The challenge of dental health provision for refugees

Access to basic healthcare is a luxury for millions of refugees, so I was pleasantly surprised to hear about a group of dental surgeons offering much-needed relief to those in Greece and Calais. It is hard enough to bear toothache at the best of times; what about if you are a refugee?

To find out more about the work of the dentists, I asked Dr Munir Ravalia, one of the volunteers, how he got involved; what kind of dental health problems has he encountered in the refugee camps; how are they organised; and why did he feel compelled to provide his services?

The extent of the problem was set out by fellow health professionals in the camps in Calais and Lesvos. Dr Ravalia, who is based in London, told me that over 25 per cent — and sometimes more than 40 per cent — of acute medical cases found amongst refugees are related to dental care. Tooth decay is one of the most common health problems worldwide, so the figure of 40 per cent was not surprising, as people are usually susceptible to this throughout their lifetime. According to Ravalia, assessments in Beirut and its suburbs have also found that 65 per cent of Syrian refugee patients there suffer most commonly from dental problems and influenza.

Like so many of his colleagues in other medical professions, the depressing condition faced by refugees prompted Dr Ravalia and others like him to offer their skills to a group of dental surgeons led by Dr Ola Hassan in Calais. He said that Dr Hassan dedicated her time to providing emergency dental care to Syrian, Iraqi and Afghan refugees. The Health Point Dental Foundation, of which she is part, provides relief to thousands of desperate refugees across a number of camp sites.

Dr Ola and her colleague treating patients in Greece‎

The static dental unit was set up initially on the island of Lesbos in Greece. Its mission is for the Dental-Point Project to deliver a much-needed service to refugee families. According to its website, Health Point Foundation (HPF) provides a holistic healthcare service to unregistered refugees, who are in the most vulnerable and desperate situation.

According to Dr Ravalia, HPF has also set up a dental unit, the first of its kind, to provide emergency dental care in camps across Northern Greece. The clinic is in the Diavata Camp, which is located close to the city of Thessaloniki and hosts up to 2,000 refugees. This is the base camp, he told me, but due to the great need for urgent dental care in many camps, HPF visits other military-run camps regularly for outreach work. All volunteers have to be as adaptable, flexible and mobile as possible for this to work. For the project to be successful and, more importantly, sustainable, it needs a strong team of volunteers who are willing to do what it takes.

For hundreds of thousands of refugees, Greece has been the landing point on their journey to Europe. Indeed, it is estimated that over a million people have travelled through the country since 2015. Although the Greek government has created temporary housing for the tens of thousands stranded by the EU-Turkey agreement, many of these camps do not meet acceptable humanitarian standards.

Dr Ravalia spoke fondly about working with refugees. He mentioned one example of a young boy who had been suffering from toothache for more than four months. “The excruciating pain from tooth decay meant that he was also finding it extremely difficult to eat,” he said. “The boy was crying constantly because of the pain, and ultimately this situation was leading to malnutrition, which in turn brings about compounding medical conditions.” It gave him tremendous joy, the dentist added, to be able to bring relief to this young Syrian refugee. “It also meant that his mother could finally get a good night’s rest, instead of having to comfort her child for hours on end.”

When I asked him about supplies and the help needed by the dental team, Ravalia was explicit: “What we need are dental supplies, rental vehicles for mobile facilities and support for dental nursing volunteers, as their skills are needed to support the dentists in order for this work to develop into a better established outreach facility. We want to go where the need is.”

An 8-year-old Syrian boy with his mum after treatment in Calais.

He was eager to stress that dental care should not be treated as a luxury. “Whilst I appreciate that mental health, the prevention of communicable diseases and acute medical care is a priority for UNHRC and other world organisations, dental care is always seen as a luxury rather than a need. But we as clinicians know all too well the disastrous affects this can have on not only an individual but, especially with paediatric patients, on the other siblings and parents. Oral disease is the most common non-communicable disease and the impact it has is significant in terms of pain and suffering related to impaired oral function — eating, speech disorders — and chronic toothache resulting in a low quality of life.”

Our conversation shifted to his reasons for getting involved. “It’s an excellent opportunity to dedicate your time and skills towards this amazing selfless cause to help the Syrian refugees,” he replied. “In some cases, they have taken a life-threatening journey to escape the war in their own country in the hope of securing a safer future for themselves and their families.”

When I probed further about his feelings on the international failure to deal with the refugee crises, he said that despair does come to him and his colleagues as individuals. “When we see the chaos around us and are pumped gallons of news items, real-time, especially. Whose fault is all this, why does the UN do nothing or very little to prevent the suffering in Syria and across the globe?”

Like many others, Dr Munir Ravalia was annoyed at the paralysis of the UN where a simple veto from a superpower was all it took to disregard the majority of its members. “The UN,” he said, “is often seen as an exclusive club, to make the world feel that there is something out there to represent member nations, when all it really does is serve the greed and power of the very few.”

In conclusion, he asked rhetorically, what does the layman do apart from feel helpless? “What about if you have a skill that may ease the suffering of those oppressed people, who have had to flee their homes, thousands of miles away? Will you not do something?”

If you wish to be a part of the HPF team, or if you have any questions or queries, please send an email to [email protected]