- With regard to the concept of vulnerability, the law ratifying the Protocol¹ refers to Legislative Decree no. 142/2015 (art. 17), implementing European Directive 2013/32/EU and European Directive 2013/33/EU, bearing the latter the rules on the reception of applicants for international protection, and which in art. 21 identifies as vulnerable persons ‘minors, unaccompanied minors, the disabled, the elderly, pregnant women, single parents with minor children, victims of human trafficking, persons suffering from serious illnesses or mental disorders and persons who have suffered torture, rape or other serious forms of psychological, physical or sexual violence, such as victims of female genital mutilation’.
We know, from the direct and tangible testimony of the people we rescue and visit on board our ships, that most of them have suffered physical violence, abuse, torture, and sexual violence, and that all of them, due to the context of their country of origin, the journey across the desert, the stay and detention in Libya or Tunisia, the journey at sea, and all that they have experienced as direct victims or as witnesses, are to be considered at risk of mental health problems, even serious ones, including post-traumatic stress disorder (5).
The Guidelines for the planning of assistance and rehabilitation interventions as well as for the treatment of mental disorders of holders of refugee status and subsidiary protection status who have suffered torture, rape or other serious forms of psychological, physical or sexual violence’ (22 March 2017) of the Ministry of Health report, in this regard, that “All refugees are to be considered as potentially vulnerable subjects, since exile is in itself a traumatic experience”. A selection of non-vulnerable persons therefore means not considering in any way the background from which the people rescued at sea come.
- In the documents published by the Ministry of the Interior itself (Legislative Decree 142/2015 art. 17 and Vademecum for the identification of vulnerability) (6) it is also emphasised that the emergence of some elements of vulnerability may not be evident at an early stage, therefore the assessment of rescued persons must be understood as a continuous process over time, which begins with the rescue at sea and continues in the various phases of reception, with particular attention to the availability of time, of an environment perceived as safe and confidential where the vulnerable person can feel welcome and with the necessary support of cultural mediators and specialised operators.
On the contrary, in the middle of the sea, on board the military ship Libra as on board Italian patrol boats, there are no conditions for an adequate assessment of a person's state of health (7). In fact, there is neither a medical clinic nor rooms used for this purpose that would guarantee adequate privacy and a proper perception of a safe place (8), just as there are no instruments capable of diagnosing certain clinical conditions and pathologies, acute or chronic. This strong limitation becomes even more evident in the presence of a large number of people to be evaluated in a short time.
- Similarly, it is not possible to identify chronic or latent pathologies or mental health problems, which may instead manifest themselves later and require specific care and treatment, no less important than acute conditions manifested at the time of screening. As reported in the Ministry of Health's LG of 22 March 2017, ‘RTPs (ed. Applicants and holders of international and humanitarian protection) who have been victims of torture, rape, abuse or extreme trauma of another nature (prolonged imprisonment in isolation and/or in inhuman and degrading conditions, shipwrecks, witnessing violent deaths, etc.) may present manifest, latent or sub-clinical psychopathological clinical pictures. This typology of refugees must be considered highly vulnerable and it is therefore necessary to implement specific actions and procedures aimed at the early identification of these persons. Identification is the indispensable prerequisite to guarantee the largest possible number of applicants who have survived extreme violence a correct and early clinical-diagnostic assessment, leading to appropriate and timely medical, psychological and social care."
- Given the very wide range of clinical and psychopathological pictures that people rescued at sea present or could present, and in view of the fact that health conditions are used as an important discriminating factor, a further limitation is the absence of specialist figures adequately trained to recognise certain clinical conditions of vulnerability, which can therefore easily escape the professionals in charge of screening on board ships, all the more so in this setting. There is therefore a risk of underestimating a number of manifest or sub-clinical clinical or mental health conditions and wrongly categorising some people as ‘not vulnerable’ from a physical or mental health perspective.
- The screening procedures on board Italian assets, the journey to Albania and possibly, in case of recognition of vulnerability in Shëngjin, the journey back to Italy, result in exposure to unjustified additional days of navigation on board militarised assets. This entails not only a delay in access to care services, and therefore a possible worsening of health conditions because not adequately and promptly recognised and treated, but also a very high risk of retraumatisation and reopening of traumatic experiences in the absence of a psychologist on board who can deal with them, and which can therefore lead to irreversible damage (such as suicide attempts).
It is the Italian government itself that has made us experts in this: in the past due to the long stand-offs while waiting for a safe port of disembarkation (POS - place of safety) and now with the allocation of distant ports, we find ourselves caring for people rescued for days on end and directly witnessing the consequences that unjustified stay at sea has on their health.
- The next step after the assessment of ‘non-vulnerability’ is then imprisonment in detention centres on Albanian territory. As reported in the ‘Appeal for an awareness-raising campaign of doctors on the certification of migrants’ suitability for life in CPRs’ signed by the Italian network No to CPRs, ASGI and the Italian Society of Migration Medicine (9), places of administrative detention represent, according to the WHO, a risk factor for mental and physical health (10), in particular for the possible spread of infectious diseases and for the low standards of care and treatment even of non-communicable diseases. Numerous reports by stakeholders as well as by the National Guarantor of the Rights of Persons Deprived of their Liberty have highlighted the poor and degrading sanitary conditions in CPRs and their ‘pathogenic’ effect on people's physical and mental health.
