Dr Pietro Bartolo, chief of 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 doesn?t hesitate. "I came looking for a better life, but I only found problems, poverty and sickness?. Omar is one of millions who have left their countries in the north of Africa and the Middle East since the revolutions began in 2010. He left Tunisia and came to Lampedusa after a very difficult journey. At the age of 21, with no relatives left in Tunisia, Omar quit his studies in literature and paid 1,800 dinars (around 785 Euros) to get on a boat with more than 100 people heading to Lampedusa.
Since 2010, this Sicilian island that is closer to Africa than mainland Europe, has received an enormous exodus that is overwhelming Italy?s health system capacity. At crisis points, 500 migrants on average have arrived on a daily basis. 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?.
Three years ago, Omar made the journey to Europe. He spent two days on a boat and survived 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 "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 to 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 (migration centre). 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?.
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, WHO established the Public Health Aspects of Migration in Europe (PHAME) project, thanks to Italian Ministry of Health funding, in order 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 in Venice provides technical assistance to ministries by supporting their emergency preparedness and risk management capacities, enhancing surveillance of communicable and non-communicable 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.
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