 Good afternoon or good morning or good evening, depending on the place of the world you're listening to us. Today I'm going to talk about the refugee crisis in Europe, a crisis that in MSF we prefer to call it a policy crisis, and I'm going to talk specifically about the health status, the life experiences, and the mental health problems of transiting refugees and migrants on the Balkan route in 2015. So 2015 was a year that Europe saw a non-presidential number of arrivals by refugees and migrants, with more than one million people arriving in its grounds, and more than three and a half thousand people dying while trying to. Comparing to the previous years, as you can see in the graph, we saw a huge increase of arrivals that they started in April-May. By July we had thousands of arrivals per day, and in November the arrivals surpassed 200,000. People were coming mostly from Turkey to the Greek islands, and from there moving northwards to Macedonia, Serbia, and then northwards to the other European countries. The response of the national governments was slow and at best insufficient, so in order to cover the increasing humanitarian needs of these people, different UN agencies, national and international NGOs, civil society, individuals, they responded, and this is just a snapshot of the UNHCR partners in Greece and Serbia in October. MSF was already in the area, and it was one of the first actors to implement activities in the Balkans. So at the end, within the year, we found ourselves providing the full package of services that we are used to providing in other low-resource setting places. So we provided primary health care with referrals and treatment of chronic diseases or refill of drugs, health promotion, we did mental health care through individual cancelling sessions and group sessions. We had a clinic for victims of torture. We did the full-blown logistics, food and non-food distribution. We provided transportation, shelter, water, sanitation, we did sets and rescue. We identified vulnerable groups and we referred them, and we had a strong component of advocacy and communications. The objective of the study that I'm presenting today is to determine among transiting refugees and migrants in 2015 the socio-demographic characteristics and their vulnerabilities, their physical and mental health status, and their traumatic life events in order to better understand their needs and to guide our interventions. This is a retrospective descriptive analysis of routinely collected anonymous patient data from the areas of the Greek islands, the Domene, the exit to Macedonia, Pressevo, the entrance to Serbia, Belgrade, and then these exit points to Hungary and the other countries. The primary health care consultations were performed from January to December 2015 and from May 2015 we also implemented the mental health activities. Patients came to us either alone or they were brought by family and friends, they were referred by other NGOs, or it was a cross referral between MSF doctors and nurses. We strived to use cultural mediators in order to provide an appropriate care, however this was not always easy or feasible due to the increase to the big number of languages people were speaking and to the increased needs in cultural mediation from many other organizations and not only MSF. We defined vulnerable groups as pregnant women, overproductive age, children under 65, elderly over 65 years old, unaccompanied minors, disabled people, single parents with minor children, and for the mental health, the individual mental health sessions, the chronic physical or mental health illness. Here are the number of consultations by month in Greece and Serbia. These are the two countries I am presenting. So we see that the number of primary health care consultations started to increase together with the increase of the influx of people but also with the increase of the projects that we were implementing, the increased number of doctors and psychologists we were putting in the field, and the increased number of shifts. So at the end we ended up covering 24-hour shifts with plenty of physicians. The socio-demographic characteristics in primary health care and mental health care, they were following more or less the profile of the arrivals in the Balkans. So almost in the primary health consultations almost half were women and children. And children under one year old, like babies, they were 3% of our consultations. Under five, one to four years old, they were 9% and five to 17, 16%. The mental health, the individual mental health sessions were slightly different because we had less children. So women were more comparing to the primary health care sessions. The nationalities of our patients, they followed again the profile of the nationalities coming to the area. So almost half of our patients, they were from Syria, from one-third to one-fifth from Afghanistan, 10% from Iraq and the others from Pakistan, Iran and other countries, mostly African. People were quite vulnerable. So for primary health care, 16% of our patients, they belonged to a vulnerable group. While for the mental health sessions, one-third of them were part of a vulnerable group. So under five, as I said before, they represented 12% of our consultations in primary health care. Pregnant women were 9% and unaccompanied minus, meaning unaccompanied minus within the under 18, they were 5%. And for Syria, for Serbia, we had a higher percentage of unaccompanied minus comparing to Greece. In the mental health sessions, we had 5% of people with a chronic mental health illness. Regarding the medical consultations and the health status of the people, what we saw were more or less the usual suspects that we see in a primary health care consultation. Most respiratory tract disease, mostly in Serbia, due to the colder weather, lots of trauma, like up to 18%, 20% of people had trauma and more of it was in Serbia. And that was probably due to violence people experienced in Macedonia or Bulgaria or Serbia itself. We also had gastrointestinal tract disorders, not only diarrhea, but lots of gastritis, spastic ulcer, constipation, hemorrhoids. We also had lots of skin disorders from simple insect bites to skin infections, to scabies, to chronic skin diseases. 93% of the people reported that their symptoms started during the emigration trip. And that was something that we were receiving back as feedback from the teams in the field that people were coming with acute symptoms that were mostly related to their migration trip. For example, for the skin conditions, we had lots of blisters, food blisters from the continuous walking in the trauma. We had some intentional trauma with reports of state violence or other armed group violence. We also had chronic diseases. So 6% of our patients suffered from a chronic disease. And 25% among these, they had cardiovascular diseases. Another 25 had diabetes. 15% had a chronic lung disease, mostly asthma. And 3% suffered from epilepsy. We tried to refer 1% of our people, mostly for trauma and respiratory tract infections, but one in 10 refused their referral. And that was mostly for gynecostatic conditions, pregnant women, respiratory tract infections, but also gastrointestinal and trauma. In the individual mental health sessions, during the sessions, we recorded up to six traumatic life events in our patients' lives, up to three events before their journey started and up to three events after their journey started. And what we saw was that 97% of people reported at least one traumatic life event before their migration trip started. And unfortunately, more than 50% reported at least one event during their migration trip. So the presentation in Kalei is more or less in, it agrees, sorry, for the English. Regarding the specific traumatic life events, the vast majority of the people, more than 80% reported that they were forced to flee or they were IDPs before their journey started. And over 20% reported bombing or sailing, 20% a life-threatening event, and another 20% physical violence. They were victims of physical violence, and their perpetrators could be state authorities, it could be other armed groups, could be smugglers, could be other community members or other co-fellow travelers. There is a huge list of traumatic life events. Family members killed, as we see here, ill-treatment, like bats' behavior from people against them. People witnessed violence, they lost their property. Plenty of the traumatic life events, wrong, sorry, here. Regarding the mental health symptoms, 79% of the patients we saw in the individual mental health sessions, they suffered from a mental health disorder. And that was mostly anxiety-related. So it was either anxiety or adjustment and acute reactions to the new conditions and stress. A small proportion, around 7%, had symptoms of post-traumatic stress disorder, and another 20% suffered from depression. This was 2% to 3% only. We were able to follow up only 11% of our patients, and the most important reason was the need of the patient to move on. They didn't want to lose their family, they didn't want to meet, to lose the friend, the group, they needed the protection of the group, so they had to move on. So we had to adapt our individual mental health sessions into more psychological first aid or single orientation to give us a first support and allow the people to continue their travel. However, we did refer one-third of our patients, mostly to other NGOs and other actors for further support and care, but also to psychiatric care and to doctors for medical conditions. Of course, we did face many challenges. There was an overwhelming number of people that they were arriving and we were striving to provide care. There were multiple actors that required collaboration and coordination, and that is not always easy when you have so many actors. We needed to do cultural mediation, but people were speaking so many languages and mediators were not enough, so that was quite challenging. And of course, patients were on the move, so quality of care, refusal of referrals, follow-up and continuity of care were very frustrating and they were quite challenging. We're trying to find solutions for that. In conclusion, what we saw were patients with increased vulnerability, having experienced multiple traumatic life events, having physical and mental health needs, having chronic diseases. And we saw a transit population which was difficult to follow up and that hindered continuity of care challenging. As with every study, especially programmatic data, we had some limitations, so we had some missing data if you might have noticed from some denominators. We had some double entries, probably we don't know exactly how many, because people may have moved, may have visited multiple clinics along the way, multiple MSF clinics, and we had anonymous patient data so we couldn't differentiate. We may have had misclassification of symptoms and symptom categories, either because case definitions were not very clear or were not there from the beginning, but also because we had a high turnover of staff and patients were on the move, so we didn't have enough time to do a proper assessment, especially in mental health, that one session is not always enough to do a proper diagnosis. Also, some of the follow-ups, few follow-ups were included in the analysis because, again, we could not differentiate in our database what was the first consultation and what was a follow-up. As recommendations, we would say that authorities need to take their responsibility. In European ground, we see, again, a full-blown human entire response with so many different actors, while the countries are not the low-resource countries. They are middle-income, higher-income countries, Greece used to be high now, it's middle to low, but still, authorities need to assume responsibility and take actions in order to ensure the safety of the people and the proper living conditions and to engage with an early vulnerability screening. They need to make sure that patients have free and easy access to health care, both for physical and mental health, providing preventive and curative activities, but with the support of cultural mediation. This is something that we learned and it's very, very important. And finally, all these people with the creative ideas and the new ideas, they need to sit down and find innovative ways in order to make sure that we can follow up our patients and there is a proper continuity of care. I would like to thank and acknowledge all the people in the fields that they supported and they collected all this data for all the work they've done, the patients who had the patience to come and see us, and you for listening. Thank you. Thank you.