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MIIR - iMEdD investigation: Covid-19 spread twice as fast in Greek prisons

Overcrowding, abuse of the minimum personal space of prisoners, hospitalization without segregation of patients, crowded quarantine, lack of medical staff and health measures, delayed vaccination.

These are just some of the causes that lead to the virus’s spread.

March 12, 2022

Research – Text: Nikos Morfonios, Ioanna Louloudi (MIIR)  

Reseach and data visualisation: Thanasis Troboukis (iMΕdDLab)*

“When I got COVID in December 2020, around half of the prisoners in the Larissa Prison were sick at the same time.  We were put into a ward with 60 people, in a space of around 110 square meters. It was a roll of the dice whether you were going to be severely or just mildly ill.” The testimony of Vangelis Stathopoulos, a prisoner of the Larissa Prison, vividly summarizes the situation of Covid-19 in Greek prisons. It is confirmed by the findings of a large analysis of data from 32 countries, conducted by 12 European media outlets led by Deutsche Welle within the European Data Journalism Network (EDJNet). 

The MIIR (Mediterranean Institute for Investigative Reporting) and iMΕdD (Incubator for Media Education and Development) collected and processed the specific data concerning Greek prisons. This concerned their capacity, overcrowding, covid cases, deaths, access to healthcare and vaccination. In parallel, interviews were conducted with prisoners, specialists and scientists. Other institutional factors were also taken into account in the context of this pan-European research. What were the conclusions about Greek prisons? 

The virus spread twice as fast in prisons compared to the rest of society. As a result, one third of prisoners have been sick  to date. Explanations include cells with prisoners crowded into a few square meters; makeshift wards without any separation of patients; crowded quarantine areas filled with both healthy people and suspected cases; and insufficient access to healthcare and safety measures. Moreover, prisoners’ rights have been curtailed with the cancellation of visits and activities. 

For the data on covid cases, deaths and vaccinations until February 2022, the sources are the General Secretariat for Crime Policy, Greece’s “Special Standing Committee on the Penitentiary System and Other Structures concerning the Detention of Prisoners”, and the “Report on the Coronavirus by the General Secretariat of Anti-Crime Policy” submitted to the Greek Parliament on 12 November 2020 by the Deputy Minister of Civil Protection, Lefteris Oikonomou.

In Greece, the overcrowded prisons have created a favorable ground for the reproduction and spread of the coronavirus. It is not just the fact that based on the comparative data of the research, Greece appears in 7th place (as of January 2020) in the list of the most crowded prisons in Europe – this refers to the official number of prisoners each prison can hold and the actual population living within the walls. It is mainly the investigation’s finding in relation to the minimum living space of each detainee based on international conventions – in 25 of the 34 Greek prisons, this requirement is disrespected, making prisoners even more exposed to the virus.

For the same reason, our comparative analysis of the data reveals a shocking reality: Greece is one of the European countries that had the highest spread of the virus in prisons compared to the spread in the general population. By 2 July 2021, 16 months after the start of the pandemic, it is estimated that 7.9% of the prisoners in total were infected with the virus. The figure for the general population was 4.1%. Transmission inside prisons was almost twice as high as outside the prisons. The situation was similar in Northern Ireland, Italy, England and Wales, Slovenia, Belgium and Catalonia. In contrast, there was a smaller spread of the disease within prisons (compared to the general population) in Hungary, Austria, Spain (excluding Catalonia), Ireland, Switzerland, Albania, Germany and Scotland. 

Regarding the number of cases, Ioannina and Patras reported more than 300 cases per 1,000 inmates in prisons (392 and 339 respectively) between 1 March and 1 July 2021. They were followed by Larissa (278) and the special health center for prisoners at Korydallos (272) – though it is estimated that cases that have been reported there had been transferred from other wards or from other prisons. In the first three prisons it is estimated that the occupancy rate during the pandemic was kept constantly above 100%. In Ioannina the number of inmates was almost double the actual available capacity. In Patras the proportion reached 137% and in Larissa 129%.   

We collected new data in November 2021, finding again that the transmission in Greek prisons was more than double compared to the rest of society (16.8% vs. 7.2%). By February 2022, a period covered by the 4th wave of the pandemic and the outbreak of Omicron, 32.6% of prisoners had been diagnosed with coronavirus compared with 21.2% of the general population. In absolute numbers, the data in the Greek penitentiary establishments from the beginning of the pandemic until February 2022 reported 3,541 cases and 14 deaths. Disease management within prisons has been improvised and fragmented in response to the pandemic, and this has been added to the traditional structural problems of Greek penitentiaries.

Korydallos prison – Credit: Prisoners’ Solidarity Network

Less than 4 square meters of personal space in 25 of the 34 prisons

The minimal space of 4 square meters is important, not only in times of pandemic. Everyone, even in prison, has a right to a minimum of privacy.

“In Larissa prisons, the cells are for 8 and 10 people, so if someone gets sick, it makes sense that in a very small space of 15 square meters everyone will probably get sick,” says Stathopoulos, describing the suffocating situation in the cells.

According to the data, until 1 July 2021 in 25 of the 34 prisons of the country, each prisoner disposed of 4 square meters. The European Committee for the Prevention of Torture (CPT) of the Council of Europe has defined this space as the minimum per detainee in his cell. More specifically, in the special detention center for young people in Volos, each detainee had approximately 1.9 square meters of personal space. In Tripoli it was 2.1, in Kos and Komotini 2.3, in Ioannina 2.4, and in Chalkida and Nafplio 2.7 square meters.

“Every prisoner, according to the European Committee’s proposal for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), should have at least four square meters of living space in his chamber and six square meters in his cell”, explains Giannis Petsas, who holds a PhD in penitentiary policy. According to the CPT’s protocol, each cell should be at least 6 square meters if it accommodates one detainee, while for each additional detainee the area of ​​the cell should be expanded by 4 square meters. “This area is important”, points out Mr Petsas: “Not only for periods of pandemic. It is already very small and does not protect against the spread of the virus. But also in general, because every person even inside a prison must have a minimum of privacy so that he can live as best as he can. When you do not have this space and you are visible to others at all times, then basic human rights are violated.”

The reality is that the living space of each inmate in a prison is even less than the result of our data analysis. This used the median number of inmates per month in relation to the total area of ​​each prison. The exact number of cells is not known even by the General Secretariat for Anti-Crime Policy. When we asked exactly how many cells there are in the country’s prisons, what their size is and how many prisoners live in them, the GAP’s answer was that “we take the total space per detention center and divide it by 16 sq m. which should be each cell (4 prisoners), since each prisoner should have 4 square meters (based on CPT specifications). We would like to inform you that in the SPACEI questionnaire (this is the annual report with statistics on prisons of the Council of Europe) on 31 January 2020, Greece reported – as a total number of cells (in the country) – 2,747. We commented that the number of cells was calculated based on the minimum standards of the CPT for the space per inmate 4 square meters”. In other words, the 2,747 cells do not correspond to real data, but to the ideal and imaginary scenario that every prisoner should have a living space of 4 square meters.


Larisa prison. Credit: Prisoners Solidarity Network

Overcrowding makes prisons health hazards

In the comparative data from 32 countries collected during the research, Greece appears in 7th place overall for overcrowded  conditions in Europe. Based on the more specific data on the occupancy rate in Greek prisons, it appears that the average occupancy rate – based on the comparative analysis of the actual prison population and space in each institution, during the period from 1/1/2020 to 1/1/2022 – far exceeds 100% in 25 of the 34 institutions.

“There are several countries where there are more people in prisons than there should be,” said Filipa Alves da Costa, a public health expert at the World Health Organization’s Prison Health Program. “So there is the issue of overcrowding, and even in areas where there is no overcrowding, the occupancy is always close to 100%. This means that prisoners cannot follow the rules of physical distancing, for example. Therefore there is a greater risk when the virus is introduced into the prison environment, precisely because it is a closed living structure and it is not possible to comply with the conditions of distancing. In other words, it is a reinforcing factor of the effects of the virus compared to what we encounter in the rest of society”, she notes. 

In the case of Greece it seems from the data analysis that during the pandemic the occupancy of Greek prisons not only did not decrease, but on the contrary increased! Specifically, while on 1 January 2020 (before the pandemic) the occupancy was 107%, from April 2020 to May 2021 it increased to 113.1% (July 2021). 

In fact, according to the data, on 1/1/2022 in the special prison for young people in Volos, the occupancy reaches 201.9%. In Komotini it was 188.3%, in Tripoli 181.1%, in Corfu 173.9%, in Ioannina 154.5%, followed by the prisons of Chalkida (154.3%), Patras (148.9%), Nafplio (147.6%) and Kos (144.6%).

But there is another variable that makes prisoners vulnerable to the coronavirus. “Many detainees have many factors that put them at increased risk for a serious Covid-19 case, including conditions such as HIV and a history of smoking or other drugs. Marginalization, poverty and inadequate access to health care often burden these populations even before imprisonment, and prison conditions often exacerbate these factors,” according to the WHO. “In prison we consider people in their 50s to be older, even though they would not be if they were part of a community,” said Da Costa.

The WHO special advisor’s description corresponds to the case of Greek prisons. Poor living conditions, inadequate access to healthcare, a lack of support for medical staff and a lack of effective healthcare measures by prison administrations and the General Secretariat for Crime Policy – all exacerbate the transmission problem.


Chalkida prison. Credit: Prisoners’ Solidarity Network

Inmates play doctor

Vassilis Dimakis is an inmate in the 4th ward of Korydallos prison. As he describes it, at the beginning of the pandemic “the only measures were some bleach, and after a few months some masks. Antiseptics and masks did not exist in the beginning, they rarely brought us any, specifically they brought us masks after the first half of the year when some people from the outside brought them to us “.

Regarding the adequacy of medical and nursing staff throughout the pandemic, Dimakis states that “it is not specialized. The same people that were here before the pandemic continued to be here after the pandemic began. The staff was not upgraded. The prisoners had to do the dirty work themselves. For example for their working day, they had to work in the pharmacy. There is also no permanent doctor here, he only comes in in the morning. In the afternoon there are some nurses who have been placed by the administration to give injections. There is no doctor at night. 2,000 people are here and we are not being taken care of. “If something happens, there are the so-called trauma specialists who deal with someone who has a problem,  and take him to the hospital”, he notes.

The same image is confirmed by Stathopoulos. Like in the Korydallos prison, in the Larissa prison “the staff is not specialized. There are some nurses, who are few in number, only 8. There were no doctors! There was a prisoner who was a doctor and was inside for a financial offence. He had undertaken to check up on the prisoners who had fallen ill. As a result, as was logical because he came in contact with everyone, he got sick and also more seriously than everyone else. He was transported to hospital with a heavy case of Covid-19 and was admitted to the intensive care ward”.

 

“They place all the sick together and what will be will be…” 

However, the inadequacy of prevention and treatment of Covid-19 is not limited to the lack of health personnel and protective equipment. The whole case management and care of the sick seems more like a system based on sloppiness and randomness.

“Whoever who gets sick with Covid”, describes Stathopoulos, “is transferred to other special wards, which have other patients from different wards. They set up some special rooms, which used to be prison cells, and simply squeeze these prisoners into other wards. So whoever gets sick is locked up in a ward for 14 days with all the other Covid patients, which means that if someone has a serious case it can automatically be transferred to everyone else and everyone can get very sick. So the method is that we put all the patients together and what will be will be”. 

Dimakis describes the same treatment in Korydallos. “The patients are in spaces that are not disinfected, without any care for 14 days. “People come in all together, with a heavy viral load, and they all wake up together.” Regarding the hospital area, Dimakis points out that “unfortunately, the third ward of the Korydallos women’s prison, promised by Ms Nikolaou (former Secretary General of Anti-Crime Policy), has not opened, and has not hosted a single person ever! It was – supposedly – the appropriate ward to be transformed into space  for patients with coronavirus. However this wing has never been used by anyone with coronavirus! They have a specific area in the church, here in Korydallos, where they place someone who has coronavirus. Therefore if he is also religious, he can pray for his health… “. 

The same is true for the quarantine areas, where those who enter the prison (new detainees, from transfers, etc.) must stay for up to 14 days. They have 3-4 cells in the 4th wing, the so-called ‘discipline / isolation cells’, which are crowded by 15 people and where people going in and coming out stay in quarantine. They are all together, and no protocol is in use. They placed all the suspect cases there, where all the prisoners were together. In the same area both healthy and suspect cases can be found, there is no separation”, concludes Dimakis.

Why did the Greek government not carry out decongestion 

According to research, one of the main strategies taken by European governments to tackle the coronavirus in prisons was to decongest the prisons. Greece, however, never proceeded with this measure. During the first wave, many countries across Europe released an unprecedented number of inmates in order to reduce the pressure in prisons. “It was what experts were telling them to do for years, but it was very scary at a  political level,” said Catherine Heard, director of the World Prison Research Program. “I believe that Covid has given many countries an excuse to quietly reduce the number of their detainees.”

Heard calculated that the number of prisoners has probably been reduced by about half a million people internationally between March 2020 and June 2021. Countries such as Slovenia, Belgium, France and Italy, which were all running at full capacity, reduced their inmate populations by up to 25%, to their official capacity number or lower. “A lesson that these countries have been taught is that they managed to reduce their number of inmates without the world coming to an end” says Heard. With the pandemic offering a public-health reason to reduce prison populations, she highlights that it is vital for these prisons to maintain this ideal. 

On the other hand, the Greek government never got the memo, and never proceeded with reducing the number of inmates to de-escalate Covid conditions in prisons. Why this happened is described by Dimakis: “Mrs Nikolaou and the right wing government could not manage the decongestion. Because she probably considered it tragic to re-create a somewhat similar law such as the Paraskevopoulos law (a 2015 decongestion law enacted by the previous left wing government of SYRIZA, that was hardly criticized by the Nea Dimokratia-ND right wing party) was a key pre-election flag for the ND party, along with the ‘crime’ agenda and the terror around this issue. In case they did something similar and applied a Paraskevopoulos law, or even  a more improved one, they would have had an issue because the central part of the Right did not allow it and would not allow such a thing to happen, as to let all the ‘criminals’ out”.

However, when we asked the General Secretariat for Anti-Crime Policy about the actions taken regarding the management of overcrowding in prisons, they answered that “regarding the reduction of the number of inmates or other ways of decongestion with reduction of sentences, etc., these are actions that concern the Ministry of Justice and the competent authorities. The General Secretariat proceeded with mass transfers from overcrowded detention centers to others which had available space. For example more than 1,000 convicts were transferred specifically from the Korydallos prison to others in the region. Thus, Korydallos was turned into a prison exclusively for convicts”. They also pointed to plans of the General Secretariat for the construction of six new prisons.

However, a specific act of the Ministry of Justice seems to have aggravated the conditions of overpopulation by putting a brake on the transfer of prisoners. It is law 4670/2020, that brought about changes in the licensing process and limited the conditions that allow the transfer of a detainee both to the rural prisons and to the Central Prison Material Warehouse. A portion of the press characterized the law as “photographic” in order not to allow Dimitris Koufontinas (convicted in 2007 for his involvement with the left wing armed group “17 November”) to remain in the Agricultural Prisons of Kassavetia, Volos. But the law also had a side effect. In the midst of a pandemic, it left rural prison licenses and other detention facilities overcrowded. The Special Agricultural Detention Center of Kassavetia in January 2022 was 31.8% full. In Agia Chania the figure was 30.3%, in Kassandra Halkidiki 28.2%, and in Tiryns Argolida 13.9%. Meanwhile, in most of the country’s detention facilities, detainees were stacked on top of each other.

As part of the investigation, we requested an interview with the Secretary General of Anti-Crime Policy, Sofia Nikolaou, when he was still in this position. However, Mrs Nikolaou refused to accord it. 

Just 410 vaccinations in one semester

The problem of transmission in prisons has been exacerbated by the delay in the vaccination program for prisoners. According to the official announcement of the General Secretariat for Crime Policy, this started late on 1 July 2021. This despite the fact that there are a large number of vulnerable populations living in prisons, hence prisons are much more dangerous structures. Based on the records of the Special Permanent Committee of the Penitentiary System and other Detention Facilities of Prisoners for 10 June 2021, only 388 prisoners (out of a total of 11,031, a percentage of 3.5%) and 504 employees had completed the vaccination! During the same period, only 22 prisoners received their first dose. That is, a total of 410 vaccinations of prisoners, the vast majority of them receiving the Johnson & Johnson vaccine. Half a year later, on 18 November 2021, the number of vaccinated prisoners had reached 6,600 (out of a total of 11,182 prisoners) and 2,653 employees in all departments.

The same delay also occurred when it came to conducting diagnostic antigen tests in prisons. According to the words of the Deputy Minister of Civil Protection, L. Oikonomou, in Parliament, by 9/3/21 only 21,000 tests had been performed on prisoners and 10,400 tests on penitentiaries in all prisons. Within a year from the onset of the pandemic, on average, each prisoner had taken just 1.85 rapid tests. In the next quarter, until June 2021, the tests doubled (66,093 of which 38,638 inmates and 27,455 in staff). But this remained less than needed, while the lack of proper sanitary conditions in the overcrowded prisons could not prevent the large transmission rates.

Research and graph development: Thanasis Troboukis (iMEdD Lab)

Contributing Reporter: Kelly Kiki (iMEdD Lab)

Original Source: https://miir.gr/el/ereyna-miir-imedd-diplasia-diaspora-tis-covid-19-stis-ellinikes-fylakes/

The post MIIR- iMEdD investigation: Covid-19 spread twice as fast in Greek prisons appeared first on MIIR.

]]> https://miir.gr/en/miir-imedd-investigation-covid-19-spread-twice-as-fast-in-greek-prisons/feed/ 0 The hidden agenda behind the Recovery and Resilience Facility https://miir.gr/en/the-hidden-agenda-behind-the-recovery-and-resilience-facility/ https://miir.gr/en/the-hidden-agenda-behind-the-recovery-and-resilience-facility/#respond Mon, 17 May 2021 23:44:57 +0000 https://miir.gr/?p=11502 The post The hidden agenda behind the Recovery and Resilience Facility appeared first on MIIR.

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The hidden agenda behind the Recovery and Resilience Facility

Member countries will be continuously assessed for meeting targets and reforms in order to receive their share of the recovery fund. If European governments do not comply with the agreed recovery plan, the purse strings will be tightened.

 

Text – Research: Nikos Morfonios

Data visualization: Ilias Stathatos

Date: 18/5/2021

Symbiot/Shutterstock.com
European governments may be relying heavily on the 750 billion in financial aid from the Recovery and Resilience package, but its disbursement will not be easy, nor is it guaranteed. This is because the European Commission will implement reforms to continuously assess and monitor investments, with specific targets and milestones as conditions for the provision of the grants and loans from the fund. In case of non-compliance, the money tap will be closed…

The mechanism of the said Fund was the result of a political agreement between the leaders of the EU and the European Parliament, with the aim of helping repair the economic and social damage caused by the coronavirus pandemic. EU Member States had until April 30 to submit to the Commission for approval their National Recovery Plans detailing their reforms and investment projects that will be financed by the recovery fund.

The Recovery and Resilience Facility is the key financial instrument of the temporary NextGenerationEU Programme, which came alongside the decision to provide targeted aid in the EU’s long-term budget (Multiannual Financial Framework) for the years 2021-2027, constituting the largest package ever financed from the EU budget totalling €1.8 trillion.

In particular, NextGenerationEU’s 750 billion will be raised from borrowing on the markets (through a joint issuance of EU debt bonds to be repaid by 2058). The bulk of the €672.5 billion will be provided by the fund in the form of non-repayable grants and loans to member countries.

The allocation will be made up of €360 billion in loans and €312.5 billion in grants (€338 billion in current prices), causing considerable discontent in countries with high deficits and public debt, such as the ‘Southern EU countries’, which wanted larger amounts of grants. They also resent receiving loans that they will have to repay directly to the EU.

However, the dissatisfaction is not only limited to the distribution between grants and loans, but also to the pre-allocation of the money that each Member State will receive and the allocation criteria which the European Commission decided on. This is because Italy and Spain, which were hit very hard especially in the first wave of the coronavirus, may be the top two countries in terms of funding, but France and Germany, the most robust and economically powerful countries in the EU, are right behind them.

NextGenerationEU, apart from the Recovery and Resilience Facility, includes the newest programme called “REACT-EU” – which is essentially the continuation of the first two Coronavirus Response Initiatives (CRII, CRII+) – while additional funds will be drawn from other European programmes such as Horizon 2020, InvestEU, European Agricultural Fund for Rural Development and the Just Transition Fund (JTF).  

All of the money mentioned earlier is also shared among the member states, with Greece for example being able to receive 1.7 billion from REACT-EU, 431 million euros from the Fair Transition Fund and 365.3 million euros from the European Agricultural Fund for Rural Development. Together with the 17.8 billion euros of funding from the Recovery Fund, this amounts to 20.3 billion euros of funds (€20,311,300,000).

In the same context, adding up the amounts of the 4 recovery instruments of the NextGenerationEU, from which we have drawn our data, Italy could receive up to 81.7 billion, Spain 81.6 billion, France 43.9 billion, Germany 29.5 billion, Poland 28.5 billion, Romania 17.3 billion and Portugal 16 billion.    

In addition to the above, member states have additional access to the 360 billion loan pool, with each member state able to raise up to 6.8% of its Gross National Income (GNI) in 2019. As set out in the Regulation establishing the recovery plan, the European Commission signs a loan agreement with each member state, and a special account is created to repay the due capital principal, interest, etc.

For Greece, the maximum amount of borrowing – which we calculated from Eurostat’s databases on population and GNI 2019 for the 27 EU member states (from 2020), as set out in the plan’s directive – is €15 billion. As set out in the Directive, the amount of money borrowed by each member state cannot exceed the difference between the total cost of the Recovery and Resilience Plan and the maximum amount of the grant corresponding to the country under the mechanism.

The granting of loans is also conditional on the mobilisation of private funds, which will contribute to the implementation of the investments. For example, in the Resilience and Growth Plan presented by Greek Prime Minister Kyriakos Mitsotakis on March 31, specifying that Greece will eventually use the 18.1 billion in grants and 12.7 billion in loans, it is stated that the loan financing should be structured as follows: 50% maximum financing from the recovery and resilience facility through the international financial institutions [European Investment Bank (EIB), European Bank for Reconstruction and Development (EBRD), etc.], 30% from commercial banks and 20% from private investors’ own participation. Finally, one should not forget that European countries are expected to receive money from the European Structural Funds as well. The maximum amount that Greece can receive in the coming years from that fund is 40.4 billion euros.

What the European Commission says about how the funds will be allocated

MIIR wrote to the European Commission to ask what were the criteria that led to the specific allocation of funds per Member State and whether it took into account factors other than economic figures, such as the state of the National Health Systems in each country or their budgetary situation. In response to our question, a Commission spokesman on 04 March gave us the following answer: 

“The allocation key for the grants under the RRF, as agreed by the co-legislators, is the following: For 70% of the total of €312.5 billion available in grants (in 2018 prices), the allocation key will take into account 1) the Member State’s population, 2) the inverse of its GDP per capita 3) its average unemployment rate over the past 5 years (2015-2019) compared to the EU average. For the remaining 30%, instead of the unemployment rate, the observed loss in real GDP over 2020 and the observed cumulative loss in real GDP over the period 2020-2021 will be considered.

The formula used to allocate the grants is aligned with the objective of the RRF facility: foster resilience, reduce the economic divergences between Member States and thereby facilitate the recovery. As a result, the allocation key channels a very large share of the funds to countries which have been very severely affected by the crisis.” 

However, after the European Council’s meeting on  21 July 2020 – when EU heads of state and government reached a negotiated political agreement on the Mechanism package – criticisms were raised about the introduction of the 70% and 30% rates, as it was not included in the Commission’s original proposal for the recovery mechanism on 27 May 2020. In an excellent article analysing the allocation published on bruegel.org, it is shown that while the initial proposal favoured countries with lower national income, however, after the political agreement and the implementation of the 30% by replacing the unemployment rate by the GDP loss rate, countries with higher national income were favoured. This is because the calculation of the GDP index is linked to the size of each country, whereas the unemployment index is independent of size and was a criterion that dealt with this obstacle, making the distribution fairer.

Continuous assessment of targets and milestones up to 2026

Robsonphoto/Shutterstock.com

The Commission will subject the member states to a continuous assessment of their effectiveness in implementing reforms/investments and whether the agreed targets and milestones are being met. The Facility will only finance mature projects (at an advanced stage of design approval, siting, etc.) so that they can be completed within the recovery plan’s provisional duration. If it is found that the objectives are not met, the Commission will cut off all or part of the recovery funding. 

In fact, the efficiency and the subsequent disbursement will not only be assessed by the Commission, as the possibility of a “veto” by one or more member countries has been introduced. They will be able to block the money if they consider that there are serious deviations from the satisfactory fulfilment of targets and milestones of a member country! 

Once the Commission receives the final Recovery Plans, it must then within two months approve them and agree on the targets/milestones. Once the assessment is completed, the Council’s approval follows within one month. The front-loaded disbursement of an amount equal to 13% of each country’s total financing will then be approved.

This means that first disbursements can start from mid-2021, and thereafter countries can submit requests for continued disbursements twice a year until 2026. These requests will again be assessed within two months by the Commission, and if it considers after an assessment that the objectives and milestones of the Plans are being satisfactorily implemented, only then will it authorise continued disbursements.  

The extension of remote work and reduced working hours

In order to receive both grants and loans, the member state’s national reform plan must meet the criteria linked to the six pillars of the recovery and resilience plan: 1. green transition; 2. digital transformation; 3. economic cohesion, productivity and competitiveness; 4. social and territorial cohesion; 5. health, economic, social and institutional resilience; 6. policies for the next generation. 

In particular, the recovery and resilience plans must cover at least 37% of funding to investments and reforms linked to climate objectives, and 20% to actions supporting digital improvement and transformation of public administration and businesses. 

However, an extremely critical and so far, a relatively obscure criterion is the implementation of reforms linked to the Council’s annual country-specific recommendations (CSRs) to each country, included in the European Semester, on the economic and structural changes they are required to implement in their National Reform Programmes. 

The European Semester is considered crucial especially for countries that are struggling financially like Italy and Spain, but most especially Greece which is already under enhanced post-monetary surveillance, as it includes recommendations for structural changes in the economy and finances. For example, in the specific recommendations for Greece for 2020-2021, the Commission urges 4 key actions to ensure debt sustainability, provide liquidity to the economy, complete its post-memorandum commitments and mitigate the impact of the crisis on employment, “including by implementing measures such as reduced working time schemes and ensuring effective support for participation in active working life”.

It is worthwhile to dwell a little on the announcement about reduced working time schemes, already implemented by the Greek government through the SYN-ERGASIA Programme, which is funded by a loan from the SURE programme. They outline a bleak future for the labour sector in Greece, against the backdrop of the labour bill that the Greek government is expected to submit on the increase of the daily working time (10 hours), unpaid overtime, remote work, changes in the trade union law, etc. 

As stated in the text of the recommendations, Greece has already introduced a temporary system that reduces labour costs for companies, “however, the implementation of a comprehensive system of reduced working hours would be a more sustainable and flexible solution and the authorities have taken steps in this direction”. At the same time, “the expansion of flexible working arrangements, such as remote working, which in Greece have so far been limited compared to other member states, will also contribute to maintaining economic activity and jobs during the period of lockdown and social distancing.”

MIIR sent a question to the Commission asking to what extent the extension of the reduced and flexible working hours scheme is linked as a criterion to the disbursement of the Facility’s money to Greece. A Commission spokesperson directly avoided linking this criterion – although central to the specific recommendations of the European Semester – to the Mechanism, replying that:

“the Commission will assess the recovery and resilience Plans based on eleven transparent criteria set out in the regulation itself. In particular, the Commission assessment will consider whether the investments and reforms set out in the plans:

– represent a balanced response to the economic and social situation of the Member State, contributing appropriately to all six RRF pillars

– contribute to effectively address the relevant country-specific recommendations

– contain measures that effectively contribute to the green and digital transitions

– contribute to strengthening the growth potential, job creation and economic, institutional and social resilience of the Member State

– do not significantly harm environmental objectives

As regards the financing of short-time work schemes, there are other instruments that Greece can use and is already using for that purpose. The SURE scheme, for instance, assists Greece in covering the costs related to its short-time work scheme and other similar measures that have been introduced in response to the coronavirus pandemic. Once all SURE disbursements have been completed Greece will receive €2.7 billion in loans.” 

It is worth noting that in the concise 67-page Resilience and Growth Plan, presented by Prime Minister Kyriakos Mitsotakis, interventions on labour are presented only in headings as axes of the “labour law reform”. In particular, it mentions “the modernisation of collective labour and trade union law” and “Adjustment to teleworking”, with no specific reference to the reduced hours regime.  

At the same time, however, in the more detailed text with the “Strategic Guidelines for the National Recovery and Resilience Plan”, the extension of the reduced and flexible working hours regime, teleworking and interventions in the pension system are analysed as a milestone target. 

Specifically, under the pillar ‘Employment, skills, social cohesion’ under axis 3.1 ‘Increasing jobs and promoting labour market participation’, it is described as an objective: ‘In addition, through the short-term Coworking work programme and reforms promoting flexible working arrangements such as teleworking, the axis mitigates the impact of the COVID-19 pandemic on the labour market and incomes’ (p. 37).

Special reference is also made to the specific recommendations for Greece on ‘the implementation of measures such as short-time work schemes (SYN-ERGASIA)’ (p. 27).

It should be recalled that under the SYN-ERGASIA scheme, which started in June 2020 and is still in force today, companies can unilaterally reduce the hours during which they employ their workers by up to 50%. The employer is required to pay only half of the employee’s salary, and the latter will receive from the state 60% of half of the net earnings lost. The total insurance contributions (employer and employee contributions), corresponding to the time during which the workers are not employed, are also paid by the State Budget.

Finally, the same axis (3.1) also includes “the reform of the current supplementary pension system, in particular the transition from a non-capitalised system of mixed pre-defined benefits and notionally defined contributions to a fully capitalised system of pay-as-you-earn withholding payments.

As our in-depth research on the Mechanism thus shows, the National Recovery Plans may seek “ownership” of reforms and investments on the part of European states, but the link to the European Semester and the setting of targets and milestones that will also determine the evolution of funding is a major challenge for European governments, especially within such a tight binding implementation timeframe defined by the temporary duration of the Mechanism.

At the same time, the reforms being promoted pose risks for labour rights, as is the case in Greece, while national borrowing, as well as grants, will affect national budget figures and budget deficits, which is of great concern, especially when the EU’s fiscal discipline rules, currently suspended due to the pandemic, are reintroduced. If the above risk is not taken care of in time, the recovery that the EU is seeking may not be possible…

Author

Text – Research: Nikos Morfonios

Data visualization: Ilias Stathatos

This investigation was published in the European Data Journalism Network – EDJNet.

Copyright: MIIR 

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]]> https://miir.gr/en/the-hidden-agenda-behind-the-recovery-and-resilience-facility/feed/ 0 What a year of pandemic tells us about European healthcare systems https://miir.gr/en/what-a-year-of-pandemic-tells-us-about-european-healthcare-systems/ https://miir.gr/en/what-a-year-of-pandemic-tells-us-about-european-healthcare-systems/#respond Mon, 10 May 2021 00:19:40 +0000 https://miir.gr/?p=11271 The post What a year of pandemic tells us about European healthcare systems appeared first on MIIR.

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What a year of pandemic tells us about European healthcare systems

  • The number of doctors and nurses and the population density of a region are more important indicators than the number of ICUs in predicting Covid-19 deaths.

  • There does not appear to be a causal association between per-capita numbers of ICUs and deaths from Covid.
  • Excess mortality showed a correlation with the “pandemic waves”.
  • State of permanent lockdown also due to national healthcare system inefficiencies.
  • Greece held in the dark regarding pandemic data.

Text – Research: Kostas Zafeiropoulos, Janine Louloudi

Data visualization: Ilias Stathatos

Date: 10/5/2021

Haris Mm/Shutterstock.com

“There are three kinds of lies: lies, damned lies, and statistics” (Mark Twain)

On April 1, 2021, Greece was the sixth “best-performing” country in Europe in terms of the total number of confirmed deaths from Covid-19, counting 783 deaths per million inhabitants since the beginning of the pandemic (according to ourworldindata.org ). The safest places to survive the coronavirus in the year of the pandemic in Europe seem to have been at the two extremes: in the North (Iceland, Norway, Finland, Denmark, although not Sweden, which followed a different model) and in the South (Cyprus and initially Greece). This is not a snapshot, but rather a general picture that applies to the average death rates in all three phases of the pandemic so far. In reality, the situation is much more complex, as the phenomenon is evolving dynamically.

The number of coronavirus deaths per capita in a country is a function of variables that are too difficult to define and accurately quantify to give safe conclusions. These variables include virus spread, degree of initial preparedness and subsequent strengthening of national health systems, response measures, population and geographical data (e.g. population distribution), behavioural trends, and evolution of the vaccination programme.

An overview of Covid-19 deaths is not sufficient to draw firm conclusions. Other epidemiological indicators are needed. “Excess mortality”, i.e. deaths from all causes in the coronavirus era which exceeded the average over a five-year reference period (2015-2019), skyrocketed in the majority of European countries. According to Eurostat data, in total, by November 2020, 450,000 more deaths were recorded in the EU than in the same reference period previously . The European platform EUROMOMO , which monitors mortality from any cause in the 27 EU member states, has recorded a relatively small increase in excess mortality in Greece in recent weeks.

Not all countries have been affected in the same way by non-Covid-19 deaths. In Greece, in the first ten months of 2020 excess mortality was close to or below the average of the last five years. But the situation started to change dramatically in November and December (when the second wave peaked). Then, in the first two months of 2021, there was an initial decline in “excess deaths” from all causes.

In Greece, 8,802 more deaths were recorded in 2020 compared to 2019. Deaths from Covid-19, however, were 4,881 , and the difference of 4,921 deaths was not evenly distributed over the year.

A one-disease system

This difference is not easy to attribute to specific causes. Despite the reasonable conclusion that it may be linked to undiagnosed Covid-19 cases, the forced conversion of the National Health System into a one-disease, coronavirus-focused system played a decisive role.

In order to document the initial preparedness and response of the Greek National Health System in the face of the pandemic, MIIR collected from various sources and analysed one year’s data on the number of deaths from Covid-19, the number of available ICUs, the number of intubated, the number of deaths and cases among nursing staff.

 

The deaths of the “heroes” in white shirts

Alexandros Michailidis/Shutterstock.com

When healthcare workers get sick during a disease epidemic, overall case numbers and mortality rates may increase significantly, according to recent research from the University of Pennsylvania . The researchers investigated the direct impact of the loss of health workers. They calculated that a reduction in the quality of care in an epidemic potentially leads to up to a 15% increase in cases and up to a 1,716% (!) increase in deaths.

During the first wave of the pandemic, according to another global study published in BMJ Global Health, Europe had the highest number of confirmed cases (119,628) and the highest number of deaths (712) among healthcare workers. The Eastern Mediterranean region in the first wave recorded the highest number of healthcare-worker deaths per 100 infections globally (5.7). In Greece, the competent body, the National Organisation of Public Health (EODY), does not provide detailed data on deaths and infections of doctors and nurses.

“Drowning is a great torture. Don’t let it happen to anyone. I flirt with death every moment. Don’t call me. Say a prayer”, wrote a 53-year-old nurse from inside a hospital in early December. He had been diagnosed positive on November 24 and was hospitalized for a week at the hospital where he worked in Kilkis. To relieve the hospital of coronavirus cases he was transferred to the Serres hospital and was hospitalized there for many days and intubated in an ICU. On January 9, 2021, he died. It was then the 20th death of a healthcare worker in Greece. By the end of March, 26 healthcare workers died in Greece, 25 of them in the second and third waves of the pandemic. Their median age was 48 years, while the median age of deaths in the rest of the population from Covid-19 is 68 years. The total toll of the pandemic after one year in the Greek NHS is more than 4,000 cases and 26 deaths. At the end of April, 700 doctors and nurses were ill and 50 of them were hospitalized. Workers regularly protest about the need to recruit doctors and especially nurses. Other demands include tenure for contract workers and the strengthening of primary healthcare in terms of staff, infrastructure and equipment.

Deaths and ICUs

The number of available multi-purpose ICUs for Covid-19 patients is one of the crucial indicators that determine the resilience of healthcare systems. Reliable, transparent, up-to-date data on the ICU numbers within the period of the pandemic do not exist in many European countries. By isolating other otherwise-important parameters (viral load, response measures, number of workers, vaccination status, etc.) we cross-referenced the number of confirmed Covid-19 deaths per capita with the number of multi-purpose ICU beds per capita at the beginning of the pandemic for a number of countries (source: OECD , Eurostat ).

Before the pandemic, Germany was the country in Europe with the highest ratio of ICUs per capita (it remains so). In contrast, Greece has generally had one of the lowest ratios of ICU beds and nurses. Nonetheless, in the first wave of the pandemic the weakness of the Greek system did not lead to its collapse. The system held up, mainly due to reduced virus circulation, timely measures and citizen compliance. The situation changed dramatically in 2021, and as a result by mid-March there were no more ICU beds available, while hospitals had lists of patients waiting to be admitted to ICUs. The data processing shows there does not seem to be a causal relationship between deaths and available ICUs. However, the graph shows that countries with a lower proportion of available ICUs (Italy, Spain, the Netherlands, Greece) are under more pressure and some have recorded disproportionate deaths (Italy). The interpretation of the phenomenon is more complex, as in several regions (Northern Italy) the system broke down. This was due partly to increased virus circulation, which in turn affects admissions, intubations and consequently deaths. Another exception is the northern countries (again, except Sweden). Indicative of the complexity of the problem is the fact that although Hungary and Switzerland had roughly similar ICU capacity, Hungary recorded almost double the number of deaths.

According to a survey by the UK-based independent Health Foundation, in the first six months of the pandemic countries with a higher ratio of ICU beds and surgeons per capita actually recorded fewer deaths from Covid-19. However, the researchers point out that it is unlikely that the particulars of healthcare systems are the sole determinant of differences in deaths around the world. They also found something remarkable: countries with higher bed capacity decided to impose lockdown measures earlier than those with lower capacity. This was interesting in social and economic terms, but also in terms of secondary healthcare issues. But it was not the case in Greece.

Another global survey of 183 countries , based on reliable data from the World Health Organization (WHO), the World Bank and other official national organisations on the availability of ICUs and hospital beds in each country, showed that there is indeed some correlation between per-capita ICUs and deaths from coronavirus. The paradox was at the global level: countries with much lower GDP and capacity in ICUs and beds had a lower death rate. The interpretation of this contradictory phenomenon, according to the researchers, was that areas with high population density are likely to have a greater number of ICU beds to meet the needs of the population. However, densely populated areas are also the ones that promote the spread of the coronavirus and ultimately yield a higher death toll. The positive correlation is likely to be influenced by population size as a modifying variable. The higher mortality rate observed in high-income countries may also be due to the increased ability of patients to travel, cancelling out high-quality care.

However, the same study shows that there is no significant association between either the per-capita number of hospital beds or ICUs and deaths from Covid-19. This, the researchers point out, suggests that there are other factors that influence coronavirus mortality, such as available supplies (e.g. ventilators) and the number of nursing staff. In addition, a relative shortage of protective material can exacerbate the effects of a shortage of healthcare personnel and can have a dramatic impact on the survival of patients with Covid-19.    

Lockdowns proved to be beneficial at reducing viral spread in Greece, especially during the first wave. However, in the third wave of the pandemic, after 5 months of restrictive measures in February and March 2021, the pandemic reached its worst stage in early April. As it prepares to open up its economy and tourism, Greece looks nothing like the country it was a year ago, with record numbers of cases, intubations and deaths.  

Information blackout in Greece

On 19 November 2020, MIIR  submitted an official request for documents submission to the Ministry of Health, the National Public Health Organization (NPHO), the Deputy Minister of Civil Protection and the General Secretariat of Civil Protection, on the basis of Greek and European legal and constitutional provisions regarding access to information and transparency (the equivalent of a FOIA request, which is a very rare request by journalists in Greece). MIIR requested, among other things, to be provided with detailed data on the total number of available intensive care units (ICU) in the National Health System throughout the country since the beginning of the pandemic. We made a new written request on 9 December. 

On 12 December 2020, we contacted the EODY by telephone. They verbally assured us that we would receive a written response within the next month. After two months and after the implicit rejection of our request we made a third written request to the relevant bodies. No response was given.  

For over a year there has been no official posting on the EODY’s website of the number of available ICUs. Only the coverage rate of the existing ICUs dedicated to Covid-19 is announced, without specifying the available total. All data obtained from media surveys and from individual citizens are secondary. The government, while regularly announcing the alleged increase in available ICU beds, constantly mixes up general ICU beds with Covid-19 ICUs. What exactly is happening? 

Alexandros Michailidis/Shutterstock.com

The actual ICUs and deaths

As of 14 September 2020, according to POEDIN , the ICU beds in Greek hospitals then amounted to 930. Of these, 701 were available for patients with diseases other than Covid-19 and 229 were available exclusively for the treatment of patients with Covid-19.

“Currently we have 1,305 ICU beds in the country, 748 Covid-19 beds and 557 non-Covid-19 beds, and we continue to open new beds. We received 557 ICUs in 2019,” Health Minister V. Kikilias said verbally (as always) on 7 December. But the reality is different. According to MIIR’s information, and as confirmed by the government and the opposition, the government received 568 ICU beds in 2019. But it also received 510 specialist ICU beds (180 in the NHS involve burn units, cardiac and coronary surgery units, plastic surgery units; 260 were in private clinics and 70 in military hospitals). The number of specialist ICUs taken over by the government is not mentioned and it claims to have increased the number of available ICUs to 1,400.

“It is a lie what the government says about 1,300 and 1,400 ICUs in Greece. That number does not exist. The multi-purpose ICUs available in the health system were about 650 in the second wave of the pandemic. Based on the data we collect, more than 80% of deaths from Covid-19 have taken place outside the ICU,” Michalis Giannakos, president of the Panhellenic Federation of Public Hospital Employees (POEDIN), tells MIIR.

 

“The primary data with which we can evaluate the work of the state and the scientific committee is lacking. In fact, they are carefully hidden. How many patients can’t find beds? How many are dying outside the ICU? Are patients being screened? Who was vaccinated as a priority? The answers to these questions are the criteria for citizens to assess whether the state did its job properly. These data exist. They are just not made public,” explains Vassilis Tsaousidis, professor in the Department of Electrical Engineering at Democritus University of Thrace . “In any case, if the recovery rate (of those discharged) in ICUs is between 35-50%, then the rate of deaths outside ICUs, so far, ranges between 61-79%,” the professor states.

Conclusions

By European standards Greece still has a relatively low per-capita death toll. But it has been severely affected in the second and third waves, and the data have changed dramatically in recent weeks. The NHS in Greece is weak compared to most European countries, having a very low number of nurses per capita and one of the lowest per-capita ICU ratios in Europe since the beginning of the pandemic. The same is still the case a year later despite government efforts to muddy the waters.

Given the above, Greece had a low capacity before the collapse of the health system, which led it to adopt a prolonged five-month lockdown which did not work. The country is opening up the economy and tourism with the epidemiological data in the red. With more ICUs, doctors and nursing staff, the country would have been better able to shield itself without having to lock down for so many months, which risks a new economic crisis after the painful decade of the Memorandum. 

The number of patients who have ended up in Covid ICUs, and the rate of recovery in them, are being concealed. It is therefore not possible to accurately calculate the number of those who have died outside of ICUs. This fact alone warrants a public outcry.

Author

Text – Research: Kostas Zafeiropoulos, Janine Louloudi

Data visualization: Ilias Stathatos

This investigation was published in the European Data Journalism Network – EDJNet.

Copyright: MIIR 

Support us

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For Independent investigative journalism, material resources and time are much needed.
We do not accept ads, so help us continue our work.

IBAN: GR08 0140 1040 1040 0200 2028 234 (Alpha Bank)

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