IL FENOMENO MIGRATORIO

Morrone A.

7° Congresso Nazionale SIMIT
Bergamo, 19-22 Novembre 2008

Introduction
Migration has been going in throughout the history of mankind, from the moment of man’s first appearance on this earth to the present day, and has completely reshuffled both the human geography and the sanitary conditions of the planet.
Migration has always been a complex social and political phenomenon, with considerable implications of a social and health nature. It implies the journey towards more favorable lands but it involves, however, also an element of danger and illness when the journey takes place. The word “ journey” itself has a semantic link with illness. In Greek, the original meaning of the noun ep?deµe?a and the verb ep?deµe? signify “to stay”, to arrive in a foreign place and remain there.
The WHO defines immigrants, refugees, political exiles, migrant workers, travelers and tourists who for any reason move from one country to another, as Human Mobile Populations. According to the WHO in 2007 they numbered 1 billion and 350 million, of which 200 million were emigrants looking for work. So at present what was once thought to be an illness typical of a specific geographical area, for example in the tropics, can now be found anywhere, especially in the northern hemisphere, the goal for most of the immigrants.
Nowadays Italy, mostly because of its geographical position and its initial lack of legislation regarding immigration, serves as a gate to Europe for thousands of immigrants and has done so since the mid 1980s. According to the official data on immigration in Italy, in January 2007 there were 3,690,052 foreigners with a regular permit-of-stay, whereas over 1 million were the undocumented immigrants.
At the beginning of the most consistent flow of the migratory phenomenon, the state of health of the immigrant was defined as “healthy migrant effect” because the emigrant was substantially a healthy, educated, young adult who had chosen to emigrate rather than being forced to it by necessity. Today this is only partially true and the immigrant falls ill more easily than before. From a large data collection, the immigrant appears to be a strong, young person, psychologically stable,
healthier than average. Being healthy is the only resource he has for himself and for his family, whose members has often to wait a long time in their country of origin before being able to complete their migratory project. Shortly after arrival in the country of destination his “heritage of health” with which he left his country slowly begins to disappear (“the interval of well-being”), due to a number of risk factors: psychological hardships, lack of work, working in dangerous jobs with no labour protection, poor living conditions, lack of family support, climate, different food habits which often lead to nutritional problems, and discrimination when in need of the health service. The time between the immigrants’ arrival in Europe, Canada, USA or Australia and the need for them to see a doctor is gradually getting shorter. Illnesses, named “hardship illnesses” or “degradation illnesses” can soon manifest themselves. If these are not properly checked, other illnesses can follow, not necessarily limited to the immigrants but also found where there is social marginalization, for example among the homeless. These can be classified as “poverty illnesses”: tuberculosis, scabies, pediculosis, some viral infections, mycotic and venereal diseases.
Considering the importance of the immigration phenomenon, since 1st January 1985 a Department of Preventive Medicine for Migration has been opened in Rome, at San Gallicano Institute. The Service is particularly addressed to regular, illegal and clandestine immigrants, homeless, nomads and those having health problems but without a health insurance card. Moreover, the Department is open to agents of tourism, missionaries, travelers from and to tropical countries, providing specialized tests, visits and updated information on the prevention of the most common diseases in tropical regions. For years, the Department has represented the only public referral point not only for assistance and treatment but also for medical-epidemiologic, social, anthropologic research
concerning immigrant, nomadic and homeless populations.
Between 1995 and 2007 we examined 94,746 regular and irregular immigrants, 45,587 (46,6%) females and 49,678 (53,4%) males. We identified some cases of tropical diseases (mycetoma, sporotrichosis, lombomycosis, paracoccidioidomycosis, blastomycosis, cryptococcosis, philariasis, myasis, loiasis) which were very probably contracted in tropical area and then imported in Italy.
The tropical diseases in immigrant population increased from 6% in 1995 to 27% in 2007.
In the developing countries, poverty, that is deprivation as far as longevity, lack of education, poor health service are concerned, affects about a quarter of that population in January 2005, San Gallicano Institute has opened a dermatological hospital named Italian Dermatological Hospital (IDH) in a village near Mekele, the capital city of the Tigray region, in Ethiopia. Communicable diseases and nutritional problems are major health problems in this country. Malaria, Tubercolosis,
acute upper respiratory infections (AURI), diarrhoeal diseases, skin infections and HIV/AIDS are among the top disease burdens.
A total of 26,461 outpatients were examined at the Hospital between January 2005 and September 2007. The main skin diseases registered were as follows: infectious dermatoses (41%), scabies (16,1%), primary pyoderma (6%) and viral infections (3,2%); among non infectious dermatoses we recorded eczematous dermatitis (22,4%), pigmentary disorders (11%), acneic dermatitis (6,4%), lichen planus (2%), psoriasis (1,6%), prurigo (4’3%) and annexal diseases (2,1%).
Various skin disease surveys conducted in developing countries have concluded that skin diseases are very common, but little information is avalaible about the magnitude and burden of skin diseases in the general population of northern Africa.
References
MAHE A., FAYE O., FANELLO S., Public health and dermatology in developing countries, Bull Soc Pathol Exot. 2003 Jan;96(5):351-6
MORRONE A., Poverty, dignity and forgotten skin care: dermatology in the system of human mobile population. Dermatol. Clin. 2008 Apr; 26(2):245-56
MORRONE A., Global dermatology, MNL, Bologna, 2007