Windows on the World: Creativity and community thriving at the border

ABSTRACTThis paper will explore an art therapist facilitated mural within a refugee camp in Greece. It will present literature regarding a ‘psychosocial’ frame of art therapy and its considered relevance when working with refugee populations, drawing particular attention to theory on working cross culturally, outside the art therapy room, and the art making process. It will describe the context and present a vignette that reflects on the author’s own challenges and discoveries within the mural project that may indicate its significance within the art therapy field. The discussion will explore the possible benefits and value of art mural practice, including thoughts on symbolism within the process and final image. Limitations and further recommendations will be explored and considered. The paper will conclude that a psychosocial approach provides an appropriate framework for art therapists working with refugees and that community murals may hold therapeutic value that could be further explored with primary research and data gathered from participants to expand the discussion of its relevance as a practice within the field. The implications of this paper are that future research into art therapist facilitated community murals is possible within a similar framework and can be used when working with a community of people who have experienced displacement in order to address some of the psychological and social needs.Plain-language summaryThis paper is an art therapist’s reflection on a community mural co-facilitated by a team of art therapists in a refugee camp in Greece.The paper will examine a ‘psychosocial’ approach within art therapy, whereby the psychological and social needs of a person/s are considered, it will also discuss ideas on working outside the art therapy room and theories relating to the healing elements in a therapeutic art making process.A vignette will describe the personal experiences of an art therapist facilitating a mural within a refugee camp in Greece. The paper will then discuss the possible therapeutic value of the mural, and the benefits of art therapist facilitated community art making that could be drawn from the vignette.The paper will conclude that further research is needed into art therapist facilitated community murals to enhance the discussion and that it would benefit from participant’s voices to understand how they experience the practice and to determine any therapeutic value. The paper implies that community murals are a relevant practice to consider within the scope of the art therapy profession and that within a similar framework it can be employed to address the psychological and social needs of a displaced community.

BackgroundAs of 2015 thousands of refugees are being hosted in temporary refugee camps in Greece. Displaced populations, travelling and living under poor conditions with limited access to healthcare are at a high risk of exposure to vector borne disease (VBD). This study sought to evaluate the risk for VBD transmission within refugee camps in Greece by analyzing the mosquito and sand fly populations present, in light of designing effective and efficient context specific vector and disease control programs.MethodsA vector/pathogen surveillance network targeting mosquitoes and sand flies was deployed in four temporary refugee camps in Greece. Sample collections were conducted bi-weekly during June–September 2017 with the use of Centers for Disease Control (CDC) light traps and oviposition traps. Using conventional and molecular diagnostic tools we investigated the mosquito/sand fly species composition, population dynamics, pathogen infection rates, and insecticide resistance status in the major vector species.ResultsImportant disease vectors including Anopheles sacharovi, Culex pipiens, Aedes albopictus and the Leishmania vectors Phlebotomus neglectus, P. perfiliewi and P. tobbi were recorded in the study refugee camps. No mosquito pathogens (Plasmodium parasites, flaviviruses) were detected in the analysed samples yet high sand fly Leishmania infection rates are reported. Culex pipiens mosquitoes displayed relatively high knock down resistance (kdr) mutation allelic frequencies (ranging from 41.0 to 63.3%) while kdr mutations were also detected in Ae. albopictus populations, but not in Anopheles and sand fly specimens. No diflubenzuron (DFB) mutations were detected in any of the mosquito species analysed.ConclusionsImportant disease vectors and pathogens in vectors (Leishmania spp.) were recorded in the refugee camps indicating a situational risk factor for disease transmission. The Cx. pipiens and Ae. albopictus kdr mutation frequencies recorded pose a potential threat against the effectiveness of pyrethroid insecticides in these settings. In contrast, pyrethroids appear suitable for the control of Anopheles mosquitoes and sand flies and DFB for Cx. pipiens and Ae. albopictus larvicide applications. Targeted actions ensuring adequate living conditions and the establishment of integrated vector-borne disease surveillance programs in refugee settlements are essential for protecting refugee populations against VBDs.

BackgroundThe metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components. MethodsWe conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling. ResultsIn total, 62.7 % of participants presented with low cardiorespiratory fitness levels (<40th percentile), and 24.6 % met the criteria for metabolic syndrome. In the intervention group, 73.5 % attended the exercise and sport sessions at least once a week. There was evidence for a direct intervention effect on cardiorespiratory fitness, ßdirect = 0.12, p = 0.022, but not for any of the metabolic syndrome components (p ≥ 0.192). Cardiorespiratory fitness significantly facilitated the intervention's indirect effect on abdominal obesity, ßindirect = −0.03, p = 0.012, high diastolic blood pressure, ßindirect = −0.04, p = 0.011, and elevated triglycerides, ßindirect = −0.03, p = 0.025. ConclusionImplementing exercise and sport activities in a refugee camp in Greece effectively reaches a wider target population and improves cardiorespiratory fitness among forcibly displaced individuals. The intervention contributes to a decrease in abdominal obesity, high diastolic blood pressure and elevated triglycerides indirectly via improved cardiorespiratory fitness.

BackgroundRefugees may have an increased vulnerability to infectious diseases, and the consequences of an outbreak are more severe in a refugee camp. When an outbreak is suspected, access to clinical information is critical for investigators to verify that an outbreak is occurring, to determine the cause and to select interventions to control it. Experience from previous outbreaks suggests that the accuracy and completeness of this information is poor. This study is the first to assess the adequacy of clinical characterisation of acute medical illnesses in refugee camps. The objective is to direct improvements in outbreak identification and management in this vulnerable setting.MethodsWe collected prospective data in 13 refugee camps in Greece. We passively observed consultations where patients presented with syndromes that might warrant inclusion into an existing syndromic surveillance system and then undertook a structured assessment of routine clinical data collection to examine the extent to which key clinical parameters required for an outbreak response were ascertained and then documented.ResultsA total of 528 patient consultations were included. The most common presenting condition was an acute respiratory illness. Clinicians often made a comprehensive clinical assessment, especially for common syndromes of respiratory and gastrointestinal conditions, but documented their findings less frequently. For fewer than 5% of patients were a full set of vital signs ascertained and so the severity of patient illnesses was largely unknown. In only 11% of consultations was it verified that a patient who met the case criteria for syndromic surveillance reporting based on an independent assessment was reported into the system.DiscussionOpportunities exist to strengthen clinical data capture and recording in refugee camps, which will produce a better calibrated and directed public health response.ConclusionInformation of significant utility for outbreak response is collected at the clinical interface and we recommend improving how this information is recorded and linked into surveillance systems.

Objective:The purpose of the present article is to present preliminary data related to the gynecological history and current health status of pregnant refugees that reside in long-term refugee camps in Greece. Materials and Methods: The study was funded by the European program “PHILOS – Emergency health response to refugee crisis” of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP), funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs.Refugee pregnant women who resided in long-stay refugee camps of the mainland in Greece in 2017 were recruited. Results: Overall, 456 pregnant women were enrolled in the present study with a mean age of 27.5±6.9 years (median 27, range 17-48 years). 182 women (39.8%) were primigravidae. Mean gravidity was 2.4 (median 2, range 1-11). Among them 105 had a previous delivery, 75 women had 2 previous deliveries, 50 women had 3 previous deliveries and 14 had four previous deliveries. Of those, only six women had access to prenatal screening.Twenty-three women (5%) reported that had at least an artificial abortion performed (median 1, range 1-4) and 87 women (19.0%) had at least one spontaneous abortion (median 1, range 1-6).Two hundred and three women (44.5%) reported the use of a contraceptive method. Among them withdrawal (pull-out method) was the most prevalent accounting for almost half cases (36.9%), by followed by condom, intrauterine devices (IUD) and oral contraceptives. No differences were observed after checking the potential differences among the different age groups (p=.234). Conclusions: Refugee women that reside in long term refugee camps have limited access to national healthcare systems concerning their gynecological and obstetrical assessment. Future studies, should specifically target these problems to help structure specific healthcare plans that will ensure maternal and fetal well-being.

Since 2015, over one million refugees sought refuge in Europe and around 70,000 refugees have been hosted in refugee camps in Greece. Refugees’ empowerment is threatened in these camps as they have restricted access to resources and decision making. This research argues that social capital plays an important role in refugees’ sense of empowerment. The research uses a mixed-methods case study of a refugee camp in Greece, including 20 interviews and 38 surveys to assess refugees’ sense of empowerment and social capital. The results showed that bridging and linking social capital enhances a sense of empowerment while bonding does not.

Working in a Refugee Camp in Greece.

The art project Border Threads was based on mobilising a collaborative art community across international borders within a time frame of five months. The collaborative community had subcommunities and individual participants in five countries. In addition, individuals participated at three open workshops in Oslo. Many among these participants were refugees in exile in Syria, Lebanon, Greece and Turkey.&#x0D; This article discusses how artistic intentions and ethical issues of user involvement in art constitute a driving force for the methods used in the project Border Threads, a collaborative artwork in the form of a textile tapestry consisting of more than 300 individual textile artworks reflecting the participants thoughts about borders. Working with subcommunities encompassing school classes in Norway and Syria, a women’s collective in Turkey, a network of women in Lebanon, and a group of women in a refugee camp in Greece, the project addresses questions about community relations, representation of others, and about contributing to something meaningful when working with participants in a collaborative art project. Discussions of these questions are based on theory from various disciplines, mostly art theory, and evolve around topics such as artistic intention, self-reflection, community building, time, participant payment, and ethics in general.&#x0D; The article describes how using methods, experience and existing networks from an interdisciplinary background within art, ethnography, social sciences, innovation, welfare services and activism was important throughout the project. Following the discussion and a retrospective reflection on the process, some proposals are outlined for further development of the Border Threads project.

Major depression prevalence among Syrian migrants seeking asylum in Greece: a cross-sectional survey

The present study aimed to explore the coping resources and mental health of women who have fled Syria to a neighboring European country. To that end, we examined the roles of sociodemographic factors, situational factors, and personal and community sense of coherence (SOC and ComSOC, respectively) in mental-health outcomes. One hundred and eleven refugee women aged 19–70 filled out self-reported questionnaires during August 2018 in a refugee camp in Greece. The questionnaires asked the participants for demographic information (i.e., age, level of education level, and time spent in the camp) and also addressed the situational factors of having received aid from various organizations, appraisal of danger during the war in Syria, and exposure to war experiences, as well as the coping resources of SOC and ComSOC. The results show that time spent in the camp, appraisal of danger, SOC, and ComSOC all play significant roles in predicting the variance of various mental-health outcomes. Together, those factors predict 56% of anxiety, 53% of depression, and 58% of somatization. SOC was also found to mediate the relationships between time spent in the camp and outcome variables, as well as the relationships between the appraisal of danger and the outcome variables. This indicates that SOC is crucial for good adaptation. These results will be discussed in light of the salutogenic theory.

This paper offers the reader insight into the experience of bringing a trauma-informed yoga healing circle into the lives of displaced Afghan families living in a refugee camp in Greece. Offering a glimpse into the plight of forcibly displaced communities as they transition into refugee camps, living in a liminal state between a traumatic past and an uncertain future, they await their fate. The paper also illustrates how autoethnography can be used as a tool for critical self-reflection. Providing a unique and intimate glimpse into the author’s background as an Iranian-American woman. Carrying a situational identity between an “insider” and “outsider” within the camp she navigates a liminal state of her own she makes sense of her cultural identity while connecting with the Afghan refugee community. The intention of this paper is to (1) humanize the headlines around the unprecedented humanitarian crises (2) shed light onto the impact of yoga healing circles within a refugee community and (3) encourage the reader to incorporate yoga into their every day by practicing moments of pause and self-reflection.

Many refugees in temporary camps face significant challenges in managing their menstruation due to persistent taboos and structural inequalities in accessing adequate menstrual products and safe water, sanitation, and hygiene (WASH) infrastructure. This study examines how an intersectional analysis within WASH programming can improve menstrual health and hygiene for refugees, drawing on evidence from refugee camps in Greece. Using a qualitative methodology, including 12 interviews with diverse stakeholders and a literature review, this research highlights critical gaps in international guidelines, local implementation, and overlooked power structures that persist in one-dimensional approaches. By adopting an intersectional lens, practitioners can better acknowledge diversity, amplify marginalised voices, challenge stigma, and address the unique lived experiences of individuals. This study advocates for inclusive, equitable, and effective humanitarian responses that leave no one behind – especially during times of crisis and uncertainty.

Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers. Participants were 151 individuals (76 women, 75 men; mean age 28.90y) displaced from their homes for an average of 32.03months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being. High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect. The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health.

Omid is a 15 years old refugee from Afghanistan. He and his family escaped persecution in their homeland and started their trip to Western Europe. They managed to reach Greece, but in the summer of 2016 the borders closed. His family was split. Now he lives in a refugee camp in Athens with his mother and sisters waiting for the family reunification decision. A short film about a young refugee, trying to come to terms with the liminality of the waiting status in a refugee camp in Greece.

Disability—a neglected issue in Greece's refugee camps