Sicily presents the first contingency plan in the European Region to address the public health needs of large immigration


Sicily has become the pioneer in the WHO European Region in the development of an operational strategy to respond to the public health implications of sudden and large arrivals of immigrants. This document has been produced by the regional health authorities of Sicily, with the technical assistance of the WHO/Europe project Public Health Aspects of Migration in Europe. During its launch, the Councillor of Health of Sicily, Lucia Borsellino, described the contingency plan as the region’s response to the “ethical duty to take care of migrants’ health, just as we do with the health of the rest of our citizens”.

Definition of stakeholders’ roles and responsibilities

Since the start of the military operation “Mare Nostrum”, the geographical distribution of immigrants in Sicily has radically changed, thus challenging the capacity of the regional health authorities throughout the whole region. To address this challenge, the contingency plan establishes a homogeneous procedure to improve the organizational aspect of the public health response by increasing the efficiency of both logistical and human resources. “The contingency plan will consolidate the regional capacity to respond to these large influxes by defining roles and responsibilities of all actors involved”, stated Lucia Borsellino.

The complexity and intersectoriality of this issue explains the wide diversity of stakeholders involved. Authorities from the Ministries of Health and Interior of Italy, both at national and regional levels, NGOs and other important stakeholders were present during the launch of the contingency plan. The document identifies all actors involved in the public health response to immigration, integrating their roles in a coherent process. Additionally, it includes an overview of the key legislation in place as well as a detailed definition of the information flows among all these actors.

From the rescue at sea to the migration centres

Besides the many actors involved in the process, another factor that contributes to its complexity is the diversity of phases and scenarios in which the arrival of these immigrants takes place. Sicily’s contingency plan includes a detailed overview of these, from migrants’ rescue at the sea to their stay in migration centres, including the different medical triages conducted throughout the process. In each phase, migrants are exposed to different risks and challenges. The management of the public health implications in each of these phases has a cumulative effect: the health conditions of migrants at the centres cannot be explained without taking into consideration their health conditions at the countries of origin, during the migration journey, or at the rescue operation.

Despite the difficult circumstances they face during the journey, evidence suggests that most migrants arriving to European soil through this Mediterranean border benefit of good physical health. However, many times the poor sanitation facilities and living conditions during their stay at migration centres affect negatively their health status. For this reason, the regional health authorities of Sicily have included for the first time in the contingency plan a mandatory monitoring and evaluation of the conditions of these centres on a periodic base. The health of an individual is much influenced by the health of the community. By improving the conditions of migration centres and migrants’ health, the final aim of this document is to improve the health of the whole resident community in Sicily.

An unprecedented number of migrants reach Sicily

Since the beginning of 2014, around 100.000 undocumented migrants have arrived to the island of Sicily. The regional health authorities have presented the contingency plan as the region’s operational answer to such dramatic and unprecedented situation. The document will be available online from the 3rd of October 2014, the day of the first anniversary of the Lampedusa tragedy. On that day, around 360 migrants coming from different countries of the African continent lost their lives when a boat sank off the coast of Lampedusa. The number of immigrants entering Europe from the Italian border has not decreased since then. Sicily’s contingency plan aims at improving the regional public health response to this reality.