*The investigation was published in the Efimerida ton Syntakton newspaper on Friday, August 8, 2025.

Research/text: Kostas Zafeiropoulos, Nikos Morfonios, Janine Louloudi (MIIR)

Data Analysis – Visualizations: Corina Petridi

Illustration: Louiza Karageorgiou 

On the 15th of December 2022 the European Medicines Agency announced that almost every EU country was facing medical replenishment gaps. It was known that a harsh winter was ahead for European countries facing both the Covid 19 pandemic and other seasonal viruses that were testing their health systems anew. However, what actually happened this year surpassed any forecast.

‘’To be honest, what took place this winter was that European countries were taken by surprise with such a large mismatch between supply and demand, especially for antibiotics’’, Steffen Thirstrup admits to MIIR – Health Head of EMA (European Medicines Agency), which is the competent body that guarantees the scientific assessment, supervision and monitoring for medicines safety in the EU.

From 2000 to 2018 there has been a 20-fold increase in recorded drug shortages in Europe. It’s like a disease that gets worse every year without -yet- a cure. The war in Ukraine and the energy crisis were used as a convenient excuse in various countries for political leaders to attempt to cover reality. But the problem seems to have other, timeless causes.

According to the latest 2022 European Pharmaceutical Union (PGEU) report, all EU countries that responded to the survey (including pharmaceutical chambers and pharmacy associations of 29 countries in the European region) experienced drug shortages in pharmacies in the last 12 months. The majority of countries reported that the situation worsened compared to the previous 12 months (75.86%) or remained the same (24.14%). No country recorded an improvement.

‘’Medicines shortages are increasing in Europe and have a huge negative impact on patients. They occur across all healthcare settings and involve both essential life-saving medicines and very commonly used medicines. Community pharmacists are very concerned about this phenomenon, which can compromise patients’ health. Moreover, pharmacies and pharmacists invest a lot of resources dealing with shortages which constitutes not only a financial burden, but also a loss of opportunity to spend time with other patient-centered tasks and to improve the quality of care”, Ilaria Pasarani,  General Secretary of PGEU, tells MIIR. On average, each pharmacy in the European Union spends 6.3 hours a week looking for missing medicines. In some countries this number reaches 20 hours per week.

‘’At present the situation is that most European countries are still reporting shortages. This is observed in 28 out of the 30 countries of the European Economic Area. The result would have been the same if you had also asked me two weeks ago,’’ EMA’s Steffen Thirstrup  points out to MIIR.

Nevertheless, which countries record the greatest drug shortages in recent years? Are the data reliable? What are the real reasons and why are we increasingly unable to find the medicines prescribed by our doctor in pharmacies? Which categories of drugs, which active substances are missing, and above all, why are they missing? The answers are not unequivocal, they are often difficult to find and they are not always common for all countries.

Inhomogeneity in records

At a pan-European level there is not yet a homogenized database recording drug shortages -i.e. in the same language- with data that can be seen in real time. There is not even a definitive European agreement on how a shortage is defined. Several European states have adopted the definition of the European Medicines Agency (EMA, 2019): “A shortage of a medicine for human or veterinary use occurs when the supply does not meet the demand at national level”.

Assessments for the actual duration of medicinal shortages are often difficult to be determined, precisely because of the gaps and inconsistencies in national medical association registries. Many listings do not even provide an (assessed) expiration date for each shortage. Most European countries have only started collecting standardized information on shortages in the last five years. There are also notable differences in the obligations surrounding the reporting of shortages. For example, in Denmark notifications are made only for “severe” shortages, while in Sweden only shortages with an expected duration of more than three weeks are required for notification by the system.

There are countries that do not even provide a registration website, while in others the database includes in parallel human, hospital, veterinary and vaccine medicines. Furthermore, not all countries publish their data in the same way. For example, the Greek National Organization for Medicines (EOF) doesn’t publish the shortages annually, doesn’t mention the classification of drugs, and does not systematically provide data about the duration of a shortage. EU member states are also far from harmonizing standards for recording and reporting shortages, a fact which hinders information-sharing and comparative analysis between countries. 

We asked the European Medicines Agency (EMA) whether it keeps aggregated data for all EU countries, but the answer was negative. Instead, the EMA referred us to the websites of the national medicine’s registries. 

‘’Some states have a very detailed network of information collection from community pharmacies, and from hospital pharmacies. But not everyone has it to the same degree. Some states have sophisticated IT systems to look at supply and demand, and can therefore respond much more quickly”, EMA’s Steffen Thirstrup explains, hoping this gap will be bridged in the future.

In an attempt to partially fill this information gap, MIIR together with collaborating media teams from EDJNET spent a three month period looking for data and managed to create an -as homogeneous as possible- updated database on drug shortages in Europe. We recorded 22,107 different entries over a five-year period (2018-2023) in a total of 9 European countries (Germany, Italy, Spain, Slovenia, Czech Republic, Greece, Romania, Austria, Belgium), from which it was possible to gather reliable data, either by extracting data from published statistics in the national medicine’s associations or by submitting data requests. In many of the above countries, we traced the Anatomical Therapeutic Chemical (ATC) classification, the marketing authorisation holder, the starting & ending date of the shortage and reasons for it being taken off circulation. 

Key Conclusions

From the total of the 9 aforementioned countries over the last five years (2018-2023), when adding up the new shortages of each year, it appears that Italy cumulatively registers the most shortages in absolute number (10,843) for human medicines, quite far from the second Czech Republic (2,699) and the third Germany (2,355). Lastly, Greece (389) is the country with the fewest records of shortages in absolute numbers.

Accordingly, 371 vaccine shortages were recorded in the countries under review in the period 2018-2023, with Italy leading (144 vaccine shortages), followed by Germany (102) and the Czech Republic (57). Belgium recorded the fewest shortages (8).

Nevertheless, the absolute number of medicines and vaccines in short supply is not always the best way to draw safe conclusions, given that not all countries keep record of their stocks with the same consistency and the same criteria. In addition, these are different reference populations, countries with different levels of demand, while the different pharmaceutical import-export balance must also be taken into account. 

The safest recording indicator that best describes the situation in each country is the duration of a shortage. In order to find the average duration of shortages in the European countries that we examined, we excluded extreme values ​​by calculating the median. Of the 22,107 drug entries we processed in total, we had data on shortages’ duration for 16,945.  Based on these, the European average duration of shortages is 94 days, meaning that it takes about three months for a drug to be back on the market. 

From the analysis MIIR conducted on the data collected, it appears that Greece has the longest median duration of shortages (130 days), followed by Germany (120 days) and Belgium (103 days). The Czech Republic may have been second in absolute numbers of shortages, but it registers the shortest amount of time with drugs in shortage (41 days).

The European average of vaccine shortages, again excluding extremes, amounts to 84 days, less than that for medicines.
For vaccines, the longest median duration of shortages is traced accordingly in Italy (111 days), Germany (68 days) and the Czech Republic (66).

The most comprehensive study carried out in recent years on medicine shortages was that of the Technopolis Group consultancy on behalf of the EU (Future-proofing pharmaceutical legislation – study on medicine shortages), which was published in December 2021. In that research, the Netherlands and Portugal turned out to be the “champions” of medicines in shortage in 2019 (over 1600 different drug shortages). In contrast, that year Austria, Croatia, Iceland and Greece recorded fewer than 100 shortages, relating to 60 or less different medicines. 

The same survey ascertained that the average duration across all shortages notices was 137 days and that 66% of all shortages were resolved within the first three months. The minimum duration of the shortage was one day, the maximum duration was about 13.5 years (!) and is related to amoxicillin which was in short supply in Spain from September 2005 until March 2019. Amoxicillin is still today among active substances that are missing mostly from the European market. However, it is noted that in all 9 countries for which data was collected by MIIR, very significant increases in shortages are recorded in 2022 compared to the previous year.

The largest percentage increase in the absolute number of drug shortages from 2021 to 2022 is recorded in Greece, which is due to the possible under-reporting by the Greek National Organisation for Medicines (EOF) or the non-declarations of the actual shortages. Pharmaceutical associations in Greece complain that the real shortages are much more than those declared by EOF.

“The shortages are neither 80 nor 130. They start from 400 and upwards. This is the image I have from running a pharmacy; I don’t care what EOF tells me. I find it reasonable for any government not to want to be exposed. If I were in the position of the respective government, I would do the same. I would call the EOF president and tell him to declare that we have at most 100 shortages. I don’t think you can have an objective view from EOF, its presidents are always appointed by the respective government,” says Konstantinos Lourantos, who has been the president of the Pharmaceutical Association of Attica for 27 years.

For the needs of this report we contacted and repeatedly sent written questions to the president of the Greek National Registry, D. Filippou, without receiving any answer.

Reasons of shortages 

According to the MIIR analysis, in a total of 6 countries (Germany, Spain, Greece, Austria, Slovenia, Czech Republic), the most drugs in shortage are those related to the neural system (1718 drugs, 19.03% of the total), such as anesthetics, psychotropics, antidepressants, anxiolytics, antiepileptics, antiparkinsonian drugs, etc.). In second place we find cardiovascular drugs (1307, 14.48% of all shortages) and in third place the anti-infectives for systemic use – antibiotics (1126 drugs, 12.47% of all). On the contrary, almost zero shortages are recorded in the same sample in the category of antiparasitic, insecticides and insect repellents.

Τhe latest report of the European Pharmaceutical Union PGEU (2022) for all European countries offered similar conclusions, according to which cardiovascular drugs were omitted in most countries (82.76%), followed by drugs for the nervous system and anti-infectives for systemic use – antibiotics (79.31%) and drugs for the respiratory system (75.86%).

In that survey almost all responding countries reported that drug shortages cause distress and suffering to patients (93.10%), discontinuation of treatments (89.66% of countries), increased co-payments as a result of more expensive and alternative solutions that are not reimbursed by the state (72.41%), but also fewer effective treatments (58.62%).

“I have been searching for 8 months and have not been able to find my medicine. The pharmacists tell me to be patient, it may come but we don’t know when”, 25-year-old Eleftheria, who suffers from a rare disease, tells MIIR. “They don’t even give me an explanation as to the reason why it suddenly stopped being available, all I hear is that this medicine is imported and that the multinational company that produces it hasn’t sent it,” she adds. As a substitute she takes another drug that does not fully cover her for the condition, and on the advice of her endocrinologist she has adjusted her diet to make up for the substances she lacks. She works as a babysitter in homes taking care of young children. “Especially this winter, I have been told by parents that not only simple medicines, respiratory and antibiotics for viruses are not easy to find, but even a simple serum,” she says.

The impact of Covid- 19

All researches converge that the problem is growing and concerns millions of patients on the European continent. “During the pandemic, but also in the post-pandemic era, with the post-COVID syndrome to have affected a large part of the population, the need for medicines and treatments increased. This fact led to an increase, to a certain extent, of the shortages of medicines”, underlined  Ioulia Tseti, CEO of the Tsetis Pharmaceutical Group of Companies and general secretary of the Hellenic Federation of Enterprises (SEV).

But this explanation is not enough. As she explains, “the problems of the supply chain and the dependence of the European Union countries on raw materials from third countries, made the problem even more explosive. As well as the fact that countries such as India and China banned the export of raw materials for their own needs – this also aggravated the problem. And it is known that when raw materials are scarce, the price is high. We must not forget that the shortage of raw materials and the increase in energy costs were reinforced by the war in Ukraine, as the (once) rich and sufficient grain silo of Ukraine is a raw material for medicine production. Unfortunately, Europe is dependent on third countries and at some point, it must become independent, acquire sufficiency and self-sufficiency in raw materials.”

The war is not the only one to blame…

The root causes of the problem are generally the result of different economic, structural or regulatory causes, Ilaria Passarani, general secretary of the PGEU, underlines at MIIR. She herself summarizes these as follows:

“o   the increasingly globalized nature of pharmaceutical manufacturing, including Active Pharmaceutical Ingredients (API), with production concentrated in fewer sites distributed around the world;

o   Shifts in demand, resulting from longer term factors such as demographic change, but also short-term factors such as tendering of medicines leading to difficulties in providing sufficient quantities of medicines for some markets;

o   Pricing strategies, both low and high, and regulatory changes that in some cases may have an impact on supply;

o   the imposition of fixed quotas of medicines by the pharmaceutical industry, often not sufficient in relation to patients’ actual needs;

o   the removal of the traditional role of the full line wholesalers as a result of Direct to Pharmacy (DTP) schemes in some markets;

o   the abolition and ineffectiveness of public service obligation/minimum national stock keeping requirements in some countries;

• the lack of priority given to smaller markets;
• The effects of the European internal market dynamics (e.g., exports).”

Dependance and friction point

As it turns out, at European level the over-reliance on a small number of suppliers for active pharmaceutical ingredients and other raw materials has made it difficult for manufacturers to meet current demand. China and India together account for more than 60% of the world’s supply of active pharmaceutical ingredients in 2020. Parallel exports are often seen by pharmacists and the pharmaceutical industry as part of the problem.

“It is a fact that parallel exports magnify the problem as the more expensive prices of the same products in European countries push pharmacies to export in order to take advantage of their price difference and, by extension, increase their profitability”, Ioulia Tseti, CEO of the Tsetis Pharmaceutical Group of Companies, tells MIIR. 

At the same time, however, at the European level, pharmaceutical companies seem to have reduced the stocks they keep in their warehouses. Thus, when a problem occurs in a manufacturing plant, the stocks are not sufficient to meet the needs until the problem is overcome and drug production returns to normal.

“Parallel exports” are a challenging point  between pharmaceutical manufacturers and drug dealers, since through them the pharmacies get a part of the profits of the pharmaceutical industry. For this reason, the multinational pharmaceutical companies strictly control the quantities they give to the domestic pharmacies, in order to limit the chances of exporting their products and the loss of profits in developed markets with high prices. All of this encourages any pharmacists who can obtain drugs directly from the companies to do so, even though this happens at an extremely slow pace.

But what is Europe doing to deal with a problem that looks like a difficult balancing act in an industry with huge competing interests? Within the next few weeks, the European Health Commissioner Stella Kyriakidou will submit the long-awaited proposals for the revision of the pharmaceutical regulations, after a long period of dialogue with the pharmaceutical industry, the relevant government authorities, health professionals, the academic community and representatives of patients. 

“This dialogue and resulting policy analysis showed that shortages of medicines have become a systemic challenge with numerous vulnerabilities, including the increased complexity and specialisation of supply chains, the lack of geographical diversification of sourcing for certain products and perceived regulatory complexity”, a Commission spokesperson admits to MIIR, adding that the upcoming bill will include “stricter procurement obligations, timely notification of shortages and withdrawals and enhanced transparency of stocks”.

* Read the second part of the MIIR investigation: Parallel exports, the EOF and the Greek Statistics of drug shortages.

Photo: The spread of the deadly Mati fire in 2018, as it was simulated by the IRIS 2.0 rapid response forecast system.- Source: Meteo.gr, 2021

In the space of just 13 days in July 2023, 470,000 acres of Greek forest were burnt to ashes. Greece’s state machinery is proving inadequate to deal with extreme weather phenomena. In Rhodes, 15% of the entire island was ravaged in the worst fire in decades. From 1 January to 1 August 2023, according to the European Forest Fire Information System (EFFIS), a total of 550,000 hectares were burnt in the 22 largest forest fires. This is more than four times the average amount of land burnt in the years 2006-2022.

In an earlier survey by MIIR in collaboration with WWF on the economics of forest-fire protection we showed that, for the period 2016-2020, only 16.05% of public funds for fire protection were spent on fire prevention. Most, 83.95%, was spent on fire suppression. This ratio has not changed significantly since then: the Greek state has continued to invest in suppression instead of prevention. Another major problem can be found in the state’s inadequate use of scientific data during the fire season.

A typical case is the notorious fire-risk forecast map, which is published daily at 12.30pm by the General Secretariat of Civil Protection, in a rather opaque manner. This map is reproduced by all the media and forms the basis of the national Fire Service’s operational planning. It started to be used in 2003 and is published daily from 1 June to 31 October each year, under the purview of the Civil Protection. However, for twenty years now, none of the experts has known exactly what data and scientific methodology is used to produce this map.

Photo: The Civil Protection’s fire risk forecast map for 18 July, the day the huge fire broke out in Rhodes. The risk level for the island and the rest of the Dodecanese region was placed in the middle of the scale, which is classified as “high”. – Source: Ministry of Climate and Civil Protection.

 Intuition instead of data

“The map circulated by the Civil Protection, whose derivation we do not know, has no scientific sources, does not mention how the different categories are regulated, nor what it takes into account. My assessment is that the Civil Protection map comes out on the basis of simple intuition,” says Kostas Lagovardos, meteorologist and research director at the National Observatory of Athens.

The map’s first drawback, according to experts, is this lack of clarity about the exact scientific data used.

The main problem, however, is that it is issued once a day (covering the next 24 hours) and so does not take into account the very frequent variations in weather conditions during the day. As confirmed in a circular of the Civil Protection, once the map is issued, it does not change in any way.

 Photo: Excerpt from the Circular of the Ministry of Climate Crisis and Civil Protection on the issue
daily Fire Risk Prediction Map from the G.G.P.P. during the 2023 fire season.

Andrianos Gourbatsis, a lieutenant-general and former deputy chief of the Fire Service, explains: “This is a big mistake, because the meteorological data may get worse, it may get better, so how is it possible not to change the map? What if you issue a hazard index of 3 for tomorrow, and suddenly in the evening the wind comes in, the temperature drops and the hazard becomes 5? This is the biggest disadvantage. There is another issue: the people who issue the map every noon then proceed to get off work, they go home, they do not follow the meteorological data of the National Weather Service.”

Another shortcoming of the map is that it treats entire regions, prefectures and other subdivisions as single units, without taking into account their different climatic conditions as pertaining to fire.

Kostas Lagovardos explains: “On the map, every region has one colour, which has no bearing on reality. For example, the winds in southern Crete are much stronger and have no relation to the winds in northern Crete. So in heavy weather, which is a typical summer event, you have a huge difference in the pyro-meteorological situation within the same prefecture. You can’t have entire regions having the same level of alert everywhere.” This means a dispersal of the firefighting forces on the ground, with all the devastation that might result.

After all, this fire-risk map is directly connected to the operational plan for fighting fires.

In the catastrophic fire in Mati in 2008 (which killed 102 people), the fire-risk map indicated a level of 4 (the maximum is 5). Andrianos Gourbatsis, who is also knowledgeable about the fires in Mati (2018) and Varibobi (2021), elaborates: “The conditions were for an index of 5 at the time. With an index of 4, the Fire Service’s state of readiness was not the maximum. If it had been 5, the Fire Service would have brought out an additional 25 units, from the 86 it had, while more fire stations would have been staffed for more hours, i.e. people would have been more ready.”

The Civil Protection’s Fire Risk Forecast Map for 23 July 2018, the day the deadly fire broke out in Mati. Source: Ministry of Climate and Civil Protection.

In the catastrophic fire in Mati in 2008 (which killed 102 people), the fire-risk map indicated a level of 4 (the maximum is 5). Andrianos Gourbatsis, who is also knowledgeable about the fires in Mati (2018) and Varibobi (2021), elaborates: “The conditions were for an index of 5 at the time. With an index of 4, the Fire Service’s state of readiness was not the maximum. If it had been 5, the Fire Service would have brought out an additional 25 units, from the 86 it had, while more fire stations would have been staffed for more hours, i.e. people would have been more ready.”

When there is a category 4 or 5 risk in an area, the Fire Service must effect an aerial surveillance. If the patrol sees a fire, the Fire Service must intervene immediately. In the catastrophic fire in Varibobi in the summer of 2021, two Air-Tractors were patrolling the area from 11 am because of the danger index. Gourbatsis notes that “Mr Hardalias [deputy minister for civil protection at the time] gave an order for them to land at 13.00 and stand by ‘if needed’. The fire in Varypobi subsequently broke out a kilometre from the airport. The planes had been on standby for 20 minutes, and precious time was lost as they got back in the air.”

Civil Protection ignoring the National Observatory

Phoebus Theodorou was for years the person who signed off on the maps of the General Secretariat of Civil Protection. He is a forester, not a meteorologist. He retired some time ago, but according to MIIR’s information, he remains an advisor to the Ministry of Climate and Civil Protection and continues to be involved in the publication of the disputed map. It is no longer approved by him, but by the scientific team at the Civil Protection secretariat. The individuals who make up this team have not been identified.

Andrianos Gourbatsis argues that “Civil Protection is stuck with the charter that was issued in 1995 when the service started. A lot of things need to change. On the weekend, these Civil Protection officials are at home, yet they still issue a map. This is not serious. They check EFFIS data every day, they see where it ‘blackens’ and issue the map accordingly”. Since the 2000s, as deputy chief of the Greek fire service, he has been asking politicians to have the map issued instead by Greece’s meteorological agency, EMY. His suggestion has gone unheeded and EMY is now doing even less work than before. It used to issue a special daily map of the conditions in the burnt areas.

Phoebus Theodorou, the official formerly in charge of issuing the Civil Protection maps, has claimed (GrTimes.gr, 08/06/2021) that they are based on the Forest Fire Weather Index (FFWI) of the Canadian Forest Service, as well as other geographic information systems and software. The National Observatory of Athens refutes this assertion. Kostas Lagovardos, at the Observatory, is categoric: “It can’t be using the Canadian index, because if it did, it would produce the results that we do. Southern and northern Crete would almost never have the same hazard index when they have different scores of 4 and 5 on the Beaufort scale.”

We contacted Phoebus Theodorou in order to answer questions about this, but to no avail. In addition, we sent written questions to the General Secretariat of Civil Protection but received no response by the time this article was published.

At the moment, the most authoritative daily fire-risk map in Greece seems to be that of the National Observatory of Athens. It is based on the Canadian pyro-meteorological index and takes into account temperature, humidity, wind, drought, how many days it has not rained, in order to produce a number to quantify risk. It offers a better analysis than the corresponding Civil Protection map, since it reaches a 2×2 km level of resolution in each region of the country. However, the fire service – at least officially – bases its planning on the Civil Protection map.

Vassiliki Kotroni, director of research at the Athens Observatory, comments that “we don’t know how the Observatory data is used by the General Secretariat for Civil Protection. We do know that our weather monitoring uses a network of 550 weather stations that we operate throughout the country. Since this data is freely available, it is possible that the Civil Protection monitors our stations. But this is not based on a memorandum of understanding, on any formalised system that would oblige us to operate in a certain way. We are doing this without any obligations. In a properly organised country, things should be a little different.”

Dr Kotroni is the scientific director of the Observatory’s Meteo team, which has pioneered a mechanism to forecast the spread of fires. Called IRIS, the system is innovative at both Greek and European levels. It aims to facilitate rapid responses to active forest fires. Knowing the location and time of the start of a fire, the system can, within 20 minutes, provide a forecast of how the fire front will develop over the next few hours. Within half an hour, it can provide a forecast for the next 24 hours. The system takes into account both the meteorology and the changing weather conditions caused by the fire itself. In 2019-2020 it was successfully used in cooperation with the Civil Protection and the Fire Service in over 200 forest fires. However, for two years now, explains Dr Kotroni, “for reasons we do not know, the cooperation has faded away, and unfortunately since 2021 it has not been sought by the Civil Protection or the Fire Service”.

Although it was available, IRIS was not used during the major fires in Varibobi and Evia in 2021. In a post after the fire in Varibobi, Meteo.gr stressed that it had carried out an “ex-post forecast”, adding that “the forecast that IRIS 2.0 could have provided operationally if it had been requested is very close to the actual spread of the fire”. Today, the IRIS system is still being developed with the Athens Observatory’s own resources, without any involvement of the state. It was not used by the Civil Protection even during the catastrophic fires of July this year.

The video shows the spread of the Varybompi forest fire in 2021, as simulated vy the IRIS 2.0 rapid forecasting system. Source: Meteo.gr

This material is published in the context of the “FIRE-RES” project co-funded by the European Union (EU). The EU is in no way responsible for the information or views expressed within the framework of the project. Responsibility for the content lies solely with EDJNet. Go to the FIRE-RES page

Authors: Janine Louloudi, Nikos Morfonios, Kostas Zafeiropoulos (MIIR)

Data Analysis – Visualisations:  Thanasis Troboukis (iMΕdDLab)

Illustration: Louiza Karageorgiou

Visualisations: Corina Petridi

On January 22nd, the first femicide for 2023 took place in Nikaia. A 50-year-old man killed his 54-year-old wife by strangulation, after first beating her up. He then called the police to tell them what had happened, uttering the aforementioned phrase on the phone. According to witness accounts and what became known after the murder, the perpetrator had been arrested by the police following domestic violence in the past, in 2017 and 2019. However his subsequent treatment by the justice system is not known. Could this crime have been avoided?

This question comes up again and again after the news of yet another femicide. Is there anything more the authorities could have done to protect the woman before she lost her life?

Apostolos Tsapas strongly voices his disappointment for the failure of law enforcement to protect his own children. 28-year-old Konstantina Tsapa, along with her 29-year-old brother Giorgos Tsapas were murdered on 5 April 2021 by her estranged husband in the village of Makrinitsa in Pelion. The double murder dominated the news at the time. It was during the third wave of the Covid-19 pandemic, a period in which a number of restrictions were still in place. Four days before the murders, the estranged husband had violently attacked the mother of his child and her parents in the same house.

Apostolos Tsapas describes his devastation to MIIR: “During the fight in Makrinitsa, before the murder, he had come to the house and beat all three of us: me, my wife and my late daughter. Then the police took him away, and detained him for two or three hours. But they let him go, saying to me, ‘We can’t hold him any longer’. They kept calling my daughter and asking her, ‘What should we do with him? We can’t keep him any longer’. And so he was released. We filed a complaint, but they didn’t arrest him. As for the blame… The harm has been done, my children are not coming back.” He adds that his daughter had filed an injunction against the perpetrator, but it was not heard in time.

“The injunction was scheduled to be heard the day after the murder. And of course he killed her in the meantime, so there was no time for them to be heard”, laments Anthoula Anasoglou, a lawyer for the victims’ family. “He had been accused of domestic violence in 2021, but was never arrested in the context of self-incrimination. The police forces had a tolerant attitude towards the perpetrator. In fact, in the courtroom at the trial, a police witness admitted having told the man’s wife, on his release, ‘It’s okay, he loves you, he won’t hurt you’. And ‘It’s okay, they’re a couple, they’ll get back together’. The police witness said this in court and it caused a lot of tension”.

In small places where everyone knows each other, as in the case of Makrinitsa, police officers often go beyond their duties in domestic violence cases, explains the lawyer of the Tsapas family: “The police officers play the role of psychologists and try to reassure the woman, without understanding the seriousness of the situation. And for Konstantina it was just an inevitable spiral towards the void, like a thriller where you already know the ending. Photos in the days leading up to the killing showed her having been abused, she had a black eye. He had been cursing her, locking her up, there was endless violence. This had been going on for two years. He had beaten the brother and the parents before. For two years there was a systematic cover-up. It all pointed to a tragedy, and that’s what happened…”

The causes of a predictable crime

As shown in the cross-border investigation the Mediterranean Institute of Investigative Journalism (MIIR) coordinated in the context of the European Data Journalism Network (EDJNet) along with 18 media partners in order to gather updated data on the extent of gender-based violence in Europe, in Greece the pandemic period was characterised by a frightening increase of 110,2% in victims of physical violence in 2020 and 90,4% in 2021, after 3,609 victims of physical violence were recorded in 2020, reaching 6,873 in 2021. Incidents of psychological violence in Greece increased from 2,906 to 5,350 during the period in question, and those of sexual violence increased from 69 to 141. Similar acts of physical, sexual, economic and psychological violence were experienced by thousands of women across Europe.

In Greece, the rise in domestic violence and femicide led the supreme court prosecutor Vassilis Pliotas to issue an encircular in November 2021. It called on prosecutors to intervene imminently, to further the process of arresting the presumed perpetrators of such crimes and for the related criminal cases to be heard as a matter of priority in court, so as to avoid all delays in delivering justice. 

Despite the Pliotas initiative, in practice the issues of both police protection and the administration of justice are not moving as fast as they should.

In domestic violence, most crimes – apart from rape and homicide – are misdemeanours, explains Kiki Petroulaki, which means that short suspended sentences are given. “This should be about the police arresting the perpetrator and the authorities punishing him immediately. Not the police arresting the perpetrator, the prosecutor letting him go and within two hours the perpetrator being able to return back home. The system has a big responsibility when it sees that there are older complaints against a perpetrator, and it does not take any action. Domestic and sexual violence is never an isolated incident, it repeats itself, with the same victims and different ones. This is an issue that has been discussed across Europe in recent years – the recurring pattern as a risk factor. It is also present in the Istanbul Convention, which aims to prevent violence against women and domestic violence. Having a previous record is an aggravating circumstance and should ring bells for the police and the public prosecutor’s office and make them respond more quickly. Putting someone in jail for a misdemeanour is almost impossible, even if they have four convictions in a row. But even if they were put in jail, I don’t think it would solve the problem of domestic violence.”

According to this experienced psychologist, who has been called upon to advise many female victims of domestic violence in Greece, it is clear what is needed: strict measures that will immediately remove from the perpetrator the ability to control the life of his victim, combined with systematic monitoring of the safety of victims and their children.

The Istanbul Convention includes many such provisions for the protection of domestic-violence survivors and children who are directly abused and/or exposed to their mother being abused. Unfortunately, our country chooses not to apply them, or even violates them in law. Examples include Articles 26, 31 and 45 of the convention, which aim to protect children, and Articles 48, 51, 52, 53 and 56, which focus on risk management to prevent recurrent victimisation. 

“The effective implementation of these and other provisions of the convention requires, for every reported case of domestic violence, an honest, immediate, coordinated, cross-sectoral response by police, justice and support services, both specialised and general. The European Anti-Violence Network is attempting to design this, alongside the authorities and using an exchange of good practices between Greece and Iceland within the framework of the “ACF project GR_IS_UnitedForDVSurvivors”, explains Kiki Petroulaki. She adds: “At the end of 2023 we will see whether the protection of women and children and the reduction of femicides is indeed a political priority – or whether the only thing that interests our country is not to ‘sound’ like we are violating European and international legislation and the human rights of survivors of domestic violence and their children.”

Among the data analysed as part of the MIIR-EDJNet investigation was the number of prosecutions, convictions and imprisonments of domestic violence perpetrators. This enables a relative estimate of the relationship between prosecutions and imprisonment for male perpetrators of domestic violence against women. From the available data collected in Greece for 2020 it is estimated that, relative to the number of perpetrators of domestic violence against women (4,436), the prosecution rate was 70.6% (3,132). Convictions account for 20.9% of these prosecutions, while imprisonment was a penalty in an estimated 13.7% of these convictions. However, comparing the number of offenders with the number of men imprisoned, it is estimated that for every 100 offenders recorded in 2020, only two were imprisoned. So overall, just 2% of perpetrators who used violence against female partners were imprisoned. 

It is worth noting that there are likely to be discrepancies in the data and that these percentages are entirely indicative. Indeed they may be overestimated, as the prosecutions brought in 2020 also relate to cases reported in 2019 or even 2018. However, they are a relative estimate of the relationship between prosecutions and imprisonment of male perpetrators of crimes of violence against women over a given period of time and they indicate a trend. Similarly, it is interesting to note the percentage of cases where prosecutions ceased due to a process of pre-trial agreement (21.7% and 33.4% of cases in 2020 and 2021 respectively), as well as the percentage of cases in which restraining orders were issued (from 0.6% to 1.6% of cases in 2016-2020).

On average, therefore, only 3% of men charged with domestic violence in Greece and 5% in Slovenia ended up in prison annually in the period 2016-2021. In contrast, in Spain the equivalent annual average figure for men prosecuted for domestic violence and ending up in jail was 30%.

Sentences and recognition of femicide

The Greek government recently moved to toughen up the penalties for perpetrators of domestic-violence crimes. But is this the solution?

“Tightening up sentences not only is not a panacea, but it seems ineffective. This does not mean that the punishment should not be proportional to the gravity of the act. But, in itself, a strict sentence is not enough to deter the perpetrator or to reaffirm citizens’ trust in institutions and the administration of justice”, says Chara Chioni-Chotouman, a lawyer at the Diotima Centre for Gender Rights and Equality. She also stresses that the failure to properly implement the law risks renders “the response to crime meaningless”, and adds that the frequency of violence against women shows that Greece needs to reassess its attitude to such crime, by recognising femicide. However, she points out that the most immediate need is to “update the protection tools by, for example, tightening rules for those who violate decisions which are intended to protect the victim and prevent crimes of violence“.

In an article last October, Prime Minister Kyriakos Mitsotakis made it clear that he had no intention of legally recognising femicide in Greece, but promised to do everything possible to restrict the phenomenon. Among other things, he referred to the establishment of 18 police “Domestic Violence Offices”, charged with managing incidents and providing information to victims. However, cases of understaffing have been reported in those offices, as well as behaviour by officials that discouraged women from reporting.

“There are ongoing trainings for police officers to better manage incidents of gender and domestic violence,” argues the deputy minister for Demography, Family Policy and Gender Equality, Maria Syrengela, adding that the legislative framework can only partly contribute to the prevention and deterrence of violence against women. However, when it comes to the legalisation of femicide, she says that “it is not a question of what to call these crimes against women but more importantly to focus on prevention and to put an end to the attitudes that allow abusive behaviours”. 

The picture is very different in Cyprus where femicide was recognised in July 2022 as an offence in its own right, following a proposal by the then speaker of the Cypriot parliament, Annita Demetriou.

Speaking to MIIR, Ms Demetriou, who is the first woman to occupy her position in Cyprus, said the term “femicide” does not negate the term homicide, but rather has a complementary and reinforcing effect: “In order to have an effective response we must first of all call a spade a spade. This is precisely why we insist on the importance of the term femicide, because it encodes, signifies and names the most extreme form of gender violence – and any modern self-respecting society must admit that victims of domestic and sexual violence, victims of misogyny, victims of intimate partner violence, victims of ‘honour’ crimes or crimes over religious beliefs – these victims are women, not men. Therefore, the establishment of femicide as a specific offence – as opposed to the common-law crime of homicide – emphasises the intensity, origin and cause of the crime. There is therefore a need for legal separation. At the same time, another valuable aspect is added to the toolbox for eradicating the phenomenon: the possibility of an official record of femicide.”

As the MIIR data investigation has demonstrated, there is a significant pan-European data gap in terms of the actual number of femicides in the first place, but also of female victims of physical, sexual, psychological and economic violence. There is also significant uncertainty over the number of perpetrators of these crimes. In Greece and across Europe, experts and women’s groups who advocate the recognition of femicide as an offence, stress that this may be the only way to tackle underreporting of crimes that kill and harm thousands of women every year.

The data resulting from this project, as well as the findings on the institutional gaps in prevention and support for victims and on the administration of justice, show that the undeclared war against women in Europe will not stop until citizens and politicians face up to the problem. There is a need to invest financially and qualitatively in strengthening the system of protection for women and vulnerable groups. Laws need to be implemented, and young people need to be better educated on gender equality and gender relations. This would at least be a small tribute to the women who have lost their lives to crimes that could have been prevented. 

By 27 December 2022, according to UNHCR  figures, 7,896,825 refugees from Ukraine had been registered in Europe, of which 4,885,650 had been granted temporary protection status.

As the EU automatically grants residence permits and visas to Ukrainian passport holders, Ukrainians are given priority for housing and social services. At the same time, however, as a recent New York Times report  showed, many of the remaining refugee camps and asylum seeker centres are being abandoned to their fate by European governments. The war in Ukraine has dramatically increased the number of asylum seekers in Europe, but has crowded out refugees from other war zones. Activists denounce the existence of a two-tier system, which is unfair to non-Ukrainian asylum seekers, who are presumed to be living in appalling conditions. In Berlin, limited refugee housing capacity has forced city officials to evict some of the Afghan refugees to make room for those arriving from Ukraine. In Brussels, asylum seekers are forced to spend the night on the street. Recently, the European Court of Human Rights ordered the Belgian government to offer shelter to an asylum seeker from Equatorial Guinea who had been living on the street since July. In southern Germany, mayors are settling refugees in gyms and concert halls, while in the Netherlands the government faced legal action over inhumane detention conditions in refugee camps. A Dutch court ruled a few days ago in the first instance that the Dutch government must provide all refugees with care similar to that given to Ukrainian refugees.

In Greece, pushbacks at land and sea borders have become de facto government policy, according to the UNHCR and numerous humanitarian organisations (but not according to the government). Fortunately, arms were opened wide for Ukrainian refugees, with little in the way of racist or intolerant rhetoric. A small detail: the refugees are white, European, Orthodox Christians. And most importantly, they want to leave again.

Most of the people who started arriving in the country last spring were women and children. There were also some elderly people. It is the same picture in other European countries. Ukrainian men up to the age of 60 are, moreover, banned from leaving their country. Although there is no conscription at the moment, those of conscriptable age must remain in Ukraine, with the exception of men with three or more children. Those who chose Greece as a destination country did so mainly because of the significant Ukrainian community, where they might have had relatives and acquaintances. Most came by road and air via Poland, while others arrived via Romania by bus. Those in Mariupol and the eastern regions of the country went first to Georgia and from there came by plane. The last official count on 8 August reported that a total of 75,945 Ukrainians have fled to Greece since the beginning of the war, of whom 19,760 are children (up to 17 years old). The peak of the Ukrainian refugee wave in Greece did not occur in the first months of the war, but rather in July.

“Greece generously opened its doors to the Ukrainians. Anyone who wanted to come came without any problem at all. At this point I don’t think we will have any new wave of refugees,” says translator Olga Sapolayeva, who used to work at the Greek consulate in Mariupol.

Few, however, apply for asylum in Greece. In 2022, Greece recorded only one case of a Ukrainian who obtained international protection. Meanwhile 20,420 people have obtained temporary protection status for one year, which was due to expire in March 2023 but is now renewed for another year until March 2024. Of the 20,420 with temporary protection, just 212 were staying in shelters at the end of October. (125 in Elefsina and 87 in Serres).

At the same time, data collected by MIIR from the Greek Ministry of Migration and Asylum identified only 49 cases of Ukrainians who applied for and obtained subsidiary protection status in 2022 (24 in August, 10 in September and 15 in October). Subsidiary protection status has similar characteristics to temporary protection and the same duration of one year, but refugees tend to avoid it as they usually have to surrender their passports. Subsidiary protection is an international protection for people who seek asylum but do not qualify as refugees.

In the European Union, a person eligible for subsidiary protection status is defined as a third-country national or stateless person who would face a risk of serious harm if returned to his or her country of origin (torture, death penalty, degrading treatment, serious personal threat to life, etc.).

“Many times people who have been granted subsidiary protection are left without any passport. You hand over the passport and then they say, ‘go and get a certificate from your country saying that you are indeed a citizen of Afghanistan, for example, and that you should normally be issued a passport by the authorities of your country’. But Afghanistan, for example, does not issue passports. So a lot of people have found themselves stranded in Greece. Ukrainians choose temporary protection because of the passport and the fact that they want to go back,” says lawyer Hara Katsigiannis from the Greek Council for Refugees.

As our translator Olga Sapolayeva explains, many Ukrainians apply for housing – as they are entitled to it under the temporary-protection status – but they usually do not choose a state structure to stay in. The majority stay with relatives and friends in Greece, with a view to returning to Ukraine or moving to another European country. Most women seek work in the service sector, while many are working online at the jobs they already had. A few have become interpreters and mediators who help other Ukrainian women, while those who do not know Greek or English take care of children and the elderly.

“Clearly the Greek state treated the Ukrainians differently from other refugees. This is discriminatory treatment, this lack of equality between asylum seekers and applicants for temporary protection. But in Greece they attribute it to the European directive”, says X. Katsigiannis. “In essence it’s as if they are saying temporary protection is something ephemeral, it will all be over. Some [Ukrainians] get a social security number straight away, and a tax number, and access to work, while the others get rejection decisions from the Asylum Service and the Refugee Authority, especially based on the safe third country and safe countries of origin.”

With migratory flows being significantly lower in recent years due to illegal pushbacks on the islands, asylum claims are generally being processed faster than in the past. According to the Ministry of Immigration, the average processing time for applications submitted in 2022 is 40 days.

In June 2021, the Greek government included Turkey in the national list of safe third countries for asylum seekers whose countries of origin include Syria and Afghanistan. The move has been criticised by dozens of NGOs working on the refugee issue. A recent report by Human Rights Watch calls for the repeal of the measure, citing the fact that Turkish authorities arbitrarily arrested, detained and deported back to Syria hundreds of Syrian refugees, both men and boys, between February and July 2022.

Meanwhile, Greece continues to be the first stop for thousands of Afghans. After Ukrainians, they are the second largest group of asylum seekers in the EU and by far the largest in Greece, where more than 37,000 – over a third of the registered – had submitted asylum applications by the beginning of October. “While the Greek government has welcomed refugees from Ukraine, efficiently registering them, issuing legal documents and allowing immediate access to work, Afghans in Greece, along with other asylum seekers and refugees, continue to be isolated from the Greek society in which they seek to rebuild their lives,” Dimitra Kalogeropoulou, director of the International Rescue Committee (IRC) in Greece, recently told The Guardian.

There are several problems with the list of so-called safe countries of origin. According to Article 87 of Greek Law 4636/2019, a country can be considered safe if the asylum applicant “does not invoke serious reasons to consider that the [applicant’s] country is not a safe country of origin for him/her”. The law began to be implemented in 2021. The list has since grown to include 17 countries, including Ghana, Senegal, Morocco, Algeria, Pakistan and Bangladesh. Even Ukraine was originally included, but on 1 December 2022 the Ministry of Immigration and Asylum at last removed it from the list.

But how do you decide whether a country of origin is safe? “The director of the asylum service has a team of officials who basically say ‘I want you to find out everything about, for example, Senegal and write a report. Then the Minister of Immigration and Asylum and the Minister of Interior issue an opinion based on this research report,” the lawyer X. Katsigiannis explains to MIIR. If someone comes from such a country, in the interview they will have to rebut the presumption of safety, which is usually impossible. 99% of these decisions are negative. “A few days ago I tried a case, a trans woman from Morocco. They dismissed it. They didn’t even go into the process of addressing the case individually and thoroughly, they relied on the country’s status. And the rejection decisions are usually 3 lines,” says Katsigiani. Applicants do not know what the internal recommendation is and cannot defend themselves. None of this applies to Ukrainians, as they are granted temporary protection immediately.

“This is institutional racism. Refugees are divided into two categories according to their origin,” laments David Schmittke, spokesman for the Saxony Refugee Council in Dresden. Indeed, in the early months of the war in Ukraine, there were also reports of discrimination against foreign residents of Ukraine attempting to flee the country.

“There is a spirit of welcome and generosity towards Ukrainians, which I do not criticise at all. They deserve it. But I would love to see the same treatment applied to Syrian refugees,” Paulo Pinheiro, chairman of the UN Commission of Inquiry on Syria, told Euronews.

In the view of Filippo Grandi, the UN High Commissioner for Refugees (UNHCR), Europeans should “learn lessons” from their experience of welcoming the displaced Ukrainians, and extend this welcome to other refugees at a time when humanitarian crises are growing worldwide: “Do not forget the others”.

Research-Text: Kostas Zafeiropoulos, Nikos Morfonios, Janine Louloudi (MIIR)

Data analysis-visualization: Korina Petridi

Illustration: Louiza Karageorgiou

“It’s been 8 months since the last time I got my medicine, I can’t find it anywhere no matter how far I’ve searched. It used to be a so-called rare drug, but now it has become a non-existent one” says 25-year-old Eleftheria. She suffers from a rare form of rickets, which is a metabolic disease of the bones. “I was told to search for it in a warehouse in the center of Athens, but I didn’t find it there either. Pharmacists advise me to be patient. There is no replacement. This situation is very serious for me, I have severe pains and my whole body is straining,” says Eleftheria to MIIR.

In Europe, about 25 million people suffer from a rare disease. The drugs that are needed are called “orphans” because they are not usually adopted by the research programs of the pharmaceutical industry. In Greece, however, as in many European countries, the shortages no longer concern only rare diseases but regular consumed ones, such as antibiotics, respiratory and cardiovascular drugs.

MIIR jointly with the collaborating journalistic teams of the EDJNET searched for data and managed to create a – as homogenized as possible – database of medicine shortages in Europe. We recorded 22,107 different entries over a five-year period (2018-2023) in a total of 9 European countries (Germany, Italy, Spain, Slovenia, Czech Republic, Greece, Romania, Austria, and Belgium). This research indicates that Greece is one of the countries that declared the lowest shortages in absolute number during the last five years. At the same time, however, the Greek official data show that even for these few – in relation to the real depiction – Greece has the longest median duration of shortages. 

In the latest related announcement of the Greek National Organization for Medicines (EOF) 148 medicine shortages are reported. ‘’There are much more but they report less. I am just indicatively saying that EOF issued a press release in September 2022 where it was mentioned that in terms of shortages we were in a better era than in 2019. We have already reported for over a year that we have much more (shortages)’’, says Ilias Giannoglou, a Board Member of Athens Pharmaceutical Association. 

According to this Association there were over 400 medicines in shortage in mid March 2023.

“EOF is clueless in terms of shortages. It doesn’t know the market. It does not know which warehouses are exporting and which are not. This year was one of the worst, if not the worst ” adds the president of Athens Pharmaceutical Association, Konstantinos Lourantos. The interview at his pharmacy was interrupted by a customer. We heard him say (Lourantos): “this is in short supply, I had 10 boxes, I gave them all today; maybe you will find somewhere, although I think it would be very difficult”. He then turned to us: “Here is a man who tries to find an antibiotic for his child but there is no Augmentin. I had taken many boxes, some 50, I collected them as if I knew, but now I don’t have any. I mean, if I don’t have it, meaning a pharmacist who had stored a lot, who will?” Lourantos wonders.

The CEO of the Greek pharmaceutical companies Uni-Pharma & InterMed and also SG of the Hellenic Federation of Enterprises, Ioulia Tseti, considers the under-registration as given. She highlights to MIIR the typical example of “paracetamol, the lack of which this year, had not been officially notified to the Greek National Organization for Medicines (EOF). This fact is due to the circumstance, that many multinational companies do not inform the Agency and prefer instead to pay the relevant fines. Unfortunately, the Agency does not work proactively in our country and in the interest of public health, except when the private sector appears. And the private sector unfortunately works -with very few exceptions- at its own interest’’.

We contacted the President of the EOF, D. Filippou and repeatedly sent our written questions to the organization without receiving any response until the publication of the present.

The Greek “paradox”

The production and distribution of pharmaceutical products is one of the most dynamic branches of the Greek industry. Based on the latest research by the Foundation for Economic & Industrial Research (IOBE) on behalf of the Hellenic Association of Pharmaceutical Companies (SFEE), in 2020 the sales of drugs in pharmacies and drugstores amounted to €4.6 billion, increased by 3.7% compared to 2019, while the sales in the hospitals and pharmacies amounted to €2.4 billion to be increased by 5.0%.

Drug sales have increased by 80% during the last five years, reaching a €3 billion in 2021. According to the Prodcom (Eurostat) survey, pharmaceutical production in Greece in value (ex-factory) approached €1.7 billion in 2020, increased by €287 million compared to 2019, while compared to the average term of the period 2010-2017 is strengthened by 82%. In addition, drug exports in 2020 increased by 48.3% compared to 2019.

So, if all these indicators are positive, why are there so many medicine shortages?

“There are two reasons: one is, the reduced import of products from some multinationals which are obviously not interested in the Greek market. By an audit we carried out over the last three years, we found out that many multinational companies imported smaller quantities of certain products,” mentions to MIIR the general secretary of the Panhellenic Association of Drugstores, Irini Markaki. And she adds, “the second reason- a very important one indeed-is the illegal export- please pay attention because there is also a legal one – that is done by some, in collaboration with pharmacies and some astute people who collect them”.

According to the analysis of MIIR, it appears that the main causes of the drug shortages in Greece for 2022 are manufacturing or product quality problems (45.3%),  supply chain delays (33.7%) and increased demand (14%) 

Shady dealers and the hoovering

These drugstores usually buy with cash from some pharmacies and then export directly to other countries. According to Ms Markaki, the problem was created during  MoU austerity years in Greece, because of the OECD toolbox that allowed the creation of such ‘’monkey business’’-pharmaceutical warehouses. 

“They create a Private Capital Company and they get easily an approval from the Greek National Organization for Medicines -because they include, for example, a refrigerator- however, without having a high stock of drugs and without having large spaces, while a wholesale pharmaceutical warehouse requires very large spaces. And what do they do? They go and collect medicines from the pharmacies (so in the market they call this “hoovering”) and then they export them, they sell them to each other, they ‘’clean’’ them, they sell them to large pharmaceutical warehouses that export at the end. Or they sell them in black market outside Greece. There, a great deal of damage is done both to the Greek State and to the public health of whatever State they will end up in, because we don’t know under which conditions they are transferred.”

In mid-winter, EOF imposed a temporary lock down on 3 pharmaceutical warehouses that refused inspection. 

However, this is also considered completely insufficient. “A short while ago, the Minister of Health, Mr. Th. Pleuris, issued an announcement about a pharmacy in Athens that had been locked down because the owners refused the inspection. This is not enough, however, as it has been observed that often companies can and do reopen, simply with a different name”, states Ilias Giannoglou of the Athens Pharmaceutical Association.
In fact, those who are “caught in the act” quickly open a new “second chance” warehouse with a different name, just paying a low fee to the Greek state.

However, apart from illegal exports, pharmaceutical manufacturers, traders and pharmacists agree that the low price of the medicine in Greece is part of the problem.

It is noted that only 34% of the total amount of medicines consumed in the country are produced by domestic factories. As Ilias Giannoglou explains, “Greek pharmaceutical companies mainly produce generics. The ones that are exported are the originals. They are multinationals which are imported and re-exported. For example, a company’s insulin comes from Denmark and the company imports 300 pieces and channels them to the Greek market. However, an imported drug is sold by the pharmacy with a multiple profit abroad, than if it is distributed within the country”.

On the other hand, the powerful pharmaceutical industry in Greece – usually immune to the press criticism due to high advertising expenditure – also has a shared responsibility. Despite the inadequacy of checks by the EOF on drugstores, pharmaceutical companies often do not disclose in real time the quantities of drugs they distribute per pharmacy. Some companies do not even disclose the period of the actual shortage, which is critical information needed by legal pharmacies, pharmacies and certainly patients. 

In addition, according to the president of the Panhellenic Pharmaceutical Association, Apostolos Valtas,  “fake shortages are created at the responsibility of companies at critical time periods as a bargaining tool to put pressure on the price committee in order to achieve better pricing.”

Under the legislative framework, pharmaceutical companies must have 3 months’ stock (plus 25% for foreigners and tourists) and any shortages must be declared 3 months in advance. “No company does that. And companies have never been audited or fined for that. Let’s not fool ourselves. The pharmaceutical industry always has a huge power towards any government and has a lot of money to push to the market, either directly or indirectly” says Irini Markaki to MIIR.

The blame game among the key players of the pharmaceutical industry can last forever. At the same time, however,  people in need of their medicines feel more insecure. 

Eleftheria had not managed to find her medicine until the publication of the present. As a substitute, she takes another drug that does not fully aplly to a proper treatment, while following the advice of her endocrinologist, she has adjusted her diet to cover the substances she is lacking.

Less money for health

The total funding for health expenditure in Greece fell by 25.9% in the period 2010-2020, while in the EU it increased by 20.7% in the same time period (source: IOBE, SFEE, The pharmaceutical market in Greece: Facts & figures 2021). The public out-of-hospital pharmaceutical expenditure suffered a significant decrease of 60.8% in the period 2009-2021. The funding decrease for health expenditure in Greece is in an opposite direction from the whole EU, but also from the southern Mediterranean countries subset.

The government, unable or unwilling to control the situation, often throws the ball of blame to doctors and patients. Indicative was the statement of the Minister of Health, Thanos Pleuris at the beginning of this year: “some parents buy more non-prescription drugs and doctors may sometimes prescribe antibiotics in excess, providing an incentive for people to stock medecins at home due to fear of shortages”. This statement provoked intense reactions from the opposition and many pharmaceutical associations.

Medicines may indeed be cheaper in Greece compared to the European average (although the continuous decline in purchasing power must be taken into account), may the EU indeed urgently need a bold patient-centred policy based on its needs of public health with the return of production to its territory, but it is the responsibility of the Greek State and the government to ensure transparency in the data of deficiencies and accountability throughout the chain of the pharmaceutical industry.

Before the shortages peak and before accusing parents of stocking medicines, many other actions should have been taken: preventive measures, transparent information with harmonized and detailed benchmarks, imposing deterrent sanctions on pharmaceutical companies and traders and banning parallel exports in time and for as long as it takes. To the question why this measure is almost always imposed with delay or not at all, a probable answer is that no government wants to reduce the index of exports, which add turnover to the country’s GDP.

As for the patients, especially for those who don’t trust the generics, as usual they are asked to bear the consequences through alchemy and prayers.

Read the first part of the MIIR investigation:  (Why) Europe is running out of Meds

Authors: Janine Louloudi, Nikos Morfonios, Kostas Zafeiropoulos (MIIR)

Data Analysis – Visualisations:  Thanasis Troboukis (iMΕdDLab)

Illustration: Louiza Karageorgiou

Visualisations: Corina Petridi

“It’s a very bad feeling, I haven’t gotten over it. You are not safe anywhere. You feel that nobody understands you, nobody wants to deal with you, nobody cares about your problem. Did you get away? Good. You didn’t? God rest her soul, we’ll cry about it on the news and that’s the end of it. One victim, then another, and another, and on and on. I have to admit to you that if I hadn’t left, I might have been one of them.”

This is how Eleni says she feels when she hears about each new femicide in the news. Divorced and the mother of a young child, she is a survivor of abuse. First, gross economic abuse in her marriage and then serious physical abuse at the hands of a colleague who insisted that he be her partner. Wearing the mask of someone who would help her through a difficult financial period, he approached her and then, when she refused to have a relationship with him, began stalking her as in a horror movie, going so far as to attack her in her home. 

That first time she ended up badly beaten in hospital, where she was urged by the staff to go to the police and press charges against him. Before she was able to do so, he visited her again at her home. And that is when “the terrible ordeal began”, she explains to MIIR. “I would call the police to my house, have them remove him, and then he would come back two days later. Broken cell phones, changing SIM cards, having no contact with anyone. Closed shutters, not being able to go to the supermarket or to work or anywhere, because he was stalking me, he would come to my house, anywhere I went.“

Eleni – who hides her real name for her safety, as the perpetrator is still at large and looking for her – lived through a six-month nightmare in which her stalker imposed a reign of terror on her in her home, self-servingly playing the role of her partner, controlling every aspect of her life by means of threats and physical violence.

In desperation, she began to secretly look for a way to escape with her young child: “I found closed doors everywhere. When I called a women’s support line, I was told: ‘You need to get an injunction and then we will put you on a list that says you have indeed been abused. There is a long wait. Only then can we deal with the question of your escape.’ Yes, I said, but if I press charges and police officers come, then who will save me from him after that? ‘Look’, they said, ‘there is nothing else that can be done’. I also approached the church, the attitude was the same, even worse… ‘It’s not their business… They can’t do anything’“.

Eleni is a prime example of a woman who, while completely isolated, with no support network, lost her independence overnight at the hands of an abusive man. Similar incidents of physical, sexual, economic and psychological violence were experienced by thousands of women in Europe during the pandemic. During that period there was an increase in violence against women in a number of European countries, as we reported in the first part of MIIR’s cross-border investigation with the European Data Journalism Network in collaboration with 18 news organisations, including iMEdD Lab, Deutsche Welle, El Confidencial, Civio, and OBCT.

Based on the data gathered by participating newsrooms, Greece showed the highest increase in femicides (187.5%), with 8 femicides officially recorded in 2020 and 23 in 2021.

This was the largest increase for 2021 among the countries for which enough data was available (Cyprus, Hungary, Italy, Serbia, Serbia, Slovenia, Sweden), in order to calculate this indicator on the basis of the index of femicides maintained by the European Institute for Gender Equality (EIGE). When comparing the two years of the pandemic with 2019, the result is a significant increase in officially recorded femicides in Greece, Slovenia, Germany and Italy.

In Greece, the pandemic period was also marked by a frightening 110,2% increase in victims of physical violence in 2020 and 90,4% in 2021. Specifically, in 2020 there were 3,609 victims of physical violence recorded, rising to 6,873 in 2021. During this same period, the victims of psychological violence increased from 2,906 to 5,350, and those of sexual violence from 69 to 141.

Speaking to MIIR, Cristina Fabre Rosell, Gender-based Violence Team Leader at the European Institute for Gender Equality, reminds that this form of violence “has its roots in gender inequalities and power imbalances in relationships. Femicide is the most extreme form of this power-based violence and remains one of the most widespread human-rights violations”. In a recent report, EIGE presented its Gender Equality Index for 2022. In this ranking Greece has consistently ranked last. Despite an improvement over the last decade, Greece remains a laggard among EU countries, at 15.2 points below the European average.

The Gender Equality Index also takes into account the handling of violence against women in the EU member states. During the pandemic, countries with higher positions in the index seemed better prepared to manage the extraordinary circumstances that exacerbated the risk for women.

“Very few member states – Ireland, Spain and Lithuania – adopted a comprehensive national policy or action plan to address the potential for violence by intimate partners in the context of Covid-19. Spain, for example, had a good contingency plan with many measures for intimate-partner violence, and also for several vulnerable groups such as women in prostitution or homeless women. Three other member states – the Czech Republic, Latvia and Poland – provided specific guidelines. In most states the measures that were strengthened were support lines or mobile apps for contacting the police, but not any increase in the provision of shelters,” explains Fabre Rosell.

Data collected for the MIIR data investigation reveal a pan-European increase in calls from victims of domestic violence or third parties to national support lines, such as the SOS 15900 hotline in Greece. The largest increase in calls occurred in the first year of the pandemic in Cyprus, with Italy, Greece and Austria just behind.

According to Greece’s deputy minister for labour and social affairs, Maria Syrengela, phone calls about incidents of domestic violence almost quadrupled during lockdowns. She interprets this as an indication that “many of the victims are no longer afraid to speak out and disclose incidents of violence, as they know that both society and the state are by their side.” In this context she mentions that the General Secretariat for Demographic Policy & Gender Equality operates a network of 44 counselling centres and 19 shelters.

The minister says that “never has a woman victim of violence who had to be removed from an abusive environment, been left outside the government structures“. According to official figures, the total availability in the shelters is about 400 beds. Data provided by the General Secretariat for Demography and Family Policy and Gender Equality shows that 244 women were accommodated in 2020, 218 in 2021, and 200 in 2022 (from January to October).

Dr Kiki Petroulaki, psychologist and chair of the board of the European Anti-Violence Network, explains that things are not that simple. For a woman in danger to be protected, it is not enough for her to just speak out. She needs to have her needs addressed seriously, both at the moment she calls for help and during the next steps. “If she is in danger when she calls, they will tell her to call the police. It’s fine if she ends up at the police station alone, but if she has a child, two children – where will she sleep at night? She will go back again. If she’s looking for shelter, she’ll be told the nearest counselling centre to get an appointment. At the shelter she can stay for three months with the possibility of extending to three more. Usually at the time the request is made, she is told the process she needs to follow, what medical tests she and her children need to do, and, if these appear alright, they will then look into which shelter in Greece might have a place. Women with children who are interested in a shelter are put off as soon as they hear about the time limit. Because if you have children and no job or support network, the three months and six months are prohibitive. If you leave the shelter after three or six months, what do you do then? Do you go back to where you were? This is something that deters too many women.”

Escape and the day after, for victims of violence

For Eleni, salvation came when she managed to get in touch with the European Anti-Violence Network, which still supports her with counselling in cooperation with “the Smile of the Child” ngo. This enabled her to find more permanent accommodation, where she currently stays with her young child. “After all this abuse, you feel as if you are reborn. The door to the new home was a security door, and it made me feel so safe”, says Eleni.

Today, however, she remains unemployed. Finding a job is not easy with a young child. Her single-parent family relies on the help of ngo’s to make ends meet. Help from the state is meagre: “I get an allowance. It used to be €300 for six months – €200 for the adult and €100 for the child. That’s what it was during the pandemic. And now it has become €80 and €80 respectively, a total of €160. It’s not enough.” 

As Kiki Petroulaki explains, without consistent and adequate financial support it is extremely difficult for women – especially when they have children – to escape the abusive environment they find themselves in. Especially since the child benefit for single-parent families in Greece was recently reduced significantly. “This is a major problem. The welfare state considers that a mother with one child can live on €300 per month and, therefore, any additional income, from any source, is deducted on her next application so that her annual income does not exceed €3,600 – and that’s if the mother meets the strict conditions to be eligible for the official minimum guaranteed income.”

“Female victims of domestic violence need a holistic framework of protection. These are women who have usually been trapped for a long time in a cycle of violence and abuse and need a more systematic and sensitised approach,” says Chara Chioni-Chotouman, a lawyer at the Diotima Centre for Gender Rights and Equality, which offers legal and psycho-social support, as well as job counselling for women who are trying to escape abuse and reclaim their autonomy by entering the workforce.

Just a few weeks ago the GREVIO committee completed an official visit to Athens. This committee represents the independent authority that monitors the implementation of the Council of Europe’s Istanbul Convention on violence against women. The visit was in the framework of its first assessment carried out in Greece and its results and recommendations are expected in the coming months. The government presented Greece’s initiatives to address violence against women, while the members of the committee also met with representatives of women’s organisations and other NGOs. There they discussed the incomplete implementation of the Istanbul Convention, and main problems which include: the increase in domestic violence and femicides, the inadequate support network for women victims of abuse, as well as the lack of a targeted support network for the most vulnerable women (such as disabled, Roma, LGBT, and migrant women) and for children. They also talked about issues arising from Greece’s Family Law Reform Act on children and abused women, and the need for systematic training to prevent gender-based violence and to better protect victims. 

There are still many steps to be taken in order to achieve a safer institutional framework for the prevention of violence against women and the support of victims. In the meantime, solutions must be found for women like Eleni, who managed to find a way out. “I never expected in my life that a front door could bring out so many emotions. Knowing you’re going to a safe home gives you great strength. It’s what you need. You feel that you’re not alone.”

Investigation ID

This cross-border data-based investigation was organised and coordinated by the Mediterranean Institute for Investigative Journalism (MIIR.gr) within the framework of the European Data Journalism Network (EDJNet). Data analysis and visualisations was conducted by iMEdD Lab (incubator for Media Education and Development). Data analysis check was performed by Kelly Kiki (iMEdD Lab). Korina Petridi contributed to visualizations for this article.

14 more EDJNet members participated in this investigation, which was conducted from October 2022 to February 2023:  Deutsche Welle (Germany), Openpolis, OBC Transeuropa (Italy), Civio, El Confidencial (Spain), Divergente (Portugal), CINS (Serbia), Pod črto (Slovenia), BIQdata/Gazeta Wyborcza, Frontstory.pl (Poland), Deník Referendum (Czech Republic), EUrologus/HVG (Hungary), PressOne (Romania), Journalism++ (Sweden). Three more media teams contributed data from their respective countries: Noteworthy (Ireland), Investigace (Czech Republic) and Atlatszo (Hungary).

The investigation has been published in three parts on miir.gr and EfSyn Newspaper.

Read in part 1: Femicide and the rise of violence against women during the pandemic

 Read in part 3: A systemic failure to prevent femicides