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Overcrowding presents serious public health risk

Copenhagen and Rome, 31 March 2011
Issued jointly with the Ministry of Health, Italy

A two-day joint mission to the island of Lampedusa by the Ministry of Health and the World Health Organization’s Regional Office for Europe was completed on 29 March 2011. It concluded that the public health situation in Lampedusa, where displaced people have arrived from northern Africa, is a cause for concern, although hitherto there have been no unusual infectious or other diseases detected among the newly arrived population. Under the current conditions of overcrowding, it is important to strengthen disease surveillance and prevention measures and to maintain rigorous environmental control. Overcrowding can cause the spread of infectious diseases transmitted through respiratory or faecal-oral routes.

This assessment will help to lay the foundation for an international conference planned for 13 April 2011, in collaboration between Italy, the European Commission and WHO/Europe, to coordinate the help being provided to address the health aspects of the crisis and to discuss contingency plans in view of a potentially large number of displaced people reaching European countries.
At national level, a technical coordination group has been established at the Italian Ministry of Health, to ensure public health preparedness and coordination of all parties. This coordination group will complement the coordination panel at the Ministry of the Interior.

At subnational level, a technical coordination group has been established in the Region of Sicily, made up of representatives of all local health institutions, in order to plan interventions and formulate a contingency plan based on the number of arrivals. As well as WHO, support for the Italian-led action is also being provided by the office of the United Nations High Commissioner for Refugees (UNHCR), the International Organization for Migration (IOM), the International Red Cross and other organizations such as Save the Children and Médecins Sans Frontières. The Italian Civil Protection National Service has also joined the efforts.

The conclusions of the health mission are given in full below.

Epidemiological surveillance

• On arrival on the island, migrants are screened by the local health centre and the Italian Red Cross for signs of acute or chronic disease. In suspected or positive cases, patients are referred to the local island’s clinics and to mainland hospitals, as appropriate.
• Although the number of migrants has increased, the capacity to provide health care has improved owing to the arrival of additional health personnel and supplies.
• Based on current conditions, it is important to strengthen disease surveillance and prevention, as well as to pay continued attention to environmental health control measures. Overcrowding can cause the spread of infectious diseases transmitted through respiratory or faecal-oral routes.

Environmental control measures

• Sanitation – Chemical toilets have been brought in to provide migrants with improved sanitation, but the number of users overstretches the capacity of this service. Depending on the ground conditions and the facilities on the island for disposal of excreta, different options are available to address these sanitation needs, in order to avoid an increase in open defecation. Regular sanitation should be provided where necessary.
• Waste – The presence of immigrants results in a substantial increase in waste (for example, plastic materials used for the delivery of meals) that is spread across the island. A waste collection service has been initiated and will be carried out regularly.
• Water – Careful planning for water supply, appropriate chlorination and careful personal hygiene are key to reducing the health risks from water scarcity; this is especially linked to the sharp increase in demand and to weather conditions that can challenge the ferrying of water to the island, especially if the arrival of migrants escalates.
• Other environmental impacts – The accumulation of boats both on the ground and in the water, used for the transport of immigrants and now abandoned on the island (and sequestrated), poses a problem of contamination and disposal in the short and long terms.

Contact

Dr Santino Severoni
Regional Coordinator, Strategic Relations with Countries &
Regional Director's Special Representative to Italy for the Northern African emergency
WHO/Europe
Copenhagen, Denmark
Tel: +45 3917 1324
Tel. Italy: +39 06 4877 549
Mob: +45 3035 6929
Mob. Italy: +39 348 400 1097
E-mail: sev@euro.who.int

Cristiana Salvi
Technical Officer, Communication
WHO/Europe - Rome Office
Tel. +39 06 4877543 
Mob. +39 3480192305