A zone without law or regulation or public services: the French state has created a strange camp on the country’s northern coast at Calais, where thousands of undocumented migrants live in a no-man’s land on top of a former garbage dump and hoping only to somehow escape to the better land across the English Channel, writes this group of astonished volunteer doctors in an open letter. Can a state simply abdicate its role as regulator and protector of public welfare, when it comes to migrants?
I am one of a group of nurses and doctors from Paris who answered the call from Doctors of the World to come and help at Calais; when we arrived here, we were stunned at what we found. We are used to dealing with illness and with the sorrows that come with illness; that is after all our profession and what we are trained to do.
We are also used to working in a country where we are provided with support and advice from government health officials who provide us with monitoring procedures, quality of care procedures, and who will step in and get involved in the case of epidemics. We know who to call if we encounter a case of a girl who is at risk of being raped, or of a child who is living in dangerous circumstances.
And we are not used to being in the situation of simply abandoning a 20-year-old woman who breaks down in tears at the prospect of spending another night in the slum where she was assaulted just the night before.
And we are not used to seeing despairing and malnourished young men, worn out by a terrible journey, coming to us with their hands torn by barbed wire fences, heels crushed in horrible falls, all due to their desperate desire to get from here to England at any cost.
But let us begin with the story of Calais and specifically, the shantytown that has arisen here.
It is a shantytown where more than 3,000 people live on top of a windswept landfill in the area that the maps describe as ‘The Dunes Industrial Park.’
The local media and the people who live there call the shantytown ‘the New Jungle.’ Why ‘New Jungle’? It is said that the Afghans who first arrived here at first camped out in a wooded public park they called ‘the Jungle’ before coming to this treeless dunescape to build their shacks. But we don’t like the word ‘jungle’ since it implies a place inhabited by wild savages.
The only savage behavior I have noticed in this place is that of the French State, which has entirely abandoned an at-risk population living on its own territory. As for our patients, I have been surprised at how calm and respectful they are. They are frequently forced to wait in line for very long hours for treatment, but it is rare to see anyone get angry. This despite the fact that frequently standing in line with Doctors of the World means going hungry, since our patients must forgo the line at the Jules Ferry Migrants center where meals are distributed once a day.
And every day here, we are forced to turn some people away because there is no time for everyone to see a doctor. Choosing which patients to see, ‘triaging’ them is a hard thing to do, but when we must bypass people who are waiting in line to see the gentleman who is clearly very sick, our profuse apologies are generally met with a kind smile and a ‘we understand.’
In this shantytown, public health regulations simply do not exist. We are no longer in France here; we are in a Third-World country. Or a war-torn country. Or a country that has been destroyed by a natural disaster. But really, even in third-world countries that have been struck by a natural disaster or a war, the camps are better-kept than here.
One of my colleagues tells me that when she was in Albania, on the frontier with Kosovo during the 1999 war, the refugee camp there was better taken care of; all of the inhabitants provided with shelter. Here, by contrast, the UN High Commission for Refugees issued a statement in August calling on French authorities to improve the “appalling conditions at Calais.”
The exiles were told to come and settle here on this piece of land, far from the city, its daily life and its shops. The only preparation the French state bothered with was piling up huge mounds of sand so that the shantytown would not be visible from the highway. Well, the mounds plus a couple of water faucets, some toilets, a few showers; nothing approaching France’s public health requirements or the needs of a refugee camp.
Later, NGOs stepped in to install more toilets (Solidarites Internationale), build wooden huts (Catholic Relief), pass out food (Islamic Relief), and provide medical care (Doctors of the World).
After a few months, a community center, the Jules Ferry Center, was requisitioned to house 100 people (out of 3,000!), exclusively women and children. The rest were left to make their own shelter with tents or shacks pieced together out of pieces of wood, garbage bags and bits of tents donated by NGOs. Some (how many we do not know) sleep outside on the ground with no shelter at all.
At the Jules Ferry center, one meal is distributed every day, and there are slots for a few warm showers. But all of this after waiting in long and arduous lines. And taking a shower every day is impossible; there are 500 daily shower slots for 3,000 people. And we are by no means certain that everyone is even able to get the single meal offered daily.
Here is the question we find ourselves asking every day: why is Calais, or specifically the Dunes Indusrtial Zone, not part of France? Why are the normal rules of public health in France inapplicable here? Why do medical “best practices” regulations not apply here?
Medically, what we have seen in this shantytown is simply unacceptable:
-a terrible scabies epidemic: bringing itches that strike especially at night, preventing sufferers from sleeping.
-young people with their hands lacerated by barbed wire.
-apparent heel fractures due to falls from 12-foot drops, what we call “high-energy accidents.” Treating broken heels poses delicate problems. The medical consequences of these fractures are severe, prolonged, and frequently lead to a permanent handicap. And the severity is directly proportional not only to the type of fracture, but to the quality of medical care.
-Unaccompanied minors, children by themselves, or frequently living with other children and without any supervising adults.
-Women who are by themselves, wandering the shantytown with nowhere to go.
-Children, young women, young men, and the old, worn out, emaciated and exhausted by a terrible journey.
-The blood pressure readings we take are frequently totally abnormal for what should be healthy young men of 25.
Many of the people we weigh at our clinic are extremely thin, and some clearly fit the definition of malnourishment. In France, in 2015, we are offering malnourished people a single meal a day on condition that they wait in line for three hours? In France?
-A few patients with more severe illnesses: a case of toxic drug reaction, a few diabetics (who are offered no special support by the state).
-Lots of chickenpox.
-Patients who have been clubbed and tear-gassed.
-Babies covered in impetigous scabies lesions.
-Terribly painful dental abscesses.
-Numerous pregnancies seeking abortions.
-Many cases of flu with complications.
In the clinics where we work, we are accustomed to alerting state agencies, in cases of epidemic, child endangerment, women who are victims of violence, young people in dangerous environments. And we are accustomed to working closely with regional health agencies that are part of a public health system. A system with rules, alerts, protocols. This is how we practice medicine, how we teach our students that the system works.
But in this shantytown, none of this applies. There are no public health authorities. Why is it that here, these rules and these protocols do not apply? Even the fire departments will not enter the shantytown, and in France, they are our most loyal allies when no one else will step in.
“A few days ago, I was urgently called to see a young man in his tent. He was not well; he could not get up, had a high fever and was unable to leave his tent. I suspected a bout of malaria, and that he needed to be moved to a hospital.
I called the fire department, perfectly confident that they would rapidly take him to a hospital.
I waited by my patient, only to learn with shock that the firemen would not enter the shantytown to find my patient. We would have to bring him out of the shantytown first.”
Once again, as always, this feeling of not being in France, here in Calais:
The alert regarding the scabies epidemic is sent out by Doctors of the World. A response by public health authorities is needed. But there is no reaction.
Instead, they apparently inform the mayor of the local municipality who comes to complain to us about the scabies epidemic in his territory.
A 24 hour clinic was created in Calais to assist and treat patients without health coverage. But the clinic is set up too far from the shantytown; it is more than an hour’s walk away. Why was it not set up at the Jules Ferry Center. And the clinic is underequipped. A single doctor on duty for 2 or 3 hours a day to take care of the medical needs of 3,000 people who have been weakened and traumatized by their long and perilous journey?
At the Doctors of the World clinic, we see between 50 and 60 patients a day.
When they need to be seen in a more advanced environment, when they need a blood test or an x-ray, we refer them to the 24-hour clinic, which regularly tells us no-can-do, we cannot take any more patients.
There is a dental clinic for patients without coverage, but it opens on Monday mornings only. This summer, the dentist was on vacation, so we had nowhere to send our patients with dental pain. Fortunately two local Calais dentists agreed to take patients with dental emergencies.
What is acceptable here, and what is unacceptable?
What is admissible and what is indecent? What should make us get up and say ‘No,’ period?
Do we have to say things like:
Fractured heels: they’re lucky to get an x-ray. Tough luck if they can’t get an MRI.
Scabies epidemic: well, scabies isn’t so bad.
Women: there are a hundred places at Jules Ferry. Thank-you to the State. Tough luck for the rest of them.
Why are they coming here anyway?
They have seen worse crossing Libya and the Mediterranean.
After what they’ve been through, they don’t have it so bad here.
Getting a free meal every day is pretty good already, right?
If somebody has to say it, let the public health authorities say it.
If we aren’t careful, we are going to lose our values, our humanity.
Mady Denantes Translated from French by International Boulevard
11 Sep 2015