Changes in flows

Over the past few months, there has been a significant increase in the number of migrants arriving through the Central-Southern Mediterranean route with embarkation from Tunisia, which is increasingly becoming a country of both emigration and transit. This new route is in fact crossed both by people wishing to avoid crossing from Libya and by people who were born in Tunisia or who have been living there for many years before deciding to leave the country due to deteriorating economic and security conditions. In Tunisia, as in Libya, according to many testimonies, severe violence and abuse against migrants are perpetrated on a dramatically recurring basis.

As for the composition of the population, early 2023 saw a drastic drop in the number of people from Afghanistan and Iran, which in 2022 represented the first and second countries of origin of migrants transiting through Oulx. At the same time, the number of people arriving from Central and West Africa via the Central Mediterranean route is constantly increasing, while the number of migrants from Morocco remains constant. The latter includes both people who have recently arrived in Italy via the Balkan route and people who have been in Europe for several years. These are sans papier who, after having had their applications for international protection rejected, remained in the limbo of irregularity, forced to travel from one country to another in search of illegal work and a way to survive.

The number of women in transit from sub-Saharan Africa, especially the Ivory Coast, is also on the rise. An increase that, upon initial observation of trafficking indicators, raises fears of the existence of a widespread and structured exploitation network. Early identification during disembarkation and at Hotspots, as indicated in the Standard Operating Procedures and Protocols in force in many regions, is a necessary condition to combat the phenomenon and ensure respect for the human rights of the persons involved. Such identification, combined with the transfer of the persons concerned to safe places, would allow a decrease in the number of people exposed to this crime but this does not seem to happen. Many of those who arrive in Italy already as part of a criminal network are not recognised as such, with the consequence that they are deprived of their rights. They are often registered as members of family units together with women and men they barely know. With this purpose, in collaboration with IRES ^[3], within the project "Anello Forte," a monitoring of the north-western border has been initiated in order to try identifying indicators of trafficking among women in transit.

In addition, the shelter saw the arrival of many pregnant women - 1 in 5 during the winter period - most of whom had already had children, either remaining in their country of origin or during the journey, with no screening along the way. About a third reported having had abortions in the past and many women were accompanied by infants and children whose only memory of life was the journey.

For all, the migratory journey is a harbinger of risks related to both nature and the conduct of the militia, paramilitary, and police corps assigned to border control in various Balkan states that are often responsible for serious human rights violations.

If crossing the borders of Bosnia, Croatia, Serbia, and Slovenia often means encountering abuses and violence of different kinds, risks do not end once entered EU territory. This is especially true for certain categories of vulnerable people such as women and children. Every day, in fact, particularly in recent months, at the “Fraternity Massi” shelter, minors who have been pushed back by the French border police are present.

The militarization of the Alpine border represents an additional risk factor for the safety of people, just one step away from their final destination. The security policy implemented by the French police forces migrants to seek out less police-controlled but more inaccessible and dangerous paths, often at night, in order to escape the “manhunt”. During the winter months, doctors working at the shelter have detected freezing injuries and states of hypothermia that have required hospitalisation. Many are also the people who have lost their lives at the French-Italian border: 46 people since 2015.

The difficulties are even greater for certain categories of vulnerable people, including people with health problems, those with disabilities, and minors. The latter are often pushed back by the French border police, despite claiming to have declared their minor age. Forced to retry or change course, very few decide to remain in Italy due to difficulties in applying for asylum and accessing the reception system.

[3] Istituto di Ricerche Economico Sociali del Piemonte

Medu's action

The number of people who accessed medical triage at the shelter is 4,193 and 1,214 are those who have been examined more thoroughly. The main health problems treated in the border clinic are diseases developed during the journey: skin infections such as scabies, mycoses, insect bites, and infected wounds that in some cases required hospitalizations as a result of over-infection; bronchitis, flu and cold syndromes related to the border crossing during the winter months, with long periods of exposure to sub-zero alpine temperatures; frostbite burns caused by prolonged body contact with snow; fuel burns occurred during the sea crossing; physical trauma, caused by accidental falls while attempting to climb walls and fences or by violence occurred at the border - particularly at the Bosnian-Croatian border, in Serbia, Bulgaria, Tunisia and Libya - by government agencies using batons, police dogs, iron rods or rifle barrels; injuries caused by passing through barbed-wire fences or wooded areas full of brambles; foot injuries caused by the hundreds of miles travelled, often wearing unsuitable footwear and muddy ground or by forced walks along rivers.

Particularly alarming then is the continued denial of access to care in transit countries, especially those of the Balkan route and Libya. The scars and signs of torture found on the bodies and in the psyches of the persons assisted are a direct testimony of the deprivations they suffered, resulting in physical and psychological harm that undermine the survival of so many men and women. Health problems that can be easily solved as they arise in some cases become chronic, due to difficult access to care in transit countries, leading to the emergence of real vulnerabilities that slow down the journey and sometimes make it impossible. Simple wounds or skin infections, if left untreated for several months, risk worsening and becoming chronic, leading in some cases to real disabilities requiring hospitalization.

In the countries they passed through - Turkey, Serbia, Bosnia for the Balkan route or Libya and Tunisia for the Mediterranean route – the migrants did not receive any medical assistance, due to the absence or shortage of staff in informal and some institutional refugee camps or the lack of access to public and private health facilities.

There is also a high percentage of people with post-traumatic stress symptoms such as insomnia, disturbing and intrusive thoughts, nightmares, panic attacks, lack of appetite, asthenia, headache, and difficulty concentrating, the outcome of the inhumane and degrading treatment they suffered, in most cases at the hands of the Taliban regime, Libyan gendarmes, and Tunisian authorities.

A particularly complex phenomenon is that of addictions, especially to drugs and medicines whose, based on the collection of testimonies and medical histories, would have mostly begun in prisons, quarantine ships, detention centers for repatriation (CPRs), or refugee camps. Over-prescription of these drugs has frequently been verified as likely to manage anxiety and agitation under conditions of uncertainty and overcrowding, situations in which the use of psychotropic drugs turns out to be a real containment strategy.

Less relevant numerically but worthy of particular note is the situation of people with health vulnerabilities and disabilities, often pre-existing in their country of origin. These are people who have set out with the hope of finding adequate assistance and care. They are housed by the Italian Red Cross at the Bussoleno Pole - a low-threshold reception facility – and assisted by MEDU for health-related issues, pending completion of the asylum procedure and possible transfer to reception centers.

Another particularly sensitive issue is that of unaccompanied minors, particularly of those who have been registered as adults when they landed on the coasts of southern Italy. Most of the minors assisted arrived in Italy through the Turkish-Calabrian maritime route traveling in groups of 5-10 people. According to the testimonies collected some of them declared to be of age out of fear of being stranded in hotspots because of the shortage of places in the reception centers for minors and the resulting long waiting times for the transfer. Others were registered as adults despite they declared to be underage. Due to the wrong registration, minors who show up at the border are rejected and "forced" to try the passage illegally, putting their lives at serious risk.

Despite the directives of the Ministry of the Interior stating that, in case of doubt about the declared age, this must be ascertained through personal records and with the collaboration of the diplomatic authorities, there are major differences between legal requirements and their actual application.

Finally, it is necessary to address the subject of those who want to ask for international protection in Italy. Firstly, applying for asylum at the Questura (Police Headquarter) of Turin is an exhausting time-consuming procedure. For at least 2 months (but in some cases up to 6) people are forced to queue every day just to make an appointment. Afterward, it is necessary to wait an additional 4-5 months to formalize the application for asylum. In the meantime, not being formally recognized as asylum seekers, they are unable to have access to the national reception system.