Lampedusa, the southern door to Europe

WHO

Dr Pietro Bartolo, Chief of the health services on Lampedusa, and Omar, a migrant who arrived in 2010, share their personal experiences of this Sicilian island.

 “If I had the chance to go back to the past, I would stay in Africa”. After three years living in Italy, Omar does not hesitate. “I came looking for a better life, but I only found problems, poverty and sickness”. Omar is one of the millions who have left their countries in North Africa and the Middle East since the revolutions began in 2010. He arrived at Lampedusa after a very difficult journey from Tunisia. At the age of 21, with no relatives left in Tunisia, Omar quit his studies in literature and paid 1800 dinars (around 785 euros) to board a boat heading for Lampedusa with more than 100 people.

Since 2010, this Sicilian island, which is closer to Africa than mainland Europe, has received an enormous exodus and it is overwhelming the capacity of Italy’s health sector. An average of 500 migrants has arrived daily at the crisis points. For Dr Pietro Bartolo, Chief of health services on Lampedusa, this year has been particularly critical. “Despite the many experiences that I have gone through over the years, the last tragedies in Lampedusa have been especially shocking with the deaths of so many women and children – some still in nappies”, he said.

It is three years since Omar made the journey to Europe. He spent two days on a boat, surviving a storm at sea before stepping on to the island of Lampedusa. “The boat stopped far from the beach. I don’t know how to swim but the water level was below my shoulders. I walked for around ten minutes in the water. There were people running everywhere, many women and children”. The boat arrived at eleven o’clock at night, but no border control stopped Omar. “I stayed near the sea for 21 days, I was scared to go to the centre [for migrants]. But I wasn’t feeling well. I was drinking water from the sea, eating from rubbish… until Father Dario found me”. Omar’s expression changes when he talks about Father Dario. “Life in Italy is very difficult… But sometimes you find different people”. Father Dario and Dr Bartolo are two of the people who made a difference to Omar’s life. With their help, Omar was hospitalized for anaemia.

Those reaching Lampedusa are “frightened and stressed”

But this is not the usual process. Dr Bartolo explains, “When boats arrive, I go to the dock where I conduct a first medical triage. If needed, I organize the transfer of patients to the hospital emergency rooms. And if there are pregnant women, I conduct ultrasound examinations to check the fetus’ health”. Dr Bartolo describes the migrants’ health status when they arrive at Lampedusa as “people frightened and stressed, suffering from diseases related mainly to the trip, such as hypothermia, dehydration, chemical burns, and mental confusion”.

Primary care services on Lampedusa include ultrasound examinations, x-rays, blood tests, specialists’ visits and subsequent drug therapy. According to Dr Bartolo, “if the patient is fine, he is sent to the CSPA [centre for first assistance and aid]. Otherwise, if he requires hospitalization, he is taken to a hospital on the Sicilian mainland”.

Volume of migrants exceeds island’s capacity

Due to the numerous and frequent waves of migration, the number of people living in the migration centres on Lampedusa has far exceeded their capacity, with consequent repercussions on the migrants’ physical and mental health. Moreover, “according to the law, migrants can only stay a maximum of 72 hours in a centre. But they often stay there for more than a month”, says Dr Bartolo. “This is obviously going to affect the psychological state of these people who want to be reunited with family and friends spread across Europe”, he added.

Despite this critical situation, Dr Bartolo highlights that there is also room for hope. “Thanks to the staff’s self-sacrifice, professionalism and competence, the health service given to migrants even in very difficult moments appears to be effective and efficient. We have always been able to overcome challenging situations, leading to what is known as the “Lampedusa model”. In 2013, new strategies have been put in place on the island. “Now migrants are rescued directly from the sea more than 100 miles away from Lampedusa by the coast guard patrol or police. This has led to an enormous decline in diseases and a reduction in medical interventions at the dock”. However, he recognizes, “there is still much to be done”.

WHO project assists Lampedusa

During the evolving North African crisis, thanks to funding from the Ministry of Health of Italy, WHO established the Public Health Aspects of Migration in Europe (PHAME) project to strengthen countries’ public health response to migration. The project is in line with the priorities and objectives of WHO’s European health policy framework, Health 2020.

Following requests from ministries of health, WHO/Europe has conducted assessment missions in Italy, Portugal and Malta in 2013, and is already preparing new missions for 2014. The PHAME team from the WHO European Office for Investment for Health and Development, Venice, Italy, provides technical assistance to ministries in supporting their emergency-preparedness and risk-management capacities, enhancing the surveillance of communicable and noncommunicable diseases among migrant populations and developing migrant-, culture-, and gender- sensitive health policies and services. The main goal is to strengthen health-sector capacity to manage large influxes of migrants.

Future dreams

“No more deaths in the Mediterranean” is Dr Bartolo’s dream for the future. Omar, despite the harsh conditions in which he has lived in Italy for three years now, feels lucky: “This new life, this new test that God gave me is not easy. But I have to thank him because I didn’t die in the sea”. His dream now is to study nursing and travel to London, where he believes will have greater opportunities to start a better life.