• For those on low incomes, even a €5 fee for a visit to the hospital is too much (Photo: Slinky2000)

Ordinary Greeks turning to NGOs as health system hit by austerity

06.10.11 @ 09:28

  1. By Leigh Phillips

Europeans and Westerners in general are accustomed to being asked to donate money to emergency aid NGOs to tackle medical humanitarian crises in Africa, Asia and other parts of the developing world where governments are too unwilling, poor or incapable to be able to help their own citizens.

It is unheard of for aid groups such as Medecins Sans Frontieres or Medicins du Monde to have to take over the role of providing basic medical services from normal state or private providers in a Western country.

But in the era of ever-tightening EU-IMF austerity, that is what is happening in Greece now, as the unemployed and HIV patients begin to turn up at temporary clinics that had been intended to come to the aid of migrants and refugees.

According to Apostolos Veizis, the head of programmes for MSF Greece, this is the new reality that the country is waking up to.

“Wherever we work, we are working not only to respond to emergencies, but also to potential unwillingness on the part of authorities to provide access to healthcare,” he explained to EUobserver.

The organisation had set up clinics as long ago as 1995 specifically to deal with migrants and refugees that the government had abandoned to detention centres whose living conditions were criticised by the EU’s Fundamental Rights Agency in March. These migrants are completely excluded from Greek healthcare provision, according to Veizis, and so NGOs have moved in to fill the gap, such as Praksis, an aid group spun off from MSF Greece in 2004.

MSF Greece today works in detention facilities, but their colleagues in Praxis report that as the crisis has deteriorated and Brussels, Washington and Frankfurt have demanded stringent austerity that is bleeding public healthcare of vital resources, ordinary Greek citizens have started turning up at the doors of these clinics that were never intended for them.

“With the growth of the economic crisis, we are seeing symptoms of a wider problem,” Veizis says. “Now pensioners, the unemployed, the homeless, HIV and TB patients are also going without healthcare.”

Even middle-class shopkeepers are falling through the cracks, unable to win the exemptions that can be provided to those who can prove they are out of a job, he says.

“Normally from the data sent to the [World Health Organisation], we basically have an idea of where we need to go. But in this case, from the data supplied to the WHO or by Eurostat, you would imagine that there is no need in Greece for MSF to intervene.”

“But looking around at what our own families are going through, what colleagues working in hospitals are reporting, as well as other organisations, ... we see that regular Greek citizens are being cut off from healthcare, that people running clinics are receiving such citizens.”

“We are seeing the budgets of some health service areas such as social support and the treatment of certain diseases being hit by cuts of up to 80 percent,” he continues.

As a result of the government’s inability to pay the debts it owes to pharmaceuticals, the drugs giants are refusing to ship medicines to certain hospitals. Swiss firm Roche said in September that it would no longer deliver drugs to indebted hospitals, but it goes beyond just pills and ointments.

“[Public healthcare is] are facing shortages of medical materials, drugs and blood,” Veizis says.

He locates three causes of the crisis in the healthcare system: that there was already a poor state of an underfunded healthcare system itself long before austerity hit, “then there is the considerable financial restrictions the government wants to make, and finally the restructuring that is being imposed.”

The government is slashing the number of hospitals from 133 down to 83, cutting the number of clinical units from 2000 down to 1700, limiting to 30,000 the number of functional beds - or 80 percent of estimated needs.

The budgets of some health service areas such as social support and the treatment of certain diseases being hit by cuts of up to 80 percent.

All of which “is being imposed by the government without any impact assessment of what will happen.”

People must also now pay €5 for every visit to the hospital. The sum may not seem much, but when so many now have three-figure monthly incomes, every little bit is an anguish to part with “Then they have to pay for their lab exams,” Veizis adds.

There are categories of people who are exempt from the fees, but in reality there are many people that do not fit into these and so are excluded from health services.

People who run small businesses for example may not count as unemployed even if they have had to shut their shop, if they do not have the proper paperwork saying that they were paying their insurance fees but are now unemployed. They also not meet government criteria for unemployed status if they own their own house or car.

Pensioners are insured, but they also have to make a contribution from their side to the purchase of medicines - as much as 20-25 percent of the cost. But if their earnings have dropped from €700 a month to €500 a month, their capacity to pay for their medicines is all but extinguished..

There are also some 50-60 HIV patients that are without insurance.

MSF Greece is currently performing an assessment of the situation in Athens to get to grips with the full extent of what is happening. Veizis says there is a need for a more in-depth analysis that goes beyond anecdotes. “Traditionally with such assessments, there are figures on the morbidity and mortality that give us a pretty good indication about where to go. But there is no hard quantitative or qualitative data on this yet.”

The group began its assessment in July, but the MSF director admits that he is uncomfortable about what the correct response should be, whether aid groups should even be providing such services if they let the government off the hook.

“What do we do when we open a clinic to these people, to everybody [and not just migrants]. Are we really being helpful? If a citizen says to himself: ‘Well, I know that there is an MSF clinic I can go to, then maybe I won’t go through the hassle of trying to go to the public hospital,” is that keeping up the pressure on the government to deliver adequate provision, to take responsibility for this, or is it letting them off?”

“It is also very difficult to say what the exit strategy is here,” he concludes. He doesn’t know when this situation is going to end. Are NGOs willing to stick it out providing healthcare where Western governments cannot for perhaps years to come?

'Deepening humanitarian crisis'

The head of Medecins du Monde in the country, dentist Nikitis Kanakis, offers an equally grim portrait of the state of health-care in austerity-ruled Greece.

“The situation in the last year has taken a turn for the worse,” he says. Of the 30,000 patients the group has attended to in the last year, some 35 percent are Greek citizens, up from 10 percent in 2010. Some nine percent of this figure are children.

“There has been a tremendous change for the worse in a very short period of time.”

He says people come to MDM clinics with prescriptions for which they cannot pay and that some hospitals “run out from time to time of even basic materials.”

Hunger has returned to Greece, he says. Visitors to their clinics are now not just asking for medical assistance and medicines, but food as well.

“Amongst some children and the elderly, signs of mild malnutrition have begun to appear. This is mostly amongst migrants, but Greek citizens as well. There is a problem also not just with the amount but the quality of the food.”

As a result, the organisation in the coming weeks is to step outside its brief and launch a campaign for food donations.

“And we are beginning to see problems we’ve not encountered before, like families not on social security missing access to vaccinations.

He has little time for the demands of international lenders to Greece: “What we know is that amongst the new measures for 2012, the troika has asked that there no longer be exceptions to the €5 fee to visit a hospital [for those who cannot afford it]. Things will certainly get worse next year.”

“There is a deepening humanitarian crisis in Greece, but nobody wants to see this.”