Time to rethink large refugee centres in Europe
Authors: Alberto Barbieri
Journal: The Lancet Public Health (2020)

Approximately 1 900 000 refugees and migrants have arrived in Europe by crossing the Mediterranean Sea since January, 2015. Most of them have experienced violence and other interpersonal traumatic events in their countries of origin or along migratory routes. Consequently, they could have a high burden of post-traumatic stress disorder (PTSD)1Rodolico A Vaccino N Riso MC Concerto C Aguglia E Signorelli MS Prevalence of post-traumatic stress disorder among asylum seekers in Italy: a population-based survey in Sicily.J Immigr Minor Health. 2020; 22: 634-638Crossref PubMed Scopus (4) Google Scholar and other mental health problems as they seek asylum. A study published in September, 2020, by the charity Medici per i Diritti Umani (Doctors for Human Rights, Italy) showed that stressors in the receiving countries, such as inadequate reception conditions in large facilities, can have detrimental effects on the mental health of asylum seekers and refugees.2Barbieri A Visco-Comandini F Alunni Fegatelli D et al.Patterns and predictors of PTSD in treatment-seeking African refugees and asylum seekers: a latent class analysis.Int J Soc Psychiatry. 2020; (published online Sept 22.)https://doi.org/10.1177/0020764020959095Crossref PubMed Scopus (8) Google Scholar The study found that living in a large reception centre (eg, the reception centre for asylum seekers located in Mineo, Italy, which hosts >1000 people) rather than in small or medium-sized centres (ie, <1000 people) was associated with PTSD. Several studies emphasise the importance of the post-migration environment on mental health outcomes and describe several post-migration stressors that are risk factors for PTSD symptomatology. Among these stressors were several characteristics of the large reception centre model—eg, living difficulties, long-term institutional accommodation, loneliness, poor social integration, difficulties accessing health care and social services, difficulties in obtaining a permanent visa.3Porter M Haslam N Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis.JAMA. 2005; 294: 602-612Crossref PubMed Scopus (1033) Google Scholar, 4Chen W Hall BJ Ling L Renzaho AM Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect of post-migration stressors: findings from the first wave data of the BNLA cohort study.Lancet Psychiatry. 2017; 4: 218-229Summary Full Text Full Text PDF PubMed Scopus (137) Google Scholar It is particularly relevant for public health at a time when refugees and asylum seekers are increasingly being hosted in huge and overcrowded first reception centres, including in high-income countries.5EU Agency for Fundamental RightsMigration: key fundamental rights concerns.https://fra.europa.eu/sites/default/files/fra_uploads/fra-2019-migration-bulletin-4_en.pdfDate: 2019Date accessed: September 25, 2020Google Scholar The Moira camp on the Greek island of Lesbos, destroyed by a fire in September, 2020, is a striking example of these reception centres in Europe. Before the fire, at least 13 000 asylum seekers had been living in poor conditions, in a space designed to accommodate 3000 people. The Moria camp was a first reception centre located on the EU borders and was set up in 2015 as part of the European Agenda on Migration. Initially, it was expected that people arriving to Greece from Turkey by sea would stay in the reception centre for the short-term (ie, a few days) so that they could be identified and fingerprinted before being relocated to other EU countries. However, programmes on asylum seeker relocation from Greece and Italy were suspended in 2017 and overcrowding and length of stay in Moria, and other camps in Europe, increased substantially. The New Pact on Migration and Asylum (NPMA), formed in September, 2020, by the European Commission, now risks promoting large reception centres at the EU's external borders. Although preventing trauma inflicted on refugees in their countries of origin is often beyond European governments control, recipient countries can address the post-migration challenges faced by incoming refugees.6Silove D Ekblad S How well do refugees adapt after resettlement in Western countries?.Acta Psychiatr Scand. 2002; 106: 401-402Crossref PubMed Scopus (57) Google Scholar It is important to extend deliberations beyond the short-term goal of immigration control to a global perspective on public health. PTSD and depressive disorders, which are often present with comorbidities, make the integration process challenging and often results in isolation of individuals, which further amplifies psychological distress and PTSD symptoms. As the European Parliament and Council examine the NPMA, it is essential that policy makers learn from past failures. Effective relocation programmes between European countries along with exhaustive and timely asylum application assessments are needed. It is necessary that the EU abandon the Mineo and Moria models and promote policies that favour reception in small-scale facilities, integration into the social environment, provision of appropriate services, and genuine inclusion for the benefit of hosted refugees and the receiving societies. This online publication has been corrected. The corrected version first appeared at thelancet.com/public-health on November 20, 2020 This online publication has been corrected. The corrected version first appeared at thelancet.com/public-health on November 20, 2020 I declare no competing interests. Correction to Lancet Public Health 2020; published online Oct 27. https://doi.org/10.1016/S2468-2667(20)30255-3Barbieri A. Time to rethink large refugee centres in Europe. Lancet Public Health 2020; published online Oct 27. https://doi.org/10.1016/S2468-2667(20)30255-3—In this Correspondence, the sentence in the fifth paragraph should read "The New Pact on Migration and Asylum (NPMA), formed in September, 2020". This correction has been made as of Nov 20, 2020. Full-Text PDF Open Access