Periods Don’t Stop During a Pandemic, But Supply of Hygiene Products in a Locked-Down Refugee Camp Does

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It has been five months of lockdown for refugee camps on the Greek island of Lesbos, the center of the refugee crisis in Europe. While Greece began reopening in May — even welcoming tourists again — the lockdown for the camps, which has been in place since March 17, has been repeatedly extended.

The infamous Moria refugee camp, the largest of the two main camps on the island - and the largest in Europe - is reeling under the weight of the lockdown. Established in 2015 by the Greek government to provide temporary shelter to asylum seekers, the camp was originally designed to hold less than 3,000 people. Today, it holds around 15,000 inhabitants; until July of this year, that number was more than 20,000.

The camp is rightly described as a "living hell" by residents, doctors, and NGO workers alike, where access to food, water, sanitation, and healthcare is continuously threatened by overcrowding in unsafe conditions. And under the pandemic, scarce resources have only become scarcer. For women, access to menstrual hygiene and sanitary materials is severely impacted --- as is their ability to healthily manage their periods, which is crucial for their safety and well-being.

Aid from international organizations and local nonprofit service providers used to be the foremost source for supplies like blankets, clothes, soap, and hygiene products.

But in February, when an anti-migrant fascist movement known as the Identitarian Movement, with members across Europe and the UK, began sinking its teeth into the island for its new frontline --- harassing refugees in the camps, assaulting locals, and even attempting to intercept boats in the Mediterranean --- tensions began to soar. NGO workers and journalists soon became regular targets of violent mobs and brutal assaults. Consequently, service providers had to rethink the safety of their staff, as well as the scale and visibility of their operations.

Then, the pandemic reached the island's shores, and international actors were forced to temporarily shutter operations until restrictions imposed to slow the spread of the virus could be safely lifted.

Worldwide, humanitarian aid groups report that funding for operations unrelated to the pandemic has been cut dramatically; border closures and lockdowns have affected supply chains; and travel restrictions have impacted their access to displaced communities. In the case of those working in Moria, the pandemic has led to an acute shortage of supplies for the camp's residents; worst hit are hygiene supplies for menstruating women and girls.

A deprioritized need

The two main providers of menstrual hygiene products in the camp, Euro Relief and Team Humanity, had to pause the regular distribution of sanitary pads to focus on other essential services. With distributions now at severely reduced capacity, the availability of hygiene products dipped even further. Many of the projects that once provided showers and hygiene materials to Moria residents have also ended.

"Most remaining service providers who are doing COVID-19 relief work are focusing on basic hygiene related to the virus, and women's hygiene needs are still largely ignored," says Ambre Macdougald, a coordinator with Becky's Bathhouse, a Greek nonprofit that provides a safe space, clean showers, and wellness services to women and children in the camp.

Even as NGOs are slowly restarting work as pandemic restrictions ease in Europe, the question of where menstrual hygiene supplies rank on the list of relief priorities is more a question of whether they make the list at all.

"I'd be surprised if they did," says Macdougald.

Additionally, the Greek government imposed new administrative regulations that affect how NGO workers access the camp. Under the new regulations, all NGO personnel are required to register to be authorized to enter the camp. Even staff already working in Moria must seek authorization---a measure, Macdougald says, that only serves to police NGOs and make it more difficult for them to operate.

As NGOs navigate administrative hurdles and the authorities ignore their needs, women in the camp continue to suffer.

"Women continue to have their periods," says Fariba, an Afghan woman refugee and former medical student who lived in the camp for nearly eight months. "The pandemic didn't pause that."

Nilofer, another Afghan woman refugee, lives with her mother and sister in the camp. Under normal circumstances, each of them would only receive four pads per month. "That's far too few pads for all of us to go through the month."

Left with few other options, women must often resort to using old pieces of cloth, toilet paper, or tissue paper instead. "Some women resort to using children's diapers, giving them skin rashes," says Macdougald. "Even access to diapers is extremely limited."

"It's not hygienic, but we have nothing else," says Nilofer.

Only a handful of NGOs are working to address this need --- albeit at a much smaller scale than the need requires. For example, an NGO collaboration between Becky's Bathhouse, The Azadi Project and International Rescue Committee (IRC), distributed menstrual hygiene products to close to 1800 women and girls in Moria in late July. But distributions are otherwise far and few and nowhere near enough to solve the problem.

Camp residents are also facing confined access to supermarkets or pharmacies, which takes away their option to secure supplies from outside the camp --- provided they can afford to do so.

Due to lockdown restrictions, residents are no longer allowed to leave the camp without authorization, which is now only granted for essential movement, such as medical referrals and grocery shopping. Roughly a hundred permits are issued a day --- including for emergency healthcare visits --- which, when serving a camp of 15,000, makes authorization cumbersome to obtain, if not nearly impossible. Police have checkpoints at the main entrances of the camp to ensure that no one slips through to the outside world.

Other than seeking help from the NGO-run clinics to obtain hygiene products, which may or may not be able to help them every time, the women don't have anywhere else to go.

"It is safe to assume that they were already facing limited access to bad quality and quantity of products," says Aanjalie Collure, a humanitarian campaigns specialist. "Now, the opportunity to get it from outside the camp is also impacted."

There are also cultural aspects to consider. "[Some] are not comfortable with using tampons," says Isabel Rueda Molina, a field coordinator for Rowing Together, a medical nonprofit that addresses gynecological needs in Moria. "But even if they were to safely use cloth or menstrual cups, they don't have private spaces to wash or dry them out," she says. "There isn't enough water either."

From their disproportionate access to basic sanitation to their unique needs for menstrual hygiene products that go unanswered, women grapple with barriers that, Molina says, just can't be addressed with only the few NGOs left on the ground. "It needs a systemic solution."

Overcrowding and gender-based violence threatens access

The difficulty faced by women and girls to safely manage their periods in a locked-down, overcrowded refugee camp is further exacerbated by widespread gender-based violence in the camp.

Nilofer says their main worry is for their safety, which restricted their movement even before the lockdown.

Fariba fled from abuse, but her fears never subsided while she lived in the crowded camp, with drunk men loitering around in the night. "I saw their shadows every night when I wanted to fall asleep," she says.

There aren't enough showers or toilets to meet the capacity of people residing in the camp, so residents must often travel long distances and wait in long lines to tend to their needs. And, for women, that often means gambling with their safety in order to do so.

"There are so many people living in a place built for only about 3,000," says Fariba. "How do women stay safe when we share one toilet with 80 people and one shower with 180 people?"

Some parts of the camp are even direr, with more than 180 people to a toilet and more than 500 to a shower. Speaking to BBC Panorama in March, Dr, Hilde Vochten, the medical coordinator in Greece for Médecins Sans Frontieres (MSF), said that there is only one water tap available for every 1,300 refugees, and families of five or six share confined sleeping spaces.

Women often have to hold it in at night rather than run the risk of violence just by going to relieve themselves after dark, which not only causes physical harm but also acute mental trauma. As a stop-gap solution, clinics have sometimes distributed funnels to women so that they can urinate in a bottle instead of harming themselves.

"Under these conditions, a woman's ability to manage her period in a dignified manner is impossible," says Collure.

There was limited human rights oversight in the camp to begin with, triggering riots and protests, and outbreaks of violence were a common sight. With nonprofits halting operations, there are even fewer eyes on ground.

Government inaction worsens impact of the pandemic

Fariba was among the refugees who were transferred from Moria to Athens in mainland Greece starting May, in a bid to decongest the camp, leaving the population to around 15,000 in July.

But the move comes without a real rehabilitation plan, leaving the refugees without cash assistance and shelter during a pandemic. Left without assistance in yet another location, some of these refugees are now stranded and living on the roads, or have found themselves back in refugee camps. Some were lucky enough to have been moved into hotels, but largely, the government's plans for these refugees stops there.

An MSF report has called for a halt in these unplanned evictions and urges the government to identify alternative solutions. The Greek government has urged other European Union countries to take in Moria's residents. Even as countries welcome small batches of vulnerable migrants, such as unaccompanied minors, from Greek island camps, larger relocation plans have not yet materialized. Meanwhile, new arrivals from Turkey continue to keep the migrant population high in Lesbos. Forced deportations and the Greek government allegedly abandoning asylum seekers at sea are only making matters worse.

"If the government keeps trying to shut the camp without caring for the needs of the refugee population, I don't see a long-term solution in sight," says Molina.

And the continued extensions of the lockdown, without concerted assistance from the Greek government, Macdougald says, only proves its indifference for refugees on the island. Their response to the pandemic to ease suffering in Moria has been negligible at best, she says.

As of yet, there are no confirmed cases of coronavirus in Moria. But there have been positive cases of the virus in two other camps and among incoming migrants to the island of Lesbos, raising concern that it's only a matter of time before Moria's residents become infected. Experts have warned that if and when even one case of the virus reaches Moria, the congestion and absence of proper sanitation would make the spread rapid.

As more migrants enter the island, potentially exposing the residents to the virus, the need for improved medical and quarantine facilities is urgent. A petition signed by NGOs and medical groups in Lesbos calls on EU countries to immediately evacuate people from Moria and transfer them to safer accommodations, with access to medical care and asylum procedures.

Meanwhile, the rest of Greece has opened up, and the country has had success in keeping transmission and death rates from the coronavirus low. Those who have seen, worked in, and lived in Moria fear that, even as the world slowly recovers from the pandemic, it will still remain oblivious to the "hell" where refugees in the camp remain trapped.