Serbia: Refugee and Asylum Seeker Support
Emergency Health Coordination: Q2 2017
August 11, 2017
Marjan al Mahamid
Summary of Activities
During the second quarter of 2017, increased numbers of refugees tried to re-enter Western Europe through Croatia, and a new trend appeared: more and more refugees tried to enter through Romania, while a large number decided to return to Greece through Serbia, then FYR Macedonia, due to the restrictive policies in many European Union countries, which have closed their borders to refugees. Additionally, a high number of pushbacks from the Hungarian border into Serbia continued throughout this period.
The most recent data show that the number of refugees, asylum seekers, and migrants in Serbia is about 6,000. Of these, more than 5,000 (about 83%) were accommodated in one of five asylum centers or thirteen reception centers as of June 2017, and the majority are from Afghanistan, followed by nationals of Pakistan, Syria, and Iraq.
Achievements and Impact
- RMF Serbia provided support during the preparations for evacuating and relocating refugees from “the Barracks” behind the main Belgrade bus station, and our team responded to the acute emergency with other organizations (UN agencies, NGOs, and civil societies).
- RMF Serbia continued to support the Institute of Public Health (IPH) of Serbia, the Ministry of Health, relevant health institutions, and partner NGOs in the coordination of healthcare provision.
- RMF Serbia continued to provide medical services, interpretation, translation and cultural mediation, escorting, and transportation to secondary medical and other facilities in 72 cases.
- RMF Serbia identified unaccompanied and separated refugee children (UASCs), who were referred to the Centre for Social Work in 21 cases.
- RMF provided assorted drugs and medical care, as well as hygiene packs, safety kits, and children’s kits to support the response to refugees.
Meeting the Needs of Refugees
A total of 4,201 men, women, and children were examined and received primary, secondary, or tertiary healthcare services in Belgrade and the Obrenovac Reception Centre. A total of 4,620 men, women, and children were examined and treated at the medical clinic within Adaševci Transit Centre.
Commonly diagnosed conditions this reporting period were:
- Common Cold – 761 patients
- Wounds – 590 patients
- Insect Bites or Stings – 398 patients
- Fibromyalgia – 186 patients
- Diarrhea – 156 patients
- Sprains and Strains – 124
- Pharyngitis – 124
Mobile Medical Clinic
Strengthening Our Response
In April 2017, RMF’s mobile medical clinic was set up at the Obrenovac Reception Centre, with approval from the Ministry of Health and Serbian Commissariat for Refugees and Migration. After a period of preparation, which involved the development of protocols and fully stocking medical supplies within the clinic, we commenced operations in the mobile medical clinic at Obrenovac in May 2017.
The mobile clinic helped strengthen our response to the acute emergencies in overcrowded Obrenovac Reception Centre, providing a versatile space from which our frontline medical workers and cultural mediators and translators can provide primary healthcare services.
A Coordinated Effort
Strategizing to Meet Needs
RMF continued to participate in monthly health cluster meetings conducted in Belgrade by the Ministry of Health and supported by the World Health Organization. The coordination meetings aim to improve the coordination of emergency health responses throughout the country. While it can be said that these coordination meetings require more targeted facilitation, they have been beneficial in acting as a platform for RMF to raise awareness of our current work.
The meetings aim to support joint rapid health assessments, identify current health service provision gaps, and support the development of joint strategies to effectively respond to the current health crises among the refugee and migrant population in Serbia.
Health Gaps Identified
Improving Access to Services
Coordinated efforts took place, emphasizing the provision of health services in Obrenovac Reception Centre. Heath gaps were identified during the meeting, and a strategy for an effective response to health crises was developed and agreed upon.
The agreed objective of RMF Serbia’s outreach team is to reduce the health consequences of crises and emergencies and minimize their economic and social impacts. Participants in the meeting agreed that RMF’s outreach team at Obrenovac Reception Centre plays an essential role by influencing the demand for health services, as well as increasing refugees’ access to health services.
Relocation of Refugees
At the end of April 2017, the Serbian Commissariat for Refugees and Migration called UN agencies, NGOs, and civil societies to an emergency meeting, where the main topic was the evacuation and relocation of refugees from “the Barracks” behind the main Belgrade bus station to refugee centers.
RMF Serbia was particularly involved in monitoring medical cases that had relocated to other centers. Following demolition of “the Barracks,” there were many emergencies, as well as a good deal of movement within the refugee population.
Eviction of "The Barracks"
On May 11, 2017, Serbian authorities evicted residents of “the Barracks,” located behind the main bus station in Belgrade. Until then, “the Barracks” had been the largest self-organized refugee camp in Europe. As a result of this and other factors, many refugees and migrants voluntarily relocated to government shelters, where more than thousand people lived for several months in conditions that can be best described as degrading and inhumane. A vast majority; mainly from Afghanistan and Pakistan, and including many children; had voluntarily relocated to reception centers, and the number of refugees and migrants in the Belgrade city center shrank from 1,200 to an estimated 200.
RMF has been responding to the refugee crisis in Serbia since January 2016, by providing comprehensive protection and medical services, including emergency triage, to persons of concern. Our teams work in and around the Belgrade city center and at Obrenovac Transit and Reception Centre, the second largest refugee camp in Serbia. We operate 3:00 PM to 10:00 PM five days a week at our mobile medical clinic located in Obrenovac, with a second medical team providing referrals for secondary and tertiary care institutions. From 2017 to 2018, we also provided services near the border with Croatia, operating the medical clinic at Adaševci Transit Centre from 4:00 PM to 12:00 AM, seven days a week.
Additional programs include a mobile dental clinic at Obrenovac Transit and Reception Centre—the first of its kind in Serbia—providing dental care for migrants, who previously only had access to emergency interventions. RMF Balkans also distributes hygiene kits at six camps throughout Serbia to help improve personal hygiene and prevent the spread of infectious diseases. To improve the residents’ quality of life, RMF renovated Obrenovac Transit and Reception Centre in 2018 and continues to maintain and use the renovated facilities to conduct cultural and empowerment activities.
- Provide comprehensive protection and assistance response
- Provide material assistance and information
- Provide psychosocial support
- Provide translation and cultural mediation services
- Support existing medical institutions with capacity and mobility
- Establish an information dissemination hotline
Click to enlarge
22-year-old man from Afghanistan
A 22-year-old young man presented with a compound fracture of the left forearm. He had been beaten by a smuggler on the Hungarian border. The injury happened 12 hours before RMF’s team examined him. First, he was checked by the orthopedic surgeon in Subotica, who recommended hospitalization. The patient refused that option, because he wanted to be treated in Belgrade, where he felt safe. RMF’s team brought him to the ER, where an orthopedic surgeon ordered another x-ray of patient’s left arm to confirm the diagnosis already made in Subotica.
The young man was also referred to the neurosurgeon and general surgeon in order to exclude trauma of any other organs. Tests did not show any other signs of trauma, and the orthopedic surgeon admitted the patient to the hospital and performed surgery on his left forearm. The patient made a full recovery.
Marginalized Local Population
46-year-old man from Serbia
In the area of “the Barracks,” where RMF’s team often worked before the buildings were demolished in May 2017, we provided care for refugees and migrants that were not in the camps and had no access to medical care, hygiene facilities, or any type of protection and care. Long before the migrant crisis occurred, however, marginalized local populations were living in “the Barracks,” and with the arrival of RMF’s medical team, they finally had someone to turn to for help.
We were approached by a homeless Serbian man who had been living on the streets of Belgrade for the last 8 years. He did not have any documents or a medical card, and he desperately needed help. One month before, he had an accident and had a severe (stage III) burn on his lower left leg, and it had been neglected. His wound was infected and in bad condition. The patient also had hepatitis C and diabetes mellitus. We took him to the plastic surgery hospital, where his wound was cleaned and our team was instructed how to treat it until next check-up. After antibiotic therapy and regular dressing, his wound had improved.
26-year-old man from Afghanistan
On May 2, 2017, a 26-year-old young man was examined by MSF and RMF doctors. He had broken his right arm on April 28th and been taken by volunteers to the ER, where a cast was put on his arm. His diagnosis: fracture of the upper part of the radial bone. In the following days, his right arm was swelling and became very painful. After examining the patient, we concluded that he needed to be taken back to the ER because of the extreme swelling and pain.
The young man received numerous blood tests, x-rays, and consultations with surgeons for 3 consecutive days, but they all concluded that his condition was not severe and didn’t require hospitalization. In between examinations, the patient started to show signs of skin discoloration and blisters that where opening and producing a discharge of fluid. Despite our efforts to clean the area and treat the young man with antibiotics (as well as trying unsuccessfully to admit him to the hospital), on May 5th, his condition deteriorated further; he had a fever of 38.5°C and heart rate of 121. The young man was in very poor physical condition, and his wound was in extremely poor condition. Our team took him to military hospital, where he was diagnosed with necrosis of the wound and sepsis. He was finally admitted to the orthopedics department of KC of Serbia, where he was later diagnosed and treated for necrotizing fasciitis, commonly known as flesh-eating disease.
The young man is now safe and well. He on his way to full recovery, and RMF’s team is monitoring his rehabilitation.
Bronchitis and Possible Bronchial Asthma
Unaccompanied 14-year-old boy from Afghanistan
A 14-year-old boy was referred to RMF’s team by MSF doctors because of a serious asthma attack that he had in their clinic, which did not subside with regular therapy. The patient reported that he has had breathing difficulties since childhood and that he used to take some therapy. He could not tell us which medications he had been taking. The boy was traveling alone, living in “the Barracks,” and there was no way to contact his relatives. Our team decided to take him to the children’s hospital, where he was diagnosed with bronchitis and possible bronchial asthma. The pediatrician prescribed him with antibiotics and inhalation therapy, but these were difficult to administer, since he was not in a state camp and did not understand the seriousness of his disease.
Eventually, the boy was moved to Obrenovac Reception Centre and placed under child protection services. At this point, we were able to provide him with proper therapy. In collaboration with DRC doctors from the camp, he was monitored at the University Children’s Hospital in Tiršova, and his asthma therapy was adjusted. He is being carefully monitored by our team in the Obrenovac camp.
30-year-old woman from Iran
A young woman was referred to RMF’s team by Miksalište Centre for Refugees (a platform that provides protection for refugees in Belgrade). They called us because the young woman had a fever of 39.7°C, nausea, and abdominal pain in the upper and right lower quadrant of her abdomen since that morning. She denied diarrhea, vomiting, and symptoms of urinary disease or pregnancy. She was completely examined by RMF’s mobile team and after negative urine and pregnancy tests, she was prescribed with antiemetic and anti-inflammatory drugs. After two hours, she was feeling much better, and we advised her to come tomorrow for another check-up.
The next day, the patient was experiencing the same symptoms, with slight deterioration. Her abdominal pain was getting worse, and she had one liquid stool that was without blood. She was taken to the general surgeon in the ER in order to exclude appendicitis. The general surgeon ordered an abdominal ultrasound, as well as CBC and urine sediment analysis. Although the tests came back negative, according to the Alvarado scoring system (6/10) and clinical presentation, appendicitis was a possible diagnosis. After an infectious diseases specialist was consulted, the general surgeon in the ER admitted the young woman to the surgery department. Later that evening, she underwent an appendectomy. The surgery went well, and the patient recovered fully.
Note: Due to privacy and safety concerns, many patients do not wish to have their photo taken.