By: Dr. Michaela Fried

Pediatrician. Child and Youth Psychiatrist & Psychotherapist

 

January 3-7, 2021

Already huge problems due to the pandemic while planning the journey. Are we going to be allowed to fly out? Is there going to be a flight during lockdown? Naturally we have to do a PCR test shortly before take-off. We met a week ago: Helga Longin volunteering for the NGO “Unser Bruck hilft” (Our Bruck helps[1]); Sabine Sommerhuber, who has been “thinking about” the refugee situation in Austria and beyond its borders together with myself and others in the think tank “Die Unerhörten” (The Outrageous) since 2015; she works with Helga, and child psychiatrist Ulla Wurm, a colleague of mine at psychosocial services in Eisenstadt, Burgenland, who spontaneously decides: I’m coming with you! First, an antigen test in my company flat and then a nice gathering with snacks and a unanimous agreement: We will fly out as soon as possible. Sabine takes care of the flights, I will scrounge medication. We want to go because it has become a matter of the heart, and we have to because so many people have generously donated money for our project, their thoughts being “If I give the money to you, I know it will go where it is needed. I can’t do anything else from Austria…” In the meantime, Ulla had contacted Kai at Medical Volunteers International (MVI), a Hamburg-based NGO. This NGO recruits medical professionals who volunteer in regions for a limited period of time to provide medical care to people in crisis areas or emergencies. They welcomed us into their team without any complications.

Helga, who recently returned from Lesbos, tells us about the situation in Kara Tepe and her friends from the NGO “Home for all” in Mytilini, the capital of Lesbos: Nikos and Katerina have been cooking 1200 meals a day in their taverna there for more than 6 years now. “No one should have to sit in front of an empty plate” is their attitude and their credo. They cook and deliver warm meals to refugees and also to locals in need since the COVID-19 pandemic began: They give refugees work in their fields harvesting vegetables and enable the refugees to sell homemade goods and fashion jewellery at small markets. “Home for all” has meanwhile rented several houses to provide shelter for the most vulnerable. They have also rented warehouses to sort donations and can deliver them within an hour, depending on the request. They supply basic foods, warm clothes, baby sheepskins and moreover still have permission to enter the camp, which other NGOs and especially journalists and reporters no longer have. Helga Longin, Doro Blancke and many others support this wunderful NGO by donating food and other goods. Helga and Sabine, together with young people from “Wandel” (Change), a political party in Vorarlberg, will recruit donation depots, sort a total of 9 tons of donations of necessities and food, deliver such goods and food to the camp every day, buy medication and hand it over to Medical Volunteers International and other doctors at the camp entrance. Helga Longin and her organisation “Unser Bruck hilft” will look for housing for recognised refugees. They have to leave the camp within a month and most face homelessness with multiple small children.

 

January 8-7, 2021

When we arrive it’s rainy, cold and wet, even though it’s about 14 degrees. However, since we frequently work outdoors because of the corona-related distancing measures, 14 degrees with strong winds feel much more uncomfortable than we first thought.

I’m not working in primary care in the medical services of MVI, which would be inside the camp, because child psychiatry specialists are needed more urgently than pediatricians right now.

The Mental Health Kids Programme, a sub-project of MVI, consists of a great international team comprised of many different professionals and is supported by people from the camp. Most of the time Dr Ulla Wurm and I work together with Dr Sadar, a doctor who fled from Afghanistan and now lives in the camp with his family. He left his home country because he was afraid of not finding his loved ones alive every time he came home from work in the hospital. As well as English he also speaks a little German because he spent some years studying in Germany. Following that, he served his home country as a doctor for 7 years. He was beaten and tortured in Afghanistan, on the run and here in Lesbos as well. His pelvis, elbows and knee joints were smashed. Dr Sadar shows me his diplomas and certificates. He probably has almost as many as I do, even though he is 20 years younger than me. Because of the suffering he had to endure he looks 10 years older than he actually is. He and others in our team who used to work as social workers, teachers and in other social professions are paid 400 Euros monthly for their work in the camp by MVI. With this amount of money they can then buy the bare necessities for their own families, which often includes up to 20 family members. What’s really important to Dr Sadar and the others, though, is to be occupied and “useful”, to be able to do something in order to escape the helplessness caused by the traumatisation that they have experienced and are still experiencing every day. To regain capability to act, to do something saves his life, he tells me. The Mental Health Kids Programme is located on a hill about 600 meters above the Kara Tepe camp, in the area of “One happy family” (OHF) which is supported by MVI.  The site was built with loving care and cultural mindfulness.

Most NGOs are not permitted to enter the camp. The people in the camp are allowed to leave the facility once a week for 4 hours. This time frame includes visits to a doctor, shopping in town as well as the time for therapies for children and parents in our programme. Families can recharge their batteries here for a few hours: There are sewing workshops for mothers and women. Over hot tea and colourful wool, there is hope for a bit of normality in the camp; perhaps permission to cook some time, familiar food, smells from the kitchen at home – instead of the prohibitions since the burning of Moria, which after the immense traumatisation now have become the equivalent of collective punishment. Men have the possibility to repair bikes in the workshop. Children can play on the playground and participate in kids’ groups where they can talk about their sorrows and share stories. Children are not shielded from anything in the camp. They hear about – or even witness – rapes and knife fights for example. The tent walls will not keep out parents’ conversations about their worries nor the anxious crying and whimpering of other children during the night.

Again and again, children have to comfort or protect their parents. Perverted states of parentification where children comfort their crying parents tear our hearts apart!

 

January 14, 2021

Dr. Wurm and I work mainly with parents while their children receive therapy and psychoeducation and strengthen social skills and self esteem in a children’s group. The children also play with each other, participate in sports and handicraft work. They are also brought to me occasionally for pediatric reasons, otherwise we don’t plan to get too attached to them in the short time we spend here. Most of the children here have had enough discontinuations already!

Parents are worried about children who withdraw more and more, no longer want to leave the tent, no longer want to live or who exhibit aggressive behaviour due to the cramped conditions in the tent. Many wet themselves at night, have nightmares in their sleep and suffer panic attacks during the day. Parents report having no more strength and hope, and that is why they can no longer comfort and support their children:

I was deeply touched by a conversation with a mother. It was not so much because of the tragedy of the story, we have heard much worse, but because of the demands she has on herself in this desperate situation: She used to be a pedagogist in her home country, has 2 sons aged 8 and 12 and is expecting a baby. She tells me that her sons want to get out of the tent and play with other children. There is hardly any space to play around the tents, and in the camp there is no playground or any other open space where the children could go to run and play. And it is also dangerous for children to leave the vicinity of their own tent as violence and attacks, even on children, occur again and again in the camp. Because of their age the children often do not understand that their mother is realistically afraid for them. When the children come back into the tent, they are often dirty and wet with mud. It is so difficult to keep the tent clean with so little space and to get their clothes dry again under these wet conditions. The mother is afraid that it is only a matter of time before the boys catch a cold and get sick.
The children lack structure because they have no regimented schooling. They are bored, every day is the same; of course they don’t want to sit in the tent and study because it is far too cold and dark. At home both boys were good students and enjoyed learning. Due to the pregnancy their mother often feels tired and weak, she also suffers from iron deficiency. She often shouts at the boys when it is too much for her, with all the dirt and wet clothes, or when the boys demand attention because they are fighting. It’s all too much for her, she tells the children off and slaps them. At home she didn’t even yell at them…

My colleague, Dr. Ulla Wurm, and I just listen to her. Then I feel the need to tell her that she is being too strict with herself, that everyone will understand that this situation is simply too much for her and this is the reason she scolds the boys now. I ask the mother what she would do at home if the boys did not do what she had told them, if they made her life more difficult. She replies that she would definitely not yell at them or hit them. So together we look for moments during the day in which the mother could get some help, over a cup of tea with the neighbour or a talk with her husband, the children’s father. She explains that her husband is completely overwhelmed with the current situation, too. He has been going on errands in town in order to get away from the tent a few hours a week. Together we can think of a few moments when she can relax, though. We reassure her that especially now, in this exceptional situation, children need rules and structure as well as praise, appreciation and encouragement. Encouragement! How can I encourage a child if I myself am tired and exhausted 24 hours a day? I try to rephrase the scene for her in which the children come into the tent dirty and wet: “I’m glad that you managed to have fun outside with a glass marble and other children under these circumstances, I watched you play. You know in our situation it is very important that we take off our shoes before we enter the tent. We will prepare one set of clothing to wear when you are playing outside and another one in case this one gets wet; but you have to be really careful with your clothes because it is so difficult to dry them when it’s raining all the time. You are already old enough that I can ask you to help me keep the inside of the tent clean. You also have to stay close to the tent. You have heard and seen what could happen if you don’t. I need to be able to rely on you and on the fact that you look after each other. Your father will support me.” As I formulate this sentence for the mother, she gets teary-eyed, takes a deep breath and relaxes. She thanks me for these words and says that she had forgotten how important it is to communicate with the children in this way. Now, while listening to me, she feels herself becoming strong again, because it was her words that I had uttered and because these words also reaffirmed something inside her, making her strong again. She will also ask for help from the mother of another family who lives in the neighbouring tent.

 

Sometimes I pass on tips from Haim Omer’s concept of non-violent resistance, which I use in parent coaching sessions in Austria, too. The idea is to keep offering loving relationship gestures from time to time, especially in challenging situations, but also to give structure and stability through resistance to oppositional behaviour. However, this is only possible if parents experience support from others too, have networks that last and can therefore react in a self-controlled way based on a relatively calm state of mind. Aggressive behaviour such as slapping by parents in exceptional situations can be repaired by making amends on the parents’ part (such as a walk in the sun and throwing stones into the sea and/or giving the kids something sweet to eat). Making amends, however, can also be demanded from children who show aggressive and oppositional behaviour. We have also used these tools taken from the concept of “New Authority” in our work with families in other crisis areas, such as the Gaza Strip. We have found that they are gratefully accepted, especially in traumatising contexts in which physical violence is likely to occur. At the same time, I agree with my colleague, Dr. Wurm, who keeps pointing out to me that this concept originating in the psychology of non-violent resistance, which is also called New Authority in Europe, can only help in a second step after pain is acknowledged and space is provided for listening, for crying: Before we give any advice, it is necessary to acknowledge pain and suffering and openly admit that we are not here to change the situation, but to be witnesses; witnesses also in our home countries, where the politicians not only oppose the evacuation of the camp, but also pass the question of responsibility on to one another. For example in the matter of why expensive aid supplies such as winter tents have been stored in Athens for weeks and have not arrived in the camp yet.

 

January 15, 2021

Today was a bad day here because the authorities and police imposed stricter lockdown rules: We have to be home by 6 pm now, no one was allowed to leave the camp today, the children were not allowed to come, it was depressingly empty on the OHF premises! Even pre-booked appointments with doctors in Mytilini or in outpatient facilities were not allowed. We used the time for a nice long supervision with the whole team, which was good. The team is taking advantage of the specialist child psychiatry expertise. We are impressed with how much professional creativity and loving consideration the team ensures that the children can talk about their worries and fears or learn how to express themselves through play in those very few hours that they are allowed to leave the camp. Paper puppets with different facial expressions break the dam of pent-up emotions: the fire in Moria in the middle of the night, physical and sexual violence against children, fears of death, the constant worries of adults, the screaming child in the adjacent tent. Having fun for four hours a week and forgetting everything for a while; suddenly you hear children laughing and see mothers who proudly present their crochet work or dance with other mothers in the sewing room…. we have started to walk back to our flat every day after work, which takes about an hour and helps a lot to get the horrifying stories out of our heads.

 

January 18, 2021

Today is Sunday: We are hosting a brunch for our friends from Austria! First, we get tested, of course, to check if our throats are “clean”. If you forgot to bring cotton buds, you have to be inventive and make some! Almost as good as the original! And it works, everybody negative! Helga Longin and Sabine Sommerhuber tell us about their expreriences in the camp, where they distributed food and clothing on Saturday. Then Doro Blancke, the Ute-Böck prize winner, joins us. Both of them are not concerned with who gets the most “likes” on Facebook, but rather how to help as efficiently and promptly as possible. They fit in well at MVI with their straightforward approach. As of today, Sabine will be supporting the MVI team in our work with parents and Doro Blanck will be doing clay work with the children in two weeks’ time.

 

January 19, 2021

It is snowing outside. We are cold despite the many socks and layers of clothing we are wearing, despite the hot soup we are drinking.

The children here are as happy about the snow as the children in Austria!

At 4 am I look out the window at the snow-covered cars and I remember the 12-month-old child with high fever that Helga Longin from “Unser Bruck hilft” contacted me about late last night: Paracetamol, for the moment and against the shivering. My 16-year-old friend Noor Tawahina from Gaza is deeply affected and asks how she can help. Europe is turning a blind eye. Doing something, being here supported by many at home, witnessing what is reported to us, is gratefully acknowledged by the refugees. Nevertheless, whatever we do only helps as much as a band-aid. The real treatment would be: evacuation, at least of families with kids.

 

January 20, 2021

Temperatures are low and we are all freezing while listening to parents, acknowledging their suffering, reassuring them again and again that it is not uncommon for children to have nightmares or dissociate under these inhumane conditions. One mother tells us, for example: My child will suddenly fall down and appear unconscious from fear when she hears loud men’s voices in the camp. On the same day, concerned parents show us a video of their daughter that they recorded during the night. The video shows a whimpering 8-year-old girl in a dissociative state, which is psychiatrically described as a post-traumatic stress disorder after severe traumatisation. The child’s eyes are wide open, she is crying and whimpering and cannot be pulled out of this state, although the parents are talking to the child in a very calm and controlled way. Parents and the media often simply refer to these types of conditions as “panic attacks”. From a child-psychiatric point of view, this is simply wrong. Leaving children like this girl in a state like this for several hours is dangerous, and causes neuronal damage to the brain.  It requires psychiatric treatment or trauma therapy. There are some trauma therapists in Doctors Without Borders and only a few – too few – specialists here who can treat traumatised children adequately. The protection of children from violence is the most important promise of the Convention on the Rights of the Child. We can testify to the fact that this very right is violated against up to 2500 children in the refugee camp here in Europe every single day.

 

January 21, 2021

Corona messes up Ulla’s travel plans, return flight cancelled! So I had the opportunity to see Helga Longin’s work and help out in her project for a day. Meanwhile, Sabine Sommerhuber worked with Ulla in the Mental Health Kids project. Sabine’s know-how as a trauma therapist was highly appreciated. She will be able to stay until 8 February, we have to go home next Friday! I met young people from “Wandel” who are active here and in Austria. They are mostly students who attend their lectures online from Lesbos due to coronavirus.

Boxes of donated clothes from Austria and other European countries are being sorted and brought to the camp and to other refugee families as required.

In the afternoon I meet Nikos and Katerina from “Home for all” and get a taste of their food. Every day they cook 1200 meals with a couple of helpers. The food is especially important for sick people and diabetics. Often the food from Athens, which is airlifted in by the Greek military, has spoiled when it arrives at the camp, so that even physically fit people are dependent on food from Home for all. We are also experiencing that warm food keeps the body warm at least for some time!

 

January 22, 2021

I would like to conclude our last day here by taking pictures of the children’s artwork. The lighthouses are not only a symbol of hope but also depict what would help against the fear of darkness at night: light and warmth. Children are building “houses” in the OHF area. Playing under therapeutic supervision means creating “as-if-situations”, recharging your batteries, hope for tomorrow. All that is left to do is to say thank you: To Medical Volunteers International and the great team in the Mental Health Kids Programme; to Helga Longin and Sabine Sommerhuber from “Unser Bruck hilft” without who we would not even be here. To the good people from Austria for their donations. To the helping NGOs and the residents of Lesbos, and last but not least to the many parents from the camp who confided in us with their sorrows!

 

Bridges for Hope and Peace

Raiffeisenbank Region Amstetten

IBAN AT44 3202 5000 0572 1584

BIC: RLNWATWWAMS

Thank you.

[1]Austrian non-governmental organisation located in Bruck, Lower Austria