ATHENS, Greece –  Thousands of men, women and children fleeing war-ravaged countries face dreadful holding conditions and a dysfunctional reception system after risking their lives in smuggling boats to reach Greece’s Aegean Sea islands, an international medical aid organization warned on Wednesday.

A Doctors Without Borders, or MSF, report said many refugees, exhausted and often soaked from the sea-crossing, spend days sleeping outdoors or squashed in tiny police cells before being moved to the mainland.

“We have seen intolerable overcrowding, with 53 people crammed into a cell meant for six,” MSF field coordinator Kostas Georgakas said. “What little they are offered after such a grueling journey is shameful, and dangerous for their health.”

Along with Italy, financially-struggling Greece is a major destination for refugees and migrants from the Middle East and Africa seeking a better life in Europe. Last week, 591 people — mostly Syrians — reached Crete on a crippled freighter.

Syrians make up more than 90 percent of the 14,000 migrants who reached the southeastern Dodecanese islands — a prime tourist destination — this year. They qualify for, and are quickly granted, refugee status in Greece, but most prefer to head for other European countries.

A mobile MSF team provides health care, sleeping bags and toiletries in the Dodecanese, where arriving migrants, including families, unaccompanied children and elderly people, have increased six-fold over 2013 as the situation in Syria has worsened.

MSF mission chief to Greece Apostolos Veizis told the AP that there is no state medical screening for migrants reaching the Dodecanese, where authorities plan to build a reception center next year. He described particularly poor conditions on the island of Symi, near Rhodes.

“The reception area is the steps beside the port authority building, and the police station’s balcony,” he said. “There’s one dysfunctional, blocked toilet. … Authorities recognize that there’s a problem, the question is, what do they do about it?”