May 2, 2011
Italy 2011 © Mattia Insolera
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Since last December, when popular uprisings and violent confrontations began to shake the Arab world, some 27,000 refugees, asylum seekers, and undocumented migrants have fled by sea from North Africa to the southern Italian island of Lampedusa. Most of the boats that made the journey originated in Tunisia, but increasing numbers are coming from Libya. On April 19, 760 people landed in Lampedusa in one of the largest single landings the island has ever seen.
Many of those who departed from Libya are actually sub-Saharan Africans from Eritrea, Somalia, Sudan, or Nigeria. Having already fled their own countries in search of better economic opportunities and a more secure environment, they were forced to flee once more due to the escalating conflict in Libya.
Italy 2011 © Mattia Insolera
Though the journey from North Africa to Lampedusa is often perilous, many deem it worthwhile because it represents their best hope of finding a way to earn a livelihood for themselves and their families away from the economic despair and rampant insecurity of their homelands. It comes with numerous risks, however. Some speak of having been victims of detention, rape, and torture, and of being targeted because they were foreigners. Unaccompanied minors and women traveling alone are particularly vulnerable.
The conditions awaiting these refugees and migrants on Lampedusa generally fail to meet the minimum standards for the reception of vulnerable persons, leading to additional suffering and uncertainty. The reception centers themselves are substandard. There is inadequate separation between men and women. There is a lack of access to information about the rights of migrants and refugees and a lack of care tailored to the most vulnerable groups, including victims of torture and violence, unaccompanied minors, and women.
Doctors Without Borders/Médecins Sans Frontières (MSF) has worked in Italy since 1999 at landing points and in open settings to provide medical care and mental health support to arriving refugees, asylum seekers, and migrants. The organization has repeatedly called attention to the appalling reception and living conditions facing this population upon their arrival—and its profound impact on their physical and mental health.
Since February 2011, MSF has conducted 765 medical consultations for migrants and refugees in Lampedusa and has provided them with a total of 4,500 hygiene kits and blankets. Seeing no improvement in the appallingly inadequate conditions, MSF is compelled to speak out again about the failure to provide assistance and protection to those fleeing from North Africa, many of whom have experienced violence and torture.
Given Lampedusa's history as a landing point for migrants, refugees, and asylum seekers, along with the dramatic events currently taking place in North Africa, the Italian authorities can anticipate significant numbers of new arrivals. It is therefore imperative that the country upholds its responsibility to provide adequate, humane reception conditions for people who have made the journey in order to survive or to escape violence.
The new arrivals on Lampedusa face vulnerability that goes beyond the need for medical care and material assistance. It is also the responsibility of the Italian state to ensure adequate reception conditions and provide information and access to legal procedures and protection.
Poor Conditions in Centers Increase Vulnerability
For many years, MSF has been calling attention to the appalling reception conditions in Italy and their impact on physical and mental health. With the increased influx of refugees and migrants from North Africa, Italy is responsible for ensuring humane conditions for new arrivals and providing access to legal procedures and protection.
Italy 2011 © Mattia Insolera
Migrants, asylum seekers, and refugees fall into distinct legal categories with different rights. Many of those who left Libya or Tunisia in recent months have special needs for assistance and safety. These include particularly vulnerable persons, such as children, unaccompanied minors, pregnant women, the disabled, and victims of torture and violence, including sexual violence. However, they are all funneled into the same inadequate system and facilities when they arrive in Italy.
The European Council Directive establishes minimum standards for the reception of asylum seekers (2003/9/EC) and explicitly states that “reception of groups with special needs should be specifically designed to meet those needs." Vulnerable asylum seekers require priority treatment according to their needs, including systematic identification of vulnerability at arrival, specialized health care if necessary, and psychosocial care addressing the short- and long-term effects of sexual and physical violence. This should be applied regardless of the country from which they arrived, be it Libya, Tunisia, or elsewhere.
MSF is deeply concerned about victims of violence among the groups the organization has assisted in Italy. Many have been directly affected by violence and war in North Africa or have been firsthand witnesses of violence. Some report suffering sexual abuse and torture, both in their home country or in the other countries where they have gone to survive and seek refuge. Most have experienced extreme hardships and suffering from the day they left their country of origin to their eventual arrival in Italy.
Women and children in Italian reception centers must be housed in areas where their safety and well-being is ensured. Many women traveling alone who were placed in reception centers told MSF that there was no effective separation from men, and they feared abuse despite the strong presence of police. Due to the lack of privacy and security, women reported being too afraid to sleep, change clothes, or even go to the toilet alone.
MSF has also witnessed children and unaccompanied minors being kept in closed centers in Lampedusa due to the lack of designated structures to shelter them—a stark contravention of the children's best interests. According to European standards, “minors should be placed with adult relatives, foster families, in accommodation centers with special provisions for minors, or in other accommodations suitable for minors.”
While conducting medical and mental health assessments in newly created reception centers in Kinisia, Manduria, and Mineo, MSF teams observed that the refugees and asylum seekers had received no clear information about how they might access legal resources or about their practical situation and future options. In some centers, there were serious gaps in the provision of basic and legal services, which caused significant anxiety, frustration, and uncertainty. Initial mental health assessments of the new arrivals pointed to the risk of widespread depression and hopelessness in response to their uncertain situation. These effects are aggravated by the lack of information about legal procedures in Italy. MSF witnessed the same dynamics in 2009, when our work in Maltese detention centers for undocumented migrants and asylum seekers revealed high rates of depression, anxiety, and post traumatic stress disorder.
Avoid Repeating Same Mistakes
MSF has provided assistance to refugees and migrants in Italy, Malta, Greece, France, and Spain—as well as in Morocco and Tunisia—since 1999. From 2002 to 2009, MSF worked on the island of Lampedusa and the southern coast of Sicily, the most frequent landing points for regular arrivals of migrants and refugees. MSF has long documented the far-reaching impact of insufficient reception and living conditions on the physical and mental health of asylum seekers and migrants, based on our work in southern Europe.
In May 2009, new government policies, in particular the “Friendship Pact” between Italy and Libya, curbed the influx of refugees and migrants. After arrivals by boat decreased in Lampedusa, MSF withdrew its team from the island and publicly expressed its fears for the health and lives of the refugees and migrants forced back to Libya.
This past February, in response to the arrival of thousands of migrants, refugees, and asylum seekers from Tunisia and Libya, MSF restarted its medical activities on the island. Between February 14 and April 21, 2011, MSF medical teams carried out 765 consultations with refugees and migrants in need of care upon arrival at the docks in Lampedusa. MSF likewise provided new arrivals with basic necessities, such as hygiene materials and blankets.
Italy 2011 © Mattia Insolera
Generally, new arrivals suffered from seasickness, dehydration, hypothermia, and generalized body pain, such as headaches or abdominal pain. At the peak of arrivals in March, 3,000 migrants slept on the docks in Lampedusa for several days, sharing 16 chemical toilets and having access to only 1.5 liters of water per day. This was completely unacceptable, and though conditions have improved somewhat since then, it is clear that the situation facing migrants, refugees, and asylum-seekers in Lampedusa and other centers across Italy today continues to compound suffering and increase vulnerability.
MSF Urgently Calls on Italian Authorities to Prepare For Influx
People fleeing Libya describe the terrifying situation of migrants and refugees still trapped by the violence. Countless people are still searching for ways to flee to more secure environs, or simply to survive. People arriving in Italy from other countries in Africa also speak of their flight from violence, fear and extreme poverty.
In view of the regular and longstanding pattern of arrivals of refugees, migrants, and asylum seekers in southern Italy from North Africa, MSF is highly concerned about the lack of concrete preparation for continued arrivals in the coming weeks and months. Despite the generally predictable nature of arrivals, reception centers currently take an unacceptably ad hoc approach that barely covers basic needs and does not adequately ensure the safety and security of new arrivals, particularly for the most vulnerable, including those who have experienced violence.
The stories told by refugees and migrants reveal the extreme mental and physical hardship they have escaped and endured. Upon their arrival in Italy, poor reception conditions expose them to further suffering and renewed vulnerability and uncertainty.
MSF calls on the Italian authorities to develop a concrete strategy to ensure an adequate, humane reception for all migrants and asylum seekers already in the country or soon to arrive, but particularly for the most vulnerable, including women, children, unaccompanied minors, and victims of violence.
The Italian government must take concrete measures to better receive, assist, and protect these people. The measures should include:
The 27,000 people who have arrived in southern Italy since January 2011 will undoubtedly be followed by others in the coming months. It is time for Italy to fully prepare itself and better fulfill its responsibilities and obligations towards the refugees, asylum-seekers, and migrants who reach its shores.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)