Greece has some of the most unrestrictive abortion laws in the world, depsite its national health care system being crippled by a fractured economy that was the result of years of mismanaged debt and strict austerity measures. Women in Greece can request an abortion for any reason for the first three months of their pregnancy and recieve it at no cost if they go to a public hospital. And despite Greece’s recent rollback in refugee health care and its economic strain, humanitarian workers in some of the country’s refugee camps are working to ensure that their residents have access to essential health care — including abortion.
In July, Greece’s new Labor Minister Yiannis Vroutsis put a freeze on issuing state-sponsored health care to refugees. Critics called him racist, for both the policy change and the way he spoke about it afterwards. “Our country is not an unfenced garden,” Vroutsis said of the decision, loosely translated, over Twitter.
New refugee arrivals to Greece, or any new non-permanent residents, don’t have state-sponsored health insurance. In most places, this means that getting an abortion could become prohibitively expensive for unregistered refugees. But this summer saw some of the highest rates of refugee arrivals in the past three years.
Women in Greece can request an abortion for any reason for the first three months of their pregnancy and recieve it at no cost if they go to a public hospital.
New arrivals don’t stay on the islands for long; they travel north to more established camps on the mainland, like the Ritsona camp in central Greece. The camp sits in a wooded area on a former Greek Air Force base. That’s where midwife Angeliki Spyridi works — the only women’s health provider on a camp with almost 1,000 residents.
“It’s difficult because I’m all alone,” Spyridi, who helped facilitate around 10 abortions last year, said.
Despite incredible challenges like limited funding and the camp’s isolated location, Spyridi is helping ensure that women at the camp have access to safe abortions. Ritsona has been operating for around five years, its population fluctuating with seasons and policy decisions that affected rates of refugee crossings across the Medeterranean and Aegean seas. Many of their residents are from Syria, though a growing cohort are from countries across Africa. Along with the population, resources have also fluctuated at the camp. While they used to have a larger medical NGO presence, now they only have a single general physician who provides care at the camp two days a week. Spyridi said they even used to have a dedicated gynecologist, who could provide IUDs on-site to refugee women at no cost.
“Now they have to buy [them] in the hospital,” Spyridi said, noting that the cost to get an IUD starts at around 20 euros, or $22. (By contrast, Planned Parenthood estimates that getting an IUD without insurance in the U.S. could cost up to $1,000.)
Spyridi sayid that the government’s decision to halt insurance has become one of the biggest challenges she faces in providing reproductive care to women on the refugee camp. If anything goes wrong, with an abortion, a pregnancy, or another specialized health issue, patients must be driven an hour and half to a larger hospital in Athens.
“It’s difficult because I’m all alone.”
With the change in policy and the constant uncertainty when it comes to acquiring essential resources, ensuring that displaced women in Greece have access to safe abortions and reproductive health care is a laborious effort. However, according the Katrin Collison, an Australian midwife who worked as a general aid worker on the Greek islands and in Ritsona at the height of the crisis in 2015 and 2016, the fact that any attention is paid to women’s health care now is a major improvement.
“It was a tent and nothing else. Moldy food from the army, nothing else,” Collison told me of Ritsona’s early days. She said, at the time, the priorities of the camp’s management were to build makeshift recreational facilities like a library and a pre-school. When Collison worked on Ritsona, there were almost 50 women who were pregnant or breastfeeding.
“The goals were completely misguided,” Collison said. “I remember having a conversation about condoms, and they didn’t want to hand them out to the women.”
Now, Spyridi said Ritsona does provide condoms for its residents, and that young people are becoming more and more willing to have conversations about reproductive health. When Collison was working on the camps, however, almost no bandwidth was dedicated to women’s health. Collison used her background in midwifery to help refugees as much as she could, but the overwhelming lack of support meant her efforts couldn’t be much more than piecemeal.
“There are so many basic needs of care, basic needs that aren’t being met,” Collison said of refugee camps in general. “And a big one of them is women’s health; everything from birth control, to abortions, to pregnancy and post-pregnancy.”
Tam Fetters leads research at Ipas, an organization dedicated to increasing access to safe abortion in humanitarian settings. She said that in addition to stigma and political or religious ideologies that limit abortion access even in developing countries, care on refugee camps is limited due to the “myth” that abortions are simply too complex to provide in the field.
“One of the reasons that was put forward by humanitarian practitioners,” Fetters told me, “is that abortion was too complicated. But we feel that we’ve debunked that myth in our work.” According to Médecins Sans Frontières, a primary reason refugee abortions in Greece are delayed is because of a requirement that an anaesthetist be present, even though early-term and medical abortions are relatively easy, outpatient procedures.
Ipas conducts research all over the world. Bill Powell, who leads the organization’s efforts with humanitarian partners to improve abortion care on the ground, said that only over the last 10 years has he seen major strides in abortion care infrastructure in refugee camps.
Care on refugee camps can be limited due to the “myth” that abortions are simply too complex to provide in the field.
“Only in the last, I would say, few years has there been any momentum for offering safe abortion in these settings,” Powell said. And development is still slow. In fact, Powell and Fetters said while having to transport refugees to local hospitals for abortions and reproductive care isn’t ideal, it’s one of the more common solutions that, if nothing else, gives women a semblance access to bodily autonomy.
And that’s how it works in Greece. For those with government registration, abortions (without complications) are performed at no cost to the patient, without exception based on citizenship. Refugee women with an insurance card can get an abortion free of charge; all they have to do is ask. Normally, Spyridi told me, once a women tells her they are seeking an abortion, Spyridi coordinates the ultrasound to confirm the pregnancy, and from there it only takes a week or two to get an appointment at the municipal hospital. Despite the fact that the government withdrew coverage, the hospital near Ritsona still provides care to women, as long as they have an ID.
While Spyridi said that getting specialized care in Athens has become more difficult due to the health care policy decision, smaller public hospitals, like the municipal hospital near Ritsona, are continuing care for new refugees who are unregistered. Spyridi said that, especially when it comes to the care of pregnant women, the municipal hospital has been generous. The problem is, as Fetters pointed out, that while Greece has been providing above-average abortion care to refugees, relying on a process that requires displaced women to navigate a complex and foreigh health care system is hardly sustainable. Discrimination, mind-melting bureacracy, and ignorance still exist across the country.
Still, stories from other hospitals in Greece show that disapproval of Vroutsis’s decision isn’t uncommon. In Kavala, another city in northern Greece that has a high refugee population, the municipal hospital announced that it had vaccinated 83 uninsured refugees before the start of the school year. According to Alfavita, Greece’s largest education news outlet, the vaccinations were paid for by the hospital. The hospital issued a statement saying, “vaccination of children was considered necessary to ensure the health of children and to enable them to seamlessly integrate into the educational processes.” In stark contrast to Vroutsis’s tweet earlier in the summer, the hospital closed its statement with, “we will be there whenever and wherever they need us.”