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