Seven years of economic depression have not been kind to the city blocks around 17 Halkokondyli St., the office of the Greek ombudsman in downtown Athens. An alphabet soup of graffiti has been splattered across empty storefronts where “for rent” stickers alternate with ads for closing-down sales. Of the two grand squares nearby, Victoria is haunted by touts for people-smuggling gangs, while Omonia is home to a run-down hotel where stolen passports are rented to desperate migrants for $3,200 a go.

It has been tempting amid the fallout from Greece’s historic recession to dismiss the mishandling of the other crisis forced upon it – that of hugely increased refugee and migrant flows – as unavoidable or inevitable.

It is a temptation that Andreas Pottakis is determined to resist. A lawyer who took over as national ombudsman toward the end of 2015, a year that saw just over a million refugees and migrants enter Greece, he is putting the finishing touches to a report on the official response. It is expected to compound recent criticism of the Greek government and the European Commission, which, as by far the largest donor, has been party to all aspects of the handling of the crisis.

The ombudsman says that while it was reasonable to declare an emergency, as the U.N. did when some 31,313 people arrived in Greece by sea in June 2015, it no longer describes the situation the country faces.

“This perpetual state of emergency has overridden all legal provisions, but we’re no longer in an emergency situation,” said Pottakis.

Daily migrant and refugee arrivals, which once topped 10,000, have averaged 45 during the first months of 2017. Of the 1.03 million asylum seekers who have entered Greece since January 2015, only 62,000 remain, according to government figures. This total is inflated according to the U.N. refugee agency, while some European officials and Greek observers believe the real number is nearer 45,000.

As well as the extraordinary lack of clarity on the numbers, the ombudsman found the emergency approach has caused an effective suspension in many cases of rights under the asylum system and a lack of transparency in the administration of a network of refugee camps.

Pottakis, the son of a former minister, has the usual trappings of high office: the boardroom table, a bookshelf heavy on ancient Greek culture and a collection of bric-a-brac attesting to his presence at various European forums. But the ombudsman, who is appointed by the Greek parliament as an independent authority to investigate complaints of maladministration and violation of rights, has had trouble getting ministries to answer his calls.

Neither the Ministry of Public Order nor the recently created Ministry of Migration Policy has responded to requests for information relating to a number of complaints.

Meanwhile, Pottakis has observed a refugee response characterized by huge delays and a lack of planning, overseen by the European Union, which, he said, acts as though “it’s doing its duty by sending money without serious examination of the results of that spending.”

If his main criticism of the E.U. is that it wants “to fund not to manage” the situation, he said the Greek government must help society face the reality of what will happen to many of the refugees and migrants currently in Greece: “Some will relocate, some will be returned and some will stay, but we’re in a constant state of denial.”

Paradoxically, the lack of advanced planning and the absence of the state was less visible while the people flows were at their highest, as most people transited Greece in a matter of days. It was the closure of Greece’s northern borders and the Balkan route in March 2016, followed by the E.U.-Turkey statement facilitating the return of new sea arrivals, that revealed the extent of earlier failures.

Two competing priorities informed the response to the more than 50,000 refugees and migrants suddenly stranded within Greece’s borders – deterrence and integration. At one end of an unbalanced scale, policies were adopted that segregated the refugees from the host population, effectively turning them into a deterrent to future migrants. At the other end lesser efforts were made at integration.

Neither of the refugees’ legal routes out of Greece are functioning as anticipated: The scheme to relocate people to other member states failed to meet one-tenth of its target and has been scaled back; reunification with family elsewhere in Europe proceeds slowly; returns to Turkey have no more than trickled after legal challenges; while voluntary returns to countries of origin have so far had only modest takeup.

Andreas Takis, a law professor and former secretary general for migration policy at the Ministry of Interior, said that Greeks and refugees remain united by their belief that this stranded cohort will not settle in Greece.

“In the minds of Greeks and the Greek state these people do not want to be here and sooner rather than later they will leave,” Takis said. “Combined with the slow pace of relocation this is a disincentive to implement any effective integration scheme.”

It is this cynicism that really governs Greece’s response to finding itself as the main entry point to an unprecedented number of people trying to reach the European Union, Takis asserted. The plan that underpins the state’s apparently chaotic actions is that “by buying time the problem will vanish by itself,” he said.

Now a professor at Aristotle University in Thessaloniki, Takis observes a gradual return to the policies of the past right-wing governments who deployed border fences, detention centers and the coast guard to push back some migrant boats in the Aegean. All in pursuit of dissuading others from the Greek route.

One of the few public voices calling for integration rather than deterrence has been Lefteris Papagiannakis, the vice mayor of Athens, whose brief includes migration and refugee affairs. While the state was all but waving refugees on their way into northern and central Europe prior to the border closures, Papagiannakis argued that efforts should be made to persuade them to stay. He advocates a public awareness campaign to bring Greeks on side and to inform asylum seekers of their options.

“In 2016 we should already have been running, but we played a very defensive game letting time pass,” he said. “We’re implementing something that’s bad and we’re implementing it badly. It’s a compound error and it’s not a mistake, it’s a choice.”

Elena Karagianni was expecting trouble, which is why she took a taxi instead of her own car on January 11 this year. Activists from the neo-Nazi Golden Dawn party had been calling on social media for supporters to picket the school where Karagianni and a team of experts from the Ministry of Education were due to talk parents through plans to begin lessons at the site for refugee children.

Arriving at Neo Ikonio in the grindingly poor port area of Perama outside Athens, she found a cheerful-looking school with exotic birds at play across bright green walls and about 40 protesters shouting, “We don’t want refugees here,” and “They can’t enter.” Among those shouting loudest were a number of thickset men more accustomed to nightclub doors than school gates.

Karagianni’s job was to prepare the ground for 20 or so children, aged between 6 and 15, to be bused in from the nearby refugee camp of Schisto. Local parents had been fed rumors that the refugees were carrying various diseases and their parents were Islamic extremists.

Once the ministry delegation jostled its way inside, the protesters surged in after them led by a member of parliament for Golden Dawn, Yiannis Lagos, who is on trial for charges ranging from conspiracy to murder to racketeering. In the melee that followed, some teachers who tried to block the invaders were punched and kicked to the ground.

The “invasion at Neo Ikonio,” as the Greek media billed the scuffles, came to dominate the public conversation on integrating the children of asylum seekers.

Ten days later, the first bus from Schisto arrived at Neo Ikonio where hundreds of supportive locals and antifascist activists formed an honor guard around the premises. The parents’ association remains divided over the presence of refugees, even under segregated arrangements. Some parents refuse to accept assurances that the inoculated refugee children pose no health risk and have now demanded that their teachers also be vaccinated.

Greece’s education ministry was largely a bystander in the first year of the refugee crisis. The few education projects that sprang up at the refugee camps and informal settlements in the wake of the record influx of people in the summer of 2015 were run by volunteers and nongovernmental organizations.

It was only after the March 2016 closure of the borders and the announcement of the E.U.-Turkey statement – in which Ankara agreed to close down people-smuggling routes in return for aid money and political concessions – that the ministry stirred. A committee was formed that drew on the considerable experience from the previous 15 years of inward migration and Greece’s faltering efforts at integrating newcomers.

According to sources present in the early meetings, ministerial experts were divided into two broad schools of thought. The first favored establishing schools inside the camps, especially preschools, regardless of the camp’s location or access to nearby educational facilities. The second group pushed a more ambitious plan to fully integrate school-aged children into the state school system without delay. The two solutions came to be known by the shorthand of “ghetto” and “integration.”

Without consulting the refugee population, it was decided that preschooling should be kept inside camp walls, even where kindergartens were next door, as was the case at Athens’ former airport at Elliniko.

Alexandra Androusou, a professor at the University of Athens and one of the committee members, said that the ideas laid out were based on “the logic of integration” but that the prevailing climate meant it was tougher to do this in Greece than it was in Germany or Sweden.

“We were doing this with the country on its knees and Islamophobia on the rise globally,” she said.

The two groups eventually agreed to reopen state schools in the afternoons, where refugee children would be taught a basic program of Greek, English and math, IT, art and physical education, but kept separate from the regular school population.  

“It was [a] ghetto that could be made to look like integration,” said one of the experts involved.

One of the byproducts of emphasizing the crisis aspect of increased refugee flows has been the consequent assumption that Greece has no past experience relevant to the scale of the current challenge.

In fact, since the 1990s some 2 million migrants had entered Greece, many of them without legal status. From the families they brought with them or began in Greece, an estimated 140,000 children entered the Greek system. Many of them had been integrated into mainstream schools via the “reception class” system, which saw specially trained teachers attached to existing schools to offer support lessons such as Greek as a second language.

Children enrolled in the reception classes would undertake intensive language instruction but attend other classes such as physical education with their fellow schoolmates. At regular intervals the reception teachers would recommend non-Greek children who were ready to join mainstream classes.

“The experience from 1990 onward was just thrown in the rubbish,” said a ministry official on condition of anonymity. “All they needed to do was invest in what was already working for 20 years instead of putting money in the semi-ghetto.”

But the reception classes also have critics. Karagianni, a teacher with two decades of experience, said that those opposed to the afternoon schools have ignored many of the failures of the reception class system: “A lot of children got lost in that system and a lot of schools were badly affected,” she said.

The afternoon school approach is also accused of disregarding an important human resource. Roughly 1,500 teachers had undergone specialist training under the reception class system, paid for by E.U. funds. Efforts were made to deploy them in the new segregated system, but these were resisted by unions, who wanted all their members to be eligible. So the ministry turned to the larger pool of substitute teachers, many of whom have been waiting more than a decade for a permanent position, to recruit the 600 educators needed to put an estimated 10,000 refugee children aged between 5 and 15 into school.

Unlike the reception class veterans, the substitute teachers often had no relevant experience at teaching children with vastly differing levels of education and language skills. Under the Greek education system, substitute teachers need to earn enough “moria” or points to secure a full-time contract and a place in a school near one of the handful of major urban centers. The fastest way to collect points is to volunteer to teach in faraway and unpopular locations for which the ministry struggles to recruit teachers.

The 600 substitute teachers would be offered only half-time contracts at the afternoon schools, which offered only three hours of instruction. Half the hours meant half the income and half the points. Such was the discontent among teachers that the lottery – in which substitute teachers enter their names – had to be run three times before the roster could be completed. Anger over the contract situation eventually led the ministry to offer some full-time contracts early in 2017.There is frustration that European Commission funding mechanisms meant it was comparatively easy for NGOs to tap funds for informal education projects -- Save the Children, Norwegian Refugee Council, Terre des Hommes were collectively awarded $22.7m for programs that included educational elements -- but support for Greece’s education ministry was minimal.

The decision to stage “welcome ceremonies” at the afternoon schools is also seen by some as a critical mistake. As the September 2016 deadline to enroll refugee children loomed, symbolism was allowed to trump the more practical concern of keeping a low profile.

“Despite its moral and political importance, such symbolism made the schools a target for all malcontents,” said Andreas Takis. “It made them visible and gave groups like Golden Dawn a target.”

At one school in Halkida on the vast island of Evia, north of Athens, the arrival of 17 refugee children in October sparked protests similar to those at Perama. Children had to be escorted into the Paralia Avlidas school by armed police in scenes reminiscent of the historic civil-rights unrest in the U.S. The protests stirred at the 160-pupil school came despite the fact that 75 pupils already enrolled in the mainstream morning school were non-Greeks. Parents were told by a local extremist and Golden Dawn supporter that the refugee children were sick, hungry, that their parents were ISIS supporters and the boys would rape their daughters.

When classes did start, refugee children found the substitute teachers to be demoralized and classes boring. A Syrian boy told a visiting Education Ministry official that there was little difference between his camp life and school. The only thing he liked about the school was the brief crossover where the morning and afternoon pupils would play football together.

Meanwhile, in Ambelokipi in central Athens, one of the neighborhoods with the highest support for Golden Dawn at the last election, one of the local schools enrolled nine children from Syria and Jordan into the normal morning school without any fanfare. No parents protested.

Enrollment at the afternoon schools has fallen far short of expectations. The U.N. estimates that roughly one in three new arrivals in Greece is a child. With official numbers maintaining that there are 62,000 refugees in the country, that ought to mean a school-aged population of nearly 20,000. Experts believe the number of 5- to 15-year-olds – the age group selected for the afternoon schools – is closer to 10,000. By Christmas of 2016, only 900 of them had been enrolled. By April 2017 that figure had climbed above 2,000. Outside of the afternoon schools, a further 700 refugee children have been enrolled in mainstream morning schools under ad hoc arrangements.

Rory Fox, a British former headmaster who now leads an education charity called Edlumino, witnessed some of the chaos in northern Greece. Fox, who has run classes in camps from France to Iraq, said he came across inexperienced and unmotivated substitute teachers and camps where educational “activities” on offer from international NGOs meant anything from formal instruction to face-painting.

“The level of bureaucratic inflexibility was astonishing … In Iraq, even though there’s obviously still a war going on, it’s so much more organized.”

Organizations, among them Edlumino, wanting to run classes in camps were made to wait for six to eight months for permits from the migration ministry, said Fox. In September 2016 the European Commission announced a further 115 million euros ($125 million) to alleviate conditions in Greece and named access to education for refugee children among the immediate priorities.

Fox equates the education challenge of reaching 10,000 children with establishing and running eight large secondary schools: “It’s a perfectly doable proposition.”

In January, Edlumino ceased operating in Greece, citing the chaos over failed winterization of the camps, which further complicated education efforts as children enrolled in afternoon schools were scattered to new locations to escape the cold.

Alongside the 600 substitute teachers, the Ministry of Education hired 62 refugee education coordinators (RECs) among whose number was Karagianni. Their job was to enroll children, inform parents, support schools and manage the transport to and from camps for which the International Organization for Migration (IOM) was being paid.

Christos Stefanou, the REC at the Elaionas, one of the largest and best served of the camps in Greece, said that persuading parents, many of whom still see their stay in Greece as temporary, to make sure their children enroll and continue to attend has been harder than expected.

“The children have one foot in Greece and the other in Germany,” he said. “Their dreams are in Germany but they find themselves in the Greek reality.”

While those on the mainland made limited headway, the seven coordinators sent to the Aegean islands found themselves with an even more thankless task. Five of the seven were sent to Lesbos, the island once famous for ouzo and olives that received the bulk of sea arrivals from spring of 2015 onward.

One aspect of the deal between the E.U. and Turkey that became clearer in the months following March 2016 was that new arrivals would be confined to the islands other than in exceptional cases. While it appears nowhere in the text of the statement, both the Greek government and the European Commission have made it clear in practice. Travel to the mainland from the islands is barred to refugees and migrants.

With a political deal in place to reduce the numbers of arrivals, islanders were promised that the transit centers operating since the year before would gradually close. No one from the government or local authorities braced islanders for the notion of integration. In an initial meeting on Lesbos with local teachers to inform them about plans for afternoon schools, one of them said: “If they want to leave, we should let them leave. I’m sick of working for the refugees; send them back where they came from.”

It was the RECs themselves who had been duped. “We quickly understood that the kids were not going to go to school,” said one coordinator.

Officially, the delays were put down to the need to register and vaccinate refugee children. When this was done inside one week, nothing changed.

“There’s no reason for me to come to work,” complained one of the coordinators. “All I have to do is register once every two weeks.”

Meanwhile, inside Moria, a government-run camp on Lesbos, education activities were dealt with by seven locals from the rolls of the long-term unemployed, under a make-work scheme that offered them 490 euros ($532) per month. None of whom had any relevant experience. They were put under the charge of the site’s sanitation manager who told them they could do whatever they like. Some took the money and “sat around smoking and drinking coffee,” said one of the team. Others made an effort to use a temporary building set aside as a school area. Inside, all they found were chairs in a locked crate: “We have so much money, so many funds and here we don’t have pen and paper,” said another member of the unemployed group.

The consequences of the delays and mismanagement have not been confined to wasting money. Poor enrollment at afternoon schools stems in part from the decision to ignore parents’ obligation to send children to school. Classes staged in camps, even when well-structured, are not compulsory. In numerous cases poor coordination has seen NGOs stage alternative activities, like soccer tournaments, during what are meant to be school hours.

With thousands of children out of school for more than one year, many of them in poorly run camps, they are vulnerable to exploitation. A Harvard University report released in April found an “epidemic of child abuse and sexual exploitation of migrant children in Greece.” When the IOM commenced school runs from one camp in the Athens area recently, the bus driver was shocked when one young refugee boy spoke to him using the only phrase he knew in Greek: “Five euros in the ass,” he said.

The abandoned airport at Elliniko, a greenfield site stretching for more than 400 hectares between Athens’ coastal highway and the concrete artery of Vouliagmenis Avenue, has been a popular canvas for grandiose ideas of rejuvenation. The 2004 Olympics left it with a handful of expensive and largely useless sports venues. Since the airport’s closure in 2001, repeated efforts to develop a giant park on the site have run afoul of competing political and economic interests.

These days Elliniko is shorthand for the interlocking crises that afflict Greece. Its crumbling arrivals and departures buildings, derelict but not demolished, are strung with streets of sheets dividing the tents of warehoused refugees brought here temporarily but remaining indefinitely.

On the inland side of the Elliniko labyrinth is the Metropolitan community clinic, another symptom of systemic collapse. It is one of the 50 or so solidarity clinics that have sprung up across Greece to provide free health care to those unable to access the public system. It was opened in 2011 by cardiologist George Vichas and operates with the help of volunteers and donated medicines.

When it opened its doors, Dr. Vichas explained, the most urgent needs came from the roughly 2 million Greeks and migrants left unemployed and uninsured. In the pre-crisis years, public hospitals had been able to absorb the relatively low numbers of uninsured, but spiking joblessness and budget cuts changed that.

Elections in 2014 saw leftists in Syriza sweep to power, in part on

the promise to bring the uninsured back into the public system. That promise was kept with new legislation, but in the face of austerity demands from its creditors, bigger budgets did not follow.

“In Greece you need to keep in mind what the law says and what happens in practice,” said Vichas. “When you give access back to 2 million people, it means you need to invest more in the public system. This did not happen.”

Vichas describes a hollow public health system with cascading debts that rebound between social security funds, hospitals and pharmacies. This is the context in which recent asylum seekers have arrived. Unable to get the care they need, a growing number of them find their way onto the doctor’s desk. He picks up a note, a reminder to seek out treatment for a refugee with kidney stones. In the past it would have meant calling in some favors; now in a bankrupt system it will mean phoning around hospitals with the requisite equipment and haranguing them, he explains, sometimes with legal threats.

While the borders remained open until March 2016, the health problems that arose for refugees were largely testament to the epic journeys they had undertaken. Upper respiratory tract infections and trauma from walking long distances and sleeping rough were common, as were skin conditions and gastrointestinal problems. Medecins Sans Frontieres (MSF), a medical charity, said that 93 percent of cases they encountered in this period related to travel.

Around the peak of the people flows in September 2015, as unprecedented numbers of refugees and migrants crossed from Turkey to the Greek islands, Jean-Claude Juncker, the president of the European Commission, admitted that Greece needed human resources. He listed border police and coast guards, asylum service workers and judges. He made no mention of doctors and nurses.

Apostolos Veizis, who was tasked with managing MSF’s relationship with the humanitarian and medical sector in Greece, including the public health system, divides the story of refugees and healthcare into two chapters. In the first of these, Greece was a place of transit, and the majority of refugees were so intent on continuing their journeys that most would stop for no longer than was necessary for a spot check. During this period the Ministry of Health was not present, said Veizis, leaving the “hotspots” where new arrivals were meant to be registered and assessed on the eastern Aegean islands to the Ministry of Migration Policy and the European border agency, Frontex.

When the second chapter began in the wake of the E.U.-Turkey deal and the closure of the Balkan route, the full scale of the health needs of a stranded population emerged. As well as chronic illness, disabilities, pregnancies and newborns, a host of mental health symptoms were waiting, from depression and anxiety to post-traumatic stress disorder.

The sudden closure of Greece’s northern exit failed to dissuade many refugees already en route from the islands, and thousands piled up on the border with the former Yugoslav Republic of Macedonia near the village of Idomeni. A tented settlement of more than 10,000 people emerged over the next three months, with MSF providing the bulk of medical services.

When Greek authorities did step in during May of 2016, it was to dismantle the camp and remove most of its residents to a hastily assembled network of army barracks and disused factories in northern Greece, chosen without consultation with health experts.

From there onward, Veizis said, it was the harsh conditions and health hazards at the camps themselves that were manufacturing mental and physical illness.

“You’re treating people and then sending them back to the place that made them sick to begin with,” he said.

Meanwhile, the isolation and uncertainty of the refugee population’s new circumstances proved a breeding ground for mental health issues. MSF psychologists in Lesbos have seen depression cases more than double since March 2016 and the percentage of those with post-traumatic stress disorder increase threefold. Symptoms of psychosis have also spiked. This all coincides, said Veizis, with more patients with severe trauma, and more cases of self-harm and suicide attempts.

”In the past, anxiety was the No. 1 health problem we treated in our mental health programs, largely because people arriving in Greece came from war and conflict or experienced trauma getting to the Europe they dreamt of,” he said. “The No. 1 health problem we see is no longer anxiety. It is depression, aggravated by the dismal living conditions, lack of information and uncertainty.”

Despite having the power on paper to inspect and close sites that were a public health hazard, Greece’s health ministry largely kept its counsel until July 2016. That silence was broken by Greece’s Center for Disease Control and Prevention (KEELPNO), which conducted a survey of 16 camps and called for their immediate closure. The report, which was ignored by the migration ministry, cited everything from inadequate clean water and sewerage to asbestos exposure, chemical pollution and, at some sites, the risk of malaria.

“Operation of the reception centers, not only due to current organizational and coordination weaknesses, but mainly as a strategic approach … should be discontinued,” KEELPNO’s vice president Alexis Benos warned. “It is useless and dangerous for public health to treat this as a crisis of a few months.”

The arrival of the European Commission’s department for overseas humanitarian aid, ECHO, deployed at scale inside the E.U. for the first time, changed the picture for health. From the early summer of 2016, MSF, which has renounced all E.U. funding over its migration policies, stepped back from primary healthcare. European Commission funds went to the International Federation for the Red Cross and Doctors of the World for basic medical services, while several other international NGOs received money to improve water, sanitation and hygiene conditions.

Doctors and medical staff from the Greek army and police were deployed as a temporary fix to the network of refugee camps, and discussions began in August to tap European funds for a more stable response. The groundwork was laid between Greece’s health ministry and the European Commission through its Asylum, Migration and Integration Fund (AMIF) for a new program called Philos, Greek for friend.

The $25 million program was meant to hire and train nearly 600 medical staff, from doctors and nurses to interpreters, under the National Health Operations Center (EKEPY), who would gradually replace the NGO medical teams with public health units and reinforce the health system in areas hosting refugees and migrants. When it was pointed out that EKEPY had no legal basis under Greek law for the necessary hiring spree, the appointments were farmed out to the center for disease control (KEELPNO). Unfortunately, this made the Philos program hostage to a power struggle inside KEELPNO, where the previous head of the organization was suing the government after refusing to resign and denouncing his replacement as “unconstitutional.” The appeal went to the Council of State, Greece’s supreme administrative court, which found in favor of the ejected boss. The effect of the tussle was that Philos, which was meant to begin in October 2016, announced its first appointments on February 27 this year.

Agapios Terzidis, KEELPNO’s senior official working on Philos, said that the funds, which come from an emergency facility, run out at the end of 2017. “The challenge for us is to try and turn this into a long-term program for integration and we will be looking for new funding,” he said.

Far from replacing the NGO teams, Philos has struggled to attract experienced doctors and interpreters and has not been able to operate independently. Doctors of the World, which had been due to cease operations on Lesbos before the summer, has been asked to continue, and negotiations with the government are ongoing.

There is another bureaucratic barrier to healthcare to surmount. The key to accessing Greece’s troubled public health system is a social security or AMKA number. Under the new Greek legislation, passed by Syriza, asylum seekers are entitled to an AMKA as long as they have the certificate of preregistration from the Greek asylum service. However, many refugees and migrants find there is a Catch-22 situation waiting for them at the citizens’ service bureau (KEPs) when they try to get one. The legislation also called for I.D. cards known as KIPAs to be issued, something that never happened. In many cases, bureaucrats familiar with the legislation demand that the asylum seeker present a card that does not exist in order to get their health number. This was belatedly recognized by the authorities, who have scrapped plans for KIPA cards. Meanwhile, some NGOs have taken to sending their staff to accompany applicants and drawing up lists of “friendly” KEPs.

The delays and dysfunctions of Philos have underlined the difficulty of supporting one vulnerable population – refugees – in isolation from another vulnerable population – struggling Greeks and residents of Greece. Lenio Capsaskis, a fellow at Chatham House in London whose research focuses on access to the Greek healthcare system for refugees and migrants, said that many of the challenges facing refugees “are similar to those faced by poorer Greeks.”

The focus in earlier phases on providing round-the-clock primary healthcare inside camps is ill-suited, expensive and wasteful, said Capsaskis, when that population begins to disperse to urban areas. Many of the health problems requiring treatment necessitate a referral to specialists or hospital facilities. Reform efforts must focus on reinforcing “a system which was already stretched before austerity or the refugees” and must do so for the benefit of both refugees and Greeks, she said.

Mytilini, the grand and dilapidated capital of Lesbos, was built on the back of its proximity to Turkey. Its seafront and hillsides are decorated with mansions that announced the fortunes made trading with the Ottomans across the water. In more recent times and in common with the rest of provincial Greece, it has found that its location far from Athens is no longer a boon.

“The further you are, the worse the health system is,” said Eirini Koumpa, a doctor on Lesbos, who works in the public system and volunteers at some of the charitable refugee shelters on the island. “So for years we’ve had to find alternative ways to help people.”

Even though there has been a tenfold decrease in the refugee population on the island from its 2015 high of more than 30,000, the limits of local healthcare workers’ improvisation have been reached. Dr. Koumpa said the donors’ pretense that refugee and public health can somehow be segregated is starting to inflict real damage. She gave the example of blood tests to illustrate.

While NGO teams on the island have the capacity to prescribe medical tests, they cannot carry out the tests themselves. That job falls to the two public health laboratories in Mytilini, which have a daily capacity to process roughly 100 tests. They now find themselves receiving up to 80 urgent tests in addition to their previous workload. Adding to the frustration, said Koumpa, is the fact that some of the NGO-requested tests appear unnecessary.

“These guys order expensive tests, but the question is not whether they are expensive. It’s whether they’re useful,” she said.

The backlog has seen staff shun breaks and work overtime, but they cannot meet the demand, and appointment slots for non-emergencies now have long waiting times.

“When local Greeks come and are told they can’t have an appointment for two months, this creates an angry response from the local community,” said Koumpa.

In theory, the Philos program should have eased the burden. In practice, it is not hiring the right people and is limited to mainland Greece, no provision is made for the islands. The project prioritizes placing unemployed or recently qualified medical staff, rather than hiring the specialists required in the field such as general practitioners, pediatricians and internal medicine specialists.

“You need to hire on the basis of your needs, not see it as a tool to combat unemployment,” said Koumpa. “There are no unemployed specialist doctors and nurses.”

Something wholly unexpected happens when you open the door to the laundry at Pikpa on Lesbos, an abandoned holiday campsite that has been transformed into a refugee shelter on the eastern Aegean island. Multicolored lights dance across the chrome and white fronts of the donated washing machines, as nearby speakers belt out Abba music, and a disco ball spins and sparkles.

The disco laundrette is the brainchild of Simos Simoleon, the volunteer caretaker whose Mohican hairstyle and slightly crooked smile have become everyday staples of life at Pikpa. Simos has fond memories of bygone summers when he was a D.J. at a bar on the island, and he thought others might enjoy a revival.

The site hosts vulnerable refugees and migrants, and outside there are picnic tables, simple wooden chalets and inflatable shelters that appear to have rolled into place under the trees like giant footballs. Colorful murals that owe more to enthusiasm and peace slogans than artistry decorate the administrative building. The vibe here, as in many of the charitable refugee shelters in Greece, is more kibbutz than camp. Situated a short drive to the south of the city of Mytilini, the only chain-link fence to be found belongs to an adjoining tennis club.

A longer drive north takes you to the hillside of Moria. The refugee camp here has had a succession of names, from transit and open reception center to pre-departure center. In the nomenclature of European policymakers, it is a “hotspot.” There are five of them on the Greek islands “designed to inject greater order into migration management,” according the European Commission, “by ensuring that all those arriving are identified, registered and properly processed.”

Amid the twisted trunks in silver, green and gray of the surrounding olive groves, the hotspot is composed almost entirely of right angles. Its palette is white and stainless steel. Nested wire fences are sunk into rough concrete foundations, with single or stacked containers for buildings. Circles break up the square landscape in the spirals of razor wire that top the walls. Tons of gravel have been poured to banish the mud of the winter past.

“It is an architecture that is the very antithesis of shelter: they are spaces designed to engender fear, compound uncertainty and maximize a sense of exposure to danger.”

These are the words of Suvendrini Perera and Joseph Pugliese, two Australian professors of cultural studies. They were not writing about Moria but Australia’s offshore refugee and migrant holding camps. Nonetheless, their basic points chime with many past and present residents and aid workers at Moria.

The closest it has to a disco is a string of cantinas near the front gates and an unofficial back door – a large hole in the fence where used condoms and empty beer cans hint at its nighttime traffic. Inside the fence, next to a group of Pakistani men making omelets, Senegalese and Nigerian men gather to talk. The recent death of a Cameroonian man after he was treated for an unknown illness at a local hospital has spooked residents.

“They are producing mentally disordered people here,” said Samuel Chidi Nduka, a 32-year-old Nigerian. “If you want to go mad, just come to this camp for one week.”

Despite Moria’s fearsome appearance, it is not a detention center. It contains one, which is euphemistically known as a pre-departure center, and it houses migrants whose asylum claims and appeals have been refused and who face being returned to Turkey. Everyone else is free to come and go within the confines of the island. In this respect at least, it performs the same function as Pikpa.

These two strongly contrasting models of shelter have dominated discourse on the housing of refugees and migrants in Greece. They have done so almost to the exclusion of another model, private accommodation in normal homes and apartments. This third way by now houses more asylum seekers than either camps or charitable shelters on mainland Greece.

In September of 2015, as the E.U. reeled from the scale of new arrivals, it announced a grand bargain designed to persuade Greece to deliver adequate shelter for refugees in return for other member states sharing responsibility. Under the two-year plan, some 160,000 asylum seekers would be relocated from front-line states under a quota system, with 66,400 from Greece, 39,600 from Italy and 54,000 Syrians from Turkey. A month later Greece undertook to provide 50,000 “reception” places for asylum seekers with European Commission funding, and the U.N. refugee agency said it would support that total by contributing 20,000 places in private accommodation for those taking part in the relocation scheme and others identified as vulnerable cases.

Progress in the first six months was slow, but this raised few alarms as Greece was still primarily a transit corridor during later 2015 and early 2016.

It was not until March when the Balkan route closed and the deal with Turkey was announced that the European Commission demanded to know where its 20,000 places were and the UNHCR was forced to admit it was nowhere near. It had fewer than 900 places. It would take until December of 2016 to hit its target, fully 14 months after the initial agreement.

As well as rented private houses and apartments, families were invited to host asylum seekers as paid lodgers. NGOs were also given scope to lease hotel rooms – something the U.N. refugee agency did directly in some cases – as well as renovate or repurpose buildings. Even with these broad definitions, progress did not meet expectations, and UNHCR had to carry out two rounds of public calls for expressions of interest.

“Some of them needed refurbishment and almost all of them needed to be furnished, connected to electricity and equipped with household appliances,” said Giovanni Lepri, the UNHCR’s top official in Greece. “Contracts were concluded in time but the refurbishments and other preparations didn’t always go as planned.”

Local partners with experience of working at this scale were hard to find, and the work was parceled out to 10 different, primarily local nongovernmental organizations, as well as the municipalities of Athens, Thessaloniki and Livadia in central Greece. A further four NGOs were contracted to provide medical and legal services to asylum seekers making the move to private accommodation.

“None of them had managed projects of such magnitude as was now expected of them under the UNHCR program,” said Lepri.

The bulk of the places had to be found in and around Athens, as Thessaloniki, even after a year, had found only 353 places.

Further controversy was stirred by the decision to prioritize families and individuals awaiting relocation to other E.U. countries. Initially the private accommodation option had been envisaged as a way of persuading mainly Syrian refugees to engage with the relocation plan and take a legal pathway into another E.U. state rather than trek the Balkan route. This had very limited success while the borders remained open and should no longer have been necessary after they closed.

“The paradox was that accommodation was provided to relocation candidates in apartments in urban areas, whereas the population that will remain in Greece and therefore needs to be integrated, such as Afghans and Iranians, is mostly channeled to camps in isolated areas,” said Eleni Takou, from Solidarity Now, one of the Athens-based partners in the scheme.

“It channels the people most likely to stay in Greece into isolated facilities, which hampers their access to education, the labor market and generally any prospect of integration.”

The irony is that the decision to use the private accommodation as a sweetener to increase takeup of the relocation program collided with opposition among some members of the E.U. to receiving asylum seekers. Hungary staged a referendum to demonstrate its opposition to receiving asylum seekers from Greece, Italy and Turkey, while others have more quietly opposed quotas.

After nearly two years of threats of fines and pleading with member states to “show solidarity,” the European Commission effectively conceded defeat in April 2017. Only 11,300 people have relocated from Greece against a target of 6,000 per month. Even fewer have left Italy and the target for the whole relocation program has been scaled back to just 30,000.

On the ground in Greece there has been a de facto uncoupling of the private accommodation scheme from the relocation program, with as many as 40 percent of places now occupied by people seeking asylum in Greece or awaiting reunification with family elsewhere in Europe.

European funding currently runs to the end of 2017 with no deadline set for a decision on continued support. The U.N. refugee agency is hoping that the scheme can be passed on to the Greek government to be used belatedly as a tool for the integration of those asylum seekers staying in the country.

“We are confident that both the government and the commission will support its continuation and will see it as a viable alternative to camps, a project to learn from and an experience to build upon, when the time comes for the Greek authorities to take it over,” said Lepri.

The delays and bureaucratic logjams encountered in the private accommodation effort pale in comparison with the chaos that unfolded in the network of refugee camps meant to support the other 30,000 places. In the six months that followed its commitment to find 50,000 reception places, the government response was characterized by inertia.

Only in February 2016, when Greece was accused by its European partners of funneling refugees and migrants out of the country with minimal checks, and its place in the passport-free Schengen zone was threatened, did it act. The Ministry of Defense was tasked with setting up spartan but functional facilities at the five hotspots and work that was completed within 10 days.

When the border closed on March 9, the two main refugee settlements on the mainland were the dockside in Piraeus and the old airport at Elliniko. In both cases the Greek state was largely absent, leaving it to charities and volunteers to alleviate harsh conditions. The same pattern held in Idomeni during the spring, when thousands began to camp in the fields.

Behind the scenes, Greece’s minister of migration and a kitchen cabinet of advisers had decided on a remarkable strategy of scattering small camps all over the country. It came to be known as the “refugee archipelago” – some 46 separate facilities, ranging from disused army barracks and industrial sites to remote villages in the mountains near the border with Albania and a rocky scree in the foothills of Mount Olympus.

The strategy was driven, according to officials involved, by a desire to avoid the creation of large refugee ghettos.

In practice it placed an administrative burden on the government that it could not bear. Infighting at the new ministry compounded the mess with precious time lost in the summer of 2016 as the minister Yiannis Mouzalas fell out with one of his lieutenants, Odysseas Voudouris, who had been appointed to run a general secretariat within the ministry tasked with much of the camp administration.

Complicated funding arrangements further muddied the picture. The E.U.’s department for overseas humanitarian aid, ECHO, according to its mandate, can fund only international aid agencies, not offer direct budgetary support to the government. This arrangement allowed Mouzalas to deflect blame for chronic delays and appalling conditions onto the NGOs and the U.N. But the Greek government remained the key coordinator and decision maker and was identified by several NGOs and foreign diplomats as the main bottleneck.

A report from Voudouris that was supported by ECHO, calling for all but 24 of the camps to be closed, was shelved. No other strategic plan detailing which camps were to be prioritized and developed was advanced in its place. The appointment of camp directors was left to an informal parallel system, leading to serious problems in the chain of command and confusion among refugees as to who was in charge.

The scale of the failures in the camp system became evident from November 2016 onward when a relatively harsh winter arrived with thousands of refugees still living in tents. The Yazidi population near Mount Olympus was removed from tents and placed in rented rooms only 24 hours before the first snowfall.

Heavy snow around Thessaloniki a month later hit similarly exposed sites before people could be moved. Identical scenes unfolded on the islands. At Moria on Lesbos, three men died in the space of a few days while sleeping in tents in the snow. The results of an official autopsy have yet to be released, but witnesses said the men appeared to have died after inhaling fumes from debris they were burning to keep warm.

According to the latest migration ministry figures, more than 18,000 refugees and migrants remain in camps on the mainland, with a further 7,500 in official facilities on the islands. The ministry insists that the refugee and migrant population in Greece remains stable at 62,000 but the numbers do not add up. The U.N. publicly disagreed with the ministry figures in December, and no credible total has emerged.

Solidarity groups in Athens estimate that 1,500 refugees are living in 18 squats in the capital. Thousands of asylum seekers have abandoned the camps and either been smuggled across the northern borders, attempted the sea route to Italy via smugglers or bought fake travel documents to leave via the airport. The government is reluctant to acknowledge these departures for fear of destabilizing the E.U.-Turkey deal or encouraging other E.U. member states to return asylum seekers to Greece under the reactivated Dublin regulation – the system meant to ensure new arrivals seek asylum in the country of entry.

Even the most fervent supporters of the archipelago strategy now concede that at least half the camps must close. Many of the worst sites in the north – including the Karamanlis tannery with its hanging asbestos roof panels and Vagiohori, where asylum seekers were left to freeze in plain sight of unconnected hot-water pipes – have been de facto closed after being abandoned.  

The ministry now plans to reduce the number of camps from 46 to 23, but has not published a timescale or a list of facilities due for closure.

When Abdullah Alkiem arrived on Chios he thought he would be on the island for only a few days. That was nearly 14 months ago. The 26-year-old Syrian, who grew up near the ancient wonders of Palmyra, since partially destroyed by ISIS, has spent most of that time in the fetid mess of Souda, a tented slum hemmed between two walls of a medieval citadel near the port of Chios.

A tramline of UNHCR tents and plastic huts that runs for less than a kilometer along what was once the castle moat, Souda has no clear legal status, much like its residents. And like them, it is not going anywhere.

During his time in Souda, Alkiem said that he learned to cope with the mosquitoes and snakes that are drawn to the damp old walls, the fights between rival nationalities and the mounting drug and alcohol problems. He also admitted he cannot sleep through the night and that he has aged dramatically. As he speaks he fidgets, his bloodshot eyes flitting from one plane of focus to another. A trained nurse, Alkiem knows he is not well.

“I have no peace. Maybe my phone will ring now, and someone will tell me I’m getting my papers. But any time I could be told I’m being sent back to Turkey.”

His application for asylum has been refused once, and he has appealed. Since the E.U. agreement with Ankara, Turkey has been established as a safe third country of return. This is being challenged in the high court in Greece where a decision is expected in May. At the interview, Alkiem was bewildered to discover that asylum officials had no interest in the horrors he lived through in Palmyra: “All they asked about was what I did in Turkey, how long I was there.”

There is no information on the progress of his appeal.

“I cannot live like this,” said Alkiem. “Who can live like this?”

According to a growing number of critics of the current asylum system, his situation is more a product of design than accident.

In December of 2013, an audio recording purported to feature the voice of Nikos Papagianopoulos, then Greece’s chief of police, was leaked. In it a man identified as Papagianopoulos tells other senior officers that they must step up detention of migrants: “We have to make life here unbearable … The other guy needs to know that if he comes to this country he is going to be put inside, otherwise we’re doing nothing.”

The alleged comments were condemned by Amnesty International, which linked them to violent pushbacks of Syrian refugees trying to cross by sea from Turkey. A little over a year later the radical left coalition Syriza came to power vowing to bring an end to the deterrence regime. They made good on this promise, and their first six months in office coincided with a huge exodus of people from Syria, many of whom crossed into Europe through Greece.

Today, Chios is the testing ground where Greece and the European Union will decide whether managed migration is more than just a euphemism for a return to practices such as indefinite detention. In recent weeks Chios has overtaken Lesbos for sea arrivals, with 825 refugees and migrants crossing during March.

Chios islanders divide the refugee crisis into before and after the E.U.-Turkey statement. During the first period, the main square in the city was transformed into a transit camp, and locals mixed with outside volunteers under the imposing palm trees to patch up and ship out new arrivals to the mainland.

The March 2016 deal changed everything. Promises from the migration ministry that Chios would be emptied were broken. Attempts to open a new hotspot facility at Vial in the hills outside the city as a detention center collapsed as hundreds of inmates pushed their way out and came down to the port to protest, eventually camping at Souda. Far from emptying, Chios now has an estimated 2,700 asylum seekers.

The Chios bar association has denounced the deal with Turkey and accused the E.U. of sacrificing the island as part of its deterrence strategy: “This practice largely constitutes a political and strategic decision, so as to avoid/suppress mass inflows, using the islands as a geophysical boundary within which the refugees and irregular immigrants are contained for an unknown period of time,” the lawyers said in a statement. “Thus engendering an unwillingness to the rest, who wish to enter the E.U., to follow the specific route.”

Now a laminated sheet of paper hangs from the Chios park gates reminding everyone that it is prohibited to sleep inside. Across the road is the Sideratos family garage. Its owner, Manolis Sideratos, is a leading member of a new civic group who call themselves the Pagxiaki, which means “all of Chios” in Greek.

“Europe has got comfortable at our expense,” he complained between filling cars. “Europe should decide what it wants. If it wants refugees then go and get them where they are, don’t put the islanders in the way.”

The Pagxiaki appeared abruptly in September 2016 after several violent incidents involving alleged members of Golden Dawn culminated in the serious assault of a local journalist. Ermioni Frezouli, a left-wing city councilor, said the violence against a respected Chios islander shocked locals and prompted Golden Dawn to keep a lower profile. Nonetheless, she said that a number of senior Golden Dawn members and other far-right ideologues have held meetings on the island, including the leader of the Perama school invasion, Yiannis Lagos.

On September 25, the Pagxiaki put on a show of strength and outlined demands including the reaffirmation of national sovereignty, the imposition of hard borders and the transfer of refugees and migrants to mainland facilities. Demonstrators filled the park that 12 months earlier had been a refugee way-station, carrying banners denouncing the E.U. and demanding the closure of the hotspot on Chios. Estimates of how many islanders took part in the protest range from 2,000 to 5,000.

Over bitter coffee and “lukumades” (honeyed doughnuts), in his seafront local, Nikos Georgoulis, the editor of the only Chios daily paper, Politis, boasted that one in 10 of all Chios islanders attended. Georgoulis said that Chios, which is a short boat ride away from Turkey, cannot afford to allow a Muslim minority to settle on the island. He said the refugees will be used by Turkey’s president Recep Tayyip Erdogan as a fifth column and a pretext for seizing the island.

Putting aside geopolitics, he shuddered as he said that Pakistani boys have been seen holding hands with local girls and that in the future “half the kindergarten will be blacks and children of migrants.”

In November 2016, suspect far-right thugs rained firebombs and rocks onto Souda, destroying sections of the camp and forcing refugees to sleep in a nearby field. Golden Dawn supporters went on the rampage again this April, attacking asylum seekers and some locals, even confronting the Chios police chief. He was out of uniform at the time, and it is not clear whether the attackers realized who he was.

It is not hard to understand why some local businessmen pressed Manolis Vournous to run for mayor in 2014. Despite being a political novice, the tall architect fills out his business suit with the right kind of serious demeanor. He campaigned as a technocrat and won.

After the September 25 demonstrations, the mayor and the council folded and endorsed all of the Pagxiaki’s demands. With no prospect of the commission reversing its hotspot strategy for managing migration and no pressure from the Greek government to revisit the E.U.-Turkey statement, there is deadlock on Chios.

Vournous now finds himself balancing Pagxiaki opposition to any new camps and violent incidents with the demands of the European Commission and Greece’s migration ministry to open a new pre-departure center – jargon for a detention center for migrants about to be returned to Turkey. Souda cannot be closed unless there is a new camp, or the government concedes and allows its residents to be moved to the mainland. Wholesale returns to Turkey – to be practicable – will need a detention center, like the one on Lesbos, to isolate those to be shipped back across the water. The mayor is in a bind.

“I can’t go with a bulldozer tomorrow and empty Souda,” he said.

Broken promises from central government have poisoned local attitudes to any form of compromise over new facilities, said Vournous.

“We’ve tried to find a solution, but in the absence of a solution the government failed us in front of the eyes of everyone on Chios.”

Almost forlornly, the mayor said that it is up to the government and its European partners to find a way out of the dead end.

“There can be no more temporary, easy fixes.”