When the world is your oyster, it sometimes takes a bit of a push to set your sails in any one direction. In the months leading up to my deployment in Ukraine in February, I had reached out to a few different non-profits. After taking some time off to bop around in southeast Asia, I juggled a few options before settling on taking a role as clinical staff at a refugee camp on the Greek island of Lesvos (also spelt Lesbos).

My interest in the island dates back to late in the year in 2024, when I met countless Syrians, Palestinians, and Afghanis in the Middle East who told me of the typical migration route from their countries through Pakistan, Iran, and Türkiye, facing immense difficulties along the way to attempt crossing the Aegean sea for asylum in Europe. In many ways it reminded me of the long journeys of Latin American asylum seekers, traveling sometimes for years while being intercepted and deported back several times through Guatemala and Mexico until crossing the border into the US. After having grown closer to Middle Eastern culture during the last year, I felt it was appropriate to deepen my understanding of their struggle on the other end. So, despite a competing offer to take charge of a mountain indigenous clinic closer to my roots in Nicaragua, I opted to join the Boat Refugee Foundation (BRF), treating asylum seekers on Lesvos.

Lesvos is the third-largest Greek island after Crete and Evia, with an area of about 1,630 square kilometers. It’s located in the northeastern Aegean Sea, extremely close to the Turkish coast—at its narrowest point, the distance between Lesvos and Türkiye is just about 10 kilometers across the Mytilini Strait. The island is known for its mountainous terrain, olive groves (reportedly over 11 million olive trees), and its long and deeply indented coastline with many natural harbors and beaches. Today, Lesvos houses a Greek population of 83,000 people and maintains a mixture of tourism, agriculture (especially olive oil and ouzo production), and fishing. In modern times, Lesvos has become a focal point in the migrant crisis that has swept Europe over the last 10 years. 

Like any exciting relationship, the dynamic evolution of Lesvos within the greater migrant crisis is complicated. My understanding of it comes from conversations with people on the island and my own reading of both the news and peer-reviewed articles on the fractious interplay between NGOs, Greek state authorities, European Union mandates, the local population, and overarching political narratives. I will try my best to summarize this the best I can, but have to recognize that in my limited time on the island, any attempts to objectively assess these dynamics are skewed by my place within them. It doesn’t make for the most enthralling reading, but anyways, here goes.

Lesvos finds itself situated closer to the Middle East than any other place in Europe. The Middle East (Everything east of Türkiye up until Afghanistan and south of the former Soviet Union) has been subject to a litany of wars and geopolitical rumblings since the turn of the millennia, and the migrant crisis as we currently understand it was most notably catalyzed by large movements of asylum seekers from the Syrian Civil War, which began in 2011. By 2015, over four million Syrians had fled the country, initially seeking refuge in neighboring Türkiye, Lebanon, and Jordan (where the vast majority of them remain) before attempting to reach Europe. Simultaneously, long-term instability in Afghanistan and the post-invasion chaos in Iraq—especially the rise of ISIS—contributed significantly to the outflow of refugees towards the same areas. In Africa, authoritarian regimes and systemic abuses in countries like Eritrea, Sudan, and Somalia also pushed many to flee, often facing dangerous journeys through the Sahara or across the Mediterranean. Through all of this, Türkiye became a key transit point for migrants trying to enter Europe, particularly through islands like Lesvos, to the tune of 2,000 people arriving per day, straining the island’s capacity to provide adequate shelter and services.

You read that right, at the peak of the crisis in the late 2010s, approximately 1 million people passed through Lesvos, an island with a population of 83,000.  

This in turn produced a series of legislative attempts by Europe to reduce the amount of migrants, including a statement signed with Türkiye in which several EU member states essentially offered financial compensation in exchange for measures that would keep migrants in Türkiye instead of moving through towards Europe. This is where opinions, politics, and media-narratives get messy, but the takeaway is that great efforts were made to protect the borders in different ways to reduce the influx of migrants, both within Europe, in the water between Europe and Türkiye, and in Türkiye itself, with loud allegations of human rights abuses carried out in the process.

Existing at the interface between the migrants and Europe proved to be incredibly challenging for populations on the islands, understandably so. The lack of bandwidth to accommodate the influx of people meant large shifts in demographics that overwhelmed local structures. As local structures failed to deal with the numbers, NGOs flocked to the island in large numbers attempting to fill the gaps without any centralized organisation, which perpetuated a broken system while state politicians and EU legislators bickered from a distance as the island fell into deeper strife. NGOs, while motivated by good intention, often positioned themselves in isolation from the local population, which led to an antagonistic relationship with locals. As a result, NGO workers came to be seen as enablers of the asylum system, and became symbolic targets for Greeks who felt ignored and overwhelmed. Escalating anti-migration sentiment among locals—fueled by economic hardship, perceived abandonment, and a lack of engagement by aid organizations—led to a convergence of grassroots protests and far-right narratives which culminated in riots and violent attacks on NGO workers in 2020. At the height of it all, the existing refugee camp with 20,000 asylum seekers inside caught fire in September of 2020, and the entire camp had to be abandoned in exchange for a new one, now called the Mavrovouni camp. A boiling point had been well reached, and both the riots and the camp fire made world-wide news, albeit lost to many in the noise of the pandemic.

Five years later, conditions on the island had simmered considerably as I hoisted my backpack into the boot of a small car at Mytilini airport to start my one month attachment as medical staff and shift coordinator with the Dutch-based medical NGO, Boat Refugee Foundation (BRF). At this point, NGO workers were no longer denied entry to restaurants or being cursed in the streets. The camp population had come down to around 2,000 people from 15,000. There were only a handful of NGOs now operating in a relatively cohesive fashion, and the migrant crisis in general had stopped being the prominent talking point on European airwaves. The demographics had also shifted, with Afghani asylum seekers making up the majority of the camp population, followed by Syrians and then a mix of other parts of the Middle East (Palestine, Yemen) and Africa (Sudan, Somalia, Sierra Leone). Still though, the migrants arrived in boats unpredictably under the cover of darkness and high winds. At least twice a week I would see people filing in near the clinic, having just arrived with no shoes, waiting for their processing slips and free bag of clothing. On the third week I was there, one of the migrant vessels capsized and seven people drowned, including one child. There was work to be done.

That first day, just one hour after getting off the plane, I rolled into the office for my orientation and got a first-hand briefing as well as logistical and cultural notes relevant to my day to day. I became rapidly acquainted with my colleagues, a blend of young and old clinical volunteers, mainly from throughout Europe,  and the local administrative staff. We had several junior doctors still in their house officer years, some in GP training, and two or three seasoned veterans now retired and staying active. We had a big house where everyone stayed, a group chat for social gatherings in town, and unfettered access to all of the perks of the Greek island lifestyle. As far as setups go, this was pretty cushy, a welcome change from my last project sleeping in a bomb shelter near the Ukrainian front lines.

This would be a little different than most of my other gigs; no formal project development or teaching role awaited me here. Instead I’d be going back to just being a doctor at a walk-in clinic for asylum seekers.

Of course, we got right into it…

It was my first shift, not more than two hours in. After wrapping up a string of visits for runny noses and tummy aches, Yvonne, our acting shift coordinator for the day, pulled me aside.

‘Juan, would you like to do an outreach into the camp?’ she said.

‘Of course,’ I answered. ‘Tell me more.’

‘It’s basically a house visit. You will take the emergency bag, it has everything you need, and one of the interpreters will go with you. You can just call me depending on what you need.’

‘Happy enough.’

‘You are going to tent number X to see a patient who is having chest pain. Mahmoud will join you,’ she said.

Just around the corner of the tent I found Mahmoud, one of our Arabic interpreters. Young guy, with a well shaped jaw and scruffy facial hair. I would go on to learn during my month here he was an excellent cook.

We got in the car and drove past the clinic into the heart of the camp. Dirt roads between labeled sections compartmentalized the whole place, with some blocks made up of tents and others of converted shipping containers. We didn’t travel far before we reached the second block of containers and came up to the container in question. At the front, a young man with a beard was gesturing to us to come inside.

The container was a humble space, with metal bunk beds. Sitting up one of the beds was a man in his late fifties looking somber.

‘This is the patient,’ Mahmoud said in translation.

Okay, I thought to myself. He looks alright. I introduced myself and shook his hand

‘Salem Aleykum. My name is Juan, I am one of the doctors. What’s the issue?’ I asked.

‘Chest pain,’ Mahmoud started. ‘He says he came to the clinic three weeks ago for chest pain and was sent to the hospital and had a procedure on his heart. Today he was doing fine and then was sitting in bed and started to get chest pain again. It was so bad he couldn’t move which is why he sent his nephew to the tent for us.’

‘How is your pain now?’ I asked. As I spoke I opened up the emergency bag and got a blood pressure cuff to start taking his vitals. ‘Also what kind of procedure on your heart? Do you have any papers?’

‘He says the pain is better now, not completely gone, but much better. It started about an hour ago and lasted from then until ten minutes ago.’

I peppered him with a few more questions while I recorded reassuringly normal vital signs. The pain felt crushing, with some shortness of breath and dizzyness, but no cough, nausea or vomiting. His exam was equally reassuring. In the meantime his wife brought me some documents, all in Greek about diagnostic tests done in hospital. He was able to tell me had something put in his heart. Using the google translate camera on my phone, I scanned the paper and it became rapidly clear. Just two weeks earlier, he had a major heart attack with two vessels blocked and got them both stented open in the hospital.

Now, it’s possible he was having one again.

‘Right,’ I said to him and his family. ‘What were you told about what happened in the hospital?’

I asked because the Greek public hospital didn’t have reliable access to interpreters, which  led to a lot of our referrals having things done that they didn’t understand. Both the patient and his family answered together.

‘They were told that he had a blockage in his heart and they placed a thing to open them. He was also given medication that he needs to take and to stop smoking,’ they said through Mahmoud.

‘Good. Now I have to ask a very important question. On any day since you left the hospital, any day at all, even if just once, did you miss taking the medicine?’ I asked. This was important because stents have a very high risk of re-blocking in the first thirty days and these heart medicines are the best way to prevent that.

‘He hasn’t missed it not even once.’

‘Great,’ I said. Then I continued to explain to them my concern. ‘You had a serious heart attack three weeks ago. Any time someone has chest pain like you are describing, especially while at rest, we have to take it very seriously. Even though you look fine and feel better now, I think you should go to the hospital for a definitive evaluation.’

Mahmoud took his time with the mouthful I just asked him to translate and the family was in accordance and agreed to go in.

Great, I thought… Now what? So I called Yvonne and got her up to speed. We agreed that the safest course of action was to go by ambulance, and I would wait there with the patient to handover the case to the paramedics. So I filled out a referral form in the emergency bag and sat on the floor cross legged.

In the next half an hour or so that followed, we got to know each other. My patient and his family asked me about my story, and I theirs. He was from Syria, more specifically he was Syrian Kurdish, from one of the northern regions of the country. His story echoed many of the horror stories from the war. At one point he was captured and detained in one of the notorious prison complexes. His family was fractured, some still in the Middle East, and others now having found refuge in Europe. Now, like all the other Syrians in the camp, he was stuck with no progress on his asylum case after the fall of Al-Assad and change in government that prompted the EU to pause all asylum processing for Syrians. I would go on to meet this man and his family again several times during my month in Lesvos. His wife and nephew regularly escorted other camp dwellers to our medical tent. I could tell they had developed a role in the community quickly.

Once the ambulance arrived, we hugged goodbye and he went on his way. I would find out later his results at the hospital came back reassuring, and he was discharged that night.

I returned to his tent two weeks later for some tea.