Still wearing the brilliant gown of her native country, Sudan, Fatimah is patiently waiting outside the ER of Alexandra Hospital, the biggest and busiest Maternity & Gynecological hospital in Greece. She is about to give birth to her first child. She’s never been in Alexandra hospital before. She’s never had prenatal tests and she’s never met the gynecologist who is going to carry out the labor, or any gynecologist for that matter. Her situation is rather complicated. She was circumcised when she was seven. She might have Hepatitis or Aids but there’s no time for running tests. She’s having a baby.
She doesn’t speak a word of Greek and there’s no interpreter to give doctors the information they need to know. She has no “papers” or money. She’s an illegal, uninsured immigrant. She left her native Sudan two months ago-seven months pregnant- and traveled by bus, foot and boat through Egypt before puttering toward Crete with 15 others in a tiny motorboat. Fatimah is a typical example of an illegal immigrant that the Greek minister of Health Andreas Loverdos calls a “burden” for ESY, Greece’s National Health System.
Sitting at the crossroads of three continents, Greece has a long history of immigration but this time the situation is out of control. Tens of thousands of migrants from Africa, Asia and the Middle East cross by boat to Greece’s Aegean islands each year. Humanitarian groups have condemned the situation as “shocking”. Such is the scale of the problem that the country has become Europe’s main gateway for illegal immigration, accounting for nearly half of those trying to reach the European Union. Greece’s constitution obliges the state to provide health care to citizens. By large, it does. Even those without resources of any kind can qualify for free health-care. But the system is a mess.
The War Zone of Alexandra Hospital ER
Should you visit the ER of Alexandra Hospital you will think you are in a conflict zone. Tens of expectant mothers from Asia and Africa lie on camp beds, endless queues of others in pain and doctors running around in panic trying to work with minimum medical supplies.
“The situation is out of control,” says a Gyn/Ob resident in Alexandra Hospital. “ Everyday we have tens of pregnant women from Asia and Africa with no medical records, no documents. They can’t even answer simple questions about their medical history because they don’t speak a word of Greek or English. They only come here when their waters brake. We don’t have time to run blood tests for Aids or Hepatitis or any tests for that matter. We go straight to the labor room without knowing what we’ll find.”
But how does a woman about to give birth feel when she’s all alone, in an unknown environment, without even being able to express her fear since she can’t even speak the language? “They are scared. Terrified… Some of them fear having a cesarean because of their perception that it could result in death or disability. Others fear how the female circumcision could affect their childbirth experience. Having a baby is a stressful procedure in any case. Imagine being in a foreign country all alone…These women are helpless but so are we. We are lacking basic medical supplies, we have tons of bureaucratic work, with endless paperwork to fill in and hoops to jump through in order to treat these women who haven’t got insurance and haven’t got the required legal documents or any documents for that matter… To us it doesn’t matter whether the patient we need to treat has “papers”. Here all women in need receive medical treatment, even the poor, uninsured or illegal immigrants but the state must provide us at least the basic medical supplies so that we do our job right and at the same time the government and the EU must implement an effective immigration policy. Greece simply can’t cope. It’s a small country. There’s only so much we can do. If this situation continues, the National Health Care System will collapse. It’s as simple as that”.
But where do these women go after they leave the hospital? With no legal documents. no money, not being able to speak Greek, carrying around a newborn? Social services in hospitals are overwhelmed by the amount of cases they have to deal on a daily basis. They haven’t got neither the stuff nor the financial resources to be able to fulfil the needs of these women. These are women who have left everything they had behind to pursue a life in a land they don’t know anyone and start with nothing-just hope that the children they are carrying will have better lives.
AIDS, Polio, Cholera and Hepatitis
Human trafficking is the main reason Greece has seen a “significant” increase of recorded HIV infections in 2011, many of which concerned women who had been brought into the country illegally and forced to work as prostitutes. “We have tens of women with AIDS, mainly from sub-Saharan Africa. Most of them don’t even know they have Aids and those who do don’t really care,” says the Alexandra Hospital resident.
Greek Health Minister Andreas Loverdos has repeatedly stressed that the huge influx of mainly African and Asian migrants into Greece in 2010-2011 posed heightened risks to public health, as well as putting massive strain on the country’s overburdened state health services. The majority of these migrants originated from countries in Africa and Asia with an entirely different epidemiological profile to those of Greeks and other Europeans, bringing with them new but also some forgotten diseases, such as polio, cholera or malaria. Due to their poor living conditions, meanwhile, they served to increase the incidence of diseases such as tuberculosis or hepatitis.
Crisis is Killing ESY
Data on health care costs for illegal immigrants are sketchy because Greek hospitals and community health centers don’t ask about patients’ legal status. One thing is clear: undocumented immigrants are driving up the number of people without health insurance. For hospitals like Alexandra the burden of the uninsured immigrant is huge. It’s exploded the amount of work the hospital has to do while the costs are staggering.There’s another peculiar category of female patients that come to the hospital to give birth, the so called “medical tourists”. These are women from neighboring countries like Bulgaria, Skopia and North Africa who come to the hospital give birth or have free tests and then return to their country.
The impact on public health exceeded the means and ability of the Greek health services to cope, while the total cost was prohibitive and came to nearly 150 million euros in 2011. In many ways, the health-care system is a microcosm of Greece itself. Big debts in the public hospital system helped usher in Greece’s financial crisis in 2009, and health care is now a key battleground as the country struggles to escape it. As a result of the crisis, doctors’ wages in the public system have been cut in line with other government workers, while hospitals fear being merged and face regular shortages of materials. At the same time, Greece’s health-care system is coming under demographic pressure. Life expectancy is already the fifth-highest in the euro area. Nearly 20% of the population is 65 or older, and demands on the health system are growing as the population ages and as immigrants keep pouring in from Asia and Africa.