Harmanli is the first arrival point in Bulgaria for refugees crossing through Türkiye from different parts of the world. Just 50 kilometres from the triple border crossing with Greece and Türkiye, Harmanli has emerged as a critical point of response to escalating refugee arrivals.

As the largest open reception centre in Bulgaria, accommodating up to 1,710 individuals, the occupancy rate has surged by 300 per cent since 2020. However, the burgeoning number of people face formidable challenges, and available services are grappling to meet the pressing medical needs within the centre.

Inadequate humanitarian response

In their quest for safety and protection, those arriving in Harmanli confront a myriad of challenges, fleeing persistent conflicts, grappling with the aftermath of a devastating earthquake, and contending with an inadequate humanitarian response.

The shifting conditions in Türkiye further propel individuals to seek sanctuary in Europe, often embarking on arduous journeys that span vast distances. The journey through Türkiye, marked by long and rough passages, is particularly grueling, compounded by the harsh winter weather and subpar living conditions in the Reception and Registration Centre (RRC) upon arrival in Bulgaria.

As people navigate this challenging landscape, their health needs intensify, exacerbated by the scarcity of medical personnel and resources in this remote area. Despite the tremendous resilience demonstrated by these individuals, their well-being is precariously balanced, and immediate attention is required to address the pressing health concerns that arise during their journey and upon reaching the Harmanli Centre.

MSF's response on the Bulgarian border

In July 2023, recognising the needs, Médecins Sans Frontières (MSF) initiated a response at the Bulgarian border. Since MSF started operating a small clinic within the Harmanli Reception Centre, our team has provided a total of 3,262 consultations including general healthcare consultations, sexual and reproductive health services, and support for patients with non-communicable diseases.

Immediate health needs arising from poor hygiene conditions, leading to the spread of infections, are a priority. MSF is also actively coordinating the referral of untreated health conditions that require specialised care.

Challenges at the border

The shortage of medical professionals is a broader issue in Bulgaria, impacting the capacity to intervene effectively for refugees in Harmanli.  The Bulgarian health system has certain limitations, requiring refugees to obtain free care with a referral from a registered general practitioner (GP). The irregular availability of GPs in the centre poses challenges for accessing essential care, which mainly focuses on emergency or chronic conditions.

Beyond general healthcare, there is a need for mental health and socio-legal services. Interpretation services for administrative processes, registration, medical consultations, and social work support are also limited.

Additionally, challenges such as a lack of adequate bed covers in cold weather and the absence of a designated safe zone for unaccompanied minors persist.