The New York Times - 12.09.2019

A12 N THE NEW YORK TIMES INTERNATIONALTHURSDAY, SEPTEMBER 12, 2019

SKALA SIKAMINEAS, Greece
— The first dinghy landed about
5:45 p.m., on a rocky shore near a
remote Greek fishing village. Af-
ter the thirteenth arrived about 35
minutes later, 547 migrants had
landed, in broad daylight, within a
few yards of each other on the
Greek island of Lesbos.
That flotilla on Aug. 29 repeated
a pattern not seen here since early
2016, when the European Union
pledged more than $6 billion to
Turkey, which lies within view of
Lesbos, to tighten its border pa-
trols and keep migrants out of Eu-
rope.
In the years since, only one or
two refugee boats have typically
made it to this stretch of Greek
coast each day, substantially eas-
ing Europe’s migration crisis. But
that rhythm changed this August,
the busiest month in more than
three years, feeding fears of a new
wave of mass migration across the
Aegean Sea.
The rate of arrivals is still just a
fraction of the 2015 peak, when
Lesbos was the busiest European
entry point for migrants — pri-
marily people fleeing the Syrian
civil war. Last month, nearly
10,000 migrants arrived in all of
Greece; in October 2015, at the
height of the crisis, more than
210,000 did.
But the recent surge comes as
President Recep Tayyip Erdogan
of Turkey threatens once again to
allow high numbers of migrants to
make their way through Turkey to
Greece, should European poli-
ticians fail to provide Turkey with
further financial support, or dis-
miss his plans to extend Turkish
influence in northern Syria.
“This either happens,” Mr. Er-
dogan said in a speech last week,
“or otherwise we will have to open
the gates.”
The August increase shows this
may not be an idle threat. But if he
intends to create a new refugee
crisis for Europe, Mr. Erdogan has
fewer tools to work with than he
did in 2015, when Syrian refugees
found it easier to enter Turkey.
Turkey has since completed a
border wall and has imposed re-
strictions on Syrians traveling
from Lebanon or Jordan. Any re-
laxation of those controls, admit-
ting more people — even if only to
use Turkey as a bridge to Europe
— would be politically risky for
Mr. Erdogan.
But 3.6 million Syrian refugees
already live in Turkey, the world’s
largest expatriate Syrian popula-
tion, along with hundreds of thou-
sands from other countries. If Tur-
key makes life untenable for them,
or relaxes efforts to keep them out
of Europe, the effect could be dra-
matic.
“Erdogan’s recent comments
on unleashing a new refugee wave
are a product of his growing frus-
tration with the huge number al-
ready in Turkey,” said Bulent Ali-
riza, director of the Turkey project
at the Center for Strategic and In-
ternational Studies, a Washing-
ton-based research group.
“It is unlikely that there is a
fully thought-through master plan
ready for implementation,” he
added.
The fact that Turkish smugglers
were able to gather so many peo-
ple on Aug. 29 and send them to
Greece in such quick succession
has raised questions about Turk-
ish state complicity.
Turkey’s Coast Guard, normally
fairly active in these waters, did
not respond that afternoon to re-
peated requests for intervention
by their Greek counterparts, ac-
cording to Refugee Rescue, a
small private lifeboat organiza-
tion that helps stricken migrants
and has access to maritime com-
munications.
Turkish vessels also stuck to a
pattern of morning patrols
throughout August, even as
smugglers repeatedly sent refu-

gees to Greece in the afternoon.

“What we found weird was that

this was a trend, and they didn’t

change the way they operated to

try to stop this,” said Finn Sands-

Robinson, who leads Refugee Res-

cue’s land-based observation

team.

A senior Turkish official, who in-

sisted that his name not be used,

denied that Turkish authorities

had turned a blind eye to smug-

glers.

Mr. Erdogan’s government

stepped up the deportation of Syr-

ians from Turkey this summer,

and it was widely assumed that

this crackdown caused the rise in

departures to Greece.

But more than 80 percent of the

migrants who landed in Lesbos in

August were from Afghanistan.

Increasingly precarious condi-

tions in Turkey and Iran, where at

least a million Afghans live in ex-

ile, as well as in Afghanistan itself,

have led many Afghan refugees to

head for Europe.

Gholam Reza Salahi, a 25-year-

old Afghan laborer who has lived

most of his life in Iran, said he de-

cided to go to Greece after being

deported for the fourth time from

Iran to Afghanistan.

“We’d be smuggled back to

Iran, and then deported again,” he

said. “And that happened too

many times.”

As a member of the Hazara eth-

nic group, who are persecuted by

the Taliban, he felt he could not

stay in his parents’ country. Nor

did Turkey feel like a plausible

sanctuary: Ankara has deported

32,000 Afghans so far this year, far

more than any other national

group.

Europe felt like the safest bet,

said Mr. Reza Salahi, who reached

Lesbos in late August.

Just 5 percent of migrants ar-

riving in Lesbos last month were

from Syria, suggesting that few

Syrians yet feel anxious enough to

leave Turkey. But the testimonies

of new Syrian arrivals provide a

hint of what might be to come.

A group of families from north-

ern Syria, huddled in a tent on a

Greek hillside, had for seven

years refused to flee their neigh-

borhood despite regular air raids,

the destruction of their homes and

schools, and the deaths of many

relatives and friends.

But this summer, they finally

decided to leave Jabal al-Zawiya,

a rebel stronghold, because of a

sharp escalation in airstrikes and

the likely recapture of the area by

President Bashar al-Assad’s

forces.

“The Assad army, when they

take a place, they burn it,” said

Obeida al-Nassouh, a shopkeeper

who said he had paid $3,500 for his

family to be smuggled through a

secret tunnel to Turkey, and then

onward to Lesbos. “They don’t

care if you’re a civilian or a soldier,

they just burn it.”

Fighting has intensified in Idlib,

a Syrian province bordering Tur-

key, prompting more people to try

to leave.

The enormous number of Syr-

ians already in Turkey provokes

considerable resentment within

Mr. Erdogan’s political base, and

he is keen to cut the refugee popu-

lation.

Youssef al-Hassan, 44, a recent

arrival to Lesbos, had for seven

years been content to stay in Tur-

key, where his family lived in pov-

erty but at least felt safe from Mr.

Assad’s forces.

But this summer’s deportations

of Syrians persuaded Mr. al-Has-

san that even Turkey was no long-

er safe.

“We felt like in the next five

minutes they could come and

throw us out,” he said a few hours

after landing in Greece. “The situ-

ation is such that many are going

to come.”

True or not, even a small in-

crease in arrivals compounds the

misery of refugees in Greece.

In 2015, new arrivals could

move swiftly toward the Greek

mainland, and then onward to

Germany. But today, migrants are

contained on the Greek islands,

mostly in overcrowded and squal-

id camps that seem out of place on

the world’s richest continent.

On Lesbos, about 10,000 people

have been crammed into Moria, a

camp built for just 3,100. Though

the European Union has allocated

around $1.9 billion to the Greek

government to subsidize refugee

welfare, Greece has refused to im-

prove the facilities for fear of en-

couraging more migrants.

Residents here sometimes

spend up to year living in tattered

tents, and up to 12 hours a day

waiting in line for food, which of-

ten runs out before everyone is

served.

“Every day we queue for hours

and they say: ‘There’s nothing

left,’ ,” said Reza Salahi. “And

that’s the case for about a quarter

of us.”

Raw sewage sometimes leaks

into tents, while fights and sexual

assaults are a regular occurrence.

Overwhelmed medical workers

struggle to treat a soaring number

of patients.

Coupled with seemingly inter-

minable asylum procedures, all

this has created what aid workers

see as a mental health crisis

among refugees on the island.

Since July, the number of children

with severe mental health issues

has more than doubled to 73, ac-

cording to Doctors Without Bor-

ders.

An Afghan mother, Sohaila Ha-

jizadeh, who fled to Greece after

the Taliban attacked her family’s

home, said she had frequently

been turned away by doctors

when seeking treatment for her

teenage son, who has severe psy-

chological trauma. From wrist to

shoulder, the boy’s arms are cov-

ered in self-inflicted knife wounds.

Unaccompanied children are

particularly at risk. Officially,

there are 747 refugee children on

Lesbos, living without their par-

ents, and provided with secure ac-

commodation by the authorities.

But poor registration processes

mean that there are more parent-

less children living undocument-

ed in the camp.

One such youth, Mohammed al-

Othman, 16, lives in a cramped

tent, together with 12 other people

from his home province in Syria.

He left Syria in August after his

school was bombed; his mother

had only enough money to smug-

gle one family member, so Mo-

hammed went alone.

Since arriving in Greece, he has

not received treatment for four

shrapnel wounds sustained dur-

ing a recent airstrike.

“The treatment is very bad,” he

said. “They just asked me: How

old are you, are you ill? And they

left me outside.”

He wore a shirt marked with the

slogan: “Grow up.”

The words had been crossed

Thirty Afghan migrants arrived in a dinghy on Aug. 8: nine men, five women and 16 children. out.

Migration to Greece Rises, and Erdogan Threatens ‘to Open the Gates’

3.6 Million Syrians

In Turkish Refuge

By PATRICK KINGSLEY

Afghan migrants near the Moria camp on the Greek island of Lesbos. Over 80 percent of the migrants who landed in Lesbos last month were from Afghanistan.

PHOTOGRAPHS BY LAURA BOUSHNAK FOR THE NEW YORK TIMES

LONDON — A court in the
Netherlands on Wednesday ac-
quitted a doctor who had been ac-
cused of unlawful euthanasia for
administering a lethal injection to
a patient with dementia, a case
that raised questions about the
clarity of the country’s law in such
circumstances.
The patient, 74, who has not
been publicly identified, had
asked in writing for doctors to end
her life if she had to be admitted to
a nursing home, and if she thought
the time was right. But, when she
entered the home, incapacitated,
she appeared to have changed her
mind, giving “mixed signals,”
about her intentions, prosecutors
said.
A doctor at the home, now re-
tired and also unidentified, de-
cided to go through with the eu-
thanasia, in close consultation
with the family, in the spring of

2016.

A paper in the London-based

Journal of Medical Ethics that re-

viewed the case said the doctor

had put a sedative in the patient’s

coffee and that the patient’s rela-

tives had helped to hold her down

as she struggled against the injec-

tion.

The review, published in 2018,

said the case demonstrated the

“myriad ethical concerns” raised

by advance euthanasia directives.

Prosecutors said that the doctor

did not act with due care, as re-

quired by the law. They said she

should have cleared any doubt

about the patient’s wish to die be-

fore going ahead with the pro-

cedure. Although prosecutors had

pushed for a guilty verdict, they

also made clear that they had

brought the criminal case to try to

resolve ambiguities of the eutha-

nasia law, rather than to punish

the doctor, whose motives they

said were blameless.

The court cleared the doctor of

any wrongdoing.

“The patient was heavily de-

mented and deemed completely

mentally incompetent,” the court

said in an online statement. Medi-

cal records, heard during the pro-

ceedings, said the patient could

not recognize her own reflection.

Taking into account the pa-

tient’s state, the court ruled that

the doctor did not have to verify

her wishes at the time of adminis-

tering euthanasia.

Franz Zonneveld, a spokesman

for the Public Prosecution Service

of The Hague, said on Wednesday

that the aim of the case had been

to resolve the limits of the law.

“The court has given a clear rul-

ing but on one point they have a

very different view,” he said by

phone, referring to the prosecu-

tors’ belief that the doctor should

have made greater efforts to con-

firm that the patient still wished to

proceed with euthanasia.

“Even though she was suffering

from dementia, you should check

that as the physician, with the pa-

tient, and you should be 100 per-

cent sure,” Mr. Zonneveld said.

The case was the first of its kind

to prompt a criminal investigation

since 2002, when the Netherlands

became the first country to legal-

ize euthanasia.

Questions are often raised

about the parameters for those

wishing to end their lives and

about who should be allowed to

take that step, and lessons from

the Dutch system often reverber-

ate internationally. The debate

can be particularly complex when

dementia patients are involved,

and opinion is often divided al-

most on a case-by-case basis.

In 2017, after reports of an in-

crease in euthanasia among de-

mentia patients in the Nether-

lands, and of a growth in the prac-

tice of administering sedatives be-

fore lethal injections, a group of

more than 200 doctors signed a

letter urging against euthanasia

based on advance directives from

patients. The doctors argued that

they were reluctant to end the life

of people who could not confirm

that they still wanted to die.

Dr. Scott Y.H. Kim, a psychia-

trist and bioethicist at the Na-

tional Institutes of Health in the

United States, wrote in an email

that, “When a human being is re-

sisting — regardless of how

‘meaningless’ the action is in

terms of intentions and under-

standing — and what she is resist-

ing is an act to end her life,” then it

could be “pretty difficult to take

in.”

The Dutch law on euthanasia

contains strict rules, known as

due care criteria, that must be met

in every case.

Among other conditions, the de-

cision to request euthanasia has to

be voluntary and carefully consid-

ered, and the patient must be fac-

ing a future of unbearable suffer-

ing with no reasonable alterna-

tive. The physician has to consult

at least one other independent

professional, and the procedure to

end the patient’s life should be ad-

ministered in a medically appro-

priate way.

The court ruling on Wednesday

underlined the legal position that

a doctor can carry out euthanasia

on patients at least 16 years old

who have made written requests

to die but are no longer able to ex-

press that will, as long as the due

care criteria have been fulfilled.

The Dutch Public Prosecution

Service said in a statement that

the patient’s advance directive in

this case was clear but that a con-

versation should have continued

about the patient’s wishes.

“As long as that conversation

gave cause for doubt,” the pros-

ecution service said, “the nursing

home doctor should have re-

frained from euthanasia.”

Doctor Acquitted in Euthanasia of Patient Who May Have Changed Her Mind

By PALKO KARASZ

Claire Moses contributed report-
ing.

A Dutch case raised

‘myriad ethical

concerns.’