1. 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

2. How we started our collaboration
• the need to confirm a diagnosis of malaria; the first
detected on Lampedusa Island, ever.
• Why not going for the easy solution? It is the best!
• Bellina L., Missoni E., Mobile cell-phones (M-phones) in
telemicroscopy: increasing connectivity of isolated laboratories,
Diagnostic Pathology 2009, 4:19 (19 June 2009)

3. 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

4. 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, disease
prevention and care for migrants, subject to national laws
and practice, without discrimination on the basis of gender,
age, religion, nationality or race;
(3) to establish health information systems in order to assess and
analyse trends in migrantsí health, disaggregating health
information by relevant categories;
(4) to devise mechanisms for improving the health of all
populations, including migrants, in particular through
identifying and filling gaps in health service delivery;

5. 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).

6. 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

7. Health care provision for
irregular immigrants
• Medical personnel of the “Malta Cross” on board of
military boats for immediate assistance to people rescued
in open sea
• On arrival at the dock, first care managed by INMP and
MSF (triage) in collaboration with the Management of
the “First aid and reception centers” (CSPA):
– Identification and management of emergencies and non
emergency conditions (subjective emergencies)
– Screening for cutaneous communicable disease
– Color codes assignment according to urgency and follow-up at
the local Emergency and Policlinic, worst cases may be
transferred by helicopter to Palermo

8. The resident population

9. The immigrant population
“boat-people”

10. Medical care

11. Laboratory services

12. Referrals to laboratory services

13. Parasitological findings

14. Conclusions (1/2)
• The high disproportion between cases referred to
health services between the resident population and
irregular immigrants, as well as differences in the
number of diagnostic services per attended patient
highlights the scarce attention given to the latter.
• The high proportion of confirmed cases of parasitic
infection shows the relevance of these diseases
among the immigrant population and elicits concerns
about the potential risk of the emergence or the
increased incidence of communicable diseases in the
island (oral-faecal route of transmission).

15. Conclusions (1/2)
Ethical concerns
• The right to health of immigrant population
is highly restricted
• Need for more attentive, comprehensive
screening and health care provision to
immigrant population
• Need to reconsider current immigration
policies and official attitude which are in
contrast with the right to health, not to
mention feelings of human compassion.