The influx of more than one million asylum seekers from Africa, Asia and the Middle East is placing unprecedented strain on Germany's healthcare system.
Hospitals, clinics and emergency rooms across Germany are being filled to capacity with migrants suffering maladies of all kinds, and medical personnel, including thousands of volunteers, are increasingly complaining of burnout.
Diseases are also reappearing that have not been seen in Germany for years. German public health officials are now on the lookout for Crimean Congo hemorrhagic fever, diphtheria, Ebola, hepatitis, HIV/AIDS, malaria, measles, meningitis, mumps, polio, scabies, tetanus, tuberculosis, typhus and whooping cough. As refugee shelters fill to overflowing, doctors are also on high alert for mass outbreaks of influenza and Norovirus.
Compounding the challenge, tens of thousands of migrants arriving in Germany — particularly migrant children — have not been immunized, and German doctors are finding that needed vaccines are not readily available due to a lack of supply. Some German parents are panicking that there are not enough vaccines to immunize their own children.
Many migrants are also suffering from a host of traumas and mental illnesses. According to the Chamber of German Psychotherapists (Bundespsychotherapeutenkammer), at least half of all migrants arriving in Germany have psychological problems, including post-traumatic stress disorder and depression, and roughly 40% have contemplated suicide.
German hospitals are also being forced to hire a virtual army of interpreters so that doctors can communicate with asylum seekers, who speak dozens of languages, dialects and variants.
At the same time, German hospitals are increasing security to protect doctors and nurses from violent attacks by migrants who are unhappy with the medical treatment they are receiving.
Critics are warning that German taxpayers will end up paying billions of euros to provide healthcare for a never-ending wave of asylum seekers. This is in addition to the billions of euros already being spent to provide newcomers with food, clothing and shelter.
Many say the German government failed fully to consider the unforeseen consequences of opening the door to so many migrants. In addition to the massive economic and social costs, as well as the burden of increased crime, including a rape epidemic, Germans are now facing the risk of being exposed to exotic diseases.
German media outlets are downplaying the extent of the healthcare problem, apparently to avoid spreading fear or provoking anti-immigrant sentiments. But a growing number of German healthcare professionals are sounding the alarm.
In an interview with Die Welt, Dr. Michael Melter, the chief physician at the University Hospital Regensburg, said that migrants are arriving at his hospital with illnesses that are hardly ever seen in Germany anymore. "Some of the ailments I have not seen for 20 or 25 years," he said, "and many of my younger colleagues have actually never seen them."
Marc Schreiner, director of international relations for the German Hospital Federation (Deutschen Krankenhausgesellschaft), has echoed Melter's concerns:
"In the clinics, it is becoming increasingly common to see patients with diseases that were considered to have been eradicated in Germany, such as scabies. These diseases must be reliably diagnosed, which is a challenge."
Schreiner said that in cases of highly contagious diseases, including tuberculosis, patients must be quarantined, an expensive procedure, the costs of which are paid for by German taxpayers.
According to Schreiner, about 15% of the newly arriving migrants require immediate medical treatment. With 1.5 million asylum seekers expected to arrive in Germany in 2015, this means that 225,000 migrants will have an urgent need for medical attention.
Siegfried Hasenbein, director of the Bavarian Hospital Association (Bayerische Krankenhausgesellschaft), estimates that in 2015, between 25,000 and 30,000 migrants will be treated in Bavarian hospitals alone. In addition, this year between 75,000 and 90,000 migrants will receive ambulatory or outpatient care.
According to Hasenbein, these numbers appear insignificant when compared to the three million hospital visits that normally occur in Bavaria every year. The problem arises in that the migration crisis is straining the Bavarian healthcare system unevenly, with hospitals in migrant "hotspots" such as Deggendorf, Ingolstadt and Passau bearing the brunt of medical care.
Markus Beier, director of the Bavarian Association of Family Physicians (Bayerischer Hausärzteverband), says that doctors in areas with large concentrations of asylum seekers are being called upon all hours of the night and day, making it impossible for them to provide anyone with superior levels of care.
Max Kaplan, director of the Bavarian Medical Board (Bayerische Landesärztekammer), says that the challenges associated with medical treatment for migrants are exacerbated by language and cultural barriers, which are "tiresome, time consuming and sometimes impossible to overcome." Adding insult to injury, he says, many Muslim women refuse to be treated by male doctors, and many Muslim men refuse to be treated by females.
In an effort to prevent diseases from spreading, Kaplan has called on German public health officials to order medical exams for all asylum seekers at the initial point of entry into Germany, before they are sent to different parts of the country. "This is in the best interest of the refugees, and also of the native population," he said.
In a November 2 interview with Spiegel TV, Dr. Ralf Mütterlein, director of the Pulmonary Clinic (Klinik für Lungen- und Bronchialheilkunde) in Parsberg, estimated that between 8,000 and 10,000 asylum seekers in Germany have tuberculosis, but only a small fraction these are currently in quarantine.
Migrants who are taken to Mütterlein's clinic are held in quarantine for up to 18 months at a time to prevent the disease from spreading to the population at large. The costs to German taxpayers are astronomical: Between 10,000 and 12,000 euros per migrant per month. Over 18 months, the total cost often exceeds 200,000 euros per migrant.
Meanwhile, a report by Die Welt describes efforts by German health officials to contain the spread of so-called resistant germs:
"Physicians are currently on high alert, because with the arrival of hundreds of thousands of refugees, infectious diseases could enter the country. This is not hysteria. It is simply a challenge our healthcare system has not faced for many decades.
"There is a danger that a refugee is 'colonized' — as doctors call it — with dangerous germs. Every person carries bacterial germs in and on the skin. For healthy people they are harmless. They become a problem when they spread among critically ill and immunocompromised patients in a clinic.
"The problem: In the refugees' countries of origin, resistant germs may spread more often than in Germany. So a refugee is immediately tested upon admission to a German clinic. Only when it is certain that there is no danger, it the patient moved to a shared room."
Dr. Jan-Thorsten Gräsner, director of the Institute for Rescue and Emergency Medicine (Institut für Rettungs- und Notfallmedizin), estimates that roughly 5% of asylum seekers are carrying resistant germs. In real numbers, this works out to around 75,000 newcomers with highly infectious diseases.
The Berlin-based Robert Koch Institute, a key governmental agency for the safeguarding of public health in Germany, has advised healthcare professionals, as well as those who are working as volunteers in refugee shelters, to update their immunizations.
But the Federal Institute for Vaccines and Biomedicines (Paul-Ehrlich-Institut), an agency of the Federal Ministry of Health, has warned that 20 types of vaccines are now in short supply, and 16 others are no longer available at all. Because of production bottlenecks, some vaccines will not become available until 2017.
Stefan Derix, director of the Chamber of Pharmacists North Rhine (Apothekerkammer Nordrhein), said the shortage of vaccines is due to the massive influx of asylum seekers. He said the Ministry of Health normally orders vaccine supplies one year in advance, and that no one in the government had anticipated that Germany would be taking in so many migrants this year.
Dr. Wolfram Hartmann, president of the Cologne-based Professional Association of Pediatricians (Berufsverband der Kinder- und Jugendärzte), has warned that many of the vaccines needed to immunize both native German children and migrant children for diphtheria, polio, tetanus and whooping cough are not available, neither in Germany nor in any other European country. He also said that basic vaccines against measles, mumps, rubella and varicella are in short supply.
In a statement, Hartmann wrote:
"We cannot provide native German children and refugees alike with the basic vaccines. The vaccine shortage, which is the responsibility of the pharmaceutical companies, must urgently be made a top priority of the Health Minister! Children have a right to vaccinations, especially for chronically ill children who need timely vaccinations against flu, especially if they are housed in communal accommodations.
"The federal government must now act urgently and enforce the right of children to vaccination. The vaccine supply is just as much of a national responsibility as is the supply of physicians."
Kordula Schulz-Asche, a politician with the Greens Party, warned against holding migrants responsible for the vaccine shortage. "The current tense vaccine situation must not be misused to stir up public opinion against refugees," she said.
In North Rhine-Westphalia, hospitals are requiring their personnel to attend courses on how to treat patients with exotic illnesses hardly ever seen in Germany. Hospital workers in Bielefeld and Siegburg are said to be groaning under the strain of having to examine up to 80 migrants a day for tuberculosis. "The workload has increased tremendously," a worker told Westdeutscher Rundfunk, a public broadcaster. Other hospitals in the state lack sufficient personnel and equipment, including the x-ray machines needed to examine patients with tuberculosis.
In Lower Saxony, public health officials, fearful of a mass outbreak of influenza, are struggling with the logistics of vaccinating tens of thousands of asylum seekers housed in refugee shelters across the state. With more than 1,000 new migrants arriving in Lower Saxony every day, initial medical exams of newcomers are backlogged by weeks, a period during which undetected diseases can spread.
In Berlin, police were forced to apologize for recommending that asylum seekers suffering from scabies, a highly contagious skin disease, be required to wear armbands to distinguish them from migrants who are healthy. The plan was for them to wear armbands with the capital letter 'K' for Krätze (German for scabies); their immediate family were to have worn armbands with the capital letter 'A' for Angehörigen (German for next of kin).
Meanwhile, reports of health-related scares, especially those involving tuberculosis, have become a daily occurrence in Germany.
In Krefeld, a city in North Rhine-Westphalia, a 27-year-old migrant was diagnosed with tuberculosis. He was being held in quarantine at a local pulmonary clinic. In Lünen, also in North Rhine-Westphalia, four migrants were diagnosed with tuberculosis.
In Nattheim, a town in Baden-Württemberg, asylum seekers at a refugee shelter underwent mass immunization after a child at the shelter fell ill with chickenpox. In Ellwangen, also in Baden-Württemberg, an asylum seeker diagnosed with tuberculosis escaped from a hospital. He remains at large.
In Gransee, a town in the eastern state of Brandenburg, a migrant was diagnosed with tuberculosis.
In Würzburg, more than 400 asylum seekers were mass immunized for chicken pox, diphtheria, measles, mumps, polio and tetanus. In Heidenheim, a town in Baden-Württemberg, public health officials are preparing for potential outbreaks of influenza and Norovirus at local refugee shelters this winter.
In Cologne, police cordoned off a refugee shelter housing more than 1,000 migrants in the Chorweiler district after a male refugee from Africa showed symptoms of Ebola. The man, who was coughing up blood for more than three days before anyone called a doctor, was rushed to a local hospital, where he was diagnosed with a gastrointestinal illness. Earlier, the same refugee shelter was the scene of an E. coli scare potentially affecting 800 migrants.
In Bochum, a 16-year-old migrant from Guinea showing symptoms of Ebola was placed in quarantine. In Saxony, public health officials are now testing all incoming asylum seekers for Ebola.
In Düsseldorf, a 30-year-old migrant from Algeria was diagnosed with tuberculosis and was being held in quarantine at a local hospital. Municipal health officials say that in 2014, there were 50 confirmed cases of tuberculosis in the city. In 2015, that number was surpassed in August, before migrants began arriving en masse in September and October.
In Tegernsee, a town in Bavaria, a 23-year-old migrant from Eritrea who was diagnosed with tuberculosis escaped from a refugee shelter. Local officials failed to inform the public about the incident for nearly one month, until they were confronted by a local newspaper, the Münchner Merkur. Wolfgang Rzehak, a local politician with the Greens Party, justified the media blackout: "We have to find a middle road between informing the public and not becoming a panic machine."
In Frankfurt, a 33-year-old migrant from Bulgaria who was diagnosed with tuberculosis escaped from a hospital and remains at large. Again, local officials kept quiet about the incident, until someone leaked information about it to the German newspaper, Bild.
In Berlin, a schoolteacher in the Steglitz-Zehlendorf district was diagnosed with tuberculosis; doctors say he was probably infected by one of his students. Also in Berlin, security guards at a refugee shelter in the Lichterfelde-Süd district locked nearly a dozen migrants in a bathroom after they were suspected of having tuberculosis. They were later transferred to a local hospital.
In Hamburg, public health officials quarantined a refugee shelter in the Jenfeld district after an outbreak of scabies. Also in Hamburg, a 17-year-old migrant from Sierra Leone was rushed to a local hospital and quarantined on suspicion that he had Ebola — just three days after arriving in Germany. Separately, at a refugee shelter in the Bahrenfeld district of Hamburg, firefighters wearing head-to-toe Ebola protection suits escorted migrants suspected of having Ebola to a local hospital.
In Bremen, after an asylum seeker was diagnosed with tuberculosis and doctors warned of the risk of contagion, all 200 migrants housed at refugee shelter on Steinsetzer Straße underwent chest x-rays to test for the disease.
In Munich, health officials are expecting more than 350 new cases of tuberculosis in 2015. The increase is being attributed to the large number of asylum seekers arriving in the city.
In Stuttgart, an average of 145 asylum seekers housed at the city's convention center seek medical attention every day. Common maladies include measles, chickenpox, flu infections, dysentery and scabies caused by mites.
In Rheingau-Taunus, a district in the state of Hesse, public health officials say they need more money and medical personnel to deal with the influx of migrants at 60 local refugee shelters. The health department expects to treat more than 1,500 newcomers this year, including a large number of children who lack proper immunization. The department has reported 60 cases of scabies and tuberculosis. According to Monika Merkert, a local health inspector: "The newly arriving asylum seekers bring diseases that occur only rarely in Germany."
Soeren Kern is a Senior Fellow at the New York-based Gatestone Institute. He is also Senior Fellow for European Politics at the Madrid-based Grupo de Estudios Estratégicos / Strategic Studies Group. Follow him on Facebook and on Twitter. His first book, Global Fire, will be out in early 2016.