Healthcare and disease burden among refugees in long-stay refugee camps at Lesbos, Greece



To assess current medical problems at two Greek refugee sites at Lesbos island (Camp Moria and Caritas hotel), to explore which care is needed and to assess how the provided healthcare can be improved.


In this dynamic cohort study all consecutive patients who visited doctors from the Boat Refugee Foundation were included.


Treatment Rates (TR) with 95% Confidence Intervals (95% CI) were calculated for all major health issues. Additionally, the provided health care was evaluated using the SPHERE project standards.


During the observation period of 30 March 2016 to 15 May 2016, 2291 persons were followed for a total of 289 person years (py). The median age of patients was 23.0 (IQR 8–38) years, 30.0% was aged <18. The healthcare demand was high with 3.6 patient visits per py. Upper respiratory tract infections were most commonly diagnosed with a TR of 89.6/100py (95% CI 78.7–10.1) followed by dental problems (TR 18.0/100py, 95% CI 13.1–22.9). The rate of suicide attempts was high at TR 1.4/100py (95% CI 0.03–2.8), and many psychological problems were diagnosed, TR 19.4/100py (95% CI 14.3–24.4). Major health care threats are the lack of a vaccination program, inadequate sanitation and hygiene, and severe overcrowding.


This study can help policy makers and Non-Governmental Organizations decide which health care is needed most in the current European refugee crisis. There is an urgent need for mental and dental healthcare. Furthermore, it is crucial that vaccination programs are initiated and “hotspot” camps should transform in camps designed for long-stay situations.

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We thank the Boat Refugee Foundation for their support, and all medical staff who volunteered to work in Greek refugee camps who helped us collecting these data.

Author contributions

BN and MPJH conceived the idea of this research and created the first and final drafts. BN, MPJH and JK were responsible for data collection and data input. The analyses were performed by BN. All authors reviewed and contributed to the first and final version of the manuscript.

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Corresponding author

Correspondence to Banne Nemeth.

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Conflict of interest

All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Ethical approval

No informed consent was obtained as this study only summarized routinely collected (as part of regular patient care) anonymous patient data. Therefore, by law, this observational study did not require ethical approval.

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Hermans, M.P.J., Kooistra, J., Cannegieter, S.C. et al. Healthcare and disease burden among refugees in long-stay refugee camps at Lesbos, Greece. Eur J Epidemiol 32, 851–854 (2017).

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  • Europe
  • Refugee
  • Health system
  • Disease burden
  • Health
  • Incidence
  • Cohort study