The next Nobel Peace Prize should go to the Grandmothers of the Aegean, having plucked migrant babies from Mediterranean waters and nurtured them. (JL)

Greece has never been a stranger to disruptive population movements or to manmade and natural disasters. At the end of the Bronze Age, Great Migrations of immense proportion took place. After population dispersal (circa 1200 BC), renewal came several centuries later (900-600 BC); written works of Homer, Hesiod (Works and Days with instructions for farmers on agricultural arts at a time of crisis), and Thales of Miletus (philosopher, scientist and entrepreneur). Descriptions of chaos passed down by folk singers and storytellers helped piece together the Iliad and the Odyssey.

Modern Greece unfolded to a background of horrendous infectious disease that took more lives than the Greek Revolutionary War occurring during this period (1821-1830). The Ottoman Empire was in collapse and refugee trails were long, suffering incredible; millions of people were homeless, undernourished, diseased, wounded and cold.

At the end of WWI, one and a half million refugees entered Greece from Turkey (circa 1922). This was a period in which there was the emergence of activities by the League of Nations and the Rockefeller Foundation. These organizations were convinced that good health is dependent on democracy, and were highly focused on disseminating the principles of public health organization. In Yugoslavia, they supported the establishment of the Zagreb or Stampar School of Public Health and the Belgrade Medical School; in Greece, they helped develop the Athens School of Public Health (1929), now called the National School of Public Health (NSPH) (1994) in both countries landmarks in social policy.

In 1928 Greece was at a standstill, knocked out by a bizarre pandemic of dengue fever introduced from the Middle East while in the grip of underdevelopment as a result of malarial disease and tuberculosis. It slowly recovered and developed as a Greek revolution in public health took hold in Europe that enabled health status improvement and dramatic gains in health. Circa 1930, Greece saw health as a means to an end central to the nation’s development and in 1931 the Athens School was described as a post war-imposed necessity based on the conviction that first among all things, Greeks must live and develop under healthy conditions. During the dictatorship (1967-1974), public health was manacled. In 1975, it again achieved a positive place on the political agenda, but in 2017 continues to be hampered by bureaucratic and legalistic obstacles.

The first international declaration by WHO underlining the importance of primary health care (PHC) came in 1978 (Declaration of Alma-Ata, Kazakhstan 1978). In Greece, the first attempt to PHC occurred with the commencement of the National Health System (NHS, 1983). In today’s Greek health sector, the government is attempting once again to implement PHC. However, psychosocial support and care are not at the same level of priority, and many hospital services are being stretched beyond the limit as in the case of cancer therapy and emergency medical services.

The WHO Declaration of Alma-Ata should be seen as basic to the global health sector and equivalent to the Paris Climate Change Agreement and its relation to global health (2016). Alma-Ata reaffirmed health as a fundamental right of all and defined health as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. It pointed to the gross inequality in health between developed and developing countries. Earlier (1966), Martin Luther King pointed to disparities in the USA when he proclaimed that of all the forms of inequality, injustice in health care is the most shocking and the most inhumane.

Background: Halfdan Mahler (1923 – 2016), three times Director-General of WHO, shaped the primary health care agenda as an addition to the goal of Health for All. Of note, Mahler saw a great need for regional schools of public health as Centres of Excellence and Relevance within a new framework of public health policy and health for all in Europe. His successor, Jo Asvall, pressed on with this agenda. My own breaking news: plans are now underway in Belgrade for a regional structure in public health education in collaboration with American institutions. [1]

Last year, and in spite of his inspirational hymn to democracy and great symbolic support for Greece, the visit of President Obama (2016) lacked a requested nudge for Greek public health. Greece was in the grip of a creeping health disaster resulting from imposed austerity that has precipitated serious losses in life expectancy and a growth in infant mortality and facing problematic migration, which places great strain on health and social services.

Greece is now a land of growing mental depression and suicide (where suicide was rock bottom in the world tables), growing numbers of hungry children and impoverished families pressured into a system of monthly instalments for the basics of life, food, water, shelter. Unemployment in Greece runs close to 20%, while that of youth nears 60%. Many have lost homes, unable to meet loan payments as salaries and pensions have been slashed by more than 50%. Many families are subsidised by the pensions of grandparents. Prior to the current mass migrations, the percentage of the foreign born population living permanently in Greece was around 11-12%, mainly those with Greek roots emigrating from Albania. Consequently, Greek migration experience departs from other southern European countries having been subject to an impact resulting from the collapse of communist regimes in Eastern Europe, some of which share borders.

The current flux of migrants have faced different types of conditions than migrants at other periods. Uncontrolled smuggling and criminal networks operate between the Horn of Africa, Yemen, North Africa, Italy and Greece. Concurrently, vulnerable migrants crossing the Mediterranean Sea face a terrible and deathly dangerous ordeal. In the first six months of this year, of the 100,000 refugees and migrants that arrived in Europe crossing the Mediterranean, 2,247 lost their lives or are missing. Over the past two decades, 20,000 have drowned. Over the past months some Greek islands have had their populations swollen by new migrants.

At present, there are 60,000 refugees and migrants (Syrians, Afghans and Iraqis) stranded in Greece as a result of border closures in the Balkans, while the number of unaccompanied migrant children is rising. Since 2015, nearly one million people have passed from Turkey to the Greek Islands, trying to reach Northern Europe. So far this year, 11,000 refugees and migrants have crossed into Greece from Turkey, a number considerably lower than in 2016. This past winter, a naval asset was deployed by the Greek authorities to temporarily shelter migrants on the island of Lesbos, opposite Turkey. As of January 2017, only 11% of stranded children have been relocated to other European countries. While facing an uncertain future in Greece, migrants are trapped within an unwieldy bureaucracy and an inflexible Europe even though they face a much friendlier situation than experienced prior to their flight. To deliver water, food and clothing to migrants in a dignified manner under difficult circumstances is necessary, but insufficient.

Greece must become a more open system. It must stop defying systematic governance and act within a scientific culture, rein in its dogma based negation of institutional autonomy and encourage a reluctant intellectual elite to live up to its enormous capacity. If this happens the debt crisis may lessen, the exodus of highly skilled graduates slow down and austerity and migration better dealt with. Preparedness, mitigation, and response to disaster with better rehabilitation must improve [2].

It can be achieved by reinforcing public health and international relations instruments that strengthen security and counter misrepresentations. Moreover, greater attention must be given to the psychological and social needs of both Greeks and migrants with the first goal to stop abuse, a difficult and complex requirement. Nonetheless, Greece, in spite of its limited infrastructure and poor governance, is still a relatively hospitable host country to migrants! Neverthless, chaos comes too close. Notes:
[1] Halfdan Mahler was a recipient of the prestigious medal for excellence named after Andrija Stampar, a founding father of the World Health Organization (Geneva, 1948) established by the Association of Schools of Public Health in the European Region (ASPHER) during the writers Presidency. The European Center for Peace and Development (ECPD), Belgrade in collaboration with American structures is in the process of establishing a regional school of public health.
[2] Momentarily unfolding (September 2017) a catastrophic oil spill in the Saronnic Gulf with an impact on much of the coast of Attica , fires in Ileia, a repeat of 2007 and an epidemic of measles, which is not confined to Greece.

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