“Please help. My brother’s hands are really bad. Come look!”

Saleema, a 16-year-old girl from Syria, walked us over to her family in the registration camp and took off her brother’s gloves. His fingers were dark purple, and he could not move them.

Saleema explained that Mohammed’s fingers became severely frostbitten while crossing the frigid Aegaen Sea two weeks earlier. They then landed on the Greek military island of Farmakonisi, where they had to sleep in freezing temperatures. “We left at night. There were more than 30 people on the boat, and it took us two hours to cross. It was bad, really bad. People were screaming when we got wet from the waves. Everyone was scared.”

We immediately took him to the Medicine Sans Frontiers (MSF) tent right outside the fenced-in registration area, where Mohammed was treated with antibiotics; the doctors said he would keep all his fingers. They told him he could stay with his family only if they found someplace warm; otherwise, he would have to stay with them. At that point, there were still no heaters at the camp, but the new temporary housing facility for families, know as Pipka, had just opened, and some of the rooms there had heaters. Mohammed and his family went through registration, and, together with other families, we brought them there.

The next day, we met Kareem, a Kurdish math teacher from northern Syria. “This is the first time we are treated like humans since we left home,” he told the volunteers who were assisting him finding sturdy shoes for his sons in the makeshift, free “boutique.” He cracked jokes and chatted about Austria, their destination country. “My brother lives there. I want my children to go to school again, and I hope I can teach in Austria. At least I will teach my children mathematics,” he said with a smile.

Frontex did not finish registering all refugees that night because it was already quite late. This meant about 70 people had to sleep in the large, unheated registration tent. We decided to stay overnight with the refugees. Some of them were in poor physical condition, and it was a cold night.

Around 2am, Fatima, a young Afghani teenager, sat up with her eyes closed and started to murmur in pain. Her parents woke up and started talking to her, but the girl was listless in her response. The girl eventually fainted, and we immediately called the MSF doctor on night duty. It turned out she had critically low blood iron levels. Over the next four days, she stayed in the local hospital, but recovered well and could leave with her family on the ferry to Athens, after they received their temporary travel papers. They were on their way to Germany, like so many others.

These individual stories are just a tiny sample of the challenges faced by the unprecedented mass movement of refugees and migrants that began last spring across the Aegean Sea, from Turkey to the Greek Islands. The armed conflict in Syria and Iraq, along with shortages in food and financial resources for Syrian refugee camps, combined with Germany’s outspoken welcome to asylum seekers, are creating the perfect conditions for the movement: dangers at home have never been greater; conditions in refugee camps have never been worse; and a safe country of destination has never been more welcoming.

While the European Union (EU) is struggling to find consensus on a common European solution, it has urged Greece to protect its borders. With more than 3,000 islands, some of them only a few miles away from the Turkish coastline, Greece’s limited financial, human and naval resources were overburdened with refugees, ultimately leading to a NATO deployment of ships in the Aegean sea in February 2016.

Out of 200 inhabited islands, six receive the majority of refugees attempting to cross the sea with small inflatable rubber boats: Chios, Lesvos, Kos, Samos, Kalymnos, and Leros. Leros is the smallest of these islands and the furthest away from Turkey, but it is also one of the least controlled smuggling routes, making it popular despite its long and dangerous sea crossing.

People attempting to reach Leros from Turkey first land on the uninhabited Greek military island of Farmakonisi, which is located 7.5 miles from the Turkish coastline. After being stranded in Farmakonisi, often spending the night without shelter or food on the island, the authorities subcontract external parties to transport refugees to Lakki, the island’s main harbor, where the port police and Frontex register them.

Leros, as the other five islands, is a transit point for asylum seekers. More than 95% of people arriving by boat are Syrians, Iraqis and Afghans, while Iranians, Moroccans, Algerians, and other nationalities represent less than 5%. The demographic composition of people arriving from war-torn countries represent a broad spectrum of the population, predominantly families with young children and babies (more than 50%), elderly people and young men, usually travelling with their families—a stark contrast to people arriving from Morocco and Algeria, mostly single young man travelling alone.[1]

The camp in Lakki is a transit point, providing food, shelter and clothes for 500 to 1,500 people, with hundreds arriving and leaving every day. Depending on the weather conditions, up to 800 people arrive every day. For a few days, they have to stay in the camp waiting to receive temporary travel documents issued by the local authorities and necessary to continue the journey to northern Europe. The journey to Europe depends on the political momentum of the inner-European negotiations and the current situation in transit countries, as borders can be temporarily or permanently closed to asylum seekers. The legally controversial temporary travel documents allow them to move on to Germany and seek asylum there. Passenger ferries take them to Piraeus (Athens) from where they continue their journey by bus to the bottleneck of the Greek-Macedonian border town of Idomeni.

In case of bad weather or of boats having capsized, people arrive at camp in critical physical and psychological conditions. When deaths occur at sea (218 cases in January 2016 alone), the psychological trauma of surviving family members is unimaginable. Social workers provide psychological assistance while people in critical physical conditions are treated by Medicins Sans Frontier and, if needed, taken to the local hospital.

Before large international organizations arrived, volunteers and NGOs served as first responders on the Greek islands. In early 2015, the Leros Solidarity Network (LSN), together with a hand full of local and international volunteers, improvised to provide food, blankets, clothes, and shelter for hundreds of people arriving every day in Leros. Over the summer months International Organizations, NGOs and more volunteers came to the island and formed what can be describe as a small-scale improvised emergency cluster.

The responsibilities and work areas of each organization developed over time, based on human and financial resource constraints. While large International Organizations need time to mobilize resources, civil society and NGOs responded very quickly and efficiently to fill gaps, while official authorities supported these efforts by providing the necessary legal signoff.

Capacity at camp was limited, and Pikpa was the response of the Leros Solidarity Network (LSN) to the increasing number of families with young children in need for a safe place to sleep. The local NGO managed to renovate an empty clinic and opened it within weeks supported by the United Nations’ refugee arm, UNHCR, and approved by the mayor’s office. Current capacity is at 120, and will be increased to 300-400 beds once the renovation of the second floor is finished.

Civil society and NGOs are extremely effective in reacting quickly to humanitarian needs with a very personal touch, as they are in close contact with refugees passing through their hometowns and are not restricted by chains of command, financial constraints and political decision making processes. This was the case in Leros and Kos.

However, once the camps reach a certain size and maturity, hierarchical structures and processes need to be implemented in order to deal with increasing complexity. At this critical point, NGOs and volunteers are at the brink of their capacity. Implementing a more structured approach with policies and processes would allow for economies of scale, facilitating the processing of asylum seekers, however compromising on the personal aspect of humanitarian aid. In order to create a sustainable solution, a joint approach of official actors and NGOs would be most desirable combining a structured operational process managed by professionals with proactive and passionate NGOs and volunteers.

Shifts for volunteers in Leros start at 9:00am and 15:00. In the kickoff meetings the coordinators brief the volunteers about special events and distribute camp work amongst 10-15 volunteers. These volunteers, some independents, some with organizations like LSN, Echo100plus or the Boat Refugee Foundation, are doing the operational day-to-day camp management. Tasks include allocation of new arrivals to tents and housing facilities, managing two additional housing facilities for families, two distribution centers for clothes, shoes, backpacks, toys and hygiene articles, sourcing, sorting and warehousing donations such as clothes, shoes, sleeping bags, tents, diapers; fundraising e.g. for goods of immediate need such as gloves, distributing food, baby bottles and diapers and organizing art programs for children. After their shifts end the volunteers usually spend time with the refugees at camp, playing soccer or chess with the children, listening to their stories and cooking tea together.

Leros is currently in a transition phase, where large international organizations have slowly taken over certain tasks and responsibilities in the maturing Lakki Camp, while at the same time the opening of a new “hotspot” camp in Lepida is underway.

Civil society, through NGOs and volunteers, were the first responders, building the camp from scratch. Once the camp reaches maturity, certain camp functions are handed over to professionals.

UNHCR is focusing on political liaison with Athens and the local authorities, camp infrastructure and protection of vulnerable persons; MSF is running a field hospital on camp; Samaritan’s Purse in coordination with UNHCR is providing new arrivals with reception goods, e.g., UNHCR blankets; Mercy Corps is sourcing and financing three meals per day for between 500 and 1,200 people at camp.

While the Lakki camp, a transit point built and run by civil society, was still operational in January-February 2016, local authorities opened a so-called hotspot in Lepida, on the other side of the bay. The location is highly controversial, as the new camp is built on the premises of a mental institution that has gained a notorious reputation in the 70s due to the inhumane treatment of the patients. Aside from the controversy regarding the location and its history, the hotspot will be fenced and guarded by police. These hotspots are designed by the EU to manage exceptional mixed migration flows, comprising refugees and migrants alike. European agencies (EASO, Frontex, Europol, and Eurojust) will collaborate with local authorities to identify, register and fingerprint people arriving. While “people in clear need of international protection will be identified in frontline member states for relocation to other EU Member States where their asylum application will be processed,” economic migrants from safe countries of origin will be detained at the hotspots and later repatriated.

In January 2016, 52,000¹ people arrived on Greek Islands. If this stream continues, one can expect more than 600,000 people to be registered in the hotspots in 2016, and a significant share of these people—those who are not identified as in need of protection—will be detained and repatriated. In the long run this could turn hotspots into extremely crowded detention camps for people without valid asylum claims.

Relocation of all people in need for protection from hotspots to other EU member states will only be possible if there is consensus about relocation among EU member states and borders are kept open. However, the current political discussion in European destination countries about upper limits (of the number of asylum seekers) and closing of borders show that relocations might come to a halt after limits are reached and borders are closed. This would lead to a drastic increase of the number of people in the hotspots. If borders are closed and people will not be relocated from Greek Islands, the European Union and the international community need to be aware and prepared for the possibility of an emerging humanitarian disaster of heavily overcrowded hotspots and more people dying in the Aegean Sea.

Michael Sarnitz, former Advisor at the International Peace Institute, worked as a volunteer in the refugee camp in Leros, Greece in January of 2016. (More info on becoming a volunteer).

[1] Numbers estimated based on people arriving in Leros in January 2016