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Italy of migrants Ranieri Guerra, Chief Medical Officer
Period 1976-‐1900 1900-‐1915 1915-‐1945 1945-‐1976
Numbers 5 million 9 million 4 million 5 million
Provenience North North and South North South and North East (internal migra@ons)
1 central coordination office at HQ 8 main hub offices 44 spoke units Staff: 110 MDs, 153 Public health inspectors,144 support staff, 65 technicians, 80 Red Cross health staff (MDs, nurses)
e) mancata informazione e consapevolezza dei propri diriE: f) qualità e con@nuità della cure: non è solo necessario l’accesso ai servizi sanitari ma anche che essi siano appropria@ rispeKo ai bisogni della popolazione interessata. Una delle cri@cità è rappresentata dal rischio di accedere e fruire di prestazioni soKo standard e inappropriate per @pologia, tempis@ca e seEng (ritardo nei traKamen@, u@lizzo di PS e accesso in emergenza, scarsa aderenza alle terapie e ai controlli). g) parcellizzazione delle inizia@ve e coordinamento degli interven@: differen@ soggeE sono impegna@ e svolgono aEvità sanitarie a beneficio dei migran@. Rela@vamente agli aspeE di assistenza e sicurezza sanitaria sappiamo che per fornire risposte efficaci e sostenibili, è necessaria una ges@one organica ed un approccio di sistema che superi la parcellizzazione e l’estemporaneità delle soluzioni, proponendo modalità assistenziali standardizzate e basate su evidenze scien@fiche, valorizzando le competenze e le esperienze che si sono affermate in ques@ anni.
IHR and permit to land (quarantine)
• Health is a fundamental right of each person (art. 32, Italian Constitution).
• Italy recognizes the right of asylum (art.10, Italian Constitution).
• Regular migrants, asylum seekers, refugees and international protection holders are registered with the National Health System (L.142/2015).
• Non-documented migrants are entitled to access preventive, urgent and essential treatments as well as treatment for public health reasons (STP code – Straniero Temporaneamente Presente, Temporarily Present Foreigner, is used to access health services, the cost being covered by MoI).
• Several centres for reception and detention are managed by MoI with governamental and NGO entities.
• MoH operates SAR operations at sea on Navy vessels and on arrival with standard general triage, syndromic screening, medical assessment and referral to LHA second level services. Forensic services are managed directly by the MoH before police investigation.
e) mancata informazione e consapevolezza dei propri diriE: f) qualità e con@nuità della cure: non è solo necessario l’accesso ai servizi sanitari ma anche che essi siano appropria@ rispeKo ai bisogni della popolazione interessata. Una delle cri@cità è rappresentata dal rischio di accedere e fruire di prestazioni soKo standard e inappropriate per @pologia, tempis@ca e seEng (ritardo nei traKamen@, u@lizzo di PS e accesso in emergenza, scarsa aderenza alle terapie e ai controlli). g) parcellizzazione delle inizia@ve e coordinamento degli interven@: differen@ soggeE sono impegna@ e svolgono aEvità sanitarie a beneficio dei migran@. Rela@vamente agli aspeE di assistenza e sicurezza sanitaria sappiamo che per fornire risposte efficaci e sostenibili, è necessaria una ges@one organica ed un approccio di sistema che superi la parcellizzazione e l’estemporaneità delle soluzioni, proponendo modalità assistenziali standardizzate e basate su evidenze scien@fiche, valorizzando le competenze e le esperienze che si sono affermate in ques@ anni.
IHR and permit to land (quarantine)
• Assistance is provided without prejudice and irrespective of legal status • Border Health Surveillance: according to IHR • Direct assistance: at landing points, providing medical assistance, handling reception Centers,
Integration Projects • Information and orientation for health and legal services • Monitoring: arrival conditions (Praesidium Project) • Advocacy and support: to asylum seekers, with full information on rights and health service • Special assistance to victims of violence: art. 27 of D.lgs. 2007, n. 251, and art. 1 of D.lgs. 21
February 2014, n.18 • RFL: Restoring Family Link and Psychosocial Support • Partnerships: with International Agencies, other Italian Government sectors, Associations, NGOs
SYRIA
From Mare Nostrum to FRONTEX • 20 December 2012: State-Regional authorities’ agreement on the provision of health care to migrants • 3 October 2013: 366 confirmed casualties and an additional unknown number of missing bodies when
a Lybian boat wrecked offshore Lampedusa • 18 October 2013: Mare Nostrum starts as a military and humanitarian operation (Search And Rescue
- SAR) to strengthen controls over undocumented migrants’ routes and safeguard their lives at sea • 18 June 2014: Agreement between the Navy and the MoH to board civilian MDs and health staff to
screen, assist, refer migrants before landing • 21 June 2014: Launch of MoH spoke units on board • 31 October 2014: Mare Nostrum ends and is replaced by Triton, operated by FRONTEX • 1 January 2015: FAMI 2 (Fondo Asilo, Migrazione e Integrazione) programme launched: objective 1,
acceptance, asylum, support, first psycho-social and health assistance at sea, with triage and referral • 1 January 2015: PASSIM project (Primissima Assistenza Sanitaria nelle operazioni di Soccorso In
Mare), cross-border activities: MoH with support by IOM, Regional health authorities, MoD, Navy, Coast Guard, Fiscal Police, Red Cross, Order of Malta, Rava Foundation, MoI
• RE-HEALTH: EC funded, implemented by IOM to pilot PHR in 3 areas: Galliera, Genua, local health authority Trapani, PA Trento
• 1 April 2016: CARE - Common Approach for REfugees and other migrants’ health” promoting migrants’ health in MS highly impacted by the wave: INMP and other 14 agencies from Italy, Greece, Malta, Slovenia, Croatia (http://careformigrants.eu/)
SYRIA
From Mare Nostrum to FRONTEX• 1 January 2015: FAMI 2 (Fondo Asilo, Migrazione e Integrazione) programme launched:
objective 1, acceptance, asylum, support, first psycho-social and health assistance at sea, with triage and referral complementing SAR
• 1a segment: Asylum, strengthening reception system 1 and 2: health services to psycho-medical vulnerable persons (8M€). 10 projects (Bologna health authority, Roma 1 health authority, Trapani health authority, Crotone health authority, Irccs "Ca' Granda", Brescia Hospital trust, Roma 6 health authority, Sardinia Regional health authority, Umbria1 health authority, Napoli 2 North health authority).
• 1b segment: Asylum, Information and legal support to (sea) migrants and vulnerable persons (1.5M€). 2 projects (Save The Children Italy, Consiglio Italiano per i Rifugiati).
• 1c segment: Asylum First reception and support to non-accompanied foreign minors (51.138 M€) 22 projects.
• 2a segment: Integration, Legal migration - Capacity building on fight against discrimination (2.750 M€). 9 projects.
• 2b segment: Integration, Legal migration - Capacity building for service governance (3M€). 81 projects under consideration.
• 2c segment: Integration, Legal migration - Capacity building good practices exchange (3M€). 55 projects under consideration.
SYRIA
From Mare Nostrum to FRONTEX
• 1 January 2014 and 1 January 2016: “Public Health Aspects of Migrations in Europe” (OMS) PHAME 1 e PHAME 2 – MoH and WHO/EURO: guidelines, contingency plans, training and capacity building in priority countries (and 2 regions), datawarehouse and observatory on health and migration
• “Equi-health' project (IOM/Europe and EC) to promote vulnerable migrants’ populations, such as asylum seekers, undocumented migrants, ROM, SINTI communities, promoting health and social integration (Italy, Malta, Spain, Greece, Croatia)
• Two MoH self funded projects: “Unwanted abortion prevention in migrant mothers” and “Intercultural campaign and training of trainers in intercultural mediation to promote integration”
SYRIA
• WHO/EURO subgroup on migrants’ health
• High Level meeting, November 2015
• Additional item at EB 2016• Technical briefing at WHA 2016• SCRC WHO/EURO report at
WHO RC 2016• Policy, Action Plan, Resolution
at WHO RC 2016• High level meeting UNGA 2016• Two side events at UNGA 2016• Second phase, SCRC
subgroup chair• Proposed item at EB 2017
leading to • New resolution at WHA May
2017S.O.P.
Non documented migrants (only) - 2013 – 2016 per month of arrival
Year / month 2013 2014 2015 2016 Grand total January 1,813 2,833 4,310 8,956 February 2,331 3,034 2,935 8,300
March 4,361 1,974 9,096 15,431 April 11,019 13,225 8,591 32,835 May 11,201 17,902 19,846 49,352 June 17,438 21,669 21,292 60,399 July 20,083 19,010 22,225 61,318
August 1,734 21,480 20,665 17,566 61,445 September 3,591 22,748 14,661 13,858 54,858
October 3,574 12,336 7,697 23,607 November 1,659 8,753 2,406 12,818 December 256 6,478 7,973 14,707
Total 10,814 140,041 118,987 119.719 404,026
Non documented migrants (only) - 2014 – 2016 gender and age groups
Males 74%
Females 12%
Minors 14%
Year: 2014 Males 93801 Females 15431 Minors 17018 Total 140041
Males 75%
Females 17%
Minors 8%
Year: 2015 Males 101161 Females 23368 Minors 10162 Total 133452
Males 72%
Females 19%
Minors 9%
Year: 2016 (26/09) Males 83615 Females 21879 Minors 10816 Total 119719
Year Males Females Minors TOTAL 2013 6,066 1,634 2,227 10,814 2014 93,801 15,431 17,018 140,041 2015 101,161 23,368 10,162 133,452 2016 83,615 21,879 10,816 119,719
Grand Total 284,643 62,312 40,223 404,026
Landing points 1/1/2015 to 31/12/2015
port Migrants arrived events LAMPEDUSA 21160 168 AUGUSTA 22391 146 REGGIO CALABRIA 16931 90 POZZALLO 16811 104 PALERMO 11456 61 MESSINA 9911 51 CATANIA 9464 64 TARANTO 9160 45 TRAPANI 8136 55 CROTONE 6114 31 VIBO VALENTIA 4245 27 CAGLIARI 5209 40 PORTO EMPEDOCLE 4364 32 SALERNO 1994 12 CORIGLIANO CALABRO 1683 8
In two typical days -‐ 29/30 March -‐3366 migrants landed in AUGUSTA, MESSINA, TRAPANI, CROTONE, REGGIO and POZZALLO where 8 ambulances, 11 gazebos, 122 volunteers had ben mobilized
A REAL TIME SURVEILLANCE & RAPID ALERT