Sobre los riesgos para la salud mental

Participants referred to several special characteristics of immigrant populations that affected the provision of health services. The socio-economic situation of immigrants, communicable diseases and occupational burdens were reported to cause difficulties in providing health care either directly through their impact on the provision of health services or indirectly through their effect on immigrant populations’ health status.

8.2.1. Difficulties posed by the socio-economic situation of immigrants

Some respondents highlighted that the housing conditions of some immigrant groups are often less propitious than those of Greek citizens. In fact, it was reported that illegal immigrants face major obstacles in accessing good quality houses because their lack of official documents and low or unstable incomes can lead them to debarment from official rental housing, discrimination and abusive practices on the part of landlords. This can lead to them living in conditions of overcrowding and poor sanitation. The existence of homeless immigrants was also mentioned:

‘… immigrants who found themselves in Greece, without being able to leave … either live … on the street in the cold winter and the summer heat or find shelter in miserable, regarding hygiene, homes …’ [P08, resident doctor (male), 34 years old]

Some respondents reported that poor housing facilities and poverty in general directly affect people’s health status and thus create increased demands on the health system. The health system was reported to be liable to manage the harmful effects on the health of immigrant groups and on public health in general:

‘Their main problem is poverty and all that emanates from it, including … the poor living conditions and their inability to buy basic goods such as food, clothes and medicines. Some immigrants do not have electricity at home and for this reason they cannot store medications that require refrigeration.’ [P06, health visitor (female), 40 years old]

Many informants stated that economic poverty is a major disadvantage making access to health services and products difficult even for patients who are covered by an

insurance fund. Indeed, it was alleged that even insured immigrants often cannot pay the expenses which are inevitably created by the use of health services, such as providing ordinary contributions to paying for laboratory tests and medications:

‘… a GLP-1 agonist [medication used for the treatment of diabetes] … costs about €130 and charges the insured around €13. The uninsured has to pay the whole amount. If the patient finds it difficult to cover such an expense (or even the contribution), I am forced to prescribe drugs of another category, cheaper and perhaps less effective … . There are also tests … which are not covered by the security funds and are therefore unfeasible to be asked from economically weak patients.’ [P01, consultant doctor (male), 63 years old]

Several respondents noted that this situation may result in poor compliance with medical instructions and can increase workloads for staff employed in public hospitals, where health care is less costly. In addition, it was reported that immigrants who cannot afford to use health services often try to get instructions for their health condition over the telephone or get information from other patients with similar problems. This practice was considered to be dangerous for their health. Moreover, as some respondents noted, health services frequently pick up more neglected cases because the financial hardships faced by immigrants may delay them in seeking treatment for their illness at the earliest point, meaning that they are not accessing services until their condition is advanced and more medically serious.

The illegal informal occupation and unemployment of some immigrants were cited as the reasons for the lack of insurance coverage. Moreover, some informants stated that uninsured employment may be preferred by some immigrants to avoid paying social security contributions so that money could be sent home or cover expenses associated with living in a foreign country. According to these accounts, uninsured immigrants are obliged to pay the full cost for tests and medications and this is a significant barrier to their utilisation of health services, resulting in them receiving only partial care.

8.2.2. Communicable diseases among immigrant populations

Several respondents recognised that infectious diseases among immigrant populations can pose significant risks for public health as well as for the operation of health services. In fact, it was noted that after the onset of huge numbers of immigrants arriving in Greece, communicable diseases that had previously vanished or decreased significantly (such as malaria) reappeared in the country. Tuberculosis was reported to be a serious risk because of its prevalence amongst immigrants:

‘… (the hospitalisation of immigrants) constitutes a danger for both the staff and the operation of the clinic. … there is an increased risk of exposure to Mycobacterium … for the staff. … patients must be hospitalised in isolation, so … an entire chamber is bound, while there is lack of beds and space. … these patients are a source of transmission … for the rest of the … patients, attendants and visitors.’ [P04, nurse (female), 32 years old]

‘(Because of living conditions) it is expected to have increased disease spread among these populations which leads them to hospitals. … . We are talking about simple diseases such as some mild respiratory tract infections and gastroenteritis, but also about much more serious (ones), such as tuberculosis.’ [P10, nurse (male), 32 years old]

Furthermore, the various forms of viral hepatitis and HIV infection among immigrant populations were reported to be frequent and constitute a serious risk to clinical personnel’s health because of the potential exposure to infectious fluids in daily practice. Although this issue was not extensively discussed during the interviews, in a few statements the causes of the increased frequency of infectious diseases among immigrant populations were attributed to the living conditions in their country of origin, the conditions through which they migrated and the disadvantaged conditions they experienced in Greece.

Some respondents offered explanations for the high prevalence of sexually transmitted diseases among immigrant populations. It was suggested that many male immigrants arrive in Greece without being accompanied by a spouse or partner and because of social exclusion and ghettoisation, many of these men are not able to enter into regular sexual relationships and thus turn to casual sexual habits and illegal

commercial sex. The same risk was reported to exist also among foreign women who were illegal sex workers (either by their own will or because of their exploitation by trafficking networks). Some respondents expressed concerns that blood-transmitted sexual diseases directly affect the work of health professionals, since they pose transmission risks in the course of clinical practice.

8.2.3. Immigrants’ occupational burdens

Some participants highlighted the employment of many male immigrants in manual employment as a factor for the increased incidence of musculoskeletal disorders:

‘… immigrant men … often visit the clinic for orthopaedic problems, especially pain in the back, but also in the knees. … all these are mainly the result of their work, because very often they lift weights …’ [P03, nurse (female), 49 years old]

Accidents and pathological symptoms were estimated by a few participants as more common among male immigrants because of their employment in dangerous and unhealthy occupations, such as in construction and agricultural work, the lack of education in the workplace and language problems that hinder the comprehension of rules and instructions. For this reason, it was found that immigrant workers often resort to the emergency departments due to injuries and physical complaints. Moreover, it was noted that some female immigrant employees do not take maternity leave because they feared dismissal. Finally, it was also reported that the strict working conditions many immigrants face do not allow them to devote the necessary time for using health services:

‘… immigrant men cannot easily visit the hospital in the hours of the regular outpatients’ clinics because they are working. … this is also a problem for the spouses who need an escort for the visit because … they do not speak Greek or they do not have the means to come alone or this is imposed by their habits. … (in case of hospitalisation) immigrant men rush to get discharged in order to return to their work and not lose a lot of wages, while women are in a hurry to return home and take care of the children.’ [P06, health visitor (female), 40 years old]