Luigi Leonori SMES - Europa No Health without Dignity no integration without dialogue and participation Key Words : Dignity – Health and quality of.

Luigi Leonori SMES - Europa

No Health without Dignity no integration without

dialogue and participation

Key Words: Dignity – Health and quality of services Access and Barriers to services; Integration – Insertion - Participation; Welcome – Respect - Rejection ; Private dispensary & institutional services; Right & Duties - Needs & Adequate answers

Basic reflections : migration has always existed, but today it is a real political ( polis) challenge concerning the whole of society.

Due to rapid and uncontrolled globalization and of a lack of far-sighted and courageous migration policy - our cities are seeing increasing numbers of migrants living in situations of discrimination and exclusion, with dramatic consequences for health.

Health passes through dignity: there is

no integration without participation

LIFE DENIED !..





If this are a man !

Spain Rescues 65 Migrants From Sea, 2 Die ; Survivors from the boat recuperate on the foreshore 3 of 65 were taken to hospital with hypothermia, after making port in Playa de Santiago

Lampedusa, 16 June (AKI)

Thousands of migrants, who perished as they tried to reach Italy by sea, will be remembered in a monument to be unveiled on the island of Lampedusa. Laura Boldrini, spokesperon for the United Nations High Commissioner for Refugees, talked :

"We are getting used to the deaths of migrants,"

In the last few years, many things have changed in this country. Italy and Italians have changed.

Only last month, a total of 101 illegal migrants died in the Mediterranean Sea as they attempted to reach Europe from North Africa.

Italy has the European Union's longest coastline - 4,500 kilometres - making it difficult to police and thus a preferred destination for migrants.

Italy: Dead immigrants to be honoured with new memoria




Life… before alldenied !..

Fortress Europe: Immigrants dead at the frontiers of Europe According to the following press review at leat 12,566 people have died since 1988 along the european frontiers. Among them 4,646 were missing in the sea. 8,824 migrants died in the Mediterranean sea, and through the Atlantic Ocean towards Spain 1.594 lost their life trying to cross Sahara desert in order to reach Boat arrivals in the Mediterranean (Italy, Spain, Greece, Malta, Cyprus)

• 2007: 51,000 • 2008 (until mid June): Italy: 7,793 (of which 7,185 in Lampedusa) Greece: 3,8473 Cyprus: 449 Spain: 4,120 (Canary Island 2,837)

WHO ARE ?... Between choice & obligation

Very divers conditions between migrant and Ulysses !..

Migrants coming from many traumatic experiences and circumstances in their native country, including

• extreme poverty, • exposure to war, ! human trafficking ! • natural disasters,

Migrants are forced … ! new slavery ! to support their families, to submit…, to accept all kinds of jobs, even though they may have the training and education for professional jobs.

The exploitation of migrant seasonal workers without work permits is a new form of colonialism and slavery.

WHO ARE ?... Between choice & obligation

Very divers conditions between migrant and Ulysses !..

• Exposure to traumatic conditions in own country, coupled with new & local difficulties in

‘acculturation – integration …. many time it means : abandon of own identity in order to be acceptable ! ! ’

can lead to serious and long-lasting psychological and behavioural problems, including :

• depression, • anxiety, • post-traumatic stress disorder, • high risk - unfortunately not only risk - of suicide.

Everyone has the RIGHT to the best available mental health services within the health and social welfare systems!

(U.N. Resolution 46/119, 1.1, 1991)

A decent society is one in which the institutions

do not humiliate people benefiting from their services

No HEALTH without Mental Health

no MENTAL HEALTH without Dignity

no DIGNITY without RIGHT

no RIGHT without ACCESS to rights, resources and services for : * health * house * job * education * leisure.

SSanté anté MMentale entale etet EExclusion xclusion SSociale ociale

MMental ental HHealth ealth andand SSocial ocial EExclusion xclusion

EEuropean N Network in favour of etwork in favour of Homeless and M Homeless and Mentally ill entally ill PPeopleeople

www.smes-europa.org [email protected]

http://www.smes-europa.org/

mailto:[email protected]


Why SMES-Europa is interested in the migrants and especially in the migrants undocumented

Target of SMES-Eu are : disadvantaged and excluded people in reason of extreme poverty and suffering of mental health problems and/or diseases :

home-less : men and women “home/belonging ‘, this includes all what need person for well being

mentally ill people without adequate assistance,

young people at risk of losing viable society’s contact,

addicted to alcohol & drugs,

ex/prisoners,

elderly people who have been abandoned,

migrants without full/real integration

MIGRANTS & HOMELESS

Similarities

• Poverty, humiliation, shame, despair, the loss of identity, the loss of social links, the need to forget with alcohol and drug and finally pulsing to make it ended with the life… ;

• Migrants in this un-existential situation joins the our European homeless who are marginalised & discriminated, rejected & excluded.

and differences :

• the personal resources of migrants that are more important

that homeless; resources at level of health, culture, courage

and desire of success, when they are not also they completely destroyed and without hope

• the second great difference consists in the right of residence closely link with the birth and the nationality.

by Luigi Leonori SMES - Europa


At least three among the more significant reasons:

1. immigrants nombre : because among the local, national and European homeless, in the European metropolises, there are immigrants more and more either `accidentally and temporarily’ homeless, or in a permanent way, with the risk of chronicisation.

2. complexity of needs : because there are a very great similarity between the complexity of the problems and needs for the ones and others, despite everything the differences given especially by the ”not belonging” (on the ground, community, culture, ecc.) : .

3. in reason of workers: very often are the same workers which works as well in the field of social as that of health and mental health for the ones and for the others.


In the field of immigration, in European Union some countries have a long experience in the immigration area whereas others have only just started developing national policies. But in both, the practitioners of health & mental health care and of social services met more and more migrants with very important and complex social and health/mental health problems and needs.

Despite national differences, in both the nature & severity of the problem, discrimination and exclusion especially concerning “homeless people (local – national – European and immigrants”, this epiphenomenon is a structural problem in European society and constitutes a political challenge for Europe.The building of the “European Community” must take place within a framework of respect of right, participation in citizenship, access to citizen’s services and of solidarity.

LIFE DENIED

No Health without Dignity no integration without dialogue and

participation

Key Words: Dignity – Health and quality of services Access and Barriers to services; Integration – Insertion - Participation; Welcome – Respect - Rejection ; Private dispensary & institutional services; Right & Duties - Needs & Adequate answers

Basic reflections : migration has always existed, but today it is a real political ( polis) challenge concerning the whole of society.

Due to rapid and uncontrolled globalization and of a lack of far-sighted and courageous migration policy - our cities are seeing increasing numbers of migrants living in situations of discrimination and exclusion, with dramatic consequences for health.

Immigration policy Today the lack of real social policy and preventive and far-sighted migration policy in Europe have as consequence that the number of homeless in precarious health and social situations will continually increase as well of homeless migrants.

BUT the “homeless migrants” – the majority without a residence permit and therefore considered non-existent - are also deprived of identity and human rights: health - housing – work.

For this reason the migration problem becomes an

• urgent issue in public health & mental health, • a test of civilization and democracy, • a promotion of respect of human rights and of active solidarity.

Inter-personal & inter-cultural

DIALOGUE

RIGHTS - INTEGRATION

Rights: The human rights “derive from the inherent dignity ofthe human person”.. In this respect, both the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social and Cultural Rights (ICESCR) 1996

Integration : by European Commission : a two-way process based on

reciprocal rights and concomitant obligations of legally resident third-country nationals and the host society. Integration means that the longer a third-country national is resident in a Member State, the more rights and obligations he should acquire

by Dear Kenan: Integration means not simply mutual

respect and tolerance between different groups but continual interaction, engagement and civic participation


Immigration, integration & employment in EUROPAhttp://europa.eu/scadplus/leg/en/cha/c10611.htm

Patterns of immigration flows in the EU

7. The Member States have a long tradition of immigration, which, on the whole, has contributed positively to economic growth and labour market adaptability. In 2000, third-country nationals living in Europe represented around 5-6% of the total population of the EU

Economic role of immigration & its impact on employment

9. Many studies carried out by (ILO) or (IMF), among others,have shown that immigration has had an undeniable positiveeffect on employment and growth for two reasons: it increases thesupply of labour and tends to have a positive influence on thedemand for products.Moreover, in general, migrants are not taking the jobs of nationalworkers.

THE PRIORITIES (?)

http://europa.eu/scadplus/leg/en/cha/c10611.htm

THE CHALLENGE OF INTEGRATION: A HOLISTIC APPROACH

The Commission stressed, in its Communications of 2000 and 2001 on Community immigration policies, the need for a holistic approach which takes into account not only the economic and social aspects of integration but also issues related to cultural and religious diversity, citizenship, participation and political rights

Integration into the labour market 14. …to reduce by half in each Member State the unemployment gap between non-EU and EU nationals by 2010…make employers aware of this diversity and its advantages

Education and language skills Housing problems

16. The lack of affordable quality housing in ethnically mixed areas is a problem many migrants encounter.Comprehensive urban and regional planning strategies taking into account, for example, housing, transport, health services, school facilities and the needs of the labour market can help to overcome ethnic and social segregation in cities and its consequences.

Health and Participation

Health and social services17. Immigrant populations may suffer from particular health problems (poor living conditions, problems arising from the uncertainty and insecurity in which they find themselves), but they often have difficulties accessing high-quality health and social services. An increased participation of persons with different ethnic backgrounds in the planning and delivery of these services should help to prevent discrimination and ensure that the services take account of cultural barriers

Social and cultural environment18. The active involvement and participation of immigrants in civil life and particularly in sports and other clubs is an important step in adapting. Promoting a generally positive attitude in the public towards immigrants requires strong political leadership in order to avoid resentment and the rise of racism. Politicians and the mass media have a major responsibility in their role as educators of public opinion

Indivisibility of the Right for a real integration

Start point : "health and wellbeing are at the base of real integration“

• Indivisibility in the RIGHT: to health - to work - to housing (declaration of the universal human right art 23-25), as exists a strict interconnection for the HEALTH: wellbeing physic - psychic - social.

If the policy of integration does not go from pair with the policy of the welcome and respect (=access to) of right health – housing – job, which are the condition sine qua non for the real & concrete integration & participation in citizenship, the risk of homelessness and mental disturbs for immigrants is very important.

A strict interdependence exists between people who welcome and people who ask hospitality, but only with inter /mediation & dialogue - trough the health - between all and sundry there, will be possible building the citizen integration.

Mental health problems of Migrants People

The European Commission Green Paper: "Improving the mental health of the population: towards a strategy on mental health for the European Union" (2005) notes that migrants may be particularly vulnerable to mental illness and may be linked to low social and economic status. G. P. proposes EU strategy could focus on :

- Promote the mental health of all;

- Address mental health through preventative action;

- Improve the quality of life of people with mental ill health or disability through social inclusion and the protection of their rights and dignity; and

- Develop a mental health information, research and knowledge system for the EU.

Mental health problems of Migrants People

The person who migrates suffers a sense of loss and faces wide changes in his everyday life, ranging from language to culture, from status to social relations.

The decision to migrate is often related to situations of extreme poverty, violence or persecution. The current restrictions to asylum seekers at arrival render refugees more vulnerable to trafficking and increase the risks related to migration.

Finally, the settlement in the host country is often complex, not only because of language and cultural differences, but also to racism, unemployment, limited access to well-paid and legal jobs and difficulties related to status legalization.

The numerous losses experienced by the migrant, coupled with the potential high level of distress prior to migration, are an undeniable source of stress which renders migrant populations particularly vulnerable.

HEALTH NEEDS ….

Dispensary of MSF in Brussels ¾ of patients don’t have valid residence permit, the others having for the majority of the temporary residence permits (tourist, petitioning visas of asylum...) Many of patients are youth (58% between 20-40 years; 10% more than 50 years) and mainly the men (56%). The patients are often worried by their future, are stressed by their current living conditions, because of their statute and about their social condition. They are sometimes still blocked and suffering because of even traumatic memories of their country of origin. They have a great mistrust compared to all the official structures, even of health, on which they are in addition badly informed.

HEALTH NEEDS ….

Exactly like for the homeless, pathologies met are absolutely related to the living conditions:

ostéo-articular pathologies (11%), due to irregular work and under bad conditions;

gastro-intestinal pathologies (11%), related to the stress;

the respiratory pathologies (13%), supported by housing conditions not always ideal;

dermatological problems (7%), increased by the promiscuity and the lack of hygiene.

psychological or psychiatric problems: many of patients were seen specifically for this problems.

Project MED-INTI : MEDIATION - INTEGRATION

AIM of the project MED-INTI: (mediation /mediterranean)

The underlying principle is: the integration pass trough the respect of human right, especially “holistic health : physical – psychical - social“, and – consequently – the access to the National system and services. Integration through health and mental health promotion” is to coworking, exchanging of experiences, knowledge and know how between workers for immigrants and workers for homeless, who in SMES network from many time are working for “Dignity & Health”, in order :

a) to promote Mental Health for immigrant people as for homeless: its means in the street, in the housing or shelters, but also in CTP to prevent the mental health problems and disturbs,

b) to diagnostic, accompany and take care as soon as the mental disturb beginning the immigrant as the homeless.


In order to promote “peer learning & working” the project propose:

1. Knowledge : to collect in synoptic way the legislations concerning the health system and right of access for all people, in relation with EU recommendations.

2. Analyze of barriers & facilitations in access to health/ mental health services. Barriers internal of users, of Institution’s workers, of civil society.

3. Exchange of reflection and experiences: realising 4 or 5 exchanging mini program comprehensive of lesson by expert on a priority definite topic, study visits, workshop for exchange and proposals.

4. Dissemination of information by reports & seminars.


AIM of MED-INTI Project

The aim of the project MED-INTI: (mediation /mediterranean) integration through health and mental health promotion” is to coworking, exchanging of experiences, knowledge and know how between workers for immigrants and workers for homeless, who in SMES network from many time are working for “Dignity & Health”, in order :




AIM of MED-INTI Project

The aim of the project MED-INTI: (mediation /mediterranean) integration through health and mental health promotion” is to coworking, exchanging of experiences, knowledge and know how between workers for immigrants and workers for homeless, who in SMES network from many time are working for “Dignity & Health”, in order :




OBJECTIVES

1.Research/action: Not enough is known; rather we seek: to identify innovative services, to develop and evaluate new interventions, to translate knowledge into practical action

2.Information and heightening of awareness : SMES promotes awareness in society as a whole, and more specifically among social and health workers, policy makers and mass-media.

3.Networking : SMES is an European network improving opportunities of working together and promoting multidisciplinary co-operation, co-working professional salaried and not people, voluntary ad volunteer people.

4.Education and training : SMES works for the promotion and dissemination of effective projects and practices by means of study days, seminars & conferences. The intention is to offer an opportunity to workers, ex/users and their relatives, immigrants of exchanging ideas, experiences and know-how.

PREVENTION & INTERMEDIATION

WELCOME: the good policy of welcome of people in need every time is the 1st step for real integration process.

If we don’t would find the local health centres and social assistance services full up of immigrants in health & mental health needs, we must have an important action of prevention and intermediation. We must create a strict collaboration in observing & knowing, analysing & research, training & informing between association working for homeless, health centres of national health system and trans-cultural mediators.

Its absolutely important also to promote dialogue with civil society, in order to prevent once again the most serious recrimination that can address to the immigrants: who occupy the places in Health and Social National Services (hospitals, ambulatory, working, housing, etc.) that are up of right to the national ones.


PROPOSAL for ACCES to HEALTH SERVICES

Vis-a-vis to a foreign population in precarious situation, the question of the access to the health care should be approached, by a multidisciplinary approach.

This one allows

a work of quality in spite of complex problems;

the offer of service optimized, thanks to the pooling of competences, around the patient;

A good communication, horizontal relations between the various speakers, the primacy of the team work, are important conditions for a work of quality.

It’s necessary to forge respect, not fear of other


Entitlement and Access to health servicesglobal approach

Migrants should be entitled to the full range of mental health services in response to their needs. To ensure that the appropriate range of services are available for all kind of migrants, independently from their current status, documented/ undocumented in the transit and/ or destination country.

Migrants should have access to mental health services A distinction must be made between entitlement and access. The former is achieved by legal and policy rules and procedures. Access, however, is a less tangible and more complex phenomenon.

The Services offered should be integrated and appropriate to the needs of Migrants

We also acknowledge the need for global approaches contemplating mental health promotion, mental disorder prevention, treatment, alcohol and other substance abuse services (where appropriate), psychosocial rehabilitation and social inclusion


QUESTIONS

Some questions exchange knowledge, information and practice:

HOPE : in what way don’t destruct & delete the hope of this people ? RIGHTS INFORMATION in what way we offer to all migrants complete information about rights: judicial - social – health ? RIGHTS ACCESSIBILITY : what kind of access to Health / Mental H. services and social services for illegal migrants? What about comprehensive, coordinated, continuous health & mental health services for migrants? What does integration means without active inclusion and participation ? WHAT ABOUT TEMPORARY HOLDING CENTRES and individual and family or mass expulsions?

Luigi Leonori SMES - Europa No Health without Dignity no integration without dialogue and participation Key Words : Dignity – Health and quality of.

Documents

participation slide

dignity health

illegal migrants

deaths of migrants

mediterranean italy

santiago slide

participation life

new memoria slide