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Background: This is a study about a refugee population of a “hidden” second wave of silent people who did not wait or could not wait for their asylum process to be completed on the Greek Island UNHCR camps or in those whose applications have been rejected (since they originated outside Syria and Iraq, and had little chance to get asylum in Greece, such as refugees from Afghanistan, Bangladesh, India, Pakistan, Iran). Material and Methods: The aim of this survey was to detect etiology and describe our experience with treatment possibilities of physiotherapy related wound infections on skin and soft tissue in injured extremities, joints, bones, during long “food based” travel between Greece and North Bosnia (800-1200 km). About 500-800 refugees of armed conflicts from Syria (80%), Iran, Afghanistan, Iraq and Pakistan (20%) with zero attendance from North Africa have been observed in permanent transit and moved from July 7 to August 15, 2018. Results: Within 144 patients who presented themselves in the Physiotherapy and Wound Unit of the Health Post in Velika Kladusa on the Bosnia/Croatia border, the majority had skin, soft tissue, joint and bone diseases, with majority presenting contaminated wounds after long walking, injuries, animal bites and accidents. Cultures were obtained in those who agreed and 51 cases were recorded and could be evaluated. 45 patients in field the Physiotherapy Ward Wound Unit had an invasive highly pathogenic bacterial pathogen including clostridium perfringens, MRSA, MSSA, P. aeruginosa, etc. In about 20% these were mixed with fungal and in more than 50% with parasitic infection or mixed bacterial and or fungal pathogens Sarcoptes scabiei plus other organism. Conclusion: In a non-refugee and non-migrant population in peace conditions, the majority of skin infections require minor debridement and local therapy with iodine, silver or alcohol based antiseptics. However in the immunocompromised population on long time of foot travel, systemic antibiotics, antifungals and anti-parasitic drugs may be required. Running title: Joint, skin and wound infections in long walking refugees on the Balkan Route.

Joint, Soft Tissue and Wound Infections in Physiotherapy Patients from a Mobile Health Care Unit in a Refugee Camp in Northern Bosnia