The study is the first comprehensive analysis of sexual and reproductive health in a European refugee camp and was, moreover, partly conducted by refugees themselves. The first part of the study, ‘Sexual and reproductive health needs of refugee women on Lesbos, Greece: a participatory cross-sectional study’, has been published in BMJ Global Health.
For the study, 247 women in the Mavrovouni refugee camp were interviewed on topics such as pregnancy, contraception, menstrual care, sexual violence, and access to medical services. The results show major gaps in both care and information provision. More than half of women victims of pushbacks.
“One of the most striking findings is that 54 percent of the women indicated they had been victims of so-called pushbacks: illegal expulsions at the border. Some women reported experiencing this dozens of times, in extreme cases up to 42 times,” says project leader, global health physician, and PhD candidate Jamilah Sherally of the Athena Institute.
Although human rights organizations have been reporting pushbacks for some time, according to the researchers, this is the first study to systematically map their extent. Two women from the study population lost a child at sea during such an expulsion.
In addition, many women reported verbal, physical, and sexual violence during displacement. Gender-based violence occurred primarily in the country of origin, en route to Europe, and during pushbacks.
Care denied due to legal status
Almost a quarter of the women (57 out of 247) said they were denied medical care because of their legal status. Access to health information also proved to be severely lacking: depending on the subject, 67 to 91 percent of women had never received essential information about their health or available care. “Adequate care begins with access to information – without this knowledge, women cannot make informed choices about their own bodies. For example, one woman said she underwent a caesarean section without understanding why the procedure was necessary.”
Major unmet needs
The study also shows that many women do not receive the care they need. Only 24 percent used modern contraception, while a significant group indicated they did have a need for it. Fertility care also proved to be inaccessible: 15 percent of women desired fertility treatment, but no one was given access to that care.
Furthermore, 61 percent reported gynecological complaints, but almost half of them did not seek medical help for this. Screening for sexually transmitted infections and cervical cancer was virtually absent.
Although prenatal care during pregnancy was accessible, postpartum care lagged far behind. Almost half of the women who had recently given birth received no postpartum care at all, despite the fact that many of them reported complications.
Refugees as co-researchers
Another unique aspect of the study is the way the research was conducted. Nine refugees participated as co-researchers and were involved in drafting the questionnaire, collecting data, and analyzing the results.
According to Sherally, this participatory approach ensures that refugees are not only subjects of research but also producers of knowledge about their own health and living conditions. In doing so, they aim to break away from traditional, “extractive” forms of research.
Call to action
The researchers advocate for urgent policies to improve access to sexual and reproductive healthcare for refugees, regardless of their legal status. They also call for an end to pushbacks and for more humane reception conditions.
According to the research, tailor-made care programs are needed that are developed in collaboration with refugee communities. Consequently, the study could have implications not only for practices in Greece but also more broadly for European migration and health policy.