SAMIFO: Health centre for asylum seekers and refugees

Practice Aim

To offer general and specialist medical care for asylum seekers and beneficiaries of protection as well as psychiatric treatment.

Target Groups

VG: Immigrants, Refugees, Asylum seekers, those who migrate due to the unusual situation, irregular migrants.

Centro Sa.Mi.Fo – Health center for asylum seekers and refugees
Public Health Care (ASL Roma A) and Private Social Assistance (Italian Jesuit Refugees Service)
Contact person: Giancarlo Santone, biomer@tiscali.it

Summary

SaMiFo (Salute Migranti Forzati) Rome is a joint project carried out by the national health service and Centro Astalli. It offers general and specialist medical care and mental health treatments for asylum seekers and beneficiaries of international protection. To gain access to treatment, a person must already be registered with the public healthcare system. The area of general medicine allows refugees not only to access cares but also to be referred to specialist doctors inside and outside the clinic. Within the SaMiFo there are psychologist and psychiatrists specialized in particular in the treatment of post-traumatic and maladaptive illnesses. An all-female team composed of health care personnel, social workers and cultural mediators works in the gynaecology clinic, which is responsible for the protection of women’s health. In fact, some of them are often victims of torture and sexual violence, forced marriages and genital mutilation. The health professionals offer appropriate care during pregnancy and in postpartum period. Throughout the years, there have been numerous orthopaedic examinations as serious physical traumas required surgery. Forensic medicine is an essential service because it certifies the results of mistreatment and torture to be submitted to the Territorial Commissions and Courts, in support of the application for international protection. The functioning of the service would not be possible without the presence of linguistic and cultural mediators and social workers, who act as a link between the reception centres and health care providers, allowing people who are often silenced, lonely and suffer discrimination to speak and be heard.

Target VG and type of host community

Immigrants, Refugees, Asylum seekers, those who migrate due to the unusual situation, irregular migrants.
SaMiFo patients often have complex problems: pain and physical pathologies, psychic suffering linked to past traumatic experiences, travel and their present precarious condition, often exacerbated by legal and social difficulties. In order to accommodate a very heterogeneous needs, the service team is composed of several professionals with different

Application setting: context

The centre was established on the basis of the experience of the Astalli Centre’s outpatient clinic, comparing the needs that patients report every day and the difficulties they find in addressing the public health system.
Forced migrants, whatever their legal status (asylum seekers, refugees or claimants) is, have the right/duty to register with the national health system and can therefore turn to public health facilities just like Italian citizens.
Unfortunately, the experience of the Astalli clinic shows that this right is not fully exercised. In addition to linguistic and cultural obstacles (which can become insurmountable without the presence of an ombudsman), there is often a lack of awareness of migrants’ right to healthcare both on the part of users and health professionals, who sometimes may even end up discriminating and harassing migrant patients.

Objectives

The main objective is the take on responsibility of asylum seekers and refugees for up to 24 months. The Centre’s staff adopt a multidimensional, inter-disciplinary and intercultural approach in order to:

promote and facilitate access to public health care;
inform patients about their rights and about relevant sources of information.
educate healthcare professionals about migration medicine topics.
ensure cultural-linguistic mediation to overcome the barrier of language and intercultural communication.
promote systemic approach to multidimensional trauma

Activities

The Centre is opened from Monday to Friday, the access is free, and offers the following services: reception office, healthcare orientation office, counselling area, intercultural mediation service, day hospital ‘general medicine’, day hospital ‘ethno-psychiatry’, psychological service, legal medicine service, day hospital of ‘gynaecology and obstetrics’, day hospital of orthopaedics, vaccinations.
SaMiFo also promotes the training of public and private social health professional through courses, seminars and meetings aimed at enhancing knowledge of the phenomenon of forced migrants and sharing of good practices. Throughout the years, several training meetings have been organized for the Territorial Commissions for the recognition of international protection. As part of the awareness-raising activity, the second volume of the Quaderni del Samifo entitled Pregiudizi (Prejudices) was presented.

Results

The centre has supported a relevant number of migrants in the past few years, by providing services such as: psychological support, mentoring, health guidance, legal counselling, assistance with legal procedures, translation/interpretation services, referrals, counselling, social support, housing support, facilities for temporary housing, among others. The centre also promotes and/or organises cultural activities and initiatives that promote the host country culture in order to facilitate the adaptation of migrants and promote intercultural dialogue.
From July 2006 to December 2014 Operators have guaranteed healthcare assistance to 9 thousand asylum seekers and refugees who have undergone 38 thousand general medical examinations and 25 thousand specialized examinations.
From July 1, 2007 to December 31, 2017 the multidisciplinary team of the SAMIFO Centre have taken care of more than 11,000 asylum seekers and refugees who have undergone 58,000 general medical examinations and 37,500 specialist examinations. Front office operations are aimed at increasing asylum seekers and refugees’ wellbeing by means of reception and orientation programmes aimed at raising awareness of their rights and responsibilities when accessing health services. About 300 victims of inhuman and degrading treatment, including torture, are assisted every year by the SAMIFO centre

Difficulties or constrains for its implementation

The Italian healthcare system is highly decentralised, since the Ministry of Health provides the guidelines and principles by which each region needs to abide. This is why it is possible to identify good practices at regional level.
Staff shortage especially on islands, lack of interpreters in emergency departments, and lack of suitable accommodations for vulnerable populations in Greece
Lack of training courses on intercultural awareness, infectious diseases, specific healthcare needs, and the consequences of adverse experiences such as trauma, violence, and trafficking targeted at health and social care professionals in Italy.

Strengths

Formal and informal networking with public institutions and private companies working in the city or at regional and national level. In fact, it is not enough to have trained specialists provide services focused on trauma recovery but it is necessary to promote also psychosocial interventions.
Social-health care and collaboration between public (ASL Rome 1) and private social services (Centro Astalli) to answer the demands of those who need both health services and social protection measures.
Presence of experienced general practitioners who work on health protection of forced migrants. Close cooperation with specialists from SAMIFO and the outpatient clinic: investigations and therapies, use of emergency services (118 and DEA), healthcare costs.

Weaknesses

The fact that users often have a blind trust on the gynaecologists’ opinions does not encourage active participation as they will abide by the indications given to them. They lack a critical attitude which would help them manage their healthcare issues in a more independent way. In an environment such as that of SA.MI.FO, this behaviour is certainly heightened by the fragility of the condition of many users.

Year and length (duration)

The Health centre for asylum seekers and refugees was established in 2006 in partnership between Centro Astalli Association (Jesuit refugees services) and a public hospital (Azienda ospedaliera Roma A). It cooperates with local authorities, including public bodies and institutions and international institutions or NGOs.
In 2018, the SaMiFo made use of the contribution of the European project FARI (Formare, Assistere, Riabilitare, Inserire), which allowed to strengthen some areas of intervention and offer an effective service to migrants in need of specialised care.

CRITERIA actors or stakeholder are using to assess them as a “good practice”

Sustainability of the centre: the economic stability of SAMIFO centre is ensured by the appropriate use of financial and human resources, including linguistic and cultural mediators. Only part of the activities is supported with project funding, which help the centre perform its functions and enrich the services offered. The Centre guaranteed usability and therefore fair access to hospital services, facilitating the appropriate use of the services and favouring the early detection of the most severe conditions of vulnerability.
Accessibility (location). It is located in the ASL Outpatient Clinic, near Piazza Vittorio and Termini Station, places which have always been very popular amongst migrant communities. Therefore, they can easily access it, knowing that their right to health will always been guaranteed.
No waiting lists (e.g. facilitated routes for persons in a particularly vulnerable condition, both internally or through structured collaborations with other public and private health services (INMI L. Spallanzani, Umberto I Polyclinic, INMP, SMOM and Caritas, etc.).
Culture and gender-oriented approach has allowed to overcome prejudices about pathologies, including mental ones, ensuring a system of reception and care services which considered gender issues.
Attention to the condition of all social and health care professionals working daily with victims of violence and torture, through the sharing of organisational and clinical choices during weekly meetings. Trainings and refresher courses on clinical, geopolitical, legal and social and medical issues targeted at healthcare professionals so as to increase their knowledge and prevent or mitigate stress.