Since 2015, more than one million asylum seekers have arrived in Greece in search of refuge in Europe [1]; and 34% of asylum applicants have been women and girls [2]. Their situation in Greece grew increasingly precarious in March 2016, when they found themselves stranded as a result of closed borders along the Western Balkan route and the introduction of the European Union (EU)-Turkey Statement.

Beyond the general difficulties facing displaced persons in Greece, asylum-seeking and refugee women and girls face unique risks. Many have experienced some form of gender-based violence (GBV) in their country of origin, during their journey to Europe, or upon arrival to Greece [3]. Their vulnerability to sexual exploitation and abuse is high: they may be traveling alone or as a head of household, but rarely independently, and are often dependent on male travelers or smugglers to arrive at their intended destination. Some may have special needs related to their age (e.g., adolescents, elderly), pregnancy, or disability. They have limited access to reproductive health care and few opportunities to provide for themselves and their families independently, or access other basic services. The one common thread they share throughout this humanitarian situation in Greece is their limited access to safe accommodation or specialized services to meet their needs, such as psychosocial support or post-rape care [4].

No Escape from Gender-based Violence

Throughout this crisis, women and girls have been living in camps that do not always meet minimum standards to prevent GBV and provided limited access to basic and protection services, or information about their rights. While the Greek Government and humanitarian actors have taken steps to incorporate women’s and girls’ needs into the response, many of the camps on the mainland and islands still fail to meet the minimum standards set out in the Interagency Standing Committee (IASC) Gender Guidelines [5]. Reports from the field support the abovementioned concern and reveal that some camps still lack sufficient lighting and gender-associated risks are not always considered in the allocation of shelter.

Women and girls in emergencies face increased risk and multiple forms of violence as a result of their gender, which is exacerbated by the effects of conflict and forced displacement. For example, in Europe, women, and girls have been forced into informal marriages, as having a male head of household is perceived as safer by their families, while others report having been sexually exploited in exchange for financial support, documentation, or transport [6]. According to a 2016 World Health Organization report [7], humanitarian and government interventions in Greece have often not adequately focused their efforts on GBV prevention, as it is not perceived as a priority due to a lack of data. Compounding the invisibility of the problem is the fact that many cases never get reported due to fears of stigma or retaliation, limited availability of or access to services, and lack of awareness about the benefits of seeking care. However, GBV minimum standards and international commitments included in the Call to Action on Protection from GBV in Emergencies clearly state that GBV services must be part of the initial emergency response without the need for evidence or data on prevalence.

There is also an evident gap in the provision of legal counseling and representation for GBV cases, which can impact survivors in many ways. Survivors of intimate partner violence, for example, are not often informed about their right to have separate asylum claims from their partners, which may force them to stay in abusive and dangerous relationships. Within the Greek public healthcare system, doctors treating sexual violence survivors are obliged to report incidents to the police, with or without the survivors’ consent. This results in survivors being exposed to an investigation and potential retaliation and other risks against their will, without the guaranteed support of a GBV case management agency which would be able to refer them to a shelter for their immediate security or offer legal representation and needed psychosocial support.

The ability to respond to GBV is closely linked to the presence of a GBV actor or other trained service providers in the camps, as well as the funds available to support their operations. According to a Centre for Women’s Issues – Diotima study on the identification of refugee women’s needs [8], the number of actors specializing in the protection of women and girls in Greece remains relatively small and the number of those undertaking GBV case management is even smaller. This means that many women and girls who survive violence have nowhere to turn for any type of sustained support. Moreover, with more women and girls starting to live outside of camps, where they are even harder to reach, the need for readily accessible GBV service providers and service provision becomes more pressing. As well, the ongoing transition of service delivery on the islands from NGO providers to the Government [9] may further exacerbate existing gaps and put already vulnerable women and girls at increased risk.

In a positive development, the Greek General Secretariat for Gender Equality (G.S.G.E.) [10] has developed an inter-agency protocol [11] for the referral of asylum-seeking and refugee survivors or those at risk of violence to 40 women’s counseling centres and 21 shelters across Greece. However, as experience shows, state-run shelters for GBV survivors, especially those in Athens and Thessaloniki, are often full and/or inaccessible on evenings and weekends, when the majority of incidents occur. Even when there are spaces available, many shelters lack trained cultural mediators, and some are located in rural areas, leaving women and girls feeling isolated and alone. Moreover, survivors experiencing mental health issues or with older male children do not meet the eligibility criteria for most shelters, leaving them with very few options for safe accommodation. An additional gap was created by the lack of temporary, urgent safe accommodation for survivors who are waiting for a space to be identified in one of the state-run shelters.

What does a GBV response include?

1. Specialized health care, including post-rape care from trained medical professionals for both adult and child survivors.
2. Individual survivor-centered case management, including cultural mediation, psychosocial support, and follow-up.
3. Access to free legal services, including information sessions, representation, and support throughout the reporting process.
4. Safe spaces and psychosocial activities for women and girls, with female staff.
5. Community outreach and awareness with GBV-sensitized staff.
6. Establishment and implementation of referral pathways.
7. Cross-sector coordination and implementation of GBV prevention activities in program design across all sectors.
8. Risk reduction for women and girls.
9. Experts on the ground assess and establish services and needs.

Limited Access to Sexual and Reproductive Health (SRH)

Despite the unique vulnerabilities of women and girls and the lifesaving nature of SRH services, their reproductive needs often go unmet in Greece.
In 2016, it was estimated that 10% of refugee women in Greece were pregnant [12] yet prenatal and postnatal care in camps remains limited. One report found [13] that as women begin to realize they may be stuck in camps for many months, they request long-term family planning options, contrary to the general assumption that they would oppose family planning and other SRH services based on cultural norms and beliefs. Nevertheless, not all health service providers offer these services, and contraceptives, especially long-term birth control, cannot be found in all of the camps.

The lack of trained cultural mediators, females, in particular, further limits already minimal access to public health services, and reports from the field indicate that some medical service providers are unwilling to provide assistance if a woman requests support without an interpreter present.
Finally, the Greek public hospitals lack staff trained in the clinical management of rape, particularly treatments for child survivors, and often do not have post-exposure prophylaxis (PEP) available, putting women and girls at heightened risk for unwanted pregnancies and sexually transmitted infections (STIs) [14]. Shame and stigma coming from a potentially inappropriately trained service provider or community can also negatively affect the survivor’s willingness to receive care.

Women’s Participation and Empowerment

As more people begin to receive refugee status in Greece, many will settle in cities, and camps will ideally become an option of last resort. At present, roughly one-third of the total refugee population in Greece is living in urban settings, the majority in Athens. Nearly all have been in Greece for more than a year. The degradation of socioeconomic conditions and a lack of means and livelihood opportunities in a protracted displacement situation often contribute to increases in intimate partner violence, sexual exploitation, and forced marriage. For example, stress and economic pressures can exacerbate intimate partner violence, women and girls may be exploited by landlords and other men due to their desperate economic situation, and some families may feel forced to encourage women and girls to marry at a younger age to cope with the cost of living.

Further compounding their challenges, many women are excluded from decision-making within the household and/or the community and lack informal support networks that provide healthy outlets for positive coping mechanisms and the opportunity to build resilience. Whilst some empowerment services can be found in some of the camps, the transition to cities is likely to result in dispersed and often inaccessible services, further aggravated by the lack of funded public transportation, a reduction in funding for similar services, and the phasing out of many actors providing women’s protection and empowerment programming in Greece due to insufficient funds. Women’s rights, women’s leadership, and women’s visibility in the public space per se are often side-lined by all stakeholders involved (i.e., Greek Government, donors, and civil society) in light of prioritizing other issues (e.g., cash assistance, shelter).
To address the specific needs of displaced women and girls in Greece, Diotima and the International Rescue Committee make the following recommendations to ensure they are protected from violence and empowered to contribute to all sectors of life to the fullest extent of their abilities.

RECOMMENDATIONS

I.

In their role as Call to Action lead, EU Institutions, and particularly DG ECHO, could play a role by sharing their expertise and tools on preventing and addressing GBV in emergencies with service providers, public servants, and other actors involved in the GBV response in Greece, in line with approaches envisaged under the European Commission’s gender policy ‘Gender in Humanitarian Aid: Different Needs, Adapted Assistance’. Contributing to efforts to end all forms of GBV against female refugees and asylum seekers would also be a key step towards honoring commitments contained in the EU document on the strategic engagement for gender equality 2016-2019.

II.

European donors and EU Institutions must encourage the Greek Government to apply Directive 2012/29 on common minimum standards on the rights, support, and protection of survivors, which makes explicit reference to GBV survivors. The EU, notably DG Home, should also encourage Greece to increase the percentage of funding dedicated to initiatives that protect and serve the specific needs of women and girls. This should go with regular monitoring of progress made by the Government on ensuring women and girls are protected both in camps and in urban settings.

III.

The Greek Government must take all necessary measures to ensure all sectors of the humanitarian response (e.g., water, sanitation, hygiene, camp management) and service providers implement minimum standards for GBV prevention and mitigation outlined in the IASC GBV Guidelines in both camps and urban settings. This includes organising monitoring visits and providing regular training on GBV prevention and response for public servants (e.g., police, army, municipality workers, and camp management) and other service providers involved in the response.

IV.

The Greek Government, in coordination with humanitarian agencies and with the financial support of donors, must increase the availability and accessibility of GBV response services in all camps, while ensuring proper identification of GBV survivors. Clear referral pathways should be available, updated and disseminated in camps by the GBV coordination body.

V.

The Greek Government, in coordination with humanitarian agencies and donors, must increase capacity and provide resources for camp-based and out-of-camp health care to ensure all women and girls have access to lifesaving services, including SRH care. This includes but is not limited to:

1. Female gynecologists and paediatricians, when possible;
2. Provision of family planning commodities and information;
3. Female cultural mediators and interpreters trained on both GBV and medical terminology to provide accompaniment and interpretation; and
4. Linguistically and culturally adapted access to clinical care for survivors of sexual assault immediately after the event, including the increased availability of PEP kits and trained medical professionals across both the islands and mainland Greece.

VI.

The Greek Government, in coordination with humanitarian agencies and donors, must ensure emergency shelter spaces are available for women with pre-existing health conditions (in particular HIV/AIDS), separate accommodation for those with older male children, and that all shelters receive support for female cultural mediators and interpreters trained on GBV.

VII.

International and national organisations, as well as municipalities and other shelter operators, must establish enhanced coordination mechanisms to ensure all available spaces are utilized to meet the needs of women and girls. This will include but is not limited to involvement by the Government and relevant municipalities in working groups, the establishment of clear guidance on referrals to the municipality- and KETHI-run shelters circulated amongst all actors providing GBV response services.

VIII.

The Greek Government must ensure sufficient financial and human resources are made available for a smooth transition from NGO to Government management with no further disruption of essential medical, psychosocial, mental health, and legal services for women and girls on the islands.

IX.

The Greek Government and humanitarian agencies must encourage community engagement and leadership of women and girls, but also ensure sufficient funds for the undisrupted operation of women’s safe spaces and urban centers, to provide opportunities for community support and cohesion.

ΝOTES:

1 UNHCR, “Refugees and Migrants Sea Arrivals to Europe, 2016,” https://data2.unhcr.org/en/documents/download/53447
2 Hellenic Republic, Ministry of Migration Policy, Asylum Service Statistical Data (7.6.2013 to 31.8.2017)
3 UNHCR, UNFPA, WRC (2016). INITIAL ASSESSMENT REPORT: Protection Risks for Women and Girls in the European Refugee and Migrant Crisis. https://goo.gl/R8s6N8
4 Ibid, p.7-11.
5 IASC Gender Guidelines are the internationally agreed guidelines for mainstreaming gender throughout humanitarian response. Women’s Refugee Commission (2016). The EU–Turkey Agreement Fails Refugee Women and Girls, p.13. .
6 UNHCR, UNFPA, WRC (2016). INITIAL ASSESSMENT REPORT: Protection Risks for Women and Girls in the European Refugee and Migrant Crisis, p.7-11. https://goo.gl/R8s6N8.
7 World Health Organization (2016). SEXUAL VIOLENCE AGAINST REFUGEE WOMEN ON THE MOVE TO AND WITHIN EUROPE. p.1
8 DIOTIMA (2016). Identification of refugee women’s needs. [online] Athens, Greece: Centre for Research on Women’s Issues “DIOTIMA”, p.41.
9 The transition began on 31 July 2017, with some NGO service providers already having had their contracts end as early as 31 May 2017. To date, there has been no formal communication from the Government on the transition plan, there has been no organised, formal engagement with the NGOs operating on the islands, and there is uncertainty about how services will be provided as NGOs continue to end their operations.
10 UNHCR Fact Sheet April 2017 https://data2.unhcr.org/en/documents/download/57263
11 Inter-Agency State Protocol of Cooperation for the establishment of common procedures12 Liza Ramrayka, “The Quiet Crisis of Europe’s Pregnant Refugees,” Huffington Post (June 13, 2016).
13 Women Refugee Committee 2016. EU-Turkey Deal Failing Refugee Women and Girls https://goo.gl/jPws8X
14 Oxfam, Diotima, UNFPA, IMC, WRC. A Summary of Assessment Findings and Recommendations The Situation of Refugee and Migrant Women Greece 2016 https://www.law.berkeley.edu/wp-content/uploads/2015/04/WomensRights_BriefingPaper_Greece_Updated_20Jan2017.pdf