Psychosocial vulnerabilities in newly arrived asylum seekers to the Greek island of Lesvos: a retrospective cross-sectional analysis

Psychosocial vulnerabilities in newly arrived asylum seekers to the Greek island of Lesvos: a retrospective cross-sectional analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychosocial vulnerabilities in newly arrived asylum seekers to the Greek island of Lesvos: a retrospective cross-sectional analysis Gregory Kavarnos, Miriam Bressaglia, Sally Hargreaves, Marie Norredam, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3542441/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Kara Tepe Registration and Identification Camp on Lesvos Island in Greece is a controlled access facility with people in various stages of the asylum procedure housed in tents, rub halls and containers in poor living conditions for prolonged periods of time. However, data are lacking on psychosocial vulnerabilities and experiences of these populations, particularly the growing number of single women residing in these settings.We aimed to explore psychosocial needs among this incamped population. Methods : We did a retrospective cross-sectional chart review of socio-demographic and psychosocial vulnerabilities of all migrants (>18 years of age) who were detained in Kara Tepe between 1st February 2021 and 31st January 2023. Data were extracted from the Knack Online Database used by INTERSOS HELLAS. Results : 701 individuals were referred to the clinic for psychosocial work, over a 2 year follow-up period, of which 165 subsequently received psychological support after initial health assessments. The majority (92.0%) of the cohort were women who were single, most from Afghanistan, Somalia, Congo, and Syria, with a range of medical and social vulnerabilities. 19.8% of the population had been subjected to gender-based violence including in their country of origin, during the migration route to Lesvos, or while on the island of Lesvos. The most common GBV incident reported was rape (48.9%) followed by physical assault (23.7%) and non-penetrative sexual assault (21.5%). 7% of the population presented with suicidal, or self-harming, behaviour, of which 26.2% had attempted suicide. Conclusion : This study highlights for the first time the stark range of vulnerabilities experienced by predominantly single women in camp settings in Greece. Introduction Since the implementation of the EU-Turkey deal in 2016 [1], the tens of thousands of asylum seekers arriving on Greek Islands from the coast of Turkey have largely been contained on these islands until their asylum claims are processed, with Lesvos continuing to be the epicentre of sea crossings from Turkey to Greece [2]. On the island of Lesvos, the majority of arrivals are currently placed in the main Registration and Identification (RIC) Camp of Kara Tepe, after the Moria camp burnt down in September 2020, leaving 12,000 people stranded on the streets of the island. Kara Tepe camp is a controlled access facility with people in various stages of the asylum procedure housed in tents, rub halls and containers in poor living conditions for prolonged periods of time [3]; with non-government organisations (NGOs) and charities involved in activities ranging from the provision of daily food supplies [4] and clothing, to medical and psychosocial support[14]. Reports have highlighted a range of mental health issues in the migrant population of Lesbos, including self-harm and suicidal behaviour linked to past traumatic experiences, disruptions to their life, uncertainty, and loss of social and family networks, alongside significant barriers to accessing appropriate mental health care and treatment [3,5,6]. During the COVID-19 pandemic these camps experienced higher rates of COVID-19 than the host population, and longer periods of lockdown [7]. However, data are lacking on the specific vulnerabilities and experiences of these populations, particularly the growing number of single women residing in these settings [8]. The INTERSOS HELLAS Mental Health and Psycho-Social Service (MHPSS) was set up in February 2021, with the aim of offering psychosocial support to refugees and asylum seekers on the island of Lesvos. A team of psychologists, case workers, and cultural mediators worked outside of the RIC, and accepted referrals to the service from a large network of actors supporting the provision of housing, social and medical services. Methods We did a retrospective cross-sectional chart review of socio-demographic and psychosocial vulnerabilities of all migrants (>18 years of age) who were: i) detained in the Kara Tepe Registration and Identification Camp in Lesvos Island and ii) referred to the INTERSOS HELLAS MHPSS programme between 1 st February 2021 and 31 st January 2023. A cultural mediator and/or an interpreter assisted with the interviews when needed. Data were extracted from the Knack Online Database used by INTERSOS HELLAS. The data came from two main sources: i) the initial assessment/intake interview performed at INTERSOS’ facilities by the social worker, and ii) the assessment and follow-up sessions of the psychologist. While every individual attending the service had an assessment by the social worker, not every patient went on to receive ongoing case management or psychological support. We assess sociodemographic data including: age, sex, marital status and country of origin as well as self-reported psychosocial vulnerabilities including gender-based violence and mental health conditions. Descriptive data analysis was conducted using Looker Studio (formerly Google Data Studio). The study is reported according to STROBE guidelines [9]. As part of the initial assessment process, individuals were given a full explanation of the assessment interview, consent process and asked if their data could be used for reporting including research purposes. Beneficiaries were informed that they would not be denied access to services if they refused to comply with this procedure. Oral and written consent was obtained. All data was fully pseudonymised before the research study took place, with individuals only identifiable by a randomly generated ID variable. Results 701 individuals were referred to the clinic for psychosocial work-up over a two-year follow-up period, of which 165 subsequently received psychological support after initial health assessments. The majority (92%) of the cohort were women and most were single (74.0%). The mean age was 30.31 years (range 13-75 years), and 48 (6.8%) were aged >50 years. Multiple countries of origin were identified, with most coming from Afghanistan (41.5%) followed by Somalia (21.5%), Congo (20.8%), Syria (3.8%), with other nationalities represented including Sierra Leone, Cameroon, Eritrea, Sudan, Cote d’Ivoire, and Angola. Individuals reported being in different stages of the asylum procedure: i) waiting for an interview to start asylum case (28.0%); ii) asylum case pending (24.5%); iii) rejected in the 1st and 2 nd instance (24.2%); iv) granted refugee status (5.6%); and v) other (17.7%) which includes: being a recipient of subsidiary status, or being in the process of making an appeal (e.g. awaiting further paperwork to prove their case, trying to find the funds to make a subsequent appeal). 19.8% of the population had been subjected to gender-based violence (GBV) of whom the majority were women (91.3%). They reported that gender-based violence had taken place in various settings, including in their country of origin, during the migration route to Lesvos, or while on the island of Lesvos, and 15% had experienced more than one assault. Furthermore, 6% of the total 701 people presented with acute mental health symptoms at the first assessment, such as hyperarousal, audial and visual hallucinations, disorientation, and mood irregularities. The majority of those with acute mental health symptoms (76.2%) presented clusters of symptoms which are not associated with any particular psychiatric disorder. Lastly, 7% of the population presented with suicidal, or self-harming, behavior. Out of these (26.2%) had attempted suicide. Table 1 highlights the range of psychosocial vulnerabilities reported. The most common GBV incident reported was rape (48.9%) followed by physical assault (23.7%) and non-penetrative sexual assault (21.5%). Discussion This study highlights for the first time the stark range of vulnerabilities experienced by predominantly single women in camp settings, on the Greek islands. Levels of gender-based violence and suicidal ideation were high in our cohort. As well as their past histories, and the impact of the migration journey, these individuals also experience psychosocial distress and social suffering because of their uncertain and disrupted lives and the loss of social and family networks over many months in detention-like settings. Previous studies have highlighted a range of mental health issues negatively associated with length of stay in camps, predominantly among men who in the past formed the majority of migrants in these settings. In one study from the Moria camp among 634 refugees (average age 23.2 years, predominantly Syrian and Afghan males) acute mental health crises were significantly and independently associated with the length of stay in the camp (p = 0·011; average length of stay in camp 70.9 days) Other studies too have confirmed a deterioration in mental health in Lesvos linked to containment in camps settings [3,12]. Concurrent with the containment issues, there is also a lack of long-term mental health services to deal with the severe trauma experienced by refugees and asylum seekers. There also needs to be a serious reassessment (and application) of the vulnerability criteria in the asylum process, as many people, although they fulfil vulnerability criteria [13], receive rejections for their asylum claims. Non-binary and/or non-cis gender identification and the impact that these have on the life of the individual are not even part of vulnerability criteria, even when there are cases of life-threatening discrimination in an asylum seekers country of origin (https://www.humandignitytrust.org/lgbt-the-law/map-of-criminalisation/). In many cases GBV experiences, or the fact that the asylum seeker is a single woman, are not considered at all when vulnerability is being assessed. As such the Ministry of Migration and Greek Asylum Service need to reassess the range of vulnerabilities being assessed, and direct Asylum Service staff to determine the presence of vulnerabilities more adequately during asylum interviews. This is necessary to make informed asylum application decisions, thus reducing the need for time consuming appeals during which the applicants are essentially prisoners. Declarations Authors contribution AV and GK designed the study and ran the psychosocial programme. GK extracted and analysed the data with support from SH, MN and AV. GK wrote a first draft of the paper and all authors were involved in commenting on subsequent drafts. Availability of Data and Materials Data are available from the authors upon reasonable request and with permission of Dr. Apostolos Veizis Conflicts of Interest All authors report that they have nothing to declare. Competing interest All the authors have no competing interests Funding and role of the funder SH acknowledges funding from the NIHR, Academy of Medical Sciences, La Caixa, MRC, and WHO. Ethics approval and consent to participate The protocol was approved by a INTERSOS Organizzazione Umanitaria onlus medical unit and the ethical board of INTERSOS Organizzazione Umanitaria onlus Consent for publication Not Applicable Informed consent Informed consent was obtained from all subjects. Acknowledgement The authors would like to thank: Prof. Karl Blanchet (Director, Geneva Center of Humanitarian Studies) References European Council EU-Turkey Statement 18 March 2016 European Council, Council of the European Union, 18 March 2016 https://www.consilium.europa.eu/en/press/press-releases/2016/03/18/eu-turkey-statement/ UNHCR Lesvos Weekly Snapshot 20-26 February 2023 UNHCR, 01 March 2023 https://data.unhcr.org/en/situations/mediterranean/location/5179 Episkopou M, Venables E, Whitehouse K, Eleftherakos C, Zamatto F, de Bartolome GF, et al. In island containment: a qualitative exploration of social support systems among asylum seekers in a mental health care programme on Lesvos Island, Greece BMC, 22 July 2019 https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-019-0218-9 Emma Musty AYS Special from Greece: Are you eligible to eat? Are You Syrious?, 17 October 2021 https://medium.com/are-you-syrious/ays-special-from-greece-are-you-eligible-to-eat-8cc3ac6bed3e Aoun I, and Myers S A Tide of Self-harm and Depression: The EU-Turkey Deal’s devastating impact on child refugees and migrants Save the Children, Child Rights Resource Centre, 2017 https://resourcecentre.savethechildren.net/document/tide-self-harm-and-depression-eu-turkey-deals-devastating-impact-child-refugees-and-migrants/ Bjertrup J, et al. A life in waiting: Refugees' mental health and narratives of social suffering after European Union border closures in March 2016 Science Direct, Social Science and Medicine, Vol 215, October 2018, pp53-60 https://www.sciencedirect.com/science/article/pii/S0277953618304726?via%3Dihub Kondilis E, Papamichail D, McVann, Carruthers E, Veizis A, Orcutt M, Hargreaves S. The impact of the COVID-19 pandemic on refugees and asylum seekers in Greece: a retrospective analysis of national surveillance data from 2020 The Lancet eClinicalMedicine 2021; 37: 100958: https://doi.org/10.1016/S0140-6736(07)61602-X Refugee Support Aegean Refugee women in the offside: Greece encampment policy and services takeover lead to isolation and deny protection Refugee Support Aegean, 21 March 2023 https://rsaegean.org/en/refugee-women-in-the-offside/ von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)statement: guidelines for reporting observational studies The Lancet, October 20 2017 https://doi.org/10.1016/S0140-6736(07)61602-X Hellenic Republic, Ministry of Migration and Asylum Presidential Decree 20 Hellenic Republic, Ministry of Migration and Asylum Press Office, 24 February 2023 https://migration.gov.gr/nomothesia-1-2/#prostasia-aitounton-asylo Van de Wiel, W, et al. Mental health consequences of long-term stays in refugee camps: preliminary evidence from Moria BMC, Public Health, 2021 https://openaccess.city.ac.uk/id/eprint/26365/ Eleftherakos C, van den Boogaard W, Barry D, Severy N, Kotsioni I, Roland- Gosselin L. ‘I prefer dying fast than dying slowly’, how institutional abuse worsens the mental health of stranded Syrian, Afghan and Congolese migrants on Lesbos island following the implementation of EU-Turkey deal BMC, Conflict and Health, Vol 12, Article Number 38, 05 September 2018 https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-018-0172-y Karin Aberg Detecting Vulnerability in Greek Hotspots Odysseus Network, Brussels, Belgium, 29 June 2022 https://eumigrationlawblog.eu/detecting-vulnerability-in-greek-hotspots/ A list, on the website of the Hellenic Democracy Ministry of Migration and Asylum, of the registered NGO providing support onsite, in the various RIC in Greece. This is a list of only those groups having formal access to the RIC sites, and does not include NGO working off-site. https://ngo.migration.gov.gr/registered.php Tables Table 1. Category of vulnerabilities in the population. The n value in the table is the number of vulnerabilities reported, not the number of individuals reporting the incidents. As such, an individual may report more than one vulnerability. Categories #1-8 are recognized by the Greek Asylum Service as vulnerabilities which affect the asylum process. # Category of Vulnerability N % of total population 1 Medical condition 72 10% 2 Special needs 13 2% 3 Single woman/parent 90 13% 4 Pregnant woman 16 2% 5 Experienced rape/torture 19 3% 6 Experienced rape/female genital mutilation 49 7% 7 Experienced gender based violence 69 10% 8 Survivor of human trafficking 11 2% 9 Acute mental health condition 47 7% 10 Experienced familial/domestic violence 32 5% 11 Issues due to sexual preference/non-cis gender identity 12 2% Table A. Gender # Gender Frequency Percentage 1. Female 645 92% 2. Male 51 7% 3. No information 5 1% Total 701 100% Table B. Country of Origin # Country of Origin Frequency Percentage 1. Afghanistan 270 39% 2. Somalia 142 20% 3. Democratic Republic of Congo 136 19% 4. Syrian Arab Republic 25 4% 5. Other 128 18% Total 701 100% Table C. Age Ranges # Age Range Frequency Percentage 1. 17 and under 4 LT 1% 2. 18-22 215 31% 3. 23-27 151 22% 4. 28-32 113 16% 5. 33-37 65 9% 6. 38-42 55 8% 7. 43-47 33 5% 8. 48 and over 65 9% Total 701 100% Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3542441","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322446647,"identity":"dc92f47a-e82d-43e2-b622-0637358b767b","order_by":0,"name":"Gregory Kavarnos","email":"","orcid":"","institution":"INTERSOS HELLAS, Thessaloniki, Greece","correspondingAuthor":false,"prefix":"","firstName":"Gregory","middleName":"","lastName":"Kavarnos","suffix":""},{"id":322446648,"identity":"55701352-f6cb-4538-a960-a8fcb552ada2","order_by":1,"name":"Miriam Bressaglia","email":"","orcid":"","institution":"INTERSOS HELLAS, Thessaloniki, Greece","correspondingAuthor":false,"prefix":"","firstName":"Miriam","middleName":"","lastName":"Bressaglia","suffix":""},{"id":322446649,"identity":"8260c58b-afc7-4f03-90dd-1a4f3ae4aaa2","order_by":2,"name":"Sally Hargreaves","email":"","orcid":"","institution":"Institute for Infection and Immunity, St George’s University of London","correspondingAuthor":false,"prefix":"","firstName":"Sally","middleName":"","lastName":"Hargreaves","suffix":""},{"id":322446650,"identity":"ae56d7ab-86d5-452f-bc6b-ed512a2a42cb","order_by":3,"name":"Marie Norredam","email":"","orcid":"","institution":"Danish Research Center for Migration Ethnicity and Health, Department of Public Health, University of Copenhagen","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"","lastName":"Norredam","suffix":""},{"id":322446651,"identity":"03a512de-1882-4493-b507-83cf71371810","order_by":4,"name":"Apostolos Veizis","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIie3RsWrDMBCA4TMCe7nG62VJXkFGELr5VSQCyQN0NzIeshSyOlNeIVOnDgeCesmc2RDInGwePFR7i1pvpejfP52kA4jF/moaCHIxmcwbSOy0SZJ/S3KLRd+Pz6Xqnrr+8V4tlja73EOEGJXUSObNzUzd3pySjC9tcAynG9JEeuWwaJDZnADXQbHkdDtoSaVqPBm5Mkf7A5EsPkBrSk7CE2BhLGcuSAonHGkm0/qLHV7Zv8VheEWLrq4fw1iV+f4s7wP7H9vtrkECX08UKMPkm7J+MonFYrF/3Sc3Q0V5Doc6xAAAAABJRU5ErkJggg==","orcid":"","institution":"INTERSOS HELLAS, Thessaloniki, Greece","correspondingAuthor":true,"prefix":"","firstName":"Apostolos","middleName":"","lastName":"Veizis","suffix":""}],"badges":[],"createdAt":"2023-11-02 09:14:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3542441/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3542441/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59632458,"identity":"00da3df1-c462-41d0-b4b3-1ace68cb6658","added_by":"auto","created_at":"2024-07-04 05:47:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":386753,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3542441/v1/bc711e60-e7fe-4238-9ed4-16d6b4787c5b.pdf"}],"financialInterests":"","formattedTitle":"Psychosocial vulnerabilities in newly arrived asylum seekers to the Greek island of Lesvos: a retrospective cross-sectional analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSince the implementation of the EU-Turkey deal in 2016 [1], the tens of thousands of asylum seekers arriving on Greek Islands from the coast of Turkey have largely been contained on these islands until their asylum claims are processed, with Lesvos continuing to be the epicentre of sea crossings from Turkey to Greece [2]. On the island of Lesvos, the majority of arrivals are currently placed in the main Registration and Identification (RIC) Camp of Kara Tepe, after the Moria camp burnt down in September 2020, leaving 12,000 people stranded on the streets of the island. Kara Tepe camp is a controlled access facility with people in various stages of the asylum procedure housed in tents, rub halls and containers in poor living conditions for prolonged periods of time [3]; with non-government organisations (NGOs) and charities involved in activities ranging from the provision of daily food supplies [4] and clothing, to medical and psychosocial support[14]. Reports have highlighted a range of mental health issues in the migrant population of Lesbos, including self-harm and suicidal behaviour linked to past traumatic experiences, disruptions to their life, uncertainty, and loss of social and family networks, alongside significant barriers to accessing appropriate mental health care and treatment [3,5,6]. During the COVID-19 pandemic these camps experienced higher rates of COVID-19 than the host population, and longer periods of lockdown [7].\u003c/p\u003e\n\u003cp\u003eHowever, data are lacking on the specific vulnerabilities and experiences of these populations, particularly the growing number of single women residing in these settings [8]. The INTERSOS HELLAS Mental Health and Psycho-Social Service (MHPSS) was set up in February 2021, with the aim of offering psychosocial support to refugees and asylum seekers on the island of Lesvos. A team of psychologists, case workers, and cultural mediators worked outside of the RIC, and accepted referrals to the service from a large network of actors supporting the provision of housing, social and medical services.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe did a retrospective cross-sectional chart review of socio-demographic and psychosocial vulnerabilities of all migrants (\u0026gt;18 years of age) who were: i) detained in the Kara Tepe Registration and Identification Camp in Lesvos Island and ii) referred to the INTERSOS HELLAS MHPSS programme between 1\u003csup\u003est\u003c/sup\u003e February 2021 and 31\u003csup\u003est\u003c/sup\u003e January 2023. A cultural mediator and/or an interpreter assisted with the interviews when needed. Data were extracted from the Knack Online Database used by INTERSOS HELLAS. The data came from two main sources: \u0026nbsp;i) the initial assessment/intake interview performed at INTERSOS\u0026rsquo; facilities by the social worker, and ii) the assessment and follow-up sessions of the psychologist. \u0026nbsp;While every individual attending the service had an assessment by the social worker, not every patient went on to receive ongoing case management or psychological support.\u003c/p\u003e\n\u003cp\u003eWe assess sociodemographic data including: age, sex, marital status and country of origin as well as self-reported psychosocial vulnerabilities including gender-based violence and mental health conditions. Descriptive data analysis was conducted using Looker Studio (formerly Google Data Studio). The study is reported according to STROBE guidelines [9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs part of the initial assessment process, individuals were given a full explanation of the assessment interview, consent process and asked if their data could be used for reporting including research purposes. \u0026nbsp; Beneficiaries were informed that they would not be denied access to services if they refused to comply with this procedure. Oral and written consent was obtained. All data was fully pseudonymised before the research study took place, with individuals only identifiable by a randomly generated ID variable.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e701 individuals were referred to the clinic for psychosocial work-up over a two-year follow-up period, of which 165 subsequently received psychological support after initial health assessments. The majority (92%) of the cohort were women and most were single (74.0%). The mean age was 30.31 years (range 13-75 years), and 48 (6.8%) were aged \u0026gt;50 years. Multiple countries of origin were identified, with most coming from Afghanistan (41.5%) followed by Somalia (21.5%), Congo (20.8%), Syria (3.8%), with other nationalities represented including Sierra Leone, Cameroon, Eritrea, Sudan, Cote d\u0026rsquo;Ivoire, and Angola. Individuals reported being in different stages of the asylum procedure: i) waiting for an interview to start asylum case (28.0%); ii) asylum case pending (24.5%); iii) rejected in the 1st and 2\u003csup\u003end\u003c/sup\u003e instance (24.2%); iv) granted refugee status (5.6%); and v) other (17.7%) which includes: being a recipient of subsidiary status, or being in the process of making an appeal (e.g. awaiting further paperwork to prove their case, trying to find the funds to make a subsequent appeal).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e19.8% of the population had been subjected to gender-based violence (GBV) of whom the majority were women (91.3%). They reported that gender-based violence had taken place in various settings, including in their country of origin, during the migration route to Lesvos, or while on the island of Lesvos, and 15% had experienced more than one assault. Furthermore, 6% of the total 701 people presented with acute mental health symptoms at the first assessment, such as hyperarousal, audial and visual hallucinations, disorientation, and mood irregularities. \u0026nbsp; The majority of those with acute mental health symptoms (76.2%) presented clusters of symptoms which are not associated with any particular psychiatric disorder. Lastly, 7% of the population presented with suicidal, or self-harming, behavior. Out of these (26.2%) had attempted suicide.\u003c/p\u003e\n\u003cp\u003eTable 1 highlights the range of psychosocial vulnerabilities reported. The most common GBV incident reported was rape (48.9%) followed by physical assault (23.7%) and non-penetrative sexual assault (21.5%). \u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights for the first time the stark range of vulnerabilities experienced by\u0026nbsp;predominantly\u0026nbsp;single women in camp settings, on the Greek islands.\u0026nbsp;Levels of gender-based violence and suicidal ideation were high in our cohort. As well as their past histories, and the impact of the migration journey, these individuals also\u0026nbsp;experience psychosocial distress and social suffering because of their uncertain and disrupted lives and the loss of social\u0026nbsp;and family\u0026nbsp;networks\u0026nbsp;over many months in detention-like settings.\u003c/p\u003e\n\u003cp\u003ePrevious studies have highlighted a range of mental health issues negatively associated with length of stay in camps, predominantly among men who in the past formed the majority of migrants\u0026nbsp;in these settings. In one study from the Moria camp among 634 refugees (average age 23.2 years, predominantly Syrian and Afghan males) acute mental health crises were significantly and independently associated with the length of stay in the camp (p = 0\u0026middot;011; average length of stay in camp 70.9 days)\u0026nbsp;Other studies too have confirmed a deterioration in mental health in Lesvos linked to containment in camps settings\u0026nbsp;[3,12].\u003c/p\u003e\n\u003cp\u003eConcurrent with the containment issues, there is also a lack of long-term mental health services to deal with the severe trauma experienced by refugees and asylum seekers. \u0026nbsp;There also needs to be a serious reassessment (and application) of the vulnerability criteria in the asylum process, as many people, although they fulfil vulnerability criteria [13], receive rejections for their asylum claims. \u0026nbsp;Non-binary and/or non-cis gender identification and the impact that these have on the life of the individual are not even part of vulnerability criteria, even when there are cases of life-threatening discrimination in an asylum seekers country of origin (https://www.humandignitytrust.org/lgbt-the-law/map-of-criminalisation/). \u0026nbsp;In many cases GBV experiences, or the fact that the asylum seeker is a single woman, are not considered at all when vulnerability is being assessed.\u003c/p\u003e\n\u003cp\u003eAs such the Ministry of Migration and Greek Asylum Service need to reassess the range of vulnerabilities being assessed, and direct Asylum Service staff to determine the presence of vulnerabilities more adequately during asylum interviews. \u0026nbsp; This is necessary to make informed asylum application decisions, thus reducing the need for time consuming appeals during which the applicants are essentially prisoners.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAV and GK designed the study and ran the psychosocial programme. GK extracted and analysed the data with support from SH, MN and AV. GK wrote a first draft of the paper and all authors were involved in commenting on subsequent drafts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the authors upon reasonable request and with permission of Dr. Apostolos Veizis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors report that they have nothing to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding and role of the funder\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSH acknowledges funding from the NIHR, Academy of Medical Sciences, La Caixa, MRC, and WHO.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe protocol was approved by a INTERSOS Organizzazione Umanitaria onlus medical unit and the ethical board of INTERSOS Organizzazione Umanitaria onlus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank: Prof. Karl Blanchet (Director, Geneva Center of Humanitarian Studies)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eEuropean Council EU-Turkey Statement 18 March 2016 European Council, Council of the European Union, 18 March 2016 https://www.consilium.europa.eu/en/press/press-releases/2016/03/18/eu-turkey-statement/\u003c/li\u003e\n \u003cli\u003eUNHCR Lesvos Weekly Snapshot 20-26 February 2023 UNHCR, 01 March 2023 https://data.unhcr.org/en/situations/mediterranean/location/5179\u003c/li\u003e\n \u003cli\u003eEpiskopou M, Venables E, Whitehouse K, Eleftherakos C, Zamatto F, de Bartolome GF, et al. In island containment: a qualitative exploration of social support systems among asylum seekers in a mental health care programme on Lesvos Island, Greece BMC, 22 July 2019 https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-019-0218-9\u003c/li\u003e\n \u003cli\u003eEmma Musty AYS Special from Greece: Are you eligible to eat? Are You Syrious?, 17 October 2021 https://medium.com/are-you-syrious/ays-special-from-greece-are-you-eligible-to-eat-8cc3ac6bed3e\u003c/li\u003e\n \u003cli\u003eAoun I, and Myers S A Tide of Self-harm and Depression: The EU-Turkey Deal\u0026rsquo;s devastating impact on child refugees and migrants Save the Children, Child Rights Resource Centre, 2017 https://resourcecentre.savethechildren.net/document/tide-self-harm-and-depression-eu-turkey-deals-devastating-impact-child-refugees-and-migrants/\u003c/li\u003e\n \u003cli\u003eBjertrup J, et al. A life in waiting: Refugees\u0026apos; mental health and narratives of social\u0026nbsp;suffering after European Union border closures in March 2016 Science Direct, Social Science and Medicine, Vol 215, October 2018, pp53-60 https://www.sciencedirect.com/science/article/pii/S0277953618304726?via%3Dihub\u003c/li\u003e\n \u003cli\u003eKondilis E, Papamichail D, McVann, Carruthers E, Veizis A, Orcutt M, Hargreaves S. The impact of the COVID-19 pandemic on refugees and asylum seekers in Greece: a retrospective analysis of national surveillance data from 2020 The Lancet eClinicalMedicine 2021; 37: 100958: https://doi.org/10.1016/S0140-6736(07)61602-X\u003c/li\u003e\n \u003cli\u003eRefugee Support Aegean Refugee women in the offside: Greece encampment policy and services takeover lead to isolation and deny protection Refugee Support Aegean, 21 March 2023 https://rsaegean.org/en/refugee-women-in-the-offside/\u003c/li\u003e\n \u003cli\u003evon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP; STROBE Initiative \u003cstrong\u003eStrengthening the Reporting of Observational Studies in Epidemiology (STROBE)statement: guidelines for reporting observational studies\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;The Lancet, October 20 2017\u0026nbsp;\u003c/strong\u003ehttps://doi.org/10.1016/S0140-6736(07)61602-X\u003c/li\u003e\n \u003cli\u003eHellenic Republic, Ministry of Migration and Asylum Presidential Decree 20 Hellenic Republic, Ministry of Migration and Asylum Press Office, 24 February 2023 https://migration.gov.gr/nomothesia-1-2/#prostasia-aitounton-asylo\u003c/li\u003e\n \u003cli\u003eVan de Wiel, W, et al. Mental health consequences of long-term stays in refugee camps: preliminary evidence from Moria BMC, Public Health, 2021 https://openaccess.city.ac.uk/id/eprint/26365/\u003c/li\u003e\n \u003cli\u003eEleftherakos C, van den Boogaard W, Barry D, Severy N, Kotsioni I, Roland- Gosselin L. \u0026lsquo;I prefer dying fast than dying slowly\u0026rsquo;, how institutional abuse worsens the mental health of stranded Syrian, Afghan and Congolese migrants on Lesbos island following the implementation of EU-Turkey deal BMC, Conflict and Health, Vol 12, Article Number 38, 05 September 2018 https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-018-0172-y\u003c/li\u003e\n \u003cli\u003eKarin Aberg Detecting Vulnerability in Greek Hotspots Odysseus Network, Brussels, Belgium, 29 June 2022 https://eumigrationlawblog.eu/detecting-vulnerability-in-greek-hotspots/\u003c/li\u003e\n \u003cli\u003eA list, on the website of the Hellenic Democracy Ministry of Migration and Asylum, of the registered NGO providing support onsite, in the various RIC in Greece. This is a list of only those groups having formal access to the RIC sites, and does not include NGO working off-site. https://ngo.migration.gov.gr/registered.php\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. \u0026nbsp; Category of vulnerabilities in the population. The n value in the table is the number of vulnerabilities reported, not the number of individuals reporting the incidents. \u0026nbsp;As such, an individual may report more than one vulnerability. \u0026nbsp;Categories #1-8 are recognized by the Greek Asylum Service as vulnerabilities which affect the asylum process.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e#\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory of Vulnerability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of total population\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eMedical condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eSpecial needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eSingle woman/parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003ePregnant woman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eExperienced rape/torture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eExperienced rape/female genital mutilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eExperienced gender based violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eSurvivor of human trafficking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eAcute mental health condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eExperienced familial/domestic violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.297709923664122%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.63358778625954%\" valign=\"top\"\u003e\n \u003cp\u003eIssues due to sexual preference/non-cis gender identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.17557251908397%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.893129770992367%\" valign=\"top\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable A. \u0026nbsp;Gender\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eNo information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable B. \u0026nbsp;Country of Origin\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eCountry of Origin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAfghanistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e39%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eSomalia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDemocratic Republic of Congo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eSyrian Arab Republic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable C. \u0026nbsp;Age Ranges\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAge Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e17 and under\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eLT 1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e18-22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e23-27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e28-32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e33-37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e38-42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e43-47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e8.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e48 and over\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3542441/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3542441/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Kara Tepe Registration and Identification Camp on Lesvos Island in Greece is a controlled access facility with people in various stages of the asylum procedure housed in tents, rub halls and containers in poor living conditions for prolonged periods of time. However, data are lacking on psychosocial vulnerabilities and experiences of these populations, particularly the growing number of single women residing in these settings.We aimed to explore psychosocial needs among this incamped population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We did a retrospective cross-sectional chart review of socio-demographic and psychosocial vulnerabilities of all migrants (\u0026gt;18 years of age) who were detained in Kara Tepe between 1st February 2021 and 31st January 2023. Data were extracted from the Knack Online Database used by INTERSOS HELLAS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 701 individuals were referred to the clinic for psychosocial work, over a 2 year follow-up period, of which 165 subsequently received psychological support after initial health assessments. The majority (92.0%) of the cohort were women who were single, most from Afghanistan, Somalia, Congo, and Syria, with a range of medical and social vulnerabilities. 19.8% of the population had been subjected to gender-based violence including in their country of origin, during the migration route to Lesvos, or while on the island of Lesvos. The most common GBV incident reported was rape (48.9%) followed by physical assault (23.7%) and non-penetrative sexual assault (21.5%). 7% of the population presented with suicidal, or self-harming, behaviour, of which 26.2% had attempted suicide.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study highlights for the first time the stark range of vulnerabilities experienced by predominantly single women in camp settings in Greece.\u003c/p\u003e","manuscriptTitle":"Psychosocial vulnerabilities in newly arrived asylum seekers to the Greek island of Lesvos: a retrospective cross-sectional analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-04 05:47:43","doi":"10.21203/rs.3.rs-3542441/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"19eef0de-20ab-4b38-a9e3-c94b85dd5755","owner":[],"postedDate":"July 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-04T05:47:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-04 05:47:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3542441","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3542441","identity":"rs-3542441","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}