ATHENS, Greece – At first glance, the waiting room near central Athens’ Omonoia Square looks like an ordinary doctor’s office. Patients wait quietly for their names to be called as a secretary takes appointments by phone. Children’s crayon drawings line the walls.

The difference is in the payroll -– or rather, the lack of one. The Athens Community Polyclinic and Pharmacy, better known its Greek initials KIFA is one of more than 40 ‘solidarity’ health clinics across Greece run completely by volunteer doctors and regular citizens.

These ‘solidarity clinics’ — free and unregulated — have sprung up around Greece in recent years to treat people who no longer have access to healthcare due to the prolonged financial crisis.

It’s just one of the many symptoms of the health crisis caused by the economic woes in Greece. Public health is in decline. Steep budget cuts translate into a lack medical staff and basic supplies like syringes, gauze and painkillers in hospitals. People who’ve lost their health insurance because they’ve lost their jobs often wait until the last possible minute to seek care. By the time they come to the clinics, some have serious or even life-threatening conditions.

“We never could have imagined….that we would be caring for each other for free in these conditions,” says Chara Matsouka, the director of hematology at Athens’ Alexandra Hospital who is also KIFA’s coordinator.

Volunteers are motivated by a sense of duty toward the more than 2.5 million Greek citizens –- a quarter of the population –- who no longer have health insurance, up five-fold since 2008. And paying out-of-pocket for health care is a distant possibility for most: a quarter of the workforce is unemployed, and

Even public hospitals are turning to the solidarity clinics for donations. The Metropolitan Community Clinic in the Athens suburb of Helliniko is Greece’s largest with 300 volunteers, 115 of whom are doctors. Medicine donations come from people who have recovered and have extra drugs, while equipment comes from retiring private doctors or donors abroad.

On Thursday, clinic cofounder Christos Sideris flipped through a three-inch-thick binder filled with donation requests from public hospitals all over Greece. “They need everything: wheelchairs, bandages, syringes,” Sideris says. “They are running out.”

Patient horror stories give another glimpse into the state of healthcare in Greece –- and why clinics have stepped in to fill the gaps. Last year, a woman called the Metropolitan clinic in hysterics because her 24-year-old grandson urgently needed anti-cancer medicine. It cost thousands of euros per month. The young man was a month away from losing his health insurance, which in Greece expires after a year of unemployment.

“Two women heard about it and volunteered to stop their own leukemia treatment, one for 10 days and the other for 20 days,” Sideris says. “That’s how we got one month of drugs for him, he says. “They saved his life.”

Last August, Greece’s health department imposed sharp cuts to its cancer screening program, imposing caps on uterus, breast, and prostate cancer screenings. Even treatable conditions like diabetes and high cholesterol are becoming serious for Greeks who can’t afford treatment.

Doctors at another clinic in the Athens suburb of Peristeri had to amputate a diabetic man’s toe because he went six months without his medicine. The disease can restrict blood flow to the feet without regular care.

“Before the crisis, he was an ordinary person,” says Olga Kesidou, an ear, nose and throat doctor and Peristeri clinic cofounder. “But he lost his job and couldn’t pay for healthcare on his own. We have a lot of people in that situation. This is why we must be in solidarity.”

Citizens’ mental health is also suffering. A January 2015 study in BMJ Open medical journal linked Greece’s rising suicide rate to higher unemployment, especially among working-age men. Several of the solidarity clinics offer group therapy for unemployed people suffering from depression and other mental health issues.

“Sometimes they think they have some pains,” Matsouka says. “They say, ‘I want to see a doctor,’ but really they just want to talk to somebody. They feel invisible because they are not part of something.”

“You can see in their eyes their gratitude because we treat them as human beings,” she adds.

As proud as they are of the clinic network they have built, the volunteers also believe they should not have to exist.

“Health is a very serious matter. It is not to be left in the hands of volunteers,” says Maria Spiliotopoulou, a history researcher who volunteers with patient intakes at KIFA. “We pay taxes. The welfare state should provide for us.”

Seven years of financial crisis have made that impossible. Greece’s once-massive public health system has been a top target for spending cuts to finance the country’s debts to international creditors. Its budget has decreased by almost 50 percent since 2009, as the prices even insured patients pay for medicines have shot up.

It’s an open secret that, by law, the solidarity clinics should not be operating. But government regulators have largely turned a blind eye, indicating, perhaps, how much the public health system has come to rely on this small army of volunteers.

“Of course we are illegal,” Sideris says. “But what’s the bigger crime? To impoverish people or to break some rules to help people?”

On the campaign trail, Greek Prime Minister Alexis Tsipras and his left-wing Syriza party pledged to fix the country’s ailing healthcare system. In April, he abolished a compulsory 5-euro fee for care at public hospitals and pledged to hire 4,500 medical staff after years of hiring freezes and personnel cuts.

But Greece’s default this week on its International Monetary Fund obligations throws such promises into question.

Several solidarity health clinics openly support a ‘no’ vote in Sunday’s referendum on its bailout deal terms because they believe Greece cannot afford to neglect its citizens’ health any longer.

Indeed, the waiting-room walls at KIFA are plastered with ‘no’ posters. Visitors to the Metropolitan clinics are greeted with ‘no’ in giant white letters on the pavement at the entrance.

A few months ago, Kesidou says, she believed the Peristeri clinic would be able to close its doors by the end of the year. Now she has little such hope.

“If ‘no’ passes, more people will have insurance, more people will be healthier,” Kesidou says. “But ‘yes’ will mean more cuts to health and social services.”

Says Sideris: “If we don’t reverse the budget cuts, nothing will change.”

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