Kyria Maria1 was an old acquaintance at the social clinic of solidarity (koinonoiko iatreio allileggiis; KIA) to which she had returned several times in the previous months, always with the same request: insulin. The request was always rejected on the same grounds: the prescription she provided not only bore the signature of a doctor who was unaffiliated with this medical facility, but it had also expired. I noticed kyria Maria, a lady in her late sixties, modestly dressed in dark colours, anxiously sitting in the reception hall on an early Tuesday afternoon in May 2016. Leafing anxiously through her medical records, she looked around, trying to catch my eye as I intently aligned the three desks behind which Costas, Eleni, Nadia, Marina and I would soon take our positions for our shift as volunteers. She seemed worried about how quickly the reception hall was filling up and getting louder as more people entered, took their seats, and patiently waited for their turn to take their prescriptions or book appointments. I would only later learn the reasons for kyria Maria's anxious expression: she feared that, once again, her request for insulin would be rejected. However, the rejection would not be straightforward. She would be asked to sit and wait so that her request could be evaluated once all the other patients had been sorted. Only then could a solution be found. Or so kyria Maria had always been told.
Epitomised in the motto ‘health for all’ (ugeia gia olous kai oles), the free and far-reaching distribution of medications and the provision of primary healthcare services was one of the goals, and indeed the major success, of KIA between its birth in 2010 and the time of my fieldwork between 2015 and 2017. These years coincided with the peak of the so-called Greek economic crisis (2009–2018),2 during which three consecutive austerity packages irreversibly dismantled the public healthcare system and reduced citizens’ access to state-provided healthcare services.3 As part of a network of solidarity initiatives – often described as a bastion of resistance against the state (Arampatzi 2018), a form of social infrastructure (Dalakoglou 2016), the other face of the crisis (Cabot 2016), and an emergent experiment in solidarity economy (Rakopoulos 2016) – KIA positioned itself in opposition to state institutions, particularly state medical institutions.
Whereas access to public healthcare services was increasingly linked to employment or reliant on private means, the social clinic promised free access to everyone, regardless of employment status and insurance at least in its official discourses. KIA operated a system that its volunteers described as organised but not as bureaucratised: ‘bureaucracy and papers’, Costas, one of the many volunteers, passionately said, ‘are things of the state. And we are not the state. Nevertheless, we must ask patients for their documents; otherwise, this place will implode in no time.’ Acting upon the rhetoric of kinship as not just a discourse but a ‘site of practice’ and ‘a moral template for behaviours between people and between people and the state’ (Pine 2018: 87–88), the volunteers emphasised that their operations were organised horizontally so both volunteers and patients would feel part of a – rather idealised – family, where care is reciprocal, gratuitous and motivated by love and solidarity. Bureaucracy was perceived and experienced as an opaque system of practices, papers, files, and procedures through which the state evaded accountability to citizens (Randeria 2003). This system could only be navigated through dense networks of patronage and clientelism (Herzfeld 1992; Lyrintzis 2011; Sotiropoulos 2018), which often operated along kinship and political party lines (Herzfeld 1997, 2018).
In what follows, I will show how the languages, practices and documents of state bureaucracy infiltrated and shaped the KIA organisation, and trace how patients and volunteers managed and negotiated, often through tense exchanges, reciprocal expectations and pragmatic concerns about their medical needs and access to healthcare resources. I will then describe how the limited flow of medications, therapies and technologies was administered through the use, request and demand for paperwork and documents. To be registered with the grassroots medical facility, the prospective patients had to provide any kind of paper that could testify to their address of residence or to having been on state care: a proof of residence, a payslip or even expired health insurance documentation would secure registration.
Predictably, documents occupied a rather controversial position within the KIA: for volunteers, they were ‘tangible icons demonstrating their competence and accountability’ (James 2012: 58) in implementing the grassroots provision of healthcare services. As regulatory mechanisms, they secured fair and transparent access to healthcare resources. For prospective patients, documents were clear signs that KIA worked in continuation with, rather than in opposition to, the state, and reproduced the same exclusionary dynamics, with access to resources regulated by documents attesting to one's identity as a Greek citizen. Accordingly, documents revealed, on the one hand, ‘the tensions between desires for collective good and the reality of inequalities’ and, on the other hand, ‘the complex collective reality that is generated from intersections between different and contradictory projects’ (Bear and Mathur 2015: 20).
This article engages with anthropological scholarship on contemporary state formations, examining how they remain sites of affective investment (Aretxaga 2005; Jansen 2014; Laszczkowski 2016; Obeid 2015; Reeves 2011; Sansone and Bonanno 2025), even if its regulatory functions – such as healthcare, education, law and national security – have been increasingly privatised under neoliberal regimes (Aretxaga 2003; Truillot 2001). I look at how the documents and paperwork handled in the Athenian social clinic of solidarity conjured eerie state images and elicited negative affective dispositions towards it. In so doing, this article adds to scholarly works that have examined how bureaucracies, their practices, procedures and documents can be relational and intimate (Moradi 2025; Thelen et al. 2018) and shape the subjective and affective, political and moral experiences of both users and bureaucrats (Andreetta and Borelli 2024; Andreetta et al. 2022; Geoffrion and Cretton 2021; Giudici 2021; Hull 2003). Accordingly, I aim to push the debate around documents beyond their material content (Riles 2006) and re-centre it on their messy and excessive potentialities (Navaro-Yashin 2007; Sansone 2025). I thus focus on the affective and imaginative dimensions lying dormant in identity documents (Allard 2012; Jansen 2009; Kelly 2006; Reeves 2015) and medical records (Gonçalves Martín 2016; McKay 2012; Moradi 2025; Street 2012; Ticktin 2006) and explore how these can be mobilised to mitigate existing or perceived power imbalances (Borelli 2021; Graeber 2015; Lindberg and Borelli 2024) and to negotiate access to resources, services, and rights (Andreetta and Borrelli 2024; Das and Randeria 2015).
Following Julie Billaud and Jane K. Cowan's (2020) call to examine how bureaucracies pursue utopian projects, I demonstrate how bureaucratic systems can simultaneously function as ‘a hope-generating machine’ (Nujten 2003: 16) and reinforce existing inequalities. Indeed, KIA's gradual bureaucratisation was justified as a means to ensure equitable distribution of scarce resources, illustrating the apparent inevitability of bureaucratic systems. As Tess Lea (2021: 61) puts it, ‘even when bureaucratic formations emerge temporally, such as when a volunteer group improvises its administration to organise a spontaneous protest, to endure, these efforts will formalise’. Crucially though, the increased reliance of KIA on paperwork and documents does not turn the volunteers into indifferent bureaucrats (Herzfeld 1992). Rather, they often – albeit never explicitly – sympathise with the prospective patients’ grappling with the KIA bureaucratic rules and enact what I call small acts of bureaucratic subversion – such as registering people without paperwork or overlooking missing documents – in the attempt to reconcile the KIA's politics with their morality as volunteers. Volunteers drew on a shared sense of humanity (anthropia) (Kirtsoglou 2018) to navigate and circumvent KIA's bureaucratic constraints and limitations. Ultimately, bending the rules in the name of humanity was a strategy to act upon the utopian project of making health for all a reality.
The ethnographic material presented in this article was collected during eighteen months of fieldwork at KIA, where I also served as a volunteer for multiple weekly shifts. In my dual role as ethnographer and volunteer, I worked at the front desk – assisting with patient registration and medical appointments – and in the social pharmacy, checking, re-labelling, storing and distributing medicines (Bonanno 2023). Crucially, this dual role granted me an ethnographic vantage point to apprehend the inner workings of KIA, its bureaucratic apparatus and its contradictions. Working closely with other volunteers meant establishing rapport beyond formal interviews: they often shared intimate chats, whispered complaints about the patients approaching KIA and occasionally made harsh commentaries about KIA's management. These offered powerful ethnographic insights into the tensions within KIA and its operational approach, revealing the disconnection between the ethos and discourses of KIA as a solidarity, anti-state organisation and the incremental bureaucratisation of its state-like practices. Crucially, the KIA's proximity to state-like operations was carefully hidden from the ethnographer carrying out formal interviews with the medics or the KIA organisers. It was, however, revealed – perhaps accidentally – during my working shifts with the volunteers: their whispered complaints and harsh commentaries together with ‘small acts of bureaucratic subversion’ surfaced their awareness of and discontent with the social clinic's ideological and practical shortcomings. At the same time, as a foreigner and outsider to KIA, I was uniquely positioned to hear patients’ experiences and complaints about KIA. Because they perceived me as less integrated into the organisation, patients often shared gossip and rumours about the volunteers with me. I was occasionally drawn into disputes between volunteers and patients, with some asking me to advocate for advancing their paperwork or to judge the fairness their treatment.
‘What Do You Want, My Death Certificate?’ or How Expectations of Shared Humanity Often Morph into Bureaucratic Frustration
Kyria Maria sat nervously for about forty minutes while volunteers booked medical appointments and handed prescriptions over to the ten patients, primarily women, who had arrived before her. Despite gentle reminders to take a ticket to keep the queue orderly and the process fairer, it was not unusual for some patients to try and skip the queue or advance claims of urgency, or simply to make an exception to the rules. There had been one such occurrence just before kyria Maria's enraged outburst.
Eleni, one of the volunteers on shift that day, was filing the documents of the patient she had just registered when another lady walked towards her desk. In a decisive tone, she stated that she needed to book an appointment with the cardiologist. It was inhumane, she said loudly, that she had to wait so long for something that should not take longer than three minutes. Taken by surprise, Eleni politely inquired if the other patients were fine with her quickly booking the appointment. With her gentle manners and soothing voice, she told the lady that she would make an exception as no one seemed to mind but, exceptions aside, everyone approaching KIA should know that there were rules in place. Raising her voice a bit, Eleni explained that the rules ensure the smooth functioning of solidarity. Furthermore, she continued, respecting the rules is a sign of respect towards the volunteers who, unlike state employees, do not earn a salary for their work, as well as the other patients who are patiently waiting to be served.
Eleni was still leafing through the black agenda book to find a suitable appointment for the lady when kyria Maria stood up and approached the desk where Costas and I were sitting. With unexpected rage, she slammed her medical booklet on the desk: ‘Take it, check it yourself! I have diabetes. Do you think it will cure itself? That it will go away? How long will you make me wait? I might be dead by the time you listen to me.’ Costas gently invited her to calm down and wait for her turn but unfortunately, his words had precisely the opposite effect. Even more upset, she continued, ‘You say you help everyone, but that is not true! You only help who you want to help! If you do not help a poor woman like me, who do you help? You are no better than the others: you have become like those in the public hospitals. Do you also want a fakelaki [bribe]?’ Costas seemed unmoved by kyria Maria's escalating rage and outrageous allegation of corruption, which implicitly bore an even graver one: KIA had started to resemble the state's healthcare institutions where fakelakia (bribes) to medics oiled the bureaucratic machine, shortened the waiting list and ultimately ensured patients’ better medical care (Souliotis et al. 2015).
Nevertheless, Costas remained intent on filling out the registration form for another prospective patient, an older man who attempted to make himself scarce as the altercation unfolded. Possibly triggered by the volunteer's apparent indifference to her claims, she turned to me: ‘Take it, my child! You see, I have the prescription signed by a doctor! I have all my medical records. Why don't you want to help me? What other paper do you want? My death certificate?’ She shoved her medical records towards me. ‘You are a foreigner, aren't you? Tell your people what a shameful country Greece has become. In this country, people like me are left to die.’
I need insulin. I have diabetes, and I came here several times hoping I could get it. They say that they welcome and help everyone, but you see, it is not true. They want papers [xartoures]; all they seem to care about is papers. I brought my medical records, but that is not enough. They said they would register me with one of their doctors, but how? I do not have the papers they want. I am old and I just need the insulin. Why should I lie about my diabetes? I cannot understand why they want all these papers. They say they do solidarity, but, in the end, all they want is papers that can prove this and that. Am I not human enough?
I replied that the KIA volunteers always tried to help everyone, but she just cut me short: ‘You cannot understand. You cannot understand how things work in this country.’ She waved her hand in circles, hinting at a reality beyond my grasp and, possibly, my naivety.
Greek scholar Elisabeth Kirtsoglou offers an illuminating contemplation on the cultural inflections and political potentialities of humanity (anthropia) (2018). Writing of 2015 and 2016, when the economic crisis in Greece dramatically overlapped with the so-called refugee crisis, Kirtsoglou dissects humanity as ‘a concept and an ethos that binds all human beings in a universal and timeless manner’ (2018: 134). Showing how an unprecedented mobilisation of resources and empathy characterised initiatives to welcome and shelter refugees, Kirtsoglou contends that humanity is ‘a state of being we all share […] and at its heart lies empathy as an affirmative political praxis and an affective ethical technology’ (2018: 134). Ultimately humanity covers ‘all the emotions, habits, attitudes and behaviours appropriate for and towards human persons’ (2018: 138). In the Greek context, Kirtsoglou explains, humanity is that which describes the condition of being human and can ultimately turn Giorgio Agamben's zoe, bare life, into bios, a socially recognised and entirely dignified life (1998). Sometimes, however, reducing a human being to bare life can trigger the recognition of the humanity of the other and compel other humans to redemption (Kirtsoglou 2018: 139). But what happens when others’ humanity is recognised but does not translate into bureaucratic categories? What happens when the volunteer's humanity represents a fissure in the bureaucratic procedures that the KIA has put in place? And what happens if strict adherence to the rules becomes a threat to a humanity that the KIA volunteers acknowledge and mean to restore?
If being human (anthropos), as Kirtsoglou contends, is about ‘having basic needs covered and being seen as deserving respect, fair treatment, being considered and taken into account’ (2018: 134), the seemingly cold treatment that Costas reserved for kyria Maria might be seen as a lack of humanity: his polite indifference revealed his unwillingness ‘to see the world from the other's point of view, to engage others in their capacity as human being and not as members of any other community’ (2018: 138) – to see her story and needs beyond the grid of documents and papers. Caught in a moment of bureaucratic impasse (Sansone and Bonanno 2025), where the logic of bureaucracy conflated with the medical reality of a chronic condition like diabetes, the encounter between kyria Maria and Costas perfectly conjures the paradox of bureaucracy: whereas it ideally served the KIA's utopian purpose to ensure a fair distribution and equitable access to healthcare resources, the strict reliance on paperwork and documents ultimately reproduced, if not magnified, the same exclusionary mechanisms that regulated the state's healthcare institutions.
However, it might be contended that when ordinary citizens are compelled to organise and engage in actions and initiatives to alleviate other people's hardships and precarious livelihoods (Koch and James 2022; Muehlebach 2012), conflicting individual moral dispositions and collective political projects can generate multiple, often discordant practices and attitudes. For instance, Costas, a retired civil servant, joined KIA from his political activism with the left-wing party, Syriza. Moved by the desire to participate in the creation of an alternative social welfare project, he took his commitment to the volunteer organisation very seriously. Convinced that ‘rules would eventually rule themselves out once everyone learns to act responsibly within the community’, he was equally adamant that, at least for the time being, documents served the almost utopian purpose of keeping the KIA going in a well-organised manner. Embodying principles of impartiality and neutrality, abiding by rules was, for Costas, crucial to keeping KIA's operations fair and transparent even if this often translated to denying people access.
If, in ‘the government of papers’ (Hull 2012) ruling over KIA, kyria Maria's humanity is reduced to a death certificate, would her death certificate be the ultimate proof of the KIA's failure to enact its political and utopian project of health for all? Protesting this rule of papers, kyria Maria reflected that her humanity, and therefore her needs, exceeded what the documents told about her story. However, even when humanity is invoked and regarded as a universal status and the basis of rights (Ticktin 2011), its applicability can be ‘immediately constrained by the need of other characteristics to make these rights effective’ (Feldman and Ticktin 2010: 7). If humanity is increasingly operationalised through bureaucracy (Billaud 2020), the tension between the latter's efforts to ensure fairness, and the language of humanity underpinning the KIA's motto of ‘health for all’ explodes through the hierarchies and distinctions that the bureaucracy inadvertently produced. Hence it challenged its claim of unconditional access to its services. If the main shortcoming of the KIA was that it did not eliminate documents, but rather increasingly relied on them to enact its solidarity principles, the elimination of records loomed as an aspirational aim among the volunteers who more strongly perceived bureaucracy as antithetic to humanity.
Furthermore, as the KIA required documents issued by various state institutions, its modus operandi also derived from the ‘documentary practices and utterances of the state’ (Das 2004: 233). However, the social clinic disembedded them from the strict logic of state governmentality and re-encoded them within its solidarity project. While state bureaucracies were often labyrinthine and opaque, within KIA, bureaucracy was seen as a positive mechanism to ensure fairness and justice.
In this sense, the KIA's case is paradigmatic of two broader processes occurring all over austerity-stricken Europe. On the one hand, welfare states have increasingly offloaded welfare services to the voluntary sector as a response to austerity policies (Alves de Matos and Pusceddu 2021; Koch and James 2020; Muehlebach 2012; Narotzky 2020). On the other hand, while state-driven reforms increasingly privatise public bureaucracies in pursuit of accountability, efficiency, and transparency (Gupta 1995; Hull 2022; Kipnis 2008; Lea 2021; Valdivieso 2025), bureaucracies in the voluntary sector (Pusceddu 2022; Pusceddu and Alves De Matos 2022) and NGOs (James 2012) increasingly mirror state bureaucracies (Ellison 2017), including their dysfunctions and seemingly anachronistic reliance on paperwork.
On Bureaucracy as a Necessary Evil and the Making of Exceptions
During one of my first visits to KIA, Dimitris, one of the volunteers, admitted how the process of checking and ascertaining prospective patients’ documents was fraught with contradictions. It entailed asking people for expired insurance, tax proof, an expired job contract or any other document that could prove that they had been entitled to, or had been on, state-provided services. According to this logic, people who had worked in informal jobs could not benefit from KIA services, nor could those who could not provide proof of residence. Dimitris acknowledged that those rules were KIA's main limit, but the social clinic also had limited resources, could run only thanks to voluntary work of medics and private citizens and could hardly accommodate the growing number of Greek citizens approaching it.
Echoing Costas’ rationale, Dimitris explained that KIA's organising committee decided that Greek citizens who could prove their entitlement, proof of residence, and tax statements would have priority. Although the volunteers were aware that this arrangement was problematic, they all agreed that rules and bureaucracy were necessary – at least for the time being. However, as Erica Caple James (2012) argues, ‘bureaucraft’ processes are likely to produce conflicting, even negative, effects: while so-called benevolent bureaucraft practices ‘can engender process of healing, reconciliation, recognition or inclusion’ (2012: 52), negative practices can instead lead to ‘slander, rumour, gossip as well as formal accusations’ (2012: 52). As a case in point, within KIA, allegations of unfair and discretionary allocation of access and provision of medical resources were not rare and often emerged as gossip and rumours. As some volunteers registered patients even when their paperwork was problematic or incomplete, stories about their approachability and kindness spread by word of mouth among prospective patients. However, while some had their registration finalised regardless their paperwork, others saw their requests stalled or rejected by those volunteers who more intransigently abided by the rules. The apparent arbitrariness and partiality moving some of the volunteers’ decision to register patients without paperwork reveal the subjective and intimate dimension of bureaucratic encounters as relational moments of negotiation (James 2012; Moradi 2025; Obeid 2019; Wilson 2017). In turn, the volunteers justified their decisions to contravene KIA's rules by appealing to their sense of humanity: the empathic recognition of and identification with the others’ suffering compelled them to take action and bend the rules.
all these rules that we have to follow are just stupid, and, in the end, no one will check if you have papers or not after you are registered. Next time you come back, you just hand in the card saying that you are a KIA patient. If a mother comes here in search of help, I see a desperate mother and I couldn't care less about whether she has a tax statement or not, whether she is Greek or not. To tell you the truth, I do not care about these rules. I volunteer here because I want to help, not to file forms. After all, I am a mother, have elderly relatives, and have humanity.
Reluctantly, Nadia added that she had to be careful when making an exception because not all her fellow volunteers were equally keen to do the same. Her behaviour might be reported and discussed at the monthly meeting, and it had already happened that volunteers who did not comply with the rules had been asked to leave. Whereas, in Nadia's view, bending the rules and making exceptions were manifestations of the humanity she shared with KIA users (see also Cabot 2019), her humanity could have been seen as a fissure in the administrative transparency of KIA, and a symptom of its vulnerability to personal and discretional management of bureaucratic procedures.
I suggest that making exceptions and bending the rules were, on the one hand, tactics by which Nadia as well as other volunteers responded to KIA users’ allegations of unfairness and appearing more and more like the state. On the other hand, the exceptions they made were symptomatic of their awareness of the stupidity of the rules (Das 2004: 234; Graeber 2015) KIA itself had put in place: meant to ensure fair and just distribution of resources and services, these rules amplified rather than mitigated already existing socio-medical inequalities. I contend that the volunteers’ small acts of bureaucratic subversion represented individual attempts to enact the moral imperative of KIA's utopian project: they feared that the organisation's utopian and collective ethos would progressively vanish under increasing bureaucratisation.
In what follows, I delve further into how the volunteers’ humanity became a crucial feature of triage during which empathy more than rational decision would move volunteers to bend the rules and make exceptions for prospective patients with incomplete, problematic or no paperwork at all. I will discuss how, in the process, legal, social and medical categories overlap and blur into narratives of suffering. Anthropological scholarship has explored the narrative strategies through which refugees and asylum seekers try to obtain legal documents or access resources (Cabot 2013; Obeid 2019; Ticktin 2011). For instance, Heath Cabot (2013) has shown how, at an Athens NGO providing pro bono aid to refugees, the criteria of eligibility rest on and, at the same time, exceed bureaucratic and legal categories. Through intersubjective dynamics and dialogical engagements, aid workers and aid candidates co-produce ‘dominant images of deservingness, victimhood and vulnerability from within the system of aid distribution’ (Cabot 2013: 453). Having traced similar dynamics in the KIA, in the next section I will show how documents functioned as narrative prompts for the patients to plead their cause and speed up the registration process. I focus on ‘narratives of suffering from the crisis’ and argue that these narratives appealed to the volunteers’ humanity by leveraging the morality of the KIA as opposed to the immoral, necropolitical attitude of the state.
‘We Are Humans, and Papers Are Just Papers’: Distilling the Social Out of the Medical
‘Greeks suffer from the crisis; that is why they come here. We give them help, we provide some healthcare and we give them medications for free’, Nadia commented on kyria Maria's situation. ‘We cannot push them away. We are human, and the papers are just papers. They come here because they do not have any other options, and we must find ways to help them.’ Eventually, at around five in the afternoon, Costas called kyria Maria back to figure out a way to register her with the KIA. As our shift ended at that time, Nadia prompted me to follow her outside for a cigarette. Sitting outside gave me the welcome opportunity to prompt her reflections on how kyria Maria had been handled. When I asked if Costas would eventually register her, Nadia replied that Costas was a good person (kalos anthropos) and a committed volunteer, aware of what the economic crisis had meant for many Greeks. ‘It is in these moments of crisis’, Nadia continued, ‘that you can fully see the humanity [anthropia] of the people.’ Puzzled by her sibylline answer, I asked her again if she thought Costas would eventually register kyria Maria and, again, she repeated, ‘He is a good person.’
Nadia's elusive answer can be interpreted in two ways: either it implied that Costas is a principled man who strictly follows the rules and would therefore refuse to register kyria Maria, or it suggested that his kindness might eventually lead him to bend the rules to help her. While I never discovered whether kyria Maria's pleas ultimately persuaded Costas to finalise her registration, this episode raises important questions about humanity as a moral posture and empathic approach to others’ suffering, and the morality of KIA's rules. Paradoxically, it appears that bureaucracy can only be fair when it deviates from strict adherence to its rules. However, as Nadia's reflexive account illustrates, the decision to break the rules and make exceptions is inherently individual and situational. These small acts of bureaucratic subversion, even when well intentioned, can inadvertently reinforce perceptions of corruption and injustice. To disentangle this paradox and unravel how some volunteers resolved to register patients regardless of their paperwork, I turn to the excessive and messy potentialities of bureaucratic documents and paperwork, whose illegibility and uncompletedness can unexpectedly open novel spaces for negotiations. While the enforcement of bureaucracy through documents often trapped patients and volunteers in a complex but unspoken bundle of unequal power relations (Henshaw 2019), in the context of KIA, documents were increasingly loaded with affects and were continuously mobilised to contravene or circumvent bureaucratic procedures and mitigate power unbalances.
In discussing the role of identification documents during the second Palestinian Intifada, Tobias Kelly (2006) contends that these forms of legal identification are central to their holders’ life chances as they determine access to rights and resources. Kelly ponders what remains hidden or goes lost behind and through the multiple layers of paperwork and administrative procedures. Whereas documents reveal partial stories, Kelly suggests that people may as well take advantage of ‘the gaps between the known and the unknown aspects of their persona’ (2006: 91) and strategically manipulate the narratives that the state has produced about them through documents. Drawing on Kelly's argument, I attend ethnographically to how prospective patients and volunteers co-produce plausible narratives of suffering to compensate for problematic or uncomplete paperwork: these narratives mobilise vernacular tropes of the economic crisis (Knight 2012) which at once subsume and amplify individual stories of suffering while providing the moral legitimation for the KIA volunteers to circumvent the rules of bureaucracy.
Narratives of suffering were particularly compelling for several reasons. First, they were all anchored in the economic crisis, which, as both a trope and a narrative device (Roitman 2013), resonated deeply with the volunteers, appealing to their sense of humanity. The crisis had not only disrupted livelihoods but also wreaked existential havoc, leaving individuals in precarious conditions. Crucially, the state was perceived as the primary culprit for the economic crisis, and narratives of state abandonment further legitimised KIA's position as an anti-state actor. These stories elicit shared affects toward the state while constructing an image of it as a necropolitical institution increasingly detached from and indifferent to its citizens. Second, narratives of suffering played a critical role in the bureaucratic negotiations between patients and doctors partly because none of the volunteers responsible for registering new patients were medical professionals: the legal documents and medical evaluations – artefacts of the state – were thus contestable and open to negotiation. Medical booklets filled with dates, diagnoses, therapies, and signatures told stories of bodies, medicines, and ill-health. However, these records held little sway with volunteers, who were often unfamiliar with medical jargon. Instead, to paraphrase Didier Fassin (2000), patients had to exhibit the stigma of indigence to benefit from KIA's services. In this context, documents – or the absence of them – functioned as narrative triggers, prompting prospective patients to share stories of abandonment and loss. By engaging with these documents, or their lack thereof, patients mobilised and conjured affects and imaginings about both their humanity, the state and KIA's role in safeguarding and restoring it.
Kyrios Yorgos's story offers a poignant example of co-production of narratives of suffering. When I met him outside the social pharmacy, kyrios Yorgos, a retired man in his early seventies, was waiting for his bag of medications which I eventually handed to him during my shift. Standing by the door of the social pharmacy, kyrios Yorgos recounted how his pension had been progressively reduced over the past six years. His situation worsened after the Greek government signed the third austerity package in July 2015, introducing further cuts to state-funded pensions. Although he was technically entitled to access the public healthcare system, his monthly pension of barely 500 euros was insufficient to cover the medications needed for his chronic heart condition. KIA not only provided him with the required medications and regular check-ups but, beyond medical support, the social clinic offered a narrative framework for social suffering that kyrios Yorgos could identify with and contribute to. His criticisms of the state became a poignant contrast, and highlighted the care he and many others had received at the KIA. Unlike many others, his case was straightforward – he had submitted all the necessary documents, including his tax statement, proof of residence, and medical records. However, this clarity was the exception rather than the rule. In many other instances, the registration process was far more complex and unfolded through an unpredictable overlap of medical and legal categories during triage.
The registration triages at KIA followed a fairly formulaic process of identifying and recording patients. In one such instance, I observed the volunteer, Marina, an elegant woman in her late forties, known for her gentle yet firm manner. When Marina called for the first person in the queue, a small woman – older than her ink-black hair suggested – approached the desk hesitantly. With careful movements, she sat down and retrieved a worn plastic bag from her purse. She began meticulously unfolding papers as though searching for the right one. Marina greeted her warmly and asked if she was already registered with the KIA. The woman, kyria Vasileia, replied that she was not but had heard that the KIA helped everyone. Marina nodded, visibly pleased by this evidence of the organisation's reputation. She began asking kyria Vasileia some general questions about her age, marital status, and medical conditions: when asked if she had any medical conditions, kyria Vasileia launched into a detailed list of her ailments, explaining she takes multiple medications, but her polypharmacy regimen was prohibitively expensive. Marina listened attentively and then replied politely that she understood her health concerns, but she could not help her. ‘You will have to speak with the doctor’, Marina uttered, before asking, ‘Shall we proceed with the registration? Have you brought any documents with you?’ Kyria Vasileia handed over her medical booklet, which she seemed to consider sufficient evidence. Marina, however, clarified that medical records did not count as documents for registration. She asked if the woman had a tax statement, proof of residence, or even a copy of her expired health insurance. Looking visibly upset, kyria Vasileia explained that her late husband used to handle all the paperwork, and since his death a year ago, she had been unable to manage it. ‘I am an old woman; how can you expect me to understand all this paperwork?’ she pleaded and added ‘I get lost in those offices. I brought my medical booklet. Surely, it's enough proof that I need to see a doctor?’
Despite kyria Vasileia's evident distress, Marina reiterated her earlier point: ‘I understand that you are concerned about your health, but I cannot register you without one of those documents.’ Marina's response seemed to leave little room for exceptions, even in the face of kyria Vasileia's vulnerability.
Austerity kills [litotita skotonei]. The crisis killed my husband because they made him wait for months for a scan, and by the time it was done, his cancer had already grown in his body. You know that it has become difficult to find the chemotherapy medications? Unless you pay for them, of course. But who can afford 500 euros these days? That's almost the pension we receive. If I had known earlier that KIA helps people, we would have come here. With Yannis still alive, we would have provided all the papers that you are asking for. I came here, hoping that you would help me. But all you are telling me is that I cannot see the doctor or get the medications because I do not have the papers. Tell me, how will you feel when you return home this evening knowing that you did not help an old lady? My child, how old are your parents? Are they still alive? They are lucky they have their child alive. I have no one, and I have nothing. The crisis has taken everything away. I only had the hope that you would help me.
In kyria Vasileia's story, the devastating effects of the economic crisis came to life through layer of material deprivation and affective loss. As she recounted her struggles, Marina appeared distracted, leafing through the medical booklet that the old lady had left open on the desk – perhaps a tacit invitation to close the distance between them.
As painful and sad as they are, they are a powerful reminder of how vital the KIA is to many people. I have been volunteering for four years, and you cannot imagine how many stories like this I have heard. In the end, as strange as it may sound, the crisis pulled the best out of us. It forced us to become better people and reminded us that all we have is each other and our humanity.
Eventually Marina registered kyria Vasileia and handed her the KIA card that confirmed she could now have her prescriptions renewed. Kyria Vasileia, visibly relieved, thanked Marina multiple times and told her how good a person she was.
When I later asked Marina how she planned to handle kyria Vasileia's missing paperwork, her response was succinct and pragmatic: ‘Paperwork and documents get lost all the time here and in any other office of this country. No one will be surprised or concerned if some are found missing in kyria Vasileia's folder.’ She ended with a wry smile: ‘Haven't you learned yet that Greece is the place where everything is forbidden, and everything is possible?’
On the Affective and Imaginative Dispositions that Bureaucracies Can Trigger, or Towards a Conclusion
While bureaucracies can prove effective in organising collective actions (as per Giulia Scalettaris in Billaud 2017; Lea 2021), in this article I have focused on ‘the exceptions to the rule’ made by KIA volunteers to ensure access for patients lacking the required documents and papers. The volunteers justified these exceptions in terms of humanity, a capacity for empathy that, in their view, ultimately distinguished them from state bureaucrats. Access to KIA's services often depended on volunteers’ affective responses to individual patients’ problems and, consequently, upon a discretional management of documents and paperwork.
Building on anthropological scholarship that views bureaucracies as a site of utopian order (Billaud and Cowan 2020), I have shown how documents, when embedded in appropriately affective narratives, unexpectedly provide novel ground upon which patients and volunteers could negotiate access to KIA services. Although these practices were not always bureaucratically appropriate, they reflected the volunteers’ humanity as a moral and political compass. Narratives of suffering, strategically filtered through the tropes of the economic crisis, underscored the necropolitical effects of the austerity and appealed to volunteers’ empathy. Ultimately, these narratives – blending emotional, personal and medical elements – compensated for missing or illegible documents (see also Das 2004; Sansone 2025).
The circulation of state-issued documents represents more than a process of vertical encompassment (Ferguson and Gupta 2002), where the state reappears where it is least expected. Instead, it signals the multiple meanings, functions and values that documents acquire as social and sociable objects when moving across the medical, bureaucratic, social and personal domains. As such, this article has extended the analytical reach of those affectively charged papers (Navaro-Yashin 2007) which are variously used, mobilised and demanded by institutions outside the state to legitimise their practices (Das 2004). Rather than inert remainders of the state bureaucracy used by KIA to legitimise its operations, documents become unstable and contentious objects which are activated, socialised and affectively charged through narratives of individual and collective suffering. I contend that the volunteers’ recognition and acknowledgement of patients’ life stories and lifeworlds manifests their willingness to ‘consciously and significantly play down the hierarchies associated with giving and receiving’ (Kirtsoglou 2018:135) in the name of a shared humanity grounded in the acute awareness that all are vulnerable and potentially in need.
If much anthropology of bureaucracy has produced ethnographic accounts of impassioned and indifferent bureaucrats (Gupta 2012; Herzfeld 1992), who are often themselves victims of the stupidity of the bureaucracy (Graeber 2012), my ethnography shows how bureaucrats can come up with strategies and tactics to evade the gridding of bureaucratic categories: appeals to the moral (sharing the same humanity) and the political (creating a fair and inclusive grassroots healthcare system) – though difficult to reconcile and in fact often cannot be reconciled – lead the volunteers to question the fairness of bureaucracy and whether it actually helped them actualise their utopian project of health for all.
Acknowledgements
I wish to thank Ahmad Moradi, Lana Askari, Diego Valdivieso, and Cosmin Popan for their generous comments and thoughtful feedback on the early drafts of this article. I also wish to extend my gratitude to Natalia Buitron and the anonymous reviewers for their engagement with my manuscript and for their insightful and constructive comments. Finally, heartfelt thanks go to my colleague and friend Rosa Sansone – without her, this manuscript would not have been possible.
Notes
All the names in this article are pseudonyms. When referring to the KIA patients, I use kyrios and kyria, which respectively translate to Mr and Mrs. Kyrios and kyria, often used in the vocative form kyrie, are how the KIA volunteers respectfully addressed the patients.
While the periodisation of the so-called Greek economic crisis has long been at the centre of academic debates concerning its causes and actual onset (see Vradis and Dalakoglou 2011; Brekke et al. 2014), in this article I opt for a commonly accepted periodisation which locates the crisis between 2009–2018: in November 2009, Prime Minister George Papandreu admitted that Greece was in crisis, also in light of the European Union's concerns about the country's debt. Following the implementation of several austerity measures to cap public expenses and reduce the debt, Greece exited the bailout programme in August 2018. Whereas macroeconomic indicators and political commentors enthusiastically commented that the crisis was finally over, people's experience with reduced services, low salaries, increasingly precarious jobs and the rise of living costs seem to suggest otherwise (see Poulimenakos et al. 2021).
For an overview of the effects of the economic crisis on the healthcare infrastructure, population health and epidemiological indicators, see Kentikelenis and Karanikolos (2014); Economou et al. (2015).
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