The lack of an individual certification for each person transferred, a medical screening carried out by military doctors, and lack of clarity on the instruments used to ascertain age: these are the new criticalities that have emerged from the latest transfer of 49 people to the Shëngjin centre, which demonstrate once again that the Italy-Albania Protocol represents a health risk for migrants. This is what various health realities dealing with civil rescue in the central Mediterranean and with support and the right to health of people on the move denounce, and they renew the appeal - already launched last November - for operators and health professionals not to become accomplices of the Protocol and its violations (here).
These critical issues - added to the outcome of the screening carried out in the centres of Shëngjin and Gjader, which led to the return to Italy of 6 of the 49 people rescued in international waters as 4 were found to be minors and 2 were found to be vulnerable - confirm our concerns about the risk of human rights violations and the serious medical and health implications of the Protocol.
Firstly, the decision to entrust the screening on board the Cassiopeia to Navy doctors, previously carried out by medical personnel belonging to civilian bodies - specifically the International Organisation for Migration (IOM) - is inappropriate from a clinical, health and deontological perspective. Health personnel responding to hierarchical military chains in civilian and humanitarian settings may experience contradictions that may limit their independence and undermine the due patient-centred approach (1). In addition, according to what is also established in the Order of the Professional and Medical Roles of the State Police and reiterated in the Code of Military Order on ‘Establishment and Functions of the Military Health Service’, law enforcement or military medical personnel can only deal with clinical activities addressed to civilians in case of ‘public calamities and accidents’. The content of the Protocol, which is also detailed in the Standard Operative Procedures (SOPs) of the Ministry of the Interior, obviously does not fall within these cases.
Secondly, the absence of an individual certification for each transferred person, pointed out by some parliamentarians during the visit of the Asylum and Immigration Table to the centre in Shëngjin, is particularly critical, since this document should precede the transfer in order to guarantee the full protection of migrants. Moreover, by analogy with the functioning of the Italian Centres of Permanence for Repatriation (CPR), the absence of this documentation blatantly violates Article 3 of the Directive of the Ministry of the Interior of 19 May 2022, which provides for the presence of this certificate signed by a doctor who is independent of the detention centre.
Regarding the age assessment, it is not clear by what means it is carried out during the pre-screening on board the Navy ship. The national legislation provides for a holistic and multidisciplinary assessment that safeguards the principle of the best interests of the child (2): such an assessment is practically impossible in the context of the pre-screening and it is at least unlikely that it will be carried out according to the criteria laid down by law even during the other two screening sessions in the centres provided for by the ministerial SOPs.
Moreover, although the law stipulates that the detention of persons must be validated by the judicial authority within 48 hours, the Protocol mechanism actually extends this limit, lengthening the period of deprivation of liberty. Detention in all its forms, including administrative detention, is one of the most powerful social determinants of mental pathology (3), and should only be allowed as an ultima ratio, particularly for vulnerable individuals such as those rescued at sea.
Following this further attempt to criminalise and render invisible people on the move, we reiterate our concerns regarding the risk of human rights violations and the serious medical and health implications of the Italy-Albania Protocol to which these aggravating factors have unfortunately been added.
In conclusion, we renew our call for the institutional and professional entities involved or not in the Italy-Albania Protocol to distance themselves from it. In particular, we consider it fundamental that UNHCR, in its role of monitoring procedures, carefully and scrupulously watch over discriminatory practices that are detrimental to human dignity, such as medical screening.
As medical organisations committed to protecting the health and relief of migrants, we reiterate our firm opposition to the Protocol, and call on all health professionals to take a stand against these measures.
We therefore relaunch our appeal, which is also supported by the Italian Federation of Medical Orders (FNOMCeO), and publish the list of the hundreds of healthcare professionals, associations and civil society organisations that have signed it
