This is a letter to the editor in response to a Lancet editorial, July 7, 2007.
We welcome your Editorial of July 7,1 in which you address the problem of access to health care for migrants. The recognition of a right to health irrespective of immigration status is fundamental; however, according to the experience of Médecins Sans Frontières (MSF) in southern Italy, legislation per se is not sufficient to ensure access.
In Italy, MSF supports various health centres dedicated to immigrants, giving special attention to cross-cultural mediation services and out reach activities, including information provision, and awareness-raising. This approach has substantially improved access to health care for undocumented migrants, as shown by data from the Campania region, where 10,151 consultations were done in seven health centres supported by MSF in 2006.
Since 1999, undocumented immigrants have had the right to receive care at dedicated health centres under Italian law, without being denounced to immigration authorities.
In 2004, we visited and interviewed 770 migrant seasonal farm workers, 51.4% of whom were undocumented and 23.4% asylum-seekers.2 Overall, 40% had become ill during their first six months in Italy and 93% after 19 months; the most common problems were infectious diseases, skin problems, intestinal parasites and mouth, throat, and respiratory infections including tuberculosis. However, 75% of the refugees, 85.3% of asylum-seekers, and 88.6% of illegal immigrants were not benefiting from any health care.
Immigrants are too often unaware of their rights, and changing the law does not automatically lead to improved access. In our experience, major determinants of access to health care for vulnerable migrants are appropriate legislation, strong political commitment, adequate cultural mediation, and proactive outreach programmes.
We declare that we have no conflict of interest.
Antonio Virgilio, Loris Defilippi, Konstantinos Moschochoritis, Raffaella Ravinetto
Médecins Sans Frontières—Missione Italia, Rome, Italy (AV); Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium (LD); and Medici Senza Frontiere, Main Headquarters, 00185 Rome, Italy (KM, RR)
1 The Lancet. Vulnerable migrants have a right to health. Lancet 2007; 370: 2.
2 Medici Senza Frontiere Onlus. The fruits of hypocrisy: history of who makes the agriculture… hidden. Rome: Medici Senza Frontiere Onlus, 2005. Report
3 Caritas Europa. Migration, a journey into
poverty? Brussels: Caritas Europa, 2006.
http://www.caritas-europa.org/code/EN/abou.asp?Page=493 (accessed Aug 15, 2007).
4 Anon. Visit of UN Special Rapporteur on the right to the highest attainable standard of health, to Sweden from 10–18th January 2006. Report (accessed Aug 15, 2007).
5 Platform for International Cooperation on Undocumented Migrants. Undocumented migrants have rights! Brussells: PICUM, 2007. http://www.picum.org/ (accessed Aug 15, 2007).