More than a thousand migrants have arrived on Italian shores since early 2012 and Médecins Sans Frontières (MSF) has been monitoring the humanitarian and medical situation in the port of Lampedusa, Sicily, where a great many make their first landfall. In other regions of Italy, the organisation concentrates its medical assistance on screening and care of tuberculosis and Chagas disease, two neglected diseases to which migrants are particularly vulnerable.
Dr Silvia Garelli, MSF’s Head of Mission in Italy, provides an update on MSF’s activities in Italy and talks about the challenges in health for migrants in Italy.
Silvia, do we have still many migrants arriving on Italian shores?
Today, the number of migrants arriving on the coast is decreasing but still a few makeshift boats coming from Libya are seen off the coasts. However, nearly 1,300 refugees, migrants and asylum seekers have been blocked by the Italian Navy on the Italian coast since the beginning of the year. No fewer than 170 migrants have lost their lives attempting the crossing, for want of effective rescue procedures at sea.
Q: Can you describe the reception conditions in Lampedusa, Sicily?
The Italian authorities had ordered the closure of the reception centre in September 2011 because of a riot by the migrants in response to forced repatriations. Today, it has been partially rehabilitated but the port has not yet been designated a safe harbor. Medical needs are now covered by the national health system, but MSF is regularly evaluating the situation and is prepared to intervene should there be a new influx of arrivals.
Q: What are MSF’s current activities for migrants in Italy?
The conditions and health situation inside the Centers for Identification and Expulsion for migrants without papers continue to be extremely critical, and has been aggravated by an extension of the detention period for up to 18 months. The health services at the centers are not provided by the Ministry of Public Health, but are subcontracted to private firms. A lack of effective coordination is causing problems that directly affect patients. For example, diseases such as tuberculosis that need to be detected very early are poorly diagnosed and treated among migrants, despite the existence of national protocols. Beyond the centers, MSF has identified another medical need that mostly affects migrants and that is not covered by the national system: diagnosis and treatment of Chagas disease. This is a disease caused by a parasite transmitted to humans by the bite of insects especially prevalent in Latin America.
Q: So you focus on neglected diseases?
MSF has massive experience in the diagnosis and treatment of neglected diseases, garnered from medical projects all around the world, and we are sharing this knowledge with the health authorities in Italy and other parties involved in migrant health. In the identification and eviction centers in Caltanissetta, Milan, Rome and Trapani, MSF works in collaboration with the Ministry of Health, the Ministry of Foreign Affaires and private entities responsible for managing the centers. An MSF mobile medical team also advises and trains medical personnel to detect and treat tuberculosis.
With Chagas disease, symptoms may do not appear for many years. The disease is almost unknown in Italy, so diagnosis and treatment are very limited. At Bergamo, in collaboration with the hospital of Verona and OIKOS, an Italian NGO that deals with health care for migrants, MSF teams meet with migrants from Latin America to identify and refer people with Chagas disease. The objective of these partnerships is to improve procedures for the active detection and prevention of a disease that is often invisible, as well as to develop standard procedures for the prevention, detection and treatment of the disease that could be duplicated in other regions of the country.
Q: Does this mean that migrants are a population particularly vulnerable to infectious diseases?
Migrants are not especially more likely to be carriers of infectious diseases. However, the poor living conditions many migrants face make them certainly more vulnerable to these infectious diseases. For example, without standards of appropriate prevention and screening, disease can be easily transmitted within the identification and eviction centers. Affected people have thus contracted this disease in Latin America. These "silent" infections such as Chagas, are characterized by a very long incubation period during which the symptoms do not appear.
In February 2011, MSF started performing medical triage of migrant, refugee and asylum-seeking patients in the port of Lampedusa and monitored their condition in the island’s reception centre. From February to May, MSF teams made more than 1,300 medical visits, distributed 4,500 hygiene kits and blankets and provided assistance to 17,000 migrants who had landed (over 500 women and 300 children). In 2011, an MSF team also provided mental health consultations for asylum seekers at Mineo identification centre in Sicily.
is caused by the parasite Trypanosoma cruzi and is transmitted to humans by the bite of insects that exist mainly in Latin America. Migrants contract it in their country of origin. The parasite can also be transmitted by blood transfusion and from mother to child through the placenta. Most of those infected show no sign or symptom at the time of infection, and the symptoms can’t appear for many years. In the end, chronic symptoms may develop in about a third of those infected. Cardiac insufficiency is the most common complication and the cause of death among adults. Chagas disease is endemic in 21 Latin American countries, with as many as 8 to10 million cases worldwide and an annual death toll estimated at 12,500.
is a contagious bacterial infection that is spread through the air. Persons who have a latent infection show no symptoms are not contagious. However, if for some reason (such as illness) the person’s immune system is weakened, the bacteria can then proliferate in the organism and the symptoms of tuberculosis can start to appear. According to the WHO, 5 to 10% of persons infected may become ill. The infection then enters its active phase. Tuberculosis may develop up to two years after infection. Today, the disease still kills nearly two million people a year worldwide and is experiencing a resurgence explained by the appearance strains that have developed resistance to the standard TB drugs.