An MSF “Medical Home” for the Homeless in Milan, Italy

Valérie Batselaere/MSF
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When a patient is discharged from the hospital after surgery or treatment for acute illness, a protected environment in which he or she can continue therapy until complete recovery is paramount. Yet for the homeless, such an option is impossible, resulting in relapses and impeding full recovery.

In Italy more than 13,000 people are considered homeless, with the biggest concentration in the city of Milan, where approximately 3,500 people sleep in the streets. In 2013, Doctors Without Borders/Médecins Sans Frontières (MSF) conducted an assessment of the health situation of homeless people in the city, including both migrants and Italian nationals that were discharged from hospitals in the last two years.

According to the assessment, a total of 850 to 900 patients still required medical follow-up for a variety of pathologies or health problems including respiratory infections, pneumonia, skin infections, and cases requiring constant medical attention such as heart, liver, or kidney disease; HIV/AIDS; and tuberculosis.

Because these pathologies are extremely difficult to stabilize among the homeless, at the start of 2014, MSF opened a 20–bed health facility to address the needs of homeless people who still require medical follow-up. Inside the facility, which works as a complement to the local health system, the MSF team provides medical and nursing care on a 24-hour basis.

“Homeless people are vulnerable as they don’t have shelter, suffer from malnutrition, and generally live in poor conditions,” explains Gianfranco De Maio, MSF field coordinator. “When released from hospital, and if not able to continue their therapy, they risk relapses to their previous illnesses and having to be re-admitted to the hospital or even go to an emergency room.  In our health facility we offer a continuation of medical care for these people. In the first weeks of activity, we received many requests both from hospitals in Milan and from outside the municipality, assisting more than 30 people who needed to continue therapy, providing medicines or dressing wounds.”

The MSF patients are almost exclusively men, carrying with them dire stories of solitude linked to family problems or financial difficulties that the current economic crisis in the country only exacerbates.

Maria, born in Brazil but living in Italy for almost twenty years, is the first female patient to come to the facility. While trying to recover from drug addiction, she was admitted to the MSF facility to recover from a major surgery. She now faces life with new determination: “It’s been two years since I saw my son and I want to regain my relationship with him,” she says. “This is why once I am discharged I will go to a recovery center and turn the page. Leaving this place will be sad, because here I found a family environment. I think that this project can really help people that, like me, live on the streets and don’t have any other help.”