.crossref.org/dialog/?doi=10.1186/s12916-018-
1028-4&domain=pdf
mailto:[email protected]
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http://creativecommons.org/publicdomain/zero/1.0/

Background
Since 2015, Europe has faced an unprecedented arrival
of refugees and migrants. According to the United
Nations High Commissioner for Refugees (UNHCR),
around 1,015,000 refugees and migrants made the dan-
gerous crossing of the Mediterranean Sea in 2015 [1],
362,753 in 2016, and 55,215 from January 1 to May 16,
2017 [2]. Furthermore, the International Organization
for Migration reports that 34,887 refugees and migrants
traveled by land from Turkey to Bulgaria and Greece in
2015 [3], 24,338 in 2016 [4], and 1205 in the first quarter
of 2017 [5]. Syrians accounted for 50% [6], 46% [7], and
36% [5], in 2015, 2016, and 2017, respectively, of these
refugees and migrants. The ongoing Syrian war con-
tinues to account for the largest number of new refugees
and internal and external displacements worldwide [6].
In early 2016, the European Union (EU) reached an
agreement with Turkey aimed at stopping the massive
influx of refugees and migrants into the Union. Under
the deal, the EU and Turkey agreed that all new mi-
grants crossing from Turkey to the Greek islands after
20 March 2016 would be returned to Turkey if they
were not applying or not eligible for asylum, or were
asylum seekers whose application was considered inad-
missible in the EU [8]. The arrangement also included
legal channels of resettlement of certain refugees and
migrants to the EU, applicable to Syrian refugees. A start
date of 4 April 2016 was set for the repatriation/deport-
ation or resettlement of refugees and migrants. However,
as of early 2017, less than 10% of the asylum seekers that
the EU had committed to resettle had been relocated
[9]. Ultimately, tens of thousands of people are currently
stranded in Greece, living in difficult conditions, as they
await resettlement, repatriation/deportation, or asylum

decisions. Exacerbating the situation, Greece has faced
an important economic crisis during these last years,
with drastic austerity measures and cuts in several
public programs, further decelerating the procedures
for refugees.
Refugees and migrants experience extremely stressful
events as a result of war, oppression, migration, and re-
settlement. This includes forced detention, violence, tor-
ture, and even witnessing death. UNHCR has repeatedly
shared the testimonials of refugees and migrants suffering
grave abuses at the hands of smugglers, other criminal
networks, and even state authorities [10]. The latter have
been implicated in forceful “pushbacks” at land borders,
denying refugees access to asylum procedures afforded
under European and international law [10]. Travel by sea
also poses great risks. The deadliest year for sea crossings
was 2016, with 5096 deaths reported [10]. As a result,
many refugees and migrants exhibit multiple distressing
somatic and psychological symptoms and poor mental
health associated with stressful events [11]. A combination
of emotional and physical distress is often symptomatic of
pre-existing mental health disorders, or a pre-disposition
to the development of mental health issues. Studies docu-
menting the types and levels of violence experienced and
the prevalence of anxiety and other mental health disor-
ders among Syrian refugees during their displacement and
resettlement are lacking [12, 13].
In response to the needs of these displaced popula-
tions in Greece and to support the assistance by the
Greek population, the international non-governmental
organization Médecins Sans Frontières France (MSF)
has been supporting refugee camps on mainland Greece,
in the regions of Ioannina in northwestern Greece and

Attica in the south, as well as a squat-hotel in the center
of Athens and a retention center on the Greek island of
Samos, providing psychological and medical services. To
document the levels and types of violence endured by
refugees in their home countries, during their journey,
and in their Greek settlements, including the types of
perpetrators as well as the prevalence of anxiety and
other mental health issues, MSF conducted quantitative
and qualitative research at various sites in Greece.
Methods
Study settings and participants
We conducted a cross-sectional population-based survey
combining quantitative and qualitative components. The
parent study took place in eight sites with a larger sam-
ple size and recruited multiple nationalities. However,
this paper will focus on data from Syrian populations,
collected at six different sites representing a range of
temporary settlements: (1) the Ritsona camp in the
Attica region near Athens, where the population was liv-
ing in bungalows; (2) the Katsikas camp in Ioannina, in
the northwest of Greece; (3) a hotel where a proportion
of the Katsikas camp population had been temporarily
relocated while the camp was being refurbished for the
winter; (4) the island of Samos, one of the first entry
points in Greece and a designated UNHCR hotspot; and
(5, 6) a pair of squat-hotels in central Athens.
Given the variability of refugee sites in terms of size,
structure, and population origin and demographic com-
position, we opted for an independent sample selection
for each study site. For the primary outcome (violence
experienced) estimated at 50%, assuming 5% precision, a
5% confidence level and a 10% non-response rate, we
estimated a sample size of 250 individuals per site. All
enumerated individuals in the randomly or exhaustively

(depending on camp size) selected shelters/households
were interviewed.
Study methodology
The quantitative survey included all individuals living in the
selected shelter. It consisted of an interviewer-administered
Ben Farhat et al. BMC Medicine (2018) 16:40 Page 2 of 12
questionnaire collecting information on socio-demographic
data, journey details, desired country of destination,
intended length of stay at the final destination, experience
with violence during the journey and in Greece, livelihood,
health status, and access to various types of information,
mostly legal. The questionnaire was complemented by a
pre-validated anxiety disorder screen (the Refugee Health
Screener 15 or RHS-15) [14, 15], to detect symptoms of
anxiety, depression, and posttraumatic stress disorder, and
was administered only to individuals aged 15 years and
older. The RHS-15 consists of two (self-administered) com-
ponents: a set of 13 symptom items scored from 0 to 4
(from “Not at all” to “Extremely”); and a graphic “distress
thermometer” scored from 0 to 10. Participants were con-
sidered positive when they had a score ≥11 out of 52 in the
symptoms component or had a self-reported score ≥5 in
the distress thermometer. Any participant who screened
positive was informed of the benefit of seeing a mental
health professional and provided with a free referral to an
on-site psychologist employed by MSF.
The qualitative study included in-depth interviews
(IDIs) and focus group discussions (FGDs). The object-
ive of the IDIs was to examine in depth the experience
of violence plus mental or psychosocial well-being and

coping mechanisms. The objective of the FGDs was to
examine access to information and services in relation
to asylum procedures. Participants were asked to share
reasons for leaving their home country, and the difficul-
ties and violence that they faced during their journey
and while in Greece. FGDs and IDIs were audio-
recorded and conducted by the qualitative research co-
ordinator with the assistance of translators.
Data collection and analyses
Quantitative data were collected on paper and entered into
the RedCap software. Data quality double-checks were per-
formed on 10% of questionnaires. Descriptive analyses
were performed using Stata 13 (Stata Corp). Comparisons
of proportions were performed using a chi-squared test.
The prevalence of anxiety disorder was stratified by key
group characteristics, of which those associated with
anxiety were analyzed using a test of proportions.
Audio-recordings of IDIs and FGDs were transcribed
into English and reviewed and revised by the qualitative
researcher in the field. Qualitative data analyses, aided
by NVivo 11 qualitative software, included both thematic
analysis and grounded theory [16]. Emergent patterns,
categories, and concepts from participants’ accounts
were identified by meticulous and systematic reading
and coding of the transcripts.
The qualitative data informed the quantitative data
and were analyzed simultaneously for the themes chosen
for this article.
Results
Study participants
The study was conducted between 29 November 2016
and 6 February 2017. Of the 382 households eligible and

visited, 363 (95%) were included, totaling 1374 eligible in-
dividuals, of whom 1293 (94.1%) agreed to participate;
only 12 refused (0.9%) (Fig. 1). Of the 1293 consenting
participants, 728 (56.3%) were from Syria and analyses
were restricted to this population. Similarly, 83 individuals
were identified for IDIs/FGDs in the parent study, of
whom 42 were of Syrian origin.
382 households visited
14 households absent (3 )
4 households refused (1 )
1 household with no interpreter
available (Urdu language) (0.3 )
363 households included, totaling 1374 eligible individuals
65 individuals absent (4.7 )
12 individuals refused (0.9 )
4 individuals with incomplete data
(0.3 )
1293 individuals included (94.1 )
728 individuals from Syria included (56.3 )
Fig. 1 Study flowchart
The characteristics of the Syrian study population
are presented in Table 1. The age and sex compos-
ition varied by camp, but overall, they were young
(median 18 years, interquartile range 7–30) and pre-

dominantly male. The majority of participants aged
15 years and older were married or in unions and a
large proportion (42.6–81.8%) had achieved at least
secondary education. Most participants were living
with their nuclear family at the time of the survey, and
34% originated from Aleppo, 16.8% from Damascus, and
15.6% from Al-Hasakah.
Altogether, 21 IDIs were conducted with Syrians: 11
with a male participant, seven with a female partici-
pant, and three with couples. Three FGDs were held,
two with women and one with men. In total, 42
Syrians, aged 18–70 years, participated in the qualita-
tive component.
Experience with violence
The prevalence of participants’ experience with at least
one violent event, according to location of occurrence,
gender, and age, is presented in Table 2.
The majority of participants experienced at least one
violent event in Syria, ranging from 30.8% of those at
Ritsona camp to 77.5% at the Samos hotspot. During
the journey (excluding in Syria), between 24.8% (Hotel
Ioannina) and 57.5% (Samos) of interviewees experi-
enced at least one violent event. Approximately one-
quarter of participants at Ritsona and Katsikas camps
and the Athens hotel, and more than half of partici-
pants at the Samos hotspot, experienced a violent event
in Turkey; and between 4.6% (Ritsona) and 7.7% (Hotel
Ioannina) in Greece; while the proportion experiencing
violence at their current settlement ranged from 0.3%
(Katsikas) to 9.6% (Samos). Among men and women,
Table 1 Population characteristics of Syrian refugees by
settlement

Characteristics Ritsona camp
N = 286
n (%)
Katsikas camp
N = 133
n (%)
Hotel Ioannina
N = 117
n (%)
Samos hotspot
N = 73
n (%)
Athens hotel
N = 119
n (%)
Total
N = 728
n (%)
Female 139 (50.2) 52 (39.7) 53 (45.7) 22 (30.1) 30 (25.2) 296
(41.3)
Median age, years [IQR] 12 [5–30] 21 [9–31] 13 [8–25] 20 [15–
31] 23 [17–30] 18 [7–30]
City of origin
Aleppo 99 (35.5) 39 (29.3) 58 (49.6) 14 (19.2) 35 (29.7) 245
(34.0)

Damascus 26 (9.3) 42 (31.6) 14 (12.0) 15 (20.6) 24 (20.3) 121
(16.8)
Al-Hasakah 61 (21.9) 13 (9.8) 11 (9.4) 18 (24.7) 9 (7.6) 112
(15.6)
Dar Ezor 21 (7.5) 5 (3.8) 11 (9.4) 1 (1.4) 12 (10.2) 50 (6.9)
Family status on site
Nuclear family 221 (82.2) 92 (71.3) 40 (37.0) 30 (56.6) 27
(25.0) 410 (61.5)
Single parent 9 (3.4) 9 (7.0) 22 (20.4) 1 (1.9) 5 (4.6) 46 (6.9)
Child alone 2 (0.7) 1 (0.8) – 5 (9.4) 2 (1.9) 10 (1.5)
Alone 10 (3.7) 24 (18.6) 4 (3.7) 16 (30.2) 62 (57.4) 116 (17.4)
Other 27 (10.0) 3 (2.3) 42 (38.9) 1 (1.9) 12 (11.1) 85 (12.7)
Among respondents ≥ 15 years
Marital status
Single 21 (18.8) 30 (39.5) 21 (39.6) 29 (53.7) 60 (62.8) 161
(41.4)
Married/union 89 (79.5) 45 (59.2) 32 (60.4) 24 (44.4) 34 (36.2)
224 (57.6)
Separated/divorced 1 (0.9) – – – – 1 (0.3)
Widowed 1 (0.9) 1 (1.3) – 1 (1.9) – 3 (0.8)
Unknown 14 2 4 2 1 23

Level of education
None 15 (13.0) 5 (6.7) 2 (3.6) 3 (5.6) 7 (7.5) 32 (8.2)
Primary 51 (44.4) 11 (14.7) 13 (23.6) 9 (16.7) 10 (10.8) 94
(24.0)
Secondary 32 (27.8) 37 (49.3) 30 (54.6) 33 (61.1) 46 (49.5) 178
(45.4)
Tertiary 17 (14.8) 22 (29.3) 10 (18.2) 9 (16.7) 30 (32.3) 88
(22.5)
Unknown 11 3 2 2 2 20
IQR interquartile range
Table 2 Violence experienced from country of origin to current
settlement
Experience of at least one violent eventa Ritsona camp
N = 286
n (%)
Katsikas camp
N = 133
n (%)
Hotel Ioannina
N = 117
n (%)

Samos hotspot
N = 73
n (%)
Athens hotel
N = 119
n (%)
In country of origin 85 (30.8) 68 (51.1) 74 (63.3) 55 (77.5) 82
(72.6)
In Turkey 58 (21.3) 36 (28.4) 16 (13.9) 39 (54.2) 23 (19.5)
In Greece 13 (4.6) 9 (6.8) 9 (7.7) – 8 (6.7)
In site 7 (2.5) 2 (0.3) 10 (8.5) 7 (9.6) 2 (1.7)
During the journey (excluding country of origin) 81 (28.3) 48
(36.1) 29 (24.8) 42 (57.5) 35 (29.4)
Characteristics
Gender p = 0.82 p = 0.73 p = 0.43 p = 0.39 p = 0.59
Men 38/138 (27.5) 28/79 (37.4) 17/63 (27.0) 31/51 (60.8) 25/89
(28.1)
Women 40/139 (28.8) 20/52 (38.5) 11/53 (20.8) 11/22 (50.0)
10/30 (33.3)
Age group p = 0.02 p = 0.07 p = 0.61 p = 0.02 p = 0.51
0–5 12 (15.4) 5 (19.2) 3 (16.7) 2 (20.0) 2 (28.6)
6–14 22 (28.6) 9 (31.0) 10 (23.8) 3 (42.9) 3 (17.7)

≥15 42 (33.3) 34 (43.6) 16 (28.1) 37 (66.1) 30 (31.6)
Types of violence experienced in Syria,
% of reported violent events
Bomb 74/112 (66.1) 49/81 (60.5) 48/87 (55.2) 48/80 (60.0)
86/113 (76.1)
Beatings 11/112 (9.8) 15/81 (18.5) 3/87 (3.5) 22/80 (27.5)
13/113 (11.5)
Threats – 8/81 (9.9) 28/87 (32.2) 2/80 (2.5) 3/113 (2.7)
Traumatized 12/112 (10.7) 5/81 (6.2) 3/87 (3.5) 5/80 (6.3)
1/113 (0.9)
Sexual violence – – – – 1/113 (0.9)
Other 15/112 (13.4) 4/81 (4.9) 5/87 (5.7) 3/80 (3.8) 9/113 (7.9)
Types of violence experienced in Turkey,
Beatings 24/73 (32.9) 4/36 (11.1) 3/16 (18.8) 32/54 (59.3) 2/26
(7.8)
Threats 1/73 (1.4) 14/36 (38.9) 2/16 (12.5) 1/54 (1.9) 5/26
(19.2)
Traumatized 10/73 (13.7) – – 5/54 (9.3) 6/26 (23.1)
Sexual violence – – – – –
Other 38/73 (52.0) 18/36 (50.0) 11/16 (68.8) 16/54 (29.6) 13/26
(50.0)

Perpetrators of violence experienced in Turkey,
Police/army 46/62 (74.2) 22/35 (62.9) 13/17 (76.5) 47/53 (88.7)
16/27 (59.3)
Smugglers 16/62 (25.8) 11/35 (31.4) 4/17 (23.5) 2/53 (3.8) 4/27
(14.8)
Other refugees – – – 1/53 (1.9) –
Local population – 1/35 (2.9) – 2/53 (3.8) 7/27 (25.9)
Others – 1/35 (2.9) – 1/53 (1.9) –
Types of violence experienced in Greece,
Beatings 14/17 (82.3) 8/10 (80.0) 8/10 (80.0) 3/7 (42.9) 4/12
(33.3)
Threats – – – 2/7 (28.6) 4/12 (33.3)
Tear gas – 1/10 (10.0) 2/10 (20.0) – –
Sexual violence – – – – –
Other 3/17 (17.7) 1/10 (10.0) – 2/7 (28.6) 4/12 (33.3)
similar proportions of violence experienced were ob-
served but across all sites, a greater proportion of the

older age group reported a violent event. Violent events
reported in Syria were mainly bombing of the cities
(55.2–76.1%) and threats (2.5–32.2%). The types of
violence in Turkey and Greece were mainly beatings
(7.8–59.3% in Turkey and 33.3–82.3% in Greece), per-
petrated by police in both countries but also by other
refugees in Greece. Furthermore, psychological trauma
from witnessing severely distressing events constituted
up to 13.3% of the violent events reported in Turkey.
Many of the participants interviewed had experienced
different forms of violence, for example torture and
bombing of their houses. Some had been detained, and
others not only lost property but also family members
and no longer felt they had any reason to remain at
home. The perpetrators of the violence in Syria were
mainly the regime or Daesh:
[Daesh] brought me to in a room, where I had to turn
against the wall and raise my arms. Then they started
whipping me. I was pregnant, eight months pregnant.
(Woman from Syria)
Participants highlighted difficulties and violence when
crossing checkpoints inside Syria. In addition, when try-
ing to enter Turkey, participants were often shot at by
the Turkish police and border guards:
[The police] fired at us and some people were injured
or killed. Others crossed the border and others were
caught by Turkish border guards and pushed back to
Syria again. (Palestinian man from Syria)
During the journey, participants interviewed in the
qualitative study often found themselves in situations
over which they could exercise little or no control and

where they received limited information from smugglers.
The ability to negotiate with smugglers was complicated
by the practice of smugglers handing over people to
other smugglers, through chains of delegation. In addition,
families were at times separated. One participant de-
scribed how he and the rest of his family were separated
from their 2-year-old son while crossing the border to
Turkey:
One guy was carrying one of my sons when we walked
through the mountains as I couldn’t carry both. […]
We got lost because of the huge numbers of people who
were trying to cross the borders. The Turkish police
caught this guy with my son and sent them back to
Syria. (Man from Syria)
Similarly, participants were threatened with guns by
the smugglers and shot at by the Turkish Coast Guard
when crossing by sea from Turkey to Greece. When
crossing into Greece by land, participants also faced
violence if caught. Participants mentioned tensions and
violent episodes in the camp, making them worry about
the safety of themselves and their families. Living in
tents and the strong feeling of not being protected by
the police increased the feeling of insecurity.
Mental health and referral and acceptance of
psychological assessment
The results of the RHS-15 screening tool for anxiety dis-
order morbidity are presented in Table 3, according to
participant characteristics and site, as well as the levels
of acceptance of referral for mental health evaluation.
For each individual characteristic, the percentages of
participants screened positive are presented. The tool
was administered to 80.5% (332/412) of the respondents

aged 15 years and over.
The vast majority of participants screened positive for
anxiety disorder meriting referral for a mental health evalu-
ation: nearly all participants (92.1%) living on Samos,
80.0% of the respondents from the Ritsona camp, and
approximately three-quarters of respondents from Katsikas
camp, Hotel Ioannina and Athens hotel (74.6%, 75.0%, and
76.0%, respectively). The prevalence of anxiety disorders
Table 2 Violence experienced from country of origin to current
settlement (Continued)
Experience of at least one violent eventa Ritsona camp
N = 286
n (%)
Katsikas camp
N = 133
n (%)
Hotel Ioannina
N = 117
n (%)
Samos hotspot
N = 73
n (%)
Athens hotel
N = 119
n (%)
Perpetrators of violence experienced in Greece,

Police/army 6/17 (35.3) 5/7 (71.4) 2/10 (20.0) 2/8 (25.0) 8/12
(66.7)
Smugglers – – – – –
Other refugees 7/17 (41.2) 1/7 (14.3) 8/10 (80.0) 2/8 (25.0) 3/12
(25.0)
Local population – – – 4/8 (50.0) 1/12 (8.3)
Others 3/17 (17.7) 1/7 (14.3) – – –
aA violent event relates to any violence experienced such as
kidnapping, tear gas, bomb, physical torture, trauma (mental
shock), knife or other weapon use,
sexual violence, beating, or other
Table 3 Prevalence of anxiety disorder morbidity
Refugee Health Screener 15 Ritsona camp
N = 100
n (%)
Katsikas camp
N = 67
n (%)
Hotel Ioannina
N = 48
n (%)
Samos hotspot
N = 38

n (%)
Athens hotel
N = 79
n (%)
Screened positive 80 (80.00) 50 (74.6) 36 (75.0) 35 (92.1) 60
(76.0)
Women 40 (83.3) 19 (82.6) 23 (82.1) 10 (100.0) 11 (91.7)
Men 39 (76.5) 30 (69.8) 13 (65.0) 25 (89.3) 49 (73.1)
Age group
14–25 21 (77.8) 20 (76.9) 16 (69.6) 19 (95.0) 31 (75.6)
>25 59 (80.8) 30 (73.2) 20 (80.0) 16 (88.9) 29 (76.3)
Marital status
Single 14 (70.0) 22 (73.3) 12 (66.7) 19 (90.5) 39 (76.5)
Married/union 59 (80.8) 26 (74.3) 21 (77.8) 15 (93.8) 20 (74.1)
Separated/divorced 1 (100.0) 1 (100.0) – 1 (100.0) –
Widowed
Family status at the site
Nuclear family 56 (80.0) 25 (71.4) to 12 (63.2) 7 (100.0) 8
(80.0)
Single parent 7 (100.0) 6 (100.0) 13 (86.7) 1 (100.0) 4 (80.0)

Child alone 2 (100.0) 1 (100.0) – 4 (100.0) 1 (100.0)
Alone 7 (77.8) 16 (72.7) 1 (50.0) 11 (91.7) 42 (76.4)
Family in Europe
Yes 70 (79.6) 44 (75.9) 32 (76.2) 29 (90.6) 55 (78.6)
No 10 (83.3) 6 (66.7) 3 (60.0) 6 (100.0) 5 (55.6)
Experienced at least one violent event
Yes 25 (83.3) 21 (72.4) 9 (75.0) 20 (90.9) 18 (75.0)
No 55 (78.6) 29 (76.3) 27 (75.0) 15 (93.8) 42 (76.4)
Chronic diseasea
Yes 8 (100.0) 3 (100.0) 6 (100.0) 4 (100.0) 7 (70.0)
No 72 (78.3) 47 (73.4) 30 (71.4) 31 (91.2) 53 (76.8)
Vulnerableb
Yes 16 (94.2) 8 (100.0) 13 (76.5) 5 (100.0) 5 (71.4)
No 64 (77.1) 42 (72.2) 23 (74.2) 30 (90.9) 55 (76.4)
Length of stay in Greece
>9 months 22 (88.0) 18 (72.0) 30 (75.0) 2 (100.0) 55 (76.4)
≤9 months 56 (76.7) 32 (76.2) 6 (75.0) 33 (91.7) 5 (71.4)
Duration of travel

>2 months 46 (85.2) 24 (75.0) 18 (94.7) 13 (92.9) 30 (69.8)
≤2 months 30 (73.2) 26 (74.3) 18 (62.1) 22 (91.7) 29 (82.9)
Women vs Men p = 0.40 p = 0.26 p = 0.18 p = 0.28 p = 0.17
14–25 years vs >25 years p = 0.74 p = 0.73 p = 0.40 p = 0.49 p
= 0.94
Young women (14–25) vs older women p = 0.47 p = 0.77 p =
0.83 – p = 0.46
Young men (14–25) vs older men p = 0.83 p = 0.71 p = 0.66 p =
0.46 p = 0.97
Having family in Europe vs no family in Europe p = 0.76 p =
0.56 p = 0.43 p = 0.43 p = 0.13
Experienced at least one violent event vs no violent event p =
0.59 p = 0.72 p = 0.99 p = 0.75 p = 0.90
Chronic disease vs no chronic disease p = 0.14 p = 0.30 p =
0.13 p = 0.54 p = 0.64
Vulnerable vs not vulnerable p = 0.11 p = 0.08 p = 0.86 p =
0.48 p = 0.77
was high, similar by sex and varied slightly by age
group. No differences between individual characteris-
tics and prevalence of anxiety were observed, except
in Hotel Ioannina where refugees who had traveled
for more than 2 months had a higher prevalence of

anxiety compared to refugees who had traveled for less
than 2 months (p = 0.01). About one-quarter of partici-
pants in Ritsona and Katsikas camps and Hotel Ioannina
declined referral. The proportion declining referral
was higher (31.4%) on Samos and lower (18.3%) at
the Athens hotel.
While war, violence, and harsh conditions during the
journey stood out as traumatic experiences for most, the
qualitative study participants emphasized that their
current lives as refugees in Greece and the uncertainty
about their futures were especially detrimental to their
mental well-being. The refugees in Greece described
their current lives as a source of pain and suffering.
Their new lives and identities as refugees were very
different and poor compared to their previous lives in
Syria before the civil war. Living or having lived in poor
housing conditions for several months (tents, containers,
etc.) in often isolated camps with movement restrictions,
and denial of or inability to exercise the same rights as the
surrounding Greek society, made refugees feel socially
marginalized and discriminated against. Some described
how they had lost their dignity, felt humiliated, or felt
treated worse than animals:
I was really humiliated here [in Greece], and I have
even experienced the bombing in Syria. However, I still
had dignity there [in Syria]. Here, I lost it completely.
When you have to stay [a] long time in line just to bring
food to your children. My son asks me for some chips,
but I can’t buy them for him. In Syria, I was buying
everything: clothes, food, everything. (Man from Syria)
Being separated from family members was another
issue that caused emotional suffering among Syrian ref-
ugees in Greece. Some had been separated during the

journey, while others were separated when certain fam-
ily members did not travel, remaining behind in their
home country. Several qualitative study participants
experienced being separated within Greece from their
adult children, adult siblings, or other family members
not defined as core family (spouses and under-aged
children). While the new life situation as a refugee in
Greece was already difficult, not being with family
members or other social support networks further
worsened the situation.
Legal procedures and access to information in Greece
Table 4 presents the initiation of legal procedures and
access to information on legal assistance, asylum proce-
dures, and healthcare. On Samos, the majority of par-
ticipants (86.1%) reported having initiated the asylum
procedure. At the Ritsona and Katsikas camps and the
Athens hotel, most participants had started the reloca-
tion procedure (70.0%, 73.2% and 71.8%, respectively).
The highest proportion of participants (60.7%) seeking
reunification were at Hotel Ioannina. However, 3.7% of
participants at Ritsona, 4.2% at the Samos hotspot, and
7.1% at Katsikas camp did not know which procedure
to pursue. At the time of the study, the majority of
respondents were waiting for an answer regarding the
outcome of their legal procedure (between 77.8% at the
Athens hotel and 100% at both the Katsikas camp and
Hotel Ioannina).
A very low proportion of participants reported having
had access to information on legal assistance, between
9.6% (Samos) and 30.1% (Katsikas.) Information on
asylum procedures was also generally limited, with only
11.0% (Samos) to 31.6% (Katsikas) of the population
considering that they had received the necessary infor-

mation. Conversely, access to information on where to
obtain healthcare was high, ranging from 60.3% (Samos)
to 84.9% (Athens hotel).
For participants, at the time of the study in Greece,
knowing what would happen to them and their families
mattered the most and they often directly linked uncer-
tainty to poor psychological well-being:
Will they accept you in Europe? And when will they
accept you? Only God knows. I am getting mentally ill
because I have been in this situation for 10 months.
(Man from Syria)
Table 3 Prevalence of anxiety disorder morbidity (Continued)
Refugee Health Screener 15 Ritsona camp
N = 100
n (%)
Katsikas camp
N = 67
n (%)
Hotel Ioannina
N = 48
n (%)
Samos hotspot
N = 38
n (%)
Athens hotel
N = 79
n (%)

Stayed in Greece <9 vs >9 months p = 0.23 p = 0.70 p = 0.99 p
= 0.67 p = 0.77
Traveled >2 vs <2 months p = 0.15 p = 0.95 p = 0.01 p = 0.90 p
= 0.18
Among those screened positive:
Declined referral 19/80 (23.8) 12/50 (24.0) 9/48 (25.0) 11/35
(31.4) 11/60 (18.3)
aA chronic disease is any disease requiring chronic treatment
bVulnerable populations include pregnant women, children
alone, single parents, and those with a self-reported chronic
disease or ≥60 years old
When is this game ending? When are we going [to
get] out of this place and out from Greece? Most of
us have someone in Europe, a child or a husband,
otherwise we could go back to our country: We
prefer to die 60 times and not to be stuck here.
(Woman from Syria)
Participants interviewed in the qualitative study said
that the lack of guidance and information on asylum
procedures increased their feelings of uncertainty about
the future, which was taking a toll on their mental and
psychosocial well-being.
When seeking information about asylum options and
consequences, participants did not receive the guidance
and information they sought. They mentioned leaving
the services offered by UNHCR or European Asylum

Support Office in the camps without getting their ques-
tions answered. Consequently, participants asked for
advice from peer refugees and migrants in similar situa-
tions. All of the Syrians wanted guidance on procedures
for family reunification or relocation to another EU
country:
We did the interview for the reunification program.
However, my daughter was over 18 years and not
eligible, which they did not inform us about at that
time. We were waiting and after 4 months, they told
us this, and asked us to apply for the relocation
program. Now all our procedures are stuck and when
we go to the asylum office to ask, they do not allow us
to enter and they give us no information at all.
(Woman from Syria)
When describing their current situation in Greece, par-
ticipants often employed such terms as “hopelessness” and
“losing hope.” On Samos and among the unregistered mi-
grants in Greece, respondents described their situation as
extremely stressful:
The fear [of being deported] is always there, and
always I find myself stressed. I try to forget, not to
think about the issues. I am on my nerves all the day,
thinking is the lawyer going to call me, I never leave
my phone. (Woman from Syria)
Discussion
To our knowledge, this is the first study conducted in
Greece using a mixed quantitative and qualitative meth-
odology to describe experiences with violence and the
prevalence of anxiety disorders amongst Syrian (and
other) refugees and migrants. Our findings provide evi-
dence of the high levels of distress caused by war, op-

pression, migration, resettlement, and uncertainty about
the future experienced by Syrian refugees and migrants.
The presence of many families in the study sites, not
only of single young men, explains the low average age
of the study population and corroborates the main rea-
sons provided by participants for migration (i.e., their
vital need to flee a horrifying conflict in their home
country with high levels of violence, rather than to seek
economic gain). Indeed and importantly, our findings
document the multiple types and levels of violence
endured by these populations when away from home,
during their journeys, and even once settled in Turkey
Table 4 Legal procedures initiated and access to legal
information
Ritsona camp
N = 286
n (%)
Katsikas camp
N = 133
n (%)
Hotel Ioannina
N = 117
n (%)
Samos hotspot
N = 73
n (%)
Athens hotel
N = 119
n (%)

Procedure initiated
Asylum in Greece 19 (7.0) 2 (1.6) – 62 (86.1) 12 (10.3)
Relocation 189 (70.0) 93 (73.2) 46 (39.3) – 84 (71.8)
Reunification 52 (19.3) 21 (16.5) 71 (60.7) 6 (8.3) 21 (18.0)
None – 2 (1.6) – 1 (1.4) –
Don’t know 10 (3.7) 9 (7.1) – 3 (4.2) –
Status of procedure
Don’t know/in progress 127 (95.5) 99 (100.0) 77 (100.0) 52
(96.3) 84 (77.8)
Accepted 6 (4.5) – – 1 (1.9) 21 (19.4)
Rejected – – – 1 (1.9) 3 (2.8)
Considered had received necessary
information about:
Legal assistance 44 (15.4) 40 (30.1) 2 7(23.1) 7 (9.6) 17 (14.3)
Procedure for asylum 47 (16.4) 42 (31.6) 44 (37.6) 8 (11.0) 17
(14.3)
Access to healthcare 222 (77.6) 101 (75.9) 89 (76.1) 44 (60.3)
101 (84.9)

and Greece. The low levels of access of refugees and
migrants to information, coupled with the extremely
long bureaucratic procedures for seeking and obtaining asy-
lum, compound the hardships endured by this population.
Humanitarian and political assistance is urgently needed to
curb the violence and provide structured protective, med-
ical, and psychological support.
One of the key objectives of the study was to docu-
ment the prevalence and types of violence experienced
by the refugees in their country of origin, during the
journey, and also, tragically, in Greece. Our description
of the reported violence is highly detailed in terms of
time and place, but also in terms of type and perpetra-
tor. For each site, the rate of violence experienced
decreased during the journey, starting at a high level in
Syria, where conflict was significant, to a lower level in
Greece, a European country with no conflict, but where
nevertheless, violent events were reported. Refugees flee-
ing war and threats [17] faced violence in their country
of origin and continued to experience violence during
their journeys and in Greece. In Turkey and in Greece,
the majority of the types of violence reported were beat-
ings, perpetrated by the police but also by other refugees
in Greece. Specific examples were reported during the
qualitative component of our study. A report pub-
lished in 2016 by the organization Human Rights
Watch has specifically documented and condemned
abuse from the Turkish police and coast guard against
Syrian refugees [18].
One of the main objectives of the study was to docu-
ment the mental health of the refugee population in the
settlement sites, using a screening tool that detects the
symptoms of anxiety and depression among refugees.
The study highlights a high prevalence of positive

screening using this anxiety disorder tool. While this
may reflect the truly astonishingly high levels of distres-
sing events encountered by this population, it may also
be that the tool is too sensitive and not specific enough
for a refugee population living in difficult material con-
ditions with high levels of recent trauma [19]. Indeed,
we did not observe significant differences between indi-
vidual characteristics and level of anxiety, suggesting
that the level of anxiety and depression observed may be
attributed to living conditions and uncertainty about the
future. Numerous other studies confirm that daily
stressors, defined as everything from poverty, social
marginalization, isolation, and inadequate housing to
changes in family structure and functioning, contribute
to the high rate of psychological distress often found in
conflict-driven migrants [20–22]. The purpose of the
screening tool is not to provide a diagnosis, but rather to
offer a referral opportunity to a mental health specialist
such as our on-site psychologists. The rate of declining a
referral was high in all sites. This could be explained by
cultural perceptions of psychological services or by a lack
of trust among refugees struggling with legal procedures
who are unwilling to discuss issues with a psychologist
without receiving procedural advances. Furthermore, in
the context of camps with communities living in close
proximity, rumors and the fear of stigma and discrimin-
ation may act as disincentives for open consultations with
psychologists.
Analyses of the legal aspects show a lack of informa-
tion and feedback being given to refugees. At all sites,
the majority of respondents did not know the status of
their applications, with many having pending procedures
at the time of the survey (late 2016). This protracted
process and lack of communication can only exacerbate

the distress experienced by refugees. The finding that
information about legal assistance and procedures for
asylum was non-existent exposes the shameful state of
an overloaded and disorganized administration in Greece,
a country that has faced drastic austerity measures, result-
ing in cuts to public employees. In particular, our study
corresponds with another MSF report that showed there
was an inefficient relocation system [23]. Furthermore, re-
search has demonstrated that lack of legal assistance and
long asylum procedures are important risk factors for
anxiety and psychological distress among asylum seekers
in high-income countries [24, 25].
The parent study of this report was conducted among
all refugees and migrants residing in the same study
sites. The findings for the Syrian population do not differ
substantially from those observed among the whole
study population [26], highlighting the importance of
the circumstances of living in camps in addition to the
traumatic journey experience. Similar findings were re-
ported in a study conducted by MSF Belgium in Serbia
between 2015 and 2016, which documented a high inci-
dence of violent events experienced by refugees traveling
through the Balkans to Northern Europe [27].
An important study limitation not already mentioned
was the difficulty of documenting individual histories,
including the complexity of reporting sexual violence.
Barriers to reporting sexual violence among Syrian pop-
ulations have been documented [28]. Importantly, as our
study population traveled in groups, often as family
units, they may have been less vulnerable and at risk of
sexual assault. It is also possible that sexual assault
might not be that common on the routes we described,
compared to refugees and migrants traveling through
other areas, such as Libya [29].

Conclusions
In conclusion, this report highlights extremely high
levels of violence experienced by Syrian refugees during
their journeys and when seeking protection in Greece,
including violence perpetrated by some state authorities.
Unsurprisingly, the report also highlights high levels of
anxiety and distress in this population, compounded by
lack of information on legal procedures and uncertainty
about the future. A comprehensive humanitarian and
political response is urgently needed to provide and
protect basic humanitarian rights and refugee laws and
provide the care and compassion owed to traumatized
populations.
Abbreviations
EU: European Union; FGD: Focus group discussion; IDI: In-
depth interview;
MSF: Médecins Sans Frontières; RHS: Refugee Health
Screener;
UNHCR: United Nations High Commissioner for Refugees
Acknowledgements
We wish to acknowledge the extraordinary endeavor of the
courageous and
resilient field staff and translators, who completed this survey
in extremely
difficult physical and emotional circumstances. Staff from the
London School
of Hygiene and Tropical Medicine wish to thank the director
and faculty

deans who authorized and supported their participation in this
research.
Funding
Funding for this study was provided by the MSF Operational
Center Paris.
Availability of data and materials
The datasets used and analyzed during the current study are
available from
the corresponding author on reasonable request.
Authors’ contributions
JBF participated in the study design, data collection, data
analysis, literature
search, creation of figures, data interpretation, and manuscript
writing. KB,
PM and SC participated in the supervision, study design,
literature search,
data interpretation, and manuscript writing. PJB participated in
the
qualitative study design, data collection, data analysis,
literature search, and
manuscript writing. AV participated in the study design. CP
participated in
the study design and operational support. RMC participated in
the literature
search, data interpretation, and manuscript writing. All authors
critically read
the manuscript and provided comments. All authors qualify for
authorship in
accordance with the criteria set out by the International
Committee of
Medical Journal Editors. All authors read and approved the final
manuscript.

Ethics approval and consent to participate
Study participants provided verbal informed consent for
participation and
audio-recording of IDIs and FGDs. For participants willing to
participate but
refusing to be recorded, interviews were conducted without
recording.
Participants were assigned a unique study identification number
to ensure
confidentiality and anonymity, with study documents stored
under lock and
key, accessible only to select study staff. The protocol was
approved by the
ethical committees of the National School of Public Health in
Greece (ref:
3411/02.03.2017) and the London School of Hygiene and
Tropical Medicine
(ref: 12033). The study was conducted in accordance with the
principles of
the Helsinki Declaration [30] and the EU guidance note on
research on
refugees, asylum seekers, and migrants [31].
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional
claims in
published maps and institutional affiliations.
Author details
1Epicentre, Paris, France. 2London School of Hygiene &

Tropical Medicine,
London, UK. 3Médecins Sans Frontières Greece, Athens,
Greece. 4Médecins
Sans Frontières France, Paris, France.
Received: 15 September 2017 Accepted: 16 February 2018
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https://viurrspace.ca/handle/10170/931
http://www.amnesty.eu/content/assets/Reports_and_Briefings_2
015/Libya_is_full_of_cruelty.pdf
http://www.amnesty.eu/content/assets/Reports_and_Briefings_2
015/Libya_is_full_of_cruelty.pdfAbstractBackgroundMethodsR
esultsConclusionsBackgroundMethodsStudy settings and
participantsStudy methodologyData collection and
analysesResultsStudy participantsExperience with
violenceMental health and referral and acceptance of
psychological assessmentLegal procedures and access to
information in
GreeceDiscussionConclusionsAbbreviationsFundingAvailability
of data and materialsAuthors’ contributionsEthics approval and
consent to participateConsent for publicationCompeting
interestsPublisher’s NoteAuthor detailsReferences
EDITORIAL
Refugee crisis in Greece: not a one-country job
Antonis A. Kousoulis . Myrsini Ioakeim-Ioannidou .
Konstantinos P. Economopoulos
Received: 14 June 2016 / Accepted: 26 August 2016 / Published
online: 18 October 2016
� Swiss School of Public Health (SSPH+) 2016
During the past years, tens of thousands of refugees have
arrived at the rocky coasts of the island of Lesbos, Greece;
occasionally in hundreds in one day, while thousands of

their compatriots have not made it alive (Lancet 2015;
Abbasi et al. 2015). Starting mainly from Syria, they have
arrived in Greece first by walking through rough areas to
the western coasts of Turkey, and then via a long, costly
and highly risky trip in inflatable, overcrowded boats
(Abbasi et al. 2015). Lesbos is situated on one of the most
direct passages to the European continent and is refugees’
hopeful safe haven. It has come to represent asylums
seekers’ gateway to a potential escape from a troubled past.
However, upon arrival to Greece, the desperate travelers
have encountered a new set of challenges.
Greece has not received consistent support from other
European countries. Notable exceptions include buses
offered by the United National High Commissioner for
Refugees (UNHCR) to transport people to Moria in Les-
bos, where Frontex (agency of the European Union) staff
have been screening and identifying refugees. Moria hosts
a hotspot, an EU-run reception centre to identify and fin-

gerprint migrants and refugees. Following the EU and
Turkey agreement on refugee movement, Moria has been
largely operating as a detention camp. It is there that
refugees have queued for their registration by the Greek
police authorities, received necessary documentation to
continue their trip to other European countries (Germany,
Hungary, UK among others) (Abbasi et al. 2015), or been
deported. Often a few have disappeared in the island’s
countryside during the night, remaining anonymous,
unaccounted for and eventually undocumented. Lesbos saw
a new influx of asylum seekers in early summer as well as
riots in June. It is in this context, that the lack of a long-
term sustainable solution to address the violation of the
basic rights of thousands of refugees going through Greece
remains important. International public health authorities
would have a role to play in assessing the unsafe and
unsanitary conditions of the hotspots. Further, as a signif-
icant number of refugees are being detained in camps for

months, they incur eventually far higher costs to receiving
societies than becoming integrated (Razum and Bozorg-
mehr 2015).
This new health crisis in Greece is reflecting the extent
of the problem on the other receiving end: Syria. During
the recent conflicts, wide destruction of health care facili-
ties, lack of secure routes, shortage in medicines, re-
emergence of polio and widespread famine and malnutri-
tion have been recorded (Ben Taleb et al. 2015). Syria
faces a human tragedy and remains a sad reminder of the
impact that neglected determinants, like conflict and poli-
tics, have on public health. This leaves Greece to
experience the consequences of the Eastern Mediterranean
refugee crisis to the utmost degree (Lancet 2015). The
country faces a significant economic and social crisis and
its approach to healthcare delivery has known problems,
A. A. Kousoulis � M. Ioakeim-Ioannidou �
K. P. Economopoulos

Society of Junior Doctors, Athens, Greece
A. A. Kousoulis (&)
Faculty of Epidemiology and Population Health, London School
of Hygiene & Tropical Medicine, 10 Norwood Avenue,
London HA0 1LY, UK
e-mail: [email protected]
M. Ioakeim-Ioannidou
Medical School, University of Athens, Athens, Greece
K. P. Economopoulos
Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USA
Int J Public Health (2017) 62:1–2
DOI 10.1007/s00038-016-0890-0
123
0890-0&domain=pdf
0890-0&domain=pdf
namely: lack of coordinated public health programs,
unequal access to healthcare, insufficient rural and remote

primary care provision (Kousoulis et al. 2013). If it aimed
at realistically supporting this international public health
agenda, Greece would indeed be required to, no less, rev-
olutionize its national healthcare system. Rather, the
country is experiencing the burden of this crisis without all
the necessary provisions in place to share the obvious
collective responsibility.
It takes creative thinking beyond borders to address
some of the health needs of refugees. Many important
predictors of long-term mortality and morbidity in immi-
grant populations are well documented: age at
immigration, burden of existent long term physical condi-
tions, and emerging conflict- and trauma-related mental
health problems (Ben Taleb et al. 2015; Holmes et al.
2015). However, whilst universal health is recognised as a
fundamental human right, it has frequently been subjected
to heterogeneous regulations and interpretations, often
impacting most negatively on migrants (WHO 2014). The

existing evidence base which addresses the needs of pop-
ulations in transit should grow further to challenge policies
and practices impacting on migration and provision of care
(Smith 2016). Thinking beyond borders in the current
context requires EU coordination and best use of available
support. However, European funding is far from sufficient
and countries with much more organized care structures
and available funds (like Germany or the UK) are
increasingly taking inward-looking approaches (Abbasi
et al. 2015).
It is unlikely that the movement of refugees across
Europe will slow down any time soon. Thus, decisive steps
should be taken to deal effectively with the mass suffering.
In addition to what has been suggested (Lancet 2015;
Abbasi et al. 2015), further actions are needed: local
authorities and large international Non Governmental
Organizations need to establish channels of interaction;
European countries should work more closely with the

Greek state; international support should be provided for
volunteers wishing to be deployed to areas like Lesbos.
Public health needs to be safeguarded by using a serious
project plan, including, at least, screening for infectious
diseases, trauma assessment, mental illness stigma pre-
vention and mass vaccination. Greece cannot -and should
not- face this alone.
References
Abbasi K, Patel K, Godlee F (2015) Europe’s refugee crisis: an
urgent
call for moral leadership. BMJ 351:h4833
Ben Taleb Z, Bahelah R, Fouad FM, Coutts A, Wilcox M,
Maziak W
(2015) Syria: health in a country undergoing tragic transition.
Int
J Public Health 60:S63–S72
Holmes JS, Driscoll AK, Heron M (2015) Mortality among US-
born
and immigrant Hispanics in the US: effects of nativity, duration
of residence, and age at immigration. Int J Public Health

60:609–617
Kousoulis AA, Angelopoulou KE, Lionis C (2013) Exploring
health
care reform in a changing Europe: lessons from Greece. Eur J
Gen Pract 19:194–199
Lancet (2015) Adapting to migration as a planetary force.
Lancet
386:1013
Razum O, Bozorgmehr K (2015) Disgrace at EU’s external
borders.
Int J Public Health 60:515–516
Smith J (2016) Thinking beyond borders: reconceptualising
migration
to better meet the needs of people in transit. Int J Public Health
61(5):521–522
WHO (2014) Public health aspects of migration in Europe
(PHAME)
newsletter: April 2014. World Health Organisation, Geneva
2 A. A. Kousoulis et al.
123
Refugee crisis in Greece: not a one-country jobReferences

Template A v3.0 (beta): Created by J. Nail 06/2015
The Effect of Displacement: Living as a refugee: An exploration
of displaced people in
refugee camps in Greece
By
TITLE PAGE
Kim Martin Parrish
A Document Type.
Submitted to the Faculty of
Mississippi State University
in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy
in Human Development and Family Studies
in the School of Human Sciences
Mississippi State, Mississippi
May 2018

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Kim Martin Parrish
2018
The Effect of Displacement: Living as a refugee: An exploration
of displaced people in
refugee camps in Greece
By
APPROVAL PAGE
Kim Martin Parrish
Approved:
____________________________________
Donna J. Peterson
(Major Professor)

____________________________________
Joe D. Wilmoth
(Minor Professor)
____________________________________
Susan Seal
(Committee Member)
____________________________________
Alisha M. Hardman
(Committee Member)
____________________________________
Tommy Phillips
(Graduate Coordinator)
____________________________________
George Hopper
Dean
College of Agriculture and Life Sciences

Name: Kim Martin Parrish
ABSTRACT
Date of Degree: May 4, 2018
Institution: Mississippi State University
Major Field: Human Development and Family Studies
Committee Chair: Dr. Donna Peterson
Title of Study: The Effect of Displacement: Living as a refugee:
An exploration of
displaced people in refugee camps in Greece
Pages in Study 160
Candidate for Degree of Doctor of Philosophy
ABSTRACT
This study utilized a phenomenological approach to describe the
experience of
displaced individuals and families in a condition of
statelessness in a refugee camp and
their experiences pre-flight, trans-flight, and post-flight.
Topics addressed included the
conditions that led to flight from the country of origin and the
individual and family

experiences in the country of origin prior to flight and during
flight, the experiences of
living as a refugee in a refugee camp in Greece, and the hopes
and dreams of the future
for the individual and the family. Fourteen individuals,
including five children in seven
families were interviewed in the study. Four of the seven
families in the research
included multiple members of the immediate family. Data
analysis followed Moustakas’
(1994) traditional phenomenological technique.
Results indicated turmoil in the country of origin was the
primary reason for
flight. All nine adult refugees indicated some type of danger or
unrest necessitating flight
from their country of origin. Two families were forced from
their country of origin based
on ethnicity. Results also indicated that separation of
immediate family members was a
common experience among refugee families. Six of the seven
families reported

separation, for various reasons, from immediate family members
during the time of this
study. Those separated expressed a desire to remain in close
contact by any means
possible with family members; this was critical for survival,
according to those
interviewed. Although there were some negative expressions of
life as a refugee, such as
the difficulty in understanding asylum processes, boredom and a
lack of purpose, and a
lack of opportunity for education and skills training in the
camp, the overall reflections
were positive, sharing hopefulness for a better future.
ii
DEDICATION
My heartfelt dedication for this work is given to the millions of
people from many tribes
and many nations who choose or are forced to flee their country
of origin for various
reasons. In specific, I am indebted to the many beautiful people
seeking refuge whom I

encountered on the island of Chios, Greece. The beauty of the
land and the majesty of its
sunsets, sunrises, pebble beaches, and breathtaking Aegean Sea
is second to the people I
met and their willingness to open their hearts to share personal
stories and feelings.
There are no adequate words to describe how each of your lives
impacted me. Your
courage, your persistence, your love for family and country,
your loyalty was shared with
me as you entrusted me with a part of your life story and
journey. Souda Refugee Camp
in Chios, Greece, is the location for this research. Just a few
months after the data
collection of this study, Souda Refugee Camp ceased to exist.
Souda Camp was not a
place of pleasant living conditions for those fleeing difficult
and deadly situations in their
country; however, an incredible movement took place through
Souda Camp where united
nations and people from all over the world created a family of
people in the midst of
heartbreaking circumstances. Memories of Souda Camp came
alive through social media

outlets, and friends were able to connect in way that is
extraordinary. To those I had the
privilege to meet in Souda Camp, wherever you are, I think
about you and your families
often, and I am forever grateful that you shared a portion of
your life with me. The
efforts and impact of this study are dedicated to each of you.
iii
ACKNOWLEDGEMENTS
This work has been a labor of love, sweat, determination,
learning, mistakes, and
more learning! This work would not have happened without the
help of so many. First, I
want to thank my advisor and mentor and friend, Dr. Donna
Peterson, especially for
allowing me to open the lid and begin sharing the stories and
experiences. I am forever
grateful for your investment in this study and your heart to hear
the experiences and

people with raw and authentic emotion and compassion. Next, I
want to thank my
husband Brent for his support in this journey as I embarked on
the final destination in my
educational journey. I am thankful for the encouragement and
faith, even when I was not
sure I could see the end of the tunnel. I am thankful for the
support of my children. To
Samuel who was able to be my guide and partner in travels to
Greece. Time spent on this
journey together is treasured. To Claire and John, thank you for
allowing me to study for
hours and write for days! To my translator, Nameh Salem,
thank you for your friendship
and investment in this study through your exemplary
transcription of all documents in
Arabic. Your contributions to this study were significant. A
special thank you to the
organization I was allowed to volunteer with in Greece, A Drop
in the Ocean. I was a
witness to beautiful work being done on the island to support
refugees in difficult living
conditions, to say the least. Your love and your concern for
humanity is authentic.

iv
Thank you for allowing me to be a Drop. I want to express
gratitude to all of my
committee members and my professors during my educational
journey at Mississippi
State University. I entered with apprehensions and
determination, you all helped me fill
in the gap to achieve much more than a degree.
v
TABLE OF CONTENTS
DEDICATION
...............................................................................................
..................... ii
ACKNOWLEDGEMENTS
...............................................................................................
iii
LIST OF TABLES
...............................................................................................
............ viii
CHAPTER

I. THE EFFECT OF DISPLACEMENT
..................................................................1
Definition of Key Terms
.......................................................................................2
Statelessness
...............................................................................................
.....2
Refugee
...............................................................................................
.............3
Asylum Seeker
...............................................................................................
..4
The Extent of Statelessness
...................................................................................6
Statement of the Problem
......................................................................................8
Background
..................................................................................... ..........
...........10
Mental and Emotional Health
........................................................................11
Education
...............................................................................................
........13
Human Ecology Theory
......................................................................................14
Purpose of the Study

............................................................................................1
5
Research Questions
.............................................................................................1
5
II. REVIEW OF LITERATURE
.............................................................................17
Statelessness
...............................................................................................
.........18
Mental Health and Statelessness
...................................................................22
Family Unit and Statelessness
.......................................................................25
Education and Statelessness
..........................................................................27
Human Ecology Theory
......................................................................................29
Summary
...............................................................................................
...............34
III. RESEARCH METHODS AND STUDY DESIGN
............................................35
Purpose
...............................................................................................
.................35
Study Design
...............................................................................................
........35
Phenomenological Research

..........................................................................36
Participants and Sampling Technique
...........................................................38
The Setting
...............................................................................................
......41
vi
Recruitment Site
............................................................................................4
2
Procedures
...............................................................................................
............44
Step 1: Problem and Question Formulation
..................................................45
Step 2: Data Generating Situation
.................................................................47
Stage 1: Introductory Dialogue and Consent to Participate
....................47
Stage 2: Formal Interviews Begin
...........................................................48
Stage 3: Interviews Continue
...................................................................49
Stage 4: Researcher Observations and Personal Reflections
..................50
Step 3: Data Organization
.............................................................................50
Quality Standards

...............................................................................................
.54
Confirmability
...............................................................................................
54
Credibility
...............................................................................................
.......55
Dependability
...............................................................................................
.56
Transferability
...............................................................................................
56
Personal Biases
..............................................................................................
57
IV. RESULTS AND DISCUSSION
.........................................................................59
Descriptions of Participating Families
................................................................59
The Haddad Family
.......................................................................................59
The Halabi Family
.........................................................................................61
The Shadid Family
........................................................................................62
The Toma Family
..........................................................................................63
The Nazari Family

.........................................................................................64
The Hamdani Family
.....................................................................................65
The Amari Family
...................................................................................... ...66
Research Question 1:
...........................................................................................67
Transition from Country of Origin
................................................................67
Reasons for Leaving
......................................................................................70
Arrival in the Transition Country
..................................................................72
Summary
...............................................................................................
.........74
...........................................................................................75
Life in the Refugee Camp
..............................................................................75
Negative Camp Life Experiences
..................................................................79
A Typical Day
...............................................................................................
80
Summary
...............................................................................................
.........82

...........................................................................................85
Concerns for the Future
.................................................................................85
Positive Aspirations for the Future
................................................................88
Dreams and Goals Upon Departure
...............................................................90
Summary
...............................................................................................
.........91
V. DISCUSSION AND CONCLUSIONS
..............................................................94
Overview
...............................................................................................
..............94
Commonalities Experienced in Statelessness
................................................95
vii
Characterizations of Flight from Country of Origin (Forced
Exile)
...........................................................................................96
Characterizations of Flight from Country of Origin (Not Forced
Exile)
.................................................................................... .......97
Environment Changes and Family Life and Function during

Displacement
.............................................................................100
Separation in the Family During Displacement
....................................104
Perceptions of Hopefulness
...................................................................106
Limitations of the Study
....................................................................................108
Directions for Future Research
..........................................................................111
Conclusions
...............................................................................................
........113
REFERENCES
...............................................................................................
................ 115
APPENDIX
A. PICTURES OF RESEARCH SITE (SOUDA CAMP)
....................................126
B. INSTITUTIONAL REVIEW BOARD FORMS
..............................................131
C. TRANSLATOR CONFIDENTIALITY AGREEMENT
.................................133
D. RECRUITMENT
SCRIPT................................................................................1
35
E. CONSENT FORMS (ENGLISH AND ARABIC)

...........................................139
F. INTERVIEW OPENING SCRIPT
...................................................................149
G. INTERVIEW (ENGLISH AND ARABIC)
......................................................151
H. INTERVIEW/FOLLOW UP QUESTIONS (ENGLISH AND
ARABIC) .......152
I. ADIAN’S DRAWING
......................................................................................157
J. NASHTANNA’S DRAWING
..........................................................................159
viii
LIST OF TABLES
1 Demographics of study participants
……………………………40
1

CHAPTER I
THE EFFECT OF DISPLACEMENT
In the study of people around the globe, it is easy to understand
that no two
individuals are exactly the same. Yet, a common trait is the
need to belong. Individuals
who feel the security of belonging to a group or a network are
more likely to demonstrate
a more positive functioning sense of self-efficacy and life
satisfaction (Allen & Bowles,
2012). Research demonstrates that life in groups and a sense of
community stability have
a positive impact on well-being and are related to cognitive
performance, physical health,
and mental health (Allen & Bowles, 2012). In the past 10 years,
the media has increased
our awareness of people who feel the urgency to flee the
country, community, and land in
which they hold citizenship for protection because of tension,
war, and political or civil
turmoil in their home country.
There are 12 million stateless people worldwide as recognized
by the United

Nations High Commissioner for Refugees (UNHCR; Paxton,
2012). A stateless person is
defined as a citizen of another state who has legal claim to
citizenship but who is unable
or unwilling to allow the state’s protection due to a civil
disorder or fear of persecution
(Tremblay & Trudel, 2013). According to the United Nations
Global High Commission
for Refugees report (Grandi, 2016), by the end of 2016, more
than 67 million people
around the world had been forced from home by conflict and
persecution. Additionally,
2
10 million stateless people had been denied a nationality and
access to basic rights such
as education, health care, employment, and freedom of
movement (Grandi, 2016).
Much of the statistical reporting from UNHCR comes from the
receiving country;
according to Article 35 of the United Nations (U.N.) 1951
Convention on the Status of
Refugees (UNHCR, 1951), contracting states are mandated to

report statistical
information related to conditions of refugees and the national
laws relating to refugees to
the U.N. In addition, UNHCR’s Field Information and
Coordination Support Section
collects statistics and operational data from country offices,
national authorities, and
international organizations to monitor trends in forced
displacement. UNHCR also works
with institutions, researchers, and reporters in the field who are
collecting data.
Definition of Key Terms
Because this research explored the experience of statelessness
for the refugee
individual and family, it is imperative to define the terms
“statelessness,” “refugee,” and
“asylum seeker” as these terms are used throughout the
research.
Statelessness
The term “statelessness” is defined as an individual who is a
citizen of another
state with legal claim to citizenship but who is unable or
unwilling to allow the state’s

protection due to a civil disorder or fear of persecution
(Tremblay & Trudel, 2013). The
1954 UNHCR Convention’s (UNHCR, 1954) contribution to
international law defines a
stateless person as someone who is not considered as a national
by any state under
operation of its law. The 1954 Convention explicitly excludes
individuals for the rights
of statelessness when there are serious reasons for considering
that they have committed
3
a crime against peace, a war crime, a crime against humanity, or
a serious nonpolitical
crime abroad. For those who do qualify as stateless persons, the
Convention provides
important minimum standards of treatment. It requires the
stateless person to have the
same rights as citizens with respect to freedom of religion and
education of their children,
the right to employment and to housing, the right, at minimum,
to the same treatment as
other non-nationals (UNHCR, 1954). Statelessness refers to the

condition of an asylum
seeker or a refugee.
Refugee
The term “refugee” includes people with three different types of
immigration
status as recognized by the legal representation (Home Office of
the Country of
Relocation): 1) full refugee status, 2) exceptional leave to
remain, or 3) asylum seekers
awaiting a decision on their asylum applications (Fell & Fell,
2010). For the purpose of
the present study, the term “refugee” will be used when making
reference to both refugee
and asylum-seeking individuals. It has to be noted that some
refugee children come to
Europe accompanied by their parents or relatives, and some
come unaccompanied. It
also has to be acknowledged that there might be different
pressures and distresses for
refugee children and their families who have been granted
asylum, for those awaiting a
decision, and also for those refugee children who are
accompanied and who are

unaccompanied. For clarity, a refugee child will be defined as
by the UNHCR Refugee
Children Guidelines on Protection and Care (1994) as an
individual below the age of 18.
4
Asylum Seeker
The term “asylum seeker” is defined in the 1971 Immigration
Act as a person who
may apply for asylum on the ground that is he/she is unwilling
to go owing to a well-
founded fear of being persecuted for reasons of race, religion,
nationality, membership of
a particular social group, or political opinion. Any such claim
is to be carefully
considered in light of all relevant circumstances (Fell & Fell,
2010).
According to the United Nations 1951 Convention on the Status
of Refugees,
refugees are persons who have crossed an international
boundary because they are unable
or unwilling to avail themselves of the protection of their
former country due to the well-

founded fear of persecution based on race, religion, nationality,
membership of a
particular social group, or political opinion. When a person is
seeking refuge because of
a civil conflict or fear of danger from their country of origin
and has no legal rights, the
term refugee may be interchanged with the term asylum seeker
(Colak, Tekin, & Aydin,
2014).
To clarify, an asylum seeker has fewer rights and protections
than a refugee.
According to the United Nations 1951 Convention on the Status
of Refugees, it is
important to understand distinct terms related to the particular
status of someone who has
fled their country of origin. First, upon arrival in another
country other than one’s
existing country of citizenship, an application for status must be
made, with the exception
of a mass exodus from a country due primarily to violence in
which case the individual
interview process will be waived and status will be distributed.
An asylum seeker is

someone who has completed an application for protection on the
basis of the 1951
Refugee Convention.
5
From the asylum application, the individual is now determined
to be an asylum
seeker. An asylum seeker is someone whose request for
sanctuary or the right to
international protection is in process. The definition of an
asylum seeker may vary from
country to country depending on the laws of that country. After
an individual has an
interview for status and that information has been processed,
the individual will receive
either an economic migrant status, a political refugee status, or
a refugee status. These
terms are extremely important as the terminology of the status
determines the rights of
the individual. It is important to note that these laws and
policies vary from country to
country or state to state as well. Economic migrant status is
defined as a person who has

left his or her own country and seeks, by lawful or unlawful
means, to make a living for
himself or herself in another country. Political refugee status
for an individual includes
any person unwilling or unable to stay in the country of his or
her nationality due to
political persecution.
For the purpose of refugee applications, persecutions may
include 1) being a
victim of politically motivated violence, resulting in pain or
suffering, 2) a violation of
human rights, 3) being unjustly imprisoned for political beliefs,
or 4) being subject to
torture, degradation, slavery and inhumane treatment. The
general rights of a political
refugee are equal to refugee protection granted internationally
according to the 1951
Refugee Convention. However, rights and protections of the
1951 Refugee Convention
do not apply to economic migrants. During the time of asylum
status (i.e., the application
is in process and is prior to a decision), the rights and
international protections are

granted. Statelessness simply refers to the condition of being
an asylum seeker or
refugee in the present research study.
6
The Extent of Statelessness
Statelessness in literature has been demonstrated to have an
effect on the well-
being of a person and his or her safety through violent
situations, mental health,
educational needs, and the stress brought upon the family
structure. “With the growing
insurrections in Syria in 2011, an exodus in large numbers has
emerged. The turmoil and
violence have caused migration to destinations both within the
region and beyond”
(Yazgan, Utku, & Sirkeci, 2015, p. 181). The refugee crisis has
risen sharply, with
impact encompassing neighboring countries toward Europe
(Yazgan et al., 2015).
According to the coordinator of Chios Greece Hotspot
Coordination for the National

Rescue Committee (P. Larsen, personal communication, June 6,
2017):
This time we have people coming from Arabic countries and
they came
massively this time because of the very significant political
issue. The
political issue is the Arabic Spring, which happened in 2010.
We know it
started then Tunisia and then to Libya, Algeria, Morocco, and
then there was
the great war in Syria.
People will continue to flee environments where they feel
insecure, and Europe will
continue to gather large influxes from neighboring countries in
trouble (Yazgan et al.,
2015). Since early 2014, if not before, unprecedented numbers
of refugees have been
trying to get to Europe. For example, near the end of 2015,
922,800 applications for
international protection in the European Union (EU) Member
States were reported to still
be under consideration (Eurostat, 2016). About 1.2 million
people started asylum

procedures in the EU countries in 2015, which is more than
twice as many as in 2014
(Eurostat, 2016).
In 2015, the number of Syrians seeking international protection
had doubled from
the previous year to reach 362,000 in total. Afghanistan
remained the second main
7
country of citizenship of asylum seekers to the EU Member
States in 2015. Iraq was the
third main country of citizenship of asylum seekers to the EU
Member States with
121,500 first-time applicants in 2015. An important factor in
the current refugee crisis,
particularly in Europe and Turkey is the European Union and
Turkey Deal of 2016. This
deal between the European Union and Turkey was aimed at
managing the uncontrolled
mass movement of people in Europe (European Commission,
2016). The deal between
the European Union and Turkey happened in March of 2016.
The core principles

stipulate that new migrants who arrive in Greece and are found
in no need of genuine
asylum or international protection under the assumptions of the
1951 UNHCR
Convention are returned to Turkey. In exchange, the European
Union will take a Syrian
who has been declared in need of asylum. In addition, for every
Syrian returned to
Turkey, another Syrian will be resettled in the European Union.
The decision is based on
the type of status upon completion of the asylum application
process (European
Commission, 2016). The 922,800 applications remaining under
consideration for
international protection reported at the end of 2015, in the EU
Member States, is
significant in understanding the current situation in Greece –
the country of focus in the
present study.
The UNHCR Mid-Year Trends released in June 2016 (UNHCR,
2016) showed
Lebanon, Pakistan, and Turkey hosted most of the world’s
refugees with a combined total

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