In Italy, campaigners are fighting immigration detention with doctors

Campaigners in Italy are fighting immigration detention by asking doctors to stop declaring anyone fit for detention. We spoke to Nicola Cocco of the Italian Society for Migrations’ Medicine to know more.

In Italy, sending a person to an immigration detention centre requires a doctor’s certificate proving that they are “fit for detention” (conditions are regulated by a 2022 ministerial directive). Often, this certification is done at the emergencies by overworked doctors, with little time and no serious medical check-up. The exam typically lacks the person’s consent and is not accompanied by a cultural mediator. The result is that doctors often merely certificate that the person does not have communicable diseases.

Most times, police are present for the whole duration of the exam. In some cases, the doctors performing the “fit for detention” exam are hired by the immigration detention centres themselves.

At the start of 2024, civil society organisations led by the Italian Society for Migrations’ Medicine (Società Italiana di Medicina delle Migrazioni, SIMM), the network “No More Lager” (Mai più lager – No ai CPR), and the Italian Association for Legal Studies on Immigration (Associazione per gli Studi Giuridici sull’Immigrazione) launched a campaign to stop doctors from declaring people “fit for detention”. In this campaign, the associations link the health risks of immigration detention with the ethical risks faced by doctors when sending someone to a place of harm.

The immigration detention centres are often unhealthy places, where broken windows, lack of hot water and dirt are commonplace. Besides the negative effects on the physical health of the people detained, the confinement and lack of activities weigh on their mental health too. For many, the harms of immigration detention add to those experienced during the migration journey.

Immigration detention centres are closed institutions, where every aspect of the life of detained people is controlled by others, and where no perspective of release is known to the person in detention.

“The only possible reaction to this environment is violence” said Cocco, “Violence from detention guards. Violence from health care personnel, which often overly prescribes psychotropic drugs. Violence from people in detention against themselves, from self-harm to suicide”.

Deportations are also violent practices. Typically, they would happen without notice, during the night, at 4 am. Police would enter the cell in riot gear and give the person 10 minutes to throw their few possessions into a garbage bag, less than 10 minutes to call a loved one. The person undergoes a quick “fit to fly” visit and are brought to the airplane.

“The point is, is it ok for a doctor to approve that a person be sent to a torturing environment?” said Cocco.  

So far, 40 to 50 doctors have adhered to the campaign, which have collectively avoided that about 100 people be sent to immigration detention. Regional medical associations have not yet responded to the campaign, leaving the ethical burden on individual doctors.

However, the national committee currently reforming the medical code of ethics has proposed to include a clause whereby doctors cannot be requested to declare a person “fit for detention”.

Stopping the “fit for detention” certificates would mean that thousands of people would be spared the suffering of immigration detention. It would save the professional dignity and ethics of doctors. And it would send a strong message to the institutions against the legitimacy of immigration detention.

In June, the network “No More Lager” (Mai più lager – No ai CPR) launched a petition targeted at health care professionals calling for the closure of immigration detention centres across Italy.

But Europe is going in the opposite direction. The EU Migration Pact is thought to lead to the detention of 70-80,000 people every year, especially at the borders, where it is harder to check abuse and respect for safeguards. The Italy-Albania deal (which would see Albania hosting people rescued at sea by Italian authorities for the examination of their asylum claims) poses serious doubts as to how people with vulnerabilities will be treated and makes rights’ monitoring extremely difficult.