Migration health surveillance system
Through the creation of an integrated healthcare system inside the refugee camps, the immediate reinforcement of the national health system and the enhancement of epidemiological surveillance, the project will allow the national health system to effectively react to the high number of people received in mainland Greece and subsequently staying temporarily in the country. Thereby the main objective of this action is to safeguard both indigenous population and refugees/migrants.
It will also ensure that people who are in need acute medicine and medical screening will be tackled and people who suffer from a chronic illness/disability, further deteriorated by the harsh conditions of their journey, will be provided with the proper care.
Within the framework of this action, it is foreseen:
- the staffing of each Health District (YPE) with at least one mobile medical unit which it will have all the necessary equipment and the competence to contact medical evacuations, emergency primary health care, as well as to provide public health services. The staff of the mobile unit will be in close cooperation with HCDCP in terms of reporting public health issues, the response to public health emergencies and the risk assessment of potential public health threats.
- the placement of an epidemiologist in each Health District.
- the association of the health districts (YPE) with the public administration by deploying a health inspector in each of the 13 administrative districts of the country.
- the realization of training courses and οn-site visits to refugee/migrant camps.
Risk assessment of public health events
Hellenic Centre for Disease Control and Prevention (HCDCP) is the major public health stakeholder in Greece, responsible for the risk assessment of health threats, the surveillance of communicable diseases and for responding to outbreaks or other major public health events.
The capacity to detect a public health event is one of the core mandates of HCDCP, directly connected to the capacity to respond by investigating the event and proposing control or prevention measures. As regards the current migration crisis, HCDCP is already in the process of developing and implementing a surveillance system targeting this population.
The main objectives of this action are:
- to ensure the early detection of a) a public health incident demanding an intervention b) possible disease outbreaks or other public health events in refugee/migrants camps that operate in the country.
- the standardization of timely medical screening procedures in order to ensure the free access of refugees/migrants to public health system, whilst avoiding the additional burden for the local hospitals with incidents that could be handled on-site.
- the development of an electronic platform to foster the submission of epidemiological surveillance data from the refugee/migrant camps.
Additionally, a series of seminars concerning the use of rapid diagnostic tests will be conducted for the personnel of the mobile medical units as well as for the health professionals working on-site.
Support of the surveillance system from refugees’ points of care (POC)
The main aim of the action is the improvement of the surveillance system operated in the refugee camps (submission time, validity, completeness and acceptance of data) as well as the diffusion of data collected to the stakeholders for immediate response.
Furthermore, the response time to public health incidents is expected to be diminished since it is envisaged the creation of:
- response protocols adapted to refugee’s needs and taking into account the living conditions in open camps.
- response protocols in case of disease outbreaks in refugee/migrant camps (various scenarios)
Strengthen diagnostic capacity of hospitals and reference laboratories
Accurate diagnosis is required both for clinical and public health reasons. Taking into consideration the total number of refugee camps operating all over the country, the aim of the action is the handling of an infectious disease incident to be managed on-site and if serious then to be referred to the nearest tertiary care facility or reference laboratory centre.
Roughly 57,000 refugees/migrants are stranded in Greece at this point of time, assigned to 48 open camps. A system of epidemiological surveillance from migrant health points of care is under development by the Hellenic Centre for Disease Control and Prevention. Based on the preliminary data already available, the most common reported syndromes include respiratory infections and gastroenteritis, follow by suspected scabies.
For the Organization it is crucial to be able to detect and diagnose clusters of syndromes in order to advice on appropriate control measures and prevent larger outbreaks.
Reinforcement of reference laboratory diagnostic capacity
The framework for reference laboratories is currently under review in Greece and the specialized laboratories operating this period still require reinforcement. Examples of such testing belonging to the level of a reference laboratory include: N.menigitides subtyping, PCR and genotyping for malaria, genotyping for Salmonella and Shigella, antibody testing for inactivating antibodies for flaviviruses, viral cultures, etc.
In addition, the capacity to diagnose and perform specialized testing for rare pathogens and toxins in Greece is limited, as in many EU countries. Examples include, but are not limited to, tests such as: detection of diphtheria toxin, detection of botulism toxin in human or environmental samples, culture of hemorrhagic fever viruses, detection and culture of rabies virus in human samples.
Following a consultation with laboratory experts, HCDCP will undertake the:
- provision of reagents to the reference laboratories
- agreement for international assistance from EU’s laboratories for rare pathogens or testing and necessary financing for said testing (e.g. international transport of biological material, testing fees)
As the whole population of refugees and migrants is expected to remain in Greece for a long period, health issues related to all the above-mentioned diseases will emerge, requiring further diagnostic testing and treatment. Diagnostic capacity for several groups of disease will need support for reagents of:
- tropical diseases (malaria, taenia, schistosoma, etc) to the reference laboratory of the Department of Entomology, Tropical Diseases and Parasites of the National School of Public Health
- mycobacteria (Reference centre for Mycobacteria)
- respiratory viruses and influenza (Pasteur Virology and Microbiology, Aristotle University of Thessaloniki)
- arboviruses (1st Microbiology, Aristotle University of Thessaloniki)
- public health laboratories for Environmental samples connected to outbreaks (Central Thessaly)
Strengthening the capacity to organize and conduct mass vaccination campaigns
The main objective of this action is the immunization coverage of the target – population to reach at such a level that it will be totally prevented the appearance of vaccine preventable diseases (VPDs) among the refugee/migrant population. Our goal is all children and teenagers living in the open camps to be fully vaccinated according the recommendations of the National Immunization Advisory Committee in Greece.
In accordance with UNHCR data, 38% of the total refugee/migrant population in Greece is children under 15 years old, plus 2.5% newborn babies and pregnancies, i.e. 25,000. Taking into consideration the risk assessment, the recommendations of the National Immunization Advisory Committee in Greece and the available vaccines in the european market, the number of vaccines needed per population group include:
- Hexavalent DTaP-IPV–Hib-HepB for children 2 mos-<8 years (estimated quantity: 47,000 doses).
- Tetravalent adult type Tdap-IPV for children 8-<15 years (estimated quantity: 34,000 doses).
Furthermore, a sufficient number of doses for other diseases guarantees the total immunization coverage of the target population who is facing a higher risk of exposure to wildlife.
The action also foresees:
- the registration of indicators with regard to the rapid diagnostic tests for use in the ambulatory clinics in refugee camps
- the calculation of indicators concerning carried out vaccinations
- the calculation of indicators as regards the immunization coverage (per vaccine, population group, sex, nationality)
- Category: Specific actions of the programme