Who are the migrants and in what health do they arrive on Lampedusa?
"The migrants who land on Lampedusa come mainly from North African countries, the Middle East and West Africa, but there are also people who have come from Pakistan and Kashmir. Most of them are men, often very young, but some with grey hair; children and women are a minority.
"The migrants began the journey that led them to Italy several months, some even one or two years prior, stopping periodically in countries along the route to work and put aside the money they needed to continue their trip. They generally reach the dock exhausted, thirsty, sometimes dehydrated, with skin erythema caused by the sun and sea salt, with burns from the petrol used as fuel for the rubber dinghies, and often with respiratory infections. Moreover, many appear resigned and completely drained of energy."
What kind of medical assistance is MSF offering at the port?
"The MSF team is made up of two doctors, a nurse and a cultural mediator. After being notified of a landing - usually by the Coast Guard or by the Revenue Guard Corps - we head to the dock with our mobile clinic, in which we have previously arranged first-aid and emergency drugs, medical materials and some food essentials such as water, tea and biscuits.
"MSF is in charge of the first medical assistance for newly-arrived migrants at the dock or in any other part of the island. We divide them into those who require immediate medical help and those who are in relatively good condition. Those who need medical care are examined and given the necessary treatment in the mobile clinic or, if their conditions so require, sent by ambulance to the Emergency Room at the island's hospital."
The past few weeks have seen a series of dramatic landings in the Canal of Sicily, and a number of people have drowned. You are a doctor but also a psychotherapist; can you tell us something about the mental state of the migrants upon arrival?
"Unfortunately, shipwrecks continue to occur and the number of victims continues to increase. The migrants cross the Canal of Sicily in dangerous conditions, in crappy dinghies and overcrowded boats, with little food and water. They stay at sea many days and nights, exposed to the sun or extreme cold, at the mercy of the wind and waves.
"The risk of submerging or capsizing is big and sometimes people are rescued just before, or even after, their boats sink. This life-threatening situation makes for a traumatic experience and tends to be accompanied by feelings of impotence and horror.
"The immediate result may be a psychological condition which manifests itself either in an acute anxiety syndrome (agitation, trembling) or, to the contrary, in a depression characterised by a total isolation from the surrounding environment.
"After a couple of weeks or months, some people may be diagnosed with post-traumatic stress sisorder, a syndrome that leaves extremely deep marks in the person's psyche. The disorder includes recurring memories of the event, nightmares which recall the horrible experience, living as though the traumatic episode might repeat itself, intense psychological discomfort, fixation on the trauma.
"More generally, migrants who have faced long and difficult journeys appear overwhelmed, almost indifferent to all that is going on around them, distant. Some of them withdraw from their environment and cry on their own."
Has there been a particularly difficult moment or case during your mission?
"Not so much professionally, but from a human perspective there is one occasion that stands out. It happened during a landing which involved a group of migrants from West Africa who had been saved while their boat was sinking.
"During the shipwreck, two of their friends had drowned. The people in the group who were closest to them were lying on their backs on the quay, eyes closed and seemingly unaware of what was going on around them, as though they had been crushed by the weight of the tragedy.
"The feeling of how little my efforts were worth and how futile my presence was in the face of the enormity of their suffering stayed with me for several days."