“The crisis was before. What started in 2011 was the treatment”. That was the reply of an interviewee from a social clinic in Greece in one of my questions. The austerity policies imposed consecutively by the Greek governments as a way to tackle the Greek debt, in accordance with the directions of the EU, the ECB and the IMF, had not left untouched the health sector. Taking into account that unemployment in the total workforce has reached almost 27% (Eurostat, 2016) and the fact that the Greek health system follows a mixed Bismarck and Beveridge model, meaning that it is based both on social security funds and on the general taxation, had as a result the exclusion of around 1/3 of the country’s population from the health system. In response to this situation, a number of social clinics had been established all over the country, providing for free primary healthcare services and medicines to those without access to the healthcare system.
In order to contribute to the debate regarding the provision of the so called second welfare, this article draws its attention to Greece and the case of social clinics.
What the social clinics are
Citizen initiatives from abroad (MKIE, 2015a), media associations (Cooper, 2014) as well as international (MKIE, 2013) and supranational organizations (MKIE, 2015b) have shown great interest regarding the work of these organizations. However, since social clinics do not constitute a unified actor, before we proceed with the analysis of their work, it is important first to clarify what the social clinics are. By using a strict dichotomization, which has been applied in studies of similar organizations (Loukakis et al, 2016), social clinics can be categorized in formal and informal. Formal social clinics are framed the organizations which have been established by a number of formal actors, such as the municipal authorities, the church, NGOs or other third sector organizations; while on the other hand, as informal are characterized the ones that came out of citizen initiatives and social movements (Adam and Teloni, 2015).
The extensive fieldwork research of Adam and Teloni (2015) have obtained valuable insights regarding both categories and revealed their most important differences. In particular, a great percentage of the workforce of the formal social clinics is constituted by employees coming from the respective municipalities or is funded from European projects, something which is extremely rare for the informal ones. Formal social clinics usually set stricter criteria regarding both their beneficiaries and their volunteers and they receive donations and funding from a broader variety of resources. On the contrary, informal social clinics usually have loosely criteria not only for their members but also for the beneficiaries and they mostly reject state, church, and EU’s organizations as potential donors.
Of course this distinction describes these two trends but it does not represent precisely the picture of all social clinics, since there are many overlaps between the two categories. However, a characteristic that provides a sharper distinction between the two is that the formal social clinics define their action as a way to help people ridden by the crisis, while for the informal ones it also constitutes an action of solidarity and active resistance to the austerity policies and politics (Cabot, 2016).
Social clinics as a vital actor in the welfare provision
What comes next is an effort to sketch out how these informal organizations, or the social solidarity clinics and pharmacies (SSCP) as they are usually called, came to constitute a vital actor in the welfare provision during the times of crisis.
As it is argued earlier, most of the SSCPs have been established during the harsh years of crisis. However, their story goes back in the beginning of the 1990s and the will of a doctor in Chania, Crete, well-known for his leftish background. Back then, together with other doctors who used to work at the local hospital, that doctor had been granted a place above the church’s soup kitchen, which was transformed into a clinic for poor and homeless people. As an interviewee recalls: “(The doctor) used to stroll in the city and especially in the old town where there were people who had been forgotten, lonely, deviants…he understood the need for a social clinic, which would be closer to them. Although the hospital might be an open structure, these people would not approach it. […] That clinic lasted for two years and then it was absorbed somehow by the hospital.”
Child of that first clinic is the SSCP of Rethimno, Crete, which was established in 2008. Due to the exclusion of the undocumented migrants from the healthcare system, some doctors from the local hospital took the decision to setup a social clinic in order to deal with that problem. After communicating with the municipality to grant a place for the clinic, they started providing their services on a voluntary basis. Their initial tasks had to do with the provision of vaccinations, medical tests and medicines as a way not only to treat the undocumented migrants living in Crete but also to demonstrate their situation in order to put pressure to the government. However, once the austerity measures realized, the clinic opened its services also to Greeks.
In a similar way, although with more radical characteristics, the SSCP in Thessaloniki have started its operation in 2011. Following the end of a successful hunger strike of 300 undocumented migrants demanding the legalization of all undocumented migrants in Greece (Kouki and Mantanika, 2011), some doctors, who at that time constituted the medical team in solidarity with the migrants, decided that the problem was still there. After discussing the character of the clinic, they had been granted a place from the local labor center in order to provide primary medical and pharmaceutical treatment to undocumented migrants. Alike with the case in Rethimno, the clinic in Thessaloniki quite soon expanded its services to everyone who did not have access at the healthcare system.
A different story derives from the Metropolitan SSCP in Elliniko, Athens. The SSCP in Ellinko started in December of 2011 after a long discussion of a group of doctors and citizens during the square movement in Syntagma (the counterparts of Spanish Indignados). After achieving the collaboration of the local municipality which had granted them a place, the initial group of 6 people became 60 just before the inauguration of the clinic. In 2016 the clinic is estimated that occupies more than 280 volunteers of which more than 115 are doctors. The services in the Metropolitan clinic are open as well to everyone in need.
Social clinics as a welfare gap-filler?
Although brief, these stories provide some indicative evidence regarding the radical roots of the SSCPs. The SSCPs participate both in protest actions, such as the blockage of hospitals’ counters; but also by obtaining different approaches, they address issues of the mainstream political environment, arguing for a public hospital system accessible to everyone in need. Together with these, other two characteristics have made the clinics welcomed by large sectors of the population. More precisely, the fact that from their very beginning the clinics advocate an anti-racist profile, in times when the percentages of the neo-Nazi party of golden dawn were quite high, was a factor that increased their popularity among the left and libertarian spectrum. Additionally, the inclusive character of their action, such as the systematic calls for collection of any kind of medicines, have made the SSCPs quite accessible and welcomed by the local communities.
Pretty much every SSCP states clearly that it is not on their intentions to substitute the healthcare system, both due to the lack of facilities and equipment but also because they believe that health is a good which should be hitherto provided by the state. However, a debate that had started long time ago in the SSCPs’ assemblies, it has appeared again with the refugee crisis. After the evacuation of Idomeni, where the SSCPs used to have quite active presence by distributing medicines, clothes and treating the refugees, the question is whether they will provide their services in the open and close concentration camps. Therefore, the dilemma whether they achieve their goals to resist austerity and the ones who implement them or through their action they fill the gaps of the welfare deficit, still remains.
Although it is hard to provide a definite answer whether the SSCPs are substitute, complementary or independent forms to the welfare provision, what seems quite interesting is the relation that the welfare system has developed these years with them. From my fieldwork research and from other empirical studies came out many times that a number of public hospitals have contacted the SSCPs in order to ask for specific pharmaceutical products. Additionally, it was not also that rare that some patients have been directed by hospitals, and sometimes also by the Ministry of Health, to contact an SSCP than waiting for months to book a date in a public agency (MKIE, 2014). Before the approval of a law in April 2016, which gives access to uninsured people at the healthcare system, SSCPs used to collaborate with hospitals in order to treat some of their beneficiaries. Among other state’s officials, the current Minister of Heath who had promoted this law, used to be also a founding member of an SSCP. Therefore, these few examples show us that although the lines for categorizing the SSCPs in relation with the welfare provision might still be blurred, it is quite sure that the agency of the SSCPs has touched upon it.
Adam S. and Teloni D.D. (2015), Social Clinics in the Crisis-ridden Greece: The experience of healthcare services when the National Healthcare System drawbacks, Studies/44, Observatory for the economic and social evolution, Institute of Labour, GSEE.
Cabot H. (2016), ‘Contagious’ solidarity: Reconfiguring care and citizenship in Greece’s social clinics, Social Anthropology, 24(2), pp.152-166
Cooper C., (2014), Tough austerity measures in Greece leave nearly a million people with no access to healthcare, leading to soaring infant mortality, HIV infection and suicide, Independent, accessed in 19/9/2016
Eurostat (2016), Unemployment by sex and age - quarterly average, accessed in 18/6/2016
Kouki H. and Mantanika, 2011, The spatiality of a social struggle in Greece at the time of the IMF, City, 15(3-4), pp.482-490.
Loukakis A., Kousis M., Lahusen C. and Kies J. (2016), Alternative Action Organizations in the Eurozone Crisis: Comparing the Greek and German Experience, 2007-2016, Paper presented at CES Conference, Philadelphia
MKIE (2015a), General Announcements, Solidarity does not have borders (in Greek)
MKIE (2015b), General Announcements, The European Parliament awards the MKIE (in Greek)
MKIE (2014), General Announcements, The Ministry of Health sends uninsured patients at MKIE (in Greek)