A Model of Protracted Suffering among Refugees on the Greek Islands: The Case of Chios

By Mohamad Alhussein Saoud and Marta Welander

This article proposes a model describing the situation for refugees and displaced people on the Greek island of Chios. This model was developed by the authors following extensive field research in Chios, consisting of 300 interviews with refugees and led by the human rights organisation Refugee Rights Europe in May 2017. It illustrates the situation on the island in a dynamic way, connecting refugees’ past, present and future, in order to make sense of the lived experiences of refugees on Chios. Based on the model, this article demonstrates that the distress refugees experience, including traumatic past experiences, a violent and desperate present situation, and an uncertain future–including fear of deportation and continued family separation–, appears to contribute to depression and mental health issues among thousands of people seeking protection in Europe. As such, the article calls for firm policy action in order to overcome a continued situation plagued by sustained and escalated violence, as well as more self-harming.

A view from Chios. Photo Credit: Mohamad Alhussein Saoud.


In several places in Europe, refugees and displaced people find themselves in situations where harsh living conditions, untreated health problems, and a heavy-handed treatment by police officers are a daily reality (Refugee Rights Europe 2018). The situation is particularly acute on the Greek islands, where thousands of prospective asylum seekers are forced to stay in overcrowded and unsanitary camps, awaiting their potential transfer to the mainland and eventual status determination. The grave situation on the islands is a result of increased number of arrivals and the signing of the EU-Turkey Statement in March 2016, which led to the introduction of what is known as the Greek ‘containment policy’, banning newly arrived individuals from travelling to mainland Greece until their asylum claims have been processed (Al Jazeera 2017).

While the legality of the containment policy has been widely criticised (Amnesty International UK 2018), it is still in place at the time of writing, and the situation has deteriorated further with rising numbers of arrivals leading to a camp population increasing from approximately 4,500 people in May to nearly 14,000 by the end of October 2019 (Reidy 2019). While accelerated transfers to the mainland are certainly urgently needed to address the overcrowding on the islands, the Greek government announced in November 2019 that individuals would be transferred to closed centres, which has been heavily criticised by rights groups as a form of de facto detention and deportation centres (Deutsche Welle 2019a).

In this article, the authors introduce a previously unpublished ‘model’ illustrating the protracted and exacerbated suffering amongst refugees on the Greek islands, based on published research findings by Refugee Rights Europe as well as the authors’ own wider familiarity with, and analysis of, the situation amongst refugees in Europe. The main research findings informing the model are derived from Refugee Rights Europe’s field research study in Chios, Greece, from May 2017. During this period, one of the authors, alongside four other field researchers, conducted 300 semi-structured surveys with refugees and displaced people on the island, in Arabic, Dari, English, Kurdish, and Pashto. Based on the estimated population in Chios at the time of the study, the research sample represented between 8-13% of the refugee population on the island, with 88% of respondents being male and 12% female. By way of comparison, in 2018 men made up 48.2% of asylum seekers in Greece, and women 19.3% (with 36% being registered as children) (The Asylum Information Database 2019). It is therefore important to note the gender imbalance of this sample, with an underrepresentation of women and girls. The researchers surveyed as many individuals as possible in and around the two camps on the island (Souda and Vial camps), mainly using a snowball sampling method to identify interviewees. The research team’s observations and complementary informal interviews with charities and NGO staff served to complement these interviews with refugees.

Based on the insights collected throughout this field research, the two authors produced a model of refugees’ experiences of suffering on the islands, using the case of Chios as a basis but suggesting that the model is representative of the wider situation on the Greek islands. In developing the model, the authors drew on their knowledge of, and insights into, the refugee context in Europe, with the aim of offering suggestions for more constructive policy proposals.

A model of protracted suffering among refugees

Through a model that connects refugees’ past, present and future, one can better make sense of the lived experiences of refugees and displaced people trapped on the Greek islands. Starting with the past, the model illustrates refugees’ experiences of war, conflict or other forms of protracted crises. Such experiences have led many to have traumatic and painful memories, also contributing to an erosion of hopes and aspirations. Indeed, feelings of hopelessness result when an individual has fled his or her country, leaving their possessions, family members and social networks behind, which is bound to be a difficult, isolating, and potentially traumatising experience for most human beings. Moreover, many individuals fleeing war and conflict may have sustained potentially severe injuries, with some having been arrested and tortured. Such experiences are likely to precipitate or be accompanied by mental health issues and/or chronic ailments. Such harsh experiences make individuals particularly vulnerable, requiring extensive and targeted rehabilitation, care and support–which is too often inaccessible to refugees, including those stuck on the Greek islands at the moment.

Figure 1. The model of the situation of refugees in Chios.

Despite these past experiences and resulting critical needs, refugees on the islands were placed in camps which do not fulfill basic living conditions. The food that they received was of very poor quality, with many interlocutors reporting that they could not eat the food due to episodes of food poisoning. For instance, one respondent told the research team: “I gave up eating the food that we received after I was poisoned few months ago” (Refugee Rights Europe 2017: 22). The lack of essential services in the camps was clearly evident, with the people in the overcrowded Souda camp on Chios living in fragile tents. Some individuals did not even have access to a tent in the first place (Refugee Rights Europe 2017: 21). In Vial camp, there were caravans, but the camp was isolated with extremely limited access to public transport and long waiting times. Sanitation issues were widespread, with insects and rats everywhere due to a drainage pipe letting out dirty water in the vicinity of the camp, and toilets were very dirty. To illustrate the urgency of this, one respondent explained: “I created a high sleeping place inside the tent for my child in order to keep her away from rats” (Refugee Rights Europe 2017: 21). In the Vial camp, informants said that there was no water in the toilets. Hot water was rarely available in Souda camp, only available for a few hours per day, while it was completely absent in the Vial camp (Ibid). Consequently, refugees residing there were barely able to wash themselves, which affected their hygiene and health, as well as their sense of dignity. The lack of medical services was mentioned frequently during the interviews, with 72% of the survey respondents with a health problem reporting that they had not received any medical support (Refugee Rights Europe 2017: 25).

Refugees on the islands live in this miserable situation for a prolonged period of time, which in turn contributes to further feelings of hopelessness and despair, especially when a critical ‘uncertainty factor’ is added. One research participant, who had been in Chios for more than a year, highlighted this sense of despair with the following statement: “Sometimes I sit alone and cry. All my friends who came with me left” (Refugee Rights Europe 2017: 19). This uncertainly stems from the fact that people have no idea about what their future might hold, or what their next steps will be. They do not know when they will be transferred to the mainland and what the final decision of their asylum application would be; everything is uncertain and the process excessively lacking in transparency. The answer refugees often receive when asking officials about their potential transfer to the mainland is that they need to ‘just wait’, without any further information given–a common frustration shared by those displaced residing on the island. “I have been here since April 2016 and I am ready to wait for two or three years, but all I need to know is when I will be transferred from here. I have no idea, I am just waiting hopelessly”, a refugee told the research team (Refugee Rights Europe 2017: 35).

The long waiting time and the accompanying absence of certainty and information about next steps, combined with an exhausting living environment and the condition of being surrounded by individuals who are already consumed by war, conflict or other protracted crises, inevitably create a critically hopeless and desperate situation. In turn, this desperation provokes and exacerbates two main serious problems, namely self-harming and violence. The absence of psychiatrists who might be able to support individuals in preventing self-harming behavior exacerbates this phenomenon. “The psychiatrist gave me only five minutes, he said he cannot give him more time as there are others waiting”, a refugee with a serious psychological issue explained (Refugee Rights Europe 2017: 25).

The researchers interviewed many people who were on the brink of harming themselves, with some interlocuters already engaging in such self-harm. For instance, one person explained: “I tried several times to hurt myself by a blade but my friend prevented me” (Ibid; Refugee Rights Europe 2017: 39). When left untreated, such tendencies are of course incredibly concerning as they may lead to even more serious outcomes, including suicide attempts. For instance, Médecins Sans Frontières (MSF) reported in September 2018 that “an unprecedented health and mental health emergency [was unfolding] amongst the men, women and especially children kept in Moria refugee camp, on Lesbos, Greece” (Médecins Sans Frontières 2018). The MSF teams reported several cases per week where young people tried to commit suicide or engaged in self-harm (Ibid, see also France 24 2018).

As regards interpersonal violence, the lack of hope and the exhausting environment appear to be contributing to increased levels of aggression amongst desperate individuals, which in turn risks leading to violence between refugees themselves. The researchers heard many accounts of fights breaking out between refugees, with 37% of interviewees reporting that they had experienced violence by other refugees on the island (Refugee Rights Europe 2017: 14). This violence would often lead to police intervention. One recent example from September 2019 was the police response to the refugee riots which broke out in response to the death of a mother and child in a fire at a reception center on Lesvos. Riots started as a protest against the slow response to tame the fire and the overall terrible living conditions experienced, and the police force moved in and fired tear gas at the protestors in response (Deutsche Welle 2019b). When a major fight would break out, police would move in to end the fight and reportedly to punish the perpetrators. However, on many occasions, it was unclear who the ‘perpetrators’ actually were, which would lead to generalised punishment against anyone who happened to find themselves on the site of the brawl. This approach by the authorities might be rooted in a general antipathy towards refugees, or simply a misguided attempt to deal with a complex situation. The researchers heard stories of how the police arrived the day after a big fight and arrested a significant number of individuals at random. 24% of the interviewees mentioned that they had themselves experienced violence by police (Refugee Rights Europe 2017: 17).

Such violent episodes would, in turn, exacerbate conflictual relationships between refugees themselves and between refugees and the police, potentially leading to increased violence in general and a heightened sense of insecurity on refugees in particular for women and children. Coupled with incidents of citizen violence by far-rightist groups reported by 22% of respondents (Refugee Rights Europe 2017: 12), the different layers of violence on the island would aggravate the overall mental condition of refugees and contribute to a further degradation of mental health and exacerbation feelings of misery and hopelessness. In turn, this may induce a cycle of further self-harm and violence.


The model of refugees’ experiences on the island of Chios illustrates critical concerns that are witnessed on many of the Greek islands in the Aegean Sea. The distress experienced by refugees, including traumatic past experiences, a violent and desperate present situation, and an uncertain future, combined with fears of deportation and continued family separation, appears to contribute to depression and mental health issues among thousands of people seeking protection in Europe. Whilst complex, these concerns are arguable not irresolvable, but would require political will and resource allocation to address. Priorities for national and EU-level actors must include increased access to healthcare, proper and quicker status determination procedures through accelerated transfers to the mainland where due process with adequate legal safeguards, legal aid and interpretation services needs to take place, and improved access to the asylum procedure.

Meanwhile, it is likely that a long-term solution can only be reached by abandoning the so-called containment policy and revising the EU-Turkey Statement which has contributed to the humanitarian crisis unfolding on the islands. The number of arrivals has again increased, with nearly 14,000 individuals in the camps at the end of October 2019 (Reidy 2019), meaning that policy action is perhaps more urgently needed than ever before. Without meaningful action at the European and national levels, we are likely to witness a continuation of a situation of collective distress and self-harming among asylum seekers.

Mohamad Alhussein Saoud holds a BA and an MA in Economics from Aleppo University, and an MA in Human Rights & Democratic Governance from the European Inter-University Centre for Human Rights (EIUC). Currently, he is a Ph.D. candidate and a research assistant to the Chair of applied economics at Otto von Guericke University Magdeburg. He is part of a project regarding the refugee crisis in Germany 2015. He also works as a statistical analyst and field researcher for Refugee Right Europe (RRE). He has joined five field research studies, conducting a large number of in-depth interviews in refugees’ mother tongue. Moreover, he has been part of the production of seventeen RRE reports, carrying out the statistical analysis for the organisation. His experience as a Syrian refugee in Europe facilitated RRE’s creation of its very first survey monitoring the situation of refugees in Europe.

Marta Welander is the Executive Director of the non-governmental human rights organisation Refugee Rights Europe. Under her leadership, the organisation has conducted extensive field research in refugee camps and settlements across Europe, interviewing and surveying more than 6,000 refugees and displaced people, subsequently conducting human rights advocacy work. Marta is a PhD candidate and visiting lecturer at the University of Westminster, where she researches European violence and rights violations in the context of the contemporary 'refugee crisis'. Marta holds an MA in Human Rights & Democratic Governance from the European Inter-University Centre for Human Rights (EIUC), and an MA in International Relations from King’s College London. Prior to that, she obtained a BA (Hons) in International Relations and Arabic from the University of Westminster.


The authors would like to thank the anonymous individuals who took part in the interviews, and would like to wish them a better and more stable life in prosperity.


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