The consequence of border securitization: trench foot among migrants at the Bulgarian-Serbian frontier

Since 2015, Serbia remains a transit country in the Balkans migration route for people fleeing war and conflict, searching for refuge in Europe. Though official estimates show a decrease in the number of migrants in the Serbian refugee camp system, from 108,000 people in 2023 to 20,000 in 2024,¹ the number transiting through Serbia is likely higher.² The closing of reception camps along the route and moving them farther south pushed migrants to travel covertly and excluded them from shelters and healthcare services. Migrants are forced to sleep rough, travel at night, and march through forests and mountains. Such conditions increase the risk of migrants to exposure injuries including trench foot. The securitization of borders and limited access to care for migrants continue to exacerbate the situation.

Médecins sans Frontières Belgium (MSF) has responded to medical humanitarian needs of migrants in Serbia for years. From 2023 to 2024, MSF operated mobile clinics for migrants in Pirot, a district near the Bulgaria–Serbia border. Clinic staff treated around 14,000 patients around camps and bus stations. Of this group, 407 cases of trench foot were documented, along with skin and gastrointestinal disorders, respiratory and urinary tract infections, and dental conditions. The number of trench foot cases is unusual for MSF's experience.³ A condition that gained prominence during World War 1, trench foot has been observed among soldiers, the unhoused and the elderly over the years.⁴ Sustained from prolonged exposure to low temperature and/or moisture, trench foot is characterized by swelling, loss of sensation and skin breakdown due to blood vessel constriction. Increasingly, it is being associated with human migration in Europe and the Americas.⁵

In the MSF cases, migrants likely developed trench foot after moving constantly in wet and cold terrains before reaching Serbia. Though the migration route via the Bulgaria–Serbia border is connected by roadways, migrants are barred from using public transport. Recent migration policies adopted by countries along the route forced them to walk in the forests covering the mountain ranges. The closure of camps such as the one in Pirot in July 2024 and the relocation of migrants to the southern camps lengthen the walking distances to reach temporary refuge. Migrants fear being apprehended so those who sought care with MSF do not stay long and opt to continue their journeys. If they are detained and relocated or pushed back to the border areas, they risk repeating their journeys.

Even after the Pirot response ended, MSF continues to treat trench foot in Belgrade and areas near the Hungary–Serbia border. Regardless of location, the migrants seen by MSF share commonalities—walking long distances without safe spaces to rest and having limited access to healthcare or dry and appropriate clothing. They risk developing complications that can lead to infections and lifelong disability.⁴ Serbia's migration policies, echoing the European Union's border management and mobility control strategies, contribute to endangerment of lives. Such outcomes can be prevented by the provision of protection, healthcare and shelter for migrants and less focus on criminalising them.

Contributors

BL, JH, FZ: conceptualization, data analysis, writing original draft and reviewing, SL: conceptualization, writing, review and editing.

Declaration of interests

The authors have no competing interests to declare.