Médecins Sans Frontières (MSF) works in Italy, Malta and Greece to provide access to healthcare and medical assistance to migrants landing at the southern borders of Europe by sea, aid offered both at their landing and during their detention in open and closed centres.
Medical assistance at arrival — Lampedusa Island
MSF has worked on the island of Lampedusa, south of Sicily, since 2002. Compared to previous years, 2008 has seen a dramatic increase in the number of boats landing on Lampedusa — by August, 17,340 migrants had landed, compared to 11,889 migrants in total in 2007. The population has also changed dramatically compared with previous years as more people are arriving from war zones or countries affected by droughts such as Somalia, Eritrea, Sudan and Ethiopia (33.5 per cent). Also remarkable is the increase in the number of women (12 per cent) and children and minors (eight per cent). In addition, MSF has noticed more pregnant women among the passengers (151 since the beginning of the year). Due to the hard and perilous conditions of the journey at sea, the need for health assistance during the first phases of landing as well as the main pathologies related to the journey have both increased. More than 5.5 per cent of the migrants needed health assistance compared to three per cent in 2006 and 2007. People are often found in a state of shock and dehydration with traumas or injuries they sustained during their travels. Currently, the presence of the MSF medical team at Lampedusa’s harbour may be hampered by difficulties in the collaboration with local authorities.
Access to healthcare projects — Naples and Caserta, southern Italy
MSF is currently running four public ambulatory clinics and carrying out outreach activities for undocumented migrants in Castelvolturno, San Cipriano, Villa Literno and Aversa areas surrounding Naples and Caserta. Since the beginning of this year, MSF medical teams have visited almost 5,000 patients and provided information to undocumented migrants about their right to access public healthcare under Italian law. Following the killing of six migrants by the local mafia on Sept. 6, 2008 in Castelvolturno, riots and violent demonstrations have meant the deployment of soldiers to the area. Due to the situation, MSF has increased the level of security measures for its activities. Outreach activities in Castelvolturno have been suspended while MSF ambulatory clinics continue.
Seasonal migrants project — Puglia and Calabria regions
Following the publication of the MSF report “A Season in Hell” in January 2008, in which MSF denounced the widespread phenomenon of migrant exploitation in southern Italy and highlighted denied access to healthcare and shameful living conditions, two agreements were signed with the governors of the Puglia and Calabria regions. In these agreements MSF asked local authorities to adopt MSF recommendations to provide adequate access to healthcare and to provide shelters to all migrants regardless of their juridical status. In the period between June and September 2008, Foggia district in the region Puglia guaranteed the opening of 21 public ambulatory clinics for undocumented migrants and installed 24 water tanks and 70 toilets and showers in four areas where seasonal workers temporarily live. In late July, MSF distributed 1,400 hygiene kits and supported hygiene sessions within migrant farmers’ communities. However in Calabria, although the region had formally agreed to implement the same measures during the farming season (between November and April) in the area of Piana di Gioia Tauro, no technical meetings have been set up yet to discuss the interventions.
Access to healthcare for migrants on the island of Malta
In July 2008, MSF signed an agreement with the Maltese authorities in order to improve access to healthcare to migrants after their landing in detention centres and open camps (temporary settlements where asylum-seekers and refugees live and can move freely while waiting for better accommodations or resettlement programs). Since August, an MSF team composed of one doctor, one psychologist and one cultural mediator has visited more than 400 people who had just landed, half of whom arrived from the Horn of Africa. The main pathologies recorded by MSF are, as in Lampedusa, directly related to the difficult travelling conditions at sea. Inside the detention centres MSF supports the Maltese health authorities in order to set up a system that can guarantee appropriate access to healthcare for people temporarily held there. Since August, MSF has visited more than 1,000 patients in the island's two main detention centres. MSF has also conducted a water and sanitation assessment in order to have a wider overview of the living conditions affecting the health of the detainees. MSF has also identified vulnerable categories of people inside the detention centres, such as pregnant women, children under 12 and sick people, in order to ask for their release and accommodation in open camps. In the open camps psychological support activities have started and at the moment nine cases are being followed. Moreover, the MSF social workers and cultural mediators provide patient referrals to public health institutions.
Temporary migrants settlement in Patras
Following exploratory missions conducted by medical teams in February 2008 at the detention centres of Chios, Samos, Lesvos and Evros and in the camp in Patras, MSF decided to start an emergency intervention program at the detention centre in Mytilini and at the temporary migrants settlement in Patras, which focuses on improving the living conditions and infrastructure at the centres and providing primary healthcare and psychological support. Patras is a town of 240,000 inhabitants and in the last 10 years there has been a constant influx of transitory migrants coming here (often hiding in trucks) on their way to Italy. The camp in Patras where undocumented migrants reside hosts about 1,000 at present. They come mainly from Afghanistan and have ended up in Patra on their way to Europe. They live in 122 makeshift houses made of wood and plastic sheets, without heating or access to medical care.
MSF has been running a clinic inside the camp since May 2008, providing medical, psychosocial and humanitarian assistance to the undocumented migrants. During this time, MSF teams have conducted a total of 3,400 medical consultations in the camp, dealing mainly with skin diseases, respiratory track infections, depression and post-traumatic stress. MSF is also able to refer patients to some hospitals in Patras and follow up on some cases of chronic illnesses.
Detention centres in Pagani and Lesvos
The number of undocumented migrants arrested by the police and coast guard increased dramatically during 2008. It is indicative that the total number of migrants arrested in the island up until August 2008 reached 6,863 (according to data from the authorities in Lesvos), already exceeding the total number for 2007 (6,147 people). The majority of people are arriving from Afghanistan, Somalia or Palestine and are fleeing from war, violence, hunger and extreme hardship. From June 2, 2008, the MSF team worked inside the Pagani detention centre and later also at the harbour of Lesvos, where migrants were brought by police. MSF teams provided primary healthcare and psychosocial support to more than 1,700 undocumented migrants. The MSF doctor and psychologist did not have proper access to the wards during this time. The majority of the time the doctor had to select some of the patients that gathered behind bars. A police officer would then bring them outside to the yard to be examined. Respiratory infections and dermatological diseases were the main medical issues. Individual and group counselling, together with play therapy sessions, were the main tools used to minimize anxiety and depression. These problems had been aggravated by the difficulties and insecurity of the journey to Europe together with problems the migrants faced in their country of origin. The lack of support and commitment by the authorities severely affected MSF’s efforts to provide medical assistance and improve the living conditions for the detained population. Given these circumstances, at the end of September MSF took the difficult decision to leave its project inside the detention centre in Lesvos.