Over the past year, SIMM has launched a campaign aimed at certifying the unsuitability of migrants for detention in Centers for the Temporary Stay of Migrants (CPRs). This campaign calls on medical professionals to refuse to certify the “suitability” of migrants for detention, given the severe and harmful conditions in these centers, which have been widely documented as posing significant risks to detainees’ physical and mental health. The initiative has garnered significant attention within the medical community, urging healthcare professionals to prioritize migrant health and human dignity over institutional demands. Recently, SIMM has expanded its efforts with a new appeal to the National Federation of the Orders of Physicians, Surgeons, and Dentists (FNOMCeO), calling for a strong stance against the involvement of medical professionals in CPRs, requesting that it be declared that no healthcare professional, acting in accordance with Article 32 of the Italian Constitution and the Medical Deontological Code, may provide, nor be forced to provide, their professional services in CPRs to allow their operation, both in Italy and abroad, as CPRs lack the essential safeguards for detained individuals and are contrary to the professional ethics of care.
In recent weeks, not only the FNOMCeO but also the National Council of the Order of Psychologists have responded to the appeal by taking a stand against the CPRs and those who collaborate with them.
To support this, we interviewed Nicola Cocco, a physician specialized in infectious diseases,member of SIMM, previous consultant to the National Guarantor of the Rights of Persons Deprived of Personal Liberty, and an activist for the abolition of administrative detention”.
1. What are the most frequent physical and/or mental health problems you observe in people detained in CPRs? How do the conditions of detention contribute to the deterioration of migrants’ physical and psychological health?
In my visits to Italian immigration detention centers (Centri di Permanenza per il Rimpatrio, CPR) as a consultant to the National Guarantor of the rights of persons deprived of personal liberty (Mauro Palma) or as a collaborator of members of the Parliament and/or regional councilors, I have always met people with health problems. Problems of infectious diseases, chronic-degenerative diseases and above all mental health issues. These are also reported every day by people detained in CPRs, for example to the SOS CPR switchboard of the Naga association and the network Mai più lager No ai CPR in Milan. The context of CPRs amplifies pathological conditions, for example worsening problems of skin diseases, due to the great hygienic-sanitary degradation of the places, or even due to the inadequate management of chronic diseases such as diabetes mellitus and its consequences. As regards mental health, administrative detention in itself is a very serious depressant, anxiety-inducing and in some cases psychogenic thorn. All these pictures are set in a context of degradation, suffering, violence and abandonment that often have outcomes of desperation, which manifest themselves for example through self-harm and suicide attempts. From this point of view, I believe that a real manicomial drift is taking place in the Italian CPRs for detained migrants, and this in Franco Basaglia’s country is a social disgrace before it is a public health emergency. These are simply pathogenic and psychopathogenic places.
2. The systematic use of psychiatric drugs in CPRs is now well documented. In your view, is this a clinically justified response to actual therapeutic needs, or rather a way to manage and contain the psychological distress caused by detention itself? What risks does this practice pose to the health and dignity of detainees?
During my visits I have been able to ascertain that at least 70% of migrants detained in CPRs are on at least one psychotropic drug, compared to (at least in theory) 0% of psychiatric diagnoses confirmed and taken into care as such, since the current legislation states that people with “psychiatric disorders” should not be in CPRs at all. This means that the majority of that 70% is made up of pure sedation. Sedation in CPRs represents a huge medical-ethical problem, since the health personnel of the centers, hired directly by the private managers who have them under contract, do not have the psychiatric skills to manage and monitor most of those therapies, which in fact end up in pure sedation. This is functional and I would say also ancillary to the needs of the police forces, for whom clearly a sedated CPR is better than a protesting CPR. The dramatic aspect is precisely this: the interests of the management body, of the police force and, dramatically, of the detainees themselves converge in the abused and improperly used psychotropic drug for sedation. Exhausted by the living conditions in the CPR, they have told me several times “Doctor, I just wish I didn’t have to wake up tomorrow morning”.
3. Can we speak of an asylum-like drift in CPRs? In what ways do the current healthcare management practices and the use of psychiatric drugs risk further transforming these facilities—already created with a function of containment and control—into spaces with a psychiatric vocation?
As previously stated, the legislation does not provide for the possibility of detaining people with mental health issues in CPRs. This is indicative of an awareness of the detention-exclusion system of CPRs that it cannot represent a place of care for people with mental health problems (among which, in my opinion and from a public health and prison medicine perspective, drug addiction problems should also be included). Instead, people with mental illnesses or who develop symptoms and even complex mental pathology during detention are present in considerable numbers in all CPRs everyday. This is despite the often ineffective referral to specialist psychiatric evaluations and, even worse, the use of ad hoc collaborations with psychiatrists from the National Health Service (SSN) who periodically enter the CPRs, effectively normalizing the presence of people with mental illness in the centers themselves. To quote Franco Basaglia, the sum of bars, psychotropic drugs and “technicians” (psychiatrists) does not make for a “happy prisoner”, but rather gives rise to a madhouse. In these terms I reiterate that there is a manicomial drift in Italian CPRs, which can only be resolved by closing them and abolishing administrative detention. These places cannot be places of psychiatric care, since they are psychopathogenic in themselves.
4. As a doctor, what are the most serious ethical, deontological and legal implications of serving or declaring medical fitness for detention in CPRs, given the conditions inside the centres?
In order to be sent to CPRs, the law requires that migrants must be assessed by a doctor from the National Health Service (e.g. in an emergency room) and certified as “fit” for life in the CPR itself. This aspect, although presented by the institutions as a protection of the most vulnerable people (with an instrumentalization of the concept of vulnerability that persists for example in the management of sending people to the centers set up for the Italy-Albania Agreement), in fact asks doctors who do not know the people or the centers to which they are destined to endorse a detention-expulsion path. The characteristics of this assessment, which for example practically never includes informed consent or even linguistic-cultural mediation, actually configure it not as a medical act, but as a nihil obstat requested by the police. This undermines numerous medical ethical principles, from the independence of the professional to the protection of health as the primary objective of medical work. Furthermore, in light of the evidence of pathogenicity and psychopathogenicity of CPRs and administrative detention, serious doubts arise on the ethical legitimacy of being able to issue certificates of suitability for sending to centers that have been internationally defined as “torturing environments”. Article 32 of the Italian Medical Deontological Code specifically provides that the doctor must protect his patient, especially if vulnerable, from places that put their health and human dignity at risk. In addition to these important ethical implications, medical-legal doubts also arise: what is the responsibility, for example, of the doctor who issues a certificate of fitness for life in the CPR for a person who after a few days manifests a health problem, even a serious one, or even acts of self-harm or suicide (as we have unfortunately had the opportunity to see in recent years)? This is a question that the prosecutors and medical associations should answer. As SIMM, ASGI and Rete Mai più lager No ai CPR, for a year we have launched a Campaign for certifying doctors who we ask, on the basis of the requests described above, to consider as unfit all migrants who are brought to them, since in the CPR their health and their lives would be at risk.
5. What has been the response of the medical community, and more broadly the healthcare sector, to SIMM’s call to refuse any form of professional involvement that supports the functioning of CPRs, including the issuing of medical fitness for detention? Has the appeal helped spark public debate and raise awareness of the serious issues within these centres?
Both the aforementioned Campaign for certifying doctors and the recent appeal that we as SIMM addressed to the National Federation of the Orders of Physicians, Surgeons and Dentists (FNOMCeO) have as their main purpose the awareness of health professionals on the enormous critical issues presented by the CPR system and administrative detention. This has allowed us to bring the discussion to numerous places where the doubts of Italian doctors have arisen, starting from emergency rooms, from the medical departments involved in the fitness examinations, up to universities and professional and union organizations. I hope the recent support that the FNOMCeO has given to our appeal will become an authoritative guide for the involvement of the Orders of Doctors, which represent the maximum guardians of medical ethics in this country. Obviously we are still talking about very small numbers compared to a public opinion that, conditioned by a propaganda of institutional racism, is blind to the suffering of the people detained in the CPR. Still too often I hear from some doctors phrases like “if the law asks me, I give the fitness certificate, no matter what I think”, or “if they are in there, it is because they have done something bad”. This is a historical period in which only a radical awareness, such as the abolitionist one regarding immigration detention, can protect professional ethics from the populist and dehumanizing discourse that is prevailing at an international level. Our appeal is only one voice, we hope it will be able to find many echoes.
