Over the past 4 years, Europe has experienced an increasing influx of migrants crossing the Mediterranean Sea seeking humanitarian protection and/or improved living conditions [1, 2]. Most are fleeing war, persecution or extreme poverty [3].
In this study we define “migrants” as persons moving from one place to another, regardless of their legal status or reasons for travelling. All migrants in this study were rescued at sea, therefore we refer to them as sea migrants.
The number of sea migrants has escalated substantially since 2011 (62,500 in 2011, 43,000 in 2013, 170,000 in 2014) following the Syrian war, the rise of the Islamic State, as well as the political crisis in Libya. In 2015 about a million of them have reached Europe [1, 2].
Before 2011, the vast majority of sea migrants came from Africa (North and West Africa, and Horn of Africa), but recently, a significantly higher proportion of them has come from the Near East and Asia (Syria, Iraq, Afghanistan, Pakistan and Bangladesh) and includes migrants of minor age [1, 2, 4]. Furthermore, migration routes have been shifting, with Southern Italy being the major landing point up to 2014 and Greece representing the most crossed European border in 2015 [1, 2].
The sea journey, as well as the land crossing, are extremely dangerous and expose the migrants to risks that threaten their health [3, 5, 6]. Between October 2013 and November 2014 the Italian government implemented the search and rescue operation called Mare Nostrum (OMN) to address the increase in deaths of migrants during their sea crossing [3, 7]. The two main landing sites for rescued migrants were Augusta (Province of Siracusa) and Pozzallo (Ragusa), in Sicily [8, 9]. In 14 months, OMN rescued 160,000 sea migrants [10].
The extraordinary wave of sea migration in 2014 represented a challenge for Italian authorities in terms of reception capacity and providing adequate medical assistance. In addition, the Ebola epidemics in West Africa aroused fear of importation of communicable diseases that could represent a public health burden in Italy and the rest of Europe [11]. Therefore, following an official agreement with the local branch of the Ministry of Health (MoH), the medical humanitarian organization Médecins Sans Frontières (MSF) supported medical care for rescued migrants at both landing sites. The collaboration project in Augusta, the busiest port, started on August 1 and ended on December 31, 2014, when all activities were handed over to MoH.
There is some literature regarding sea migrants. Three previous studies analyzed medical activities in Malta in 2010–2011, in Lampedusa in 2010 as well as in 139 immigration centers operating in 13 Italian regions from May 2011 to June 2013. These studies showed that migrants were usually young men from African countries [12–14]. Although most were healthy or presented with minor health conditions, the main diseases observed were dermatological, respiratory and gastrointestinal. Furthermore, a significant part of their morbidity was related to the migration experience and/or the adjustment to the new environment in Italy. No major risks to public health were observed. Three previous studies focused on reasons for referral of migrants to hospitals in Lampedusa and Palermo [15–17].
In addition, studies in countries receiving a significant influx of migrants, including Italy, Spain, Germany and Greece, sought to describe health needs of immigrants as well as factors impairing their utilization of health care services [17–20]. However, these studies focused on the health status of migrants already settled in European countries.
What is lacking is accurate and up-to-date information regarding the burden of illnesses of migrants on their arrival in order to provide accessible and adequate medical care. As well, the changing profile of migrants has not been documented. This information is especially relevant for countries receiving the majority of them such as Greece, Italy and Germany during 2015. It is also important to document the health status of recently arrived migrants to properly evaluate their potential impact on European public health and health care systems.
The aim of this study was to define the demographic and clinical features, as well as referral patterns of newly arrived sea migrants seen at a MSF-MoH outpatient clinic at Augusta harbor from August 1–December 31, 2014. In addition, we compared migrants from Near Eastern war-torn regions (Syrians, Iraqis and Palestinians) versus those of all other nationalities (mostly from Africa), as there appeared to be substantial differences in terms of demographic and clinical characteristics.