Out of Place: A reception system designed to exclude, not to welcome

Rome: At least 10,000 asylum seekers and refugees in Italy are living in precarious conditions outside the reception system, without assistance from authorities and with limited access to medical treatment, according to a new report by international medical organisation Doctors Without Borders (MSF), Out of Place. Asylum seekers and refugees in Italy: informal settlements and social marginalisation.

Based on research carried out in 2015, the report details the unacceptable conditions in which thousands of people are living in dozens of informal sites which have sprung up around the country. Most are asylum seekers and holders of international protection – and therefore legally present in the country – who have been forced to live in these conditions for months, and sometimes years, due to the inadequacies of Italy’s reception system and social integration policies. They include asylum seekers who have just arrived in Italy and who are being denied the assistance to which they are entitled by law due to a shortage of places in reception centres. They also include people in transit towards other European countries, and refugees who have lived in Italy for years but remain excluded from mainstream society.

“For over a year we have visited occupied buildings, slums, farms, parks and railway stations, in rural areas as well as in city centres, and we have documented a disheartening reality, practically ignored by the institutions,” says MSF researcher Giuseppe De Mola. “Thousands of men, women, children – vulnerable people who have fled dramatic situations and have a right to assistance – are living in deplorable conditions, often facing insurmountable barriers to access essential treatment.”

Living conditions in the informal settlements are often desperate. In half the sites, there is no drinking water or electricity, and residents have little or no access to medical services. People waiting to be admitted to the Italian asylum system are excluded from any public medical assistance, while even amongst the refugees who have lived in Italy for several years, one in three is not registered with the National Health Service, and two in three have no regular access to a doctor.

 Sites range from the former Olympic village in Turin, sheltering more than 1,000 refugees, to the Don Gallo house in central Padua, where the shower is a rubber hosepipe in the garden. They include railway stations in both north and south Italy, where Afghans and Pakistanis wait for months at a time to access the asylum procedure; permanent sites for Eritreans in Rome; a disused “Ex-Set” factory in Bari, where African refugees have been living since 2014; and the Borgo Mezzanone runway in Foggia, an informal site beside a government reception centre.

These sites have sprung into existence as the result of Italy’s inadequate reception system, which is chronically short of places and operating in emergency mode. At present, more than 70 percent of the 100,000 available reception places are inside ‘extraordinary structures’ – buildings that have been opened as an emergency measure.

 “This is an invisible population, whose existence is ignored or tolerated by the authorities,” says MSF president Loris De Filippi. “The authorities fail to take into account their vulnerability, reacting with forced evictions, rather than finding solutions for them. In the absence of an immediate and structured response, many of the 100,000 people currently in the reception system, as well as those who arrive in the next few months, could soon share this marginalised future. This is completely unacceptable in a country like Italy and could be further worsened by the ‘hotspots’, where thousands of migrants are being arbitrarily excluded from the asylum procedure and literally abandoned.”

 MSF has been working in Italy for 15 years, providing assistance to migrants who have been forced to leave their countries of origin. While acknowledging the efforts made by Italy to fill gaps and solve chronic delays, MSF calls on the authorities to increase the number of places available in the reception system in a structured manner, and to end the current emergency approach. MSF also calls on the government to guarantee dignified living conditions and basic rights to all migrants, asylum seekers and refugees in informal sites, including the right to health. At last, registration to the National Health Service and the assignment of a medical doctor should be linked only to the effective place residency.

In the last few months, MSF teams have provided medical and psychological assistance in Gorizia, at the Baobab centre in Rome, and on the rocks of Ventimiglia. MSF is also setting up a permanent national observatory on asylum seekers and refugees who are outside the reception system, to call attention to the most critical situations in terms of humanitarian needs and of barriers to accessing medical treatment. This will be achieved in collaboration with those who have contributed to this report: local entities, associations and other civil society organisations active in the protection of migrant populations, including MSF’s own local groups of volunteers.

MSF has been working in Italy since 1999, providing assistance to thousands of migrants, refugees and asylum seekers arriving on our shores or already in the country, with the aim of guaranteeing access to medical treatment, as stipulated in our law. This has included: providing medical and psychological care to new arrivals in Lampedusa and Sicily; setting up outpatient clinics for illegal foreigners in public health facilities in a number of regions; assisting seasonal agricultural workers; and speaking out about poor conditions in identification and expulsion centres. In 2015 MSF tripled the scale of its projects for migrants and refugees in Europe and ran search and rescue operations on the Mediterranean Sea from three ships. MSF has dedicated its #Milionidipassi campaign to people on the move.

Find out more about MSF's work in Italy.