Ethical and public health concerns

based on the retrospective analysis of

referrals for diagnostic parasitology

of immigrants and autochtonous population

in Lampedusa island (Italy)

Livia Bellina - ASL 6 - Sicily Region

Marcella Maugeri - ASL 6 - Sicily Region

Eduardo Missoni - CERGAS, Bocconi University, Milano

How we started our collaboration

• the need to confirm a diagnosis of malaria; the firstdetected on Lampedusa Island, ever.

• Why not going for the easy solution? It is the best!

• Bellina L., Missoni E., Mobile cell-phones (M-phones) intelemicroscopy: increasing connectivity of isolated laboratories,Diagnostic Pathology 2009, 4:19 (19 June 2009)

The Method

• Analysis of the legal and procedural framework

for immigrants’ care and right to health

• A retrospective review (January 2008- May 2009)

of referral to Policlinic and to the clinical

laboratory (only one in Lampedusa), with focus on

parasitological diagnosis (blood, urine and stools)

• Comparison of data related to regular resident

population (permanent and seasonal) and irregular

immigrant (“boat-people”) population

WHO on immigrants health

WHA Resolution 61.17 “Health of migrants”

World Health Assembly CALLS UPON Member States:

(1) to promote migrant-sensitive health policies;

(2) to promote equitable access to health promotion, diseaseprevention and care for migrants, subject to national lawsand practice, without discrimination on the basis of gender,age, religion, nationality or race;

(3) to establish health information systems in order to assess andanalyse trends in migrantsí health, disaggregating healthinformation by relevant categories;

(4) to devise mechanisms for improving the health of allpopulations, including migrants, in particular throughidentifying and filling gaps in health service delivery;

The Right to Health in Italy

• According to Italian Constitution, health is a

“fundamental right of the individual and (an)

interest of the community” (art. 32)

• “political, economic and social solidarity”

are identified as “intransgressible duties”

(art. 2).

Immigrants health care in the

Italian Law

• Legislative Decree n.286/98 - the access to health services

is granted to foreign citizens without permit and they

cannot be reported to authority, but in the cases where this

is foreseen also for Italian citizens

• Law n. 94 15.7.2009 criminalizes illegal immigration -

debate about interpretation of its effect of LD n.286/98,

obligation of Medical officers to report illegal immigrants

• Following Agreement with Lybia, Italy introduced a policy

of returning boatloads of migrants to Libya before they can

claim asylum. This policy was actively implemented

starting in May 2009

Health care provision for

irregular immigrants• Medical personnel of the “Malta Cross” on board of

military boats for immediate assistance to people rescuedin open sea

• On arrival at the dock, first care managed by INMP andMSF (triage) in collaboration with the Management ofthe “First aid and reception centers” (CSPA):

– Identification and management of emergencies and nonemergency conditions (subjective emergencies)

– Screening for cutaneous communicable disease

– Color codes assignment according to urgency and follow-up atthe local Emergency and Policlinic, worst cases may betransferred by helicopter to Palermo

The resident population

The immigrant population“boat-people”

Medical care

Laboratory services

Referrals to laboratory services

Parasitological findings

Conclusions (1/2)

• The high disproportion between cases referred tohealth services between the resident population andirregular immigrants, as well as differences in thenumber of diagnostic services per attended patienthighlights the scarce attention given to the latter.

• The high proportion of confirmed cases of parasiticinfection shows the relevance of these diseasesamong the immigrant population and elicits concernsabout the potential risk of the emergence or theincreased incidence of communicable diseases in theisland (oral-faecal route of transmission).

Conclusions (1/2)

Ethical concerns

• The right to health of immigrant populationis highly restricted

• Need for more attentive, comprehensivescreening and health care provision toimmigrant population

• Need to reconsider current immigrationpolicies and official attitude which are incontrast with the right to health, not tomention feelings of human compassion.