By Kate Kelland, Health and Science Correspondent
ATHENS (Reuters) - Just when it seems things couldn't get any worse for Greece, the exhausted and indebted country has a new threat to deal with: mosquito-borne diseases.
Species of the blood-sucking insects that can carry exotic-sounding tropical infections like malaria, West Nile Virus, chikungunya and dengue fever are enjoying the extra bit of warmth climate change is bringing to parts of southern Europe.
And with austerity budgets, a collapsing health system, political infighting and rising xenophobia all conspiring to allow pest and disease control measures here to slip through the net, the mosquitoes are biting back.
Already malaria, a disease eliminated from Greece in 1974, is not just returning with visitors and migrants - as it does from time to time in the rest Europe - but is being transmitted from person to person within Greek borders.
This year's death toll from West Nile Virus, a disease spread by Culex modestus mosquitoes, stood at 16 on October 11.
It's a sign of the times that Medecins Sans Frontiers (MSF), a global medical charity more usually associated with the fight to save lives of babies in sub-Saharan Africa, is now working full time in parts of southern Greece.
In a country visited by 16 million tourists a year and where austerity measures mean up to 30 percent of the population is already struggling to access the healthcare they need, keeping infectious bites to a minimum is an economic necessity.
Yet far from coordinated, timely action, the rising threat from mosquitoes has instead brought a blame game pitching Greeks against foreigners, local mayors against national politicians and patients and doctors against ministers and officials.
"For a European country, letting this kind of situation develop and not controlling it is a big concern," says Apostolos Veizis, MSF's director of medical-operational support in Greece.
"You can't run after malaria. In a country in the European Union, we should not be running after a disease like this in emergency mode. Even in poorly-resourced countries in Africa, they have a national plan in place. What I expect from a country that is a member of the EU is at least that."
But this EU country is in deep trouble.
Outside one of Athens' oldest and most respected hospitals, the effects of the debt crisis that has brought this country to its knees can't be ignored. The homeless sleep on streets and park benches, and a banner hanging from the Evangelismos hospital's main gate says "the health system is bleeding".
On a white bed sheet daubed in red and black paint and hung up by doctors who often work 36-hour on-call shifts and haven't been paid for them for months, it declares "no to more layoffs, no to a lack of supplies, no to making us work without pay."
Greece is in its fifth year of recession, with unemployment at 25 percent. Savage austerity steps have not proved enough so far and Greece now needs to make at least 11.5 billion euros of new cuts to secure the next tranche of a European Union bailout.
Infectious disease experts here and at a European level agree that for now, at least in terms of patient numbers, the country's malaria problem pales beside its many other worries.
Some 59 cases of the parasitic infection have been recorded in Greece so far this year, 48 of which were imported either by migrants or returning Greek travelers. West Nile Virus cases are around three times that, at 159 so far this year.
Still, says Johan Giesecke, of the European Centre for Disease Prevention and Control (ECDC) cases of these diseases "should not be coming back".
"It's a serious problem," the ECDC's chief scientist says.
Giesecke and others believe climate change is part of the problem, as is the arrival of several new species of mosquito in Europe - including the Asian tiger mosquito known to carry dengue, West Nile Virus and chikungunya.
It's only a snapshot, but in this mid October, when many northern Europeans are putting on coats and boots, Athens still has shorts and flip-flops weather at up to 30 degrees and humid.
While Greece has had no cases of chikungunya in the past three years, the disease is popping up elsewhere in Europe - as is dengue, which is causing a large outbreak on the Portuguese island of Madeira [ID:nL5E8LCJBW].
At the University of Thessaly, Christos Hadjichristodoulou, a consultant for the Hellenic Centre for Disease Control and Prevention (HCDCP) says the return of mosquito-borne diseases is primarily an issue not of health, but of immigration.
A country of 11 million people, Greece is a major gateway for Asian and African migrants trying to get to the EU. It is home to more than a million immigrants, both legal and illegal.
"We get a lot of immigrants from malaria-endemic countries like Pakistan and Afghanistan who spread throughout the country, including to areas where the risk is high because we have the vectors (mosquitoes)," said Hadjichristodoulou.
This includes places like the rural municipality of Evrotas, where many of Greece's malaria cases have been found. Here some 4,000 poor and mainly Asian migrants work in fields producing oranges and olive oil, irrigated by 130 kilometers of canals.
Hadjichristodoulou cites a survey of 6,000 immigrants in southern Greece which found that 60 percent of them had antibodies to malaria in their blood - meaning they had previously been infected with it.
With the form of malaria endemic to Pakistan and Afghanistan, known as vivax malaria, patients can relapse, often several times, allowing the disease to be picked up again by a hungry mosquito and spread to a new victim.
Ioannis Grevenitis, a 41-year-old restaurant owner in the southern town of Agios Georgios Skalas, is sure this is what happened when he fell prey to malaria last year. The illness put him in hospital for three days then, he says, and he suffered a relapse a few weeks ago.
While he insists he's not racist -"no way" - he also says he no longer serves Pakistanis in his restaurant. The other customers, local Greeks, are afraid of them, he says.
"The problem is...down to the immigrants," he told Reuters.
Eleni Kakalou, a doctor at Evangelismos hospital, grimaces with frustration when she hears such talk, which she says is part of a "rising wave of racism and xenophobia" in Greece.
Such prejudice, she worries, could drive Greek politicians, already moving to the right to capture populist votes, to introduce policies banning migrants from free healthcare - keeping them away from exactly those health services they need, and Greece needs, to help get on top such diseases.
Kakalou, like MSF's Veizis, is most concerned about what Greece is doing - or not doing - to control its mosquitoes.
In countries where the disease is endemic, so-called "vector control" measures such as spraying insecticides to limit mosquito populations, and environmental measures like making sure areas of standing water are drained or at least kept to a minimum, are the basics of national malaria control plans.
In Greece, however, where MSF says malaria is a "forgotten" disease, spraying is not getting the attention it deserves.
According to Veizis, of the 56 municipalities that make up the Attica region of which Athens is the centre, "only eight undertook anti-mosquito spraying at the time that is recommended for effective vector control" - which in 2012 was early Spring.
And as with the immigration row and battles over health services, dysfunctional politics creep in here too.
Part of the problem is that while the health ministry is responsible for health services, responsibility for mosquito control falls to Greece's hundreds of municipalities, the lowest level of government run by local councils and led by mayors.
"They don't have specialized scientific staff and have been suffering budget cuts from central government," said Kakalou.
"And public health in Greece is not developed enough, co-ordinated, funded or staffed at a central or local level."
Health Minister Andreas Lykourentzos has said he would secure the funds needed and be better prepared next year.
"We must act in a timely manner to prevent a repeat of this summer's incidents," he said in a statement last month.
Drawing on the know-how of MSF the authorities have drawn up a "Strategic Plan of Action for Malaria Control".
Kakalou welcomes the plan as a positive step but has little faith in what it will mean in practice: "Unless it is implemented entirely, funded appropriately and supported, it will remain on paper."
(Additional reporting by Karolina Tagaris and Renee Maltezou; editing by Anna Willard)