Our experience in migrants’ and refugees’ shelters in Milan, Italy 

Migration is a dynamic phenomenon that requires active engagement of stakeholders working in different sectors and, in general, of the community as a whole to allow a humane and effective support to those in need. In recent years, migrant influxes towards the European shores increased in 2015 because of the tightening of civil tensions and conflicts in some parts of the globe. Following such a large arrival of migrants, the EU system for asylum application, relocation and resettlement, was rapidly overwhelmed. Likewise, public health agencies responsible for the health of individuals were burdened with a tremendous amount of work. 

The experience in Milan’s shelters
In Milan, Italy, between 2015 and 2018, we participated in a project focussed on tuberculosis (TB) prevention and care for those migrants arriving in the city as a result of the Italian relocation scheme. The project was coordinated by the public health agency of Milan, with the expertise of physicians of the Istituto Villa Marelli which serves as the regional reference centre for TB. As University of Milan, we were involved in producing evidence and best-practice guidance. The interventions applied to safeguard the health of migrants included screening for TB infection and disease, confirmation of diagnosis, and offer adequate treatment. 

The most difficult task was to care for the health of those migrants affected by TB who could suddenly be relocated within the EU thus interrupting ongoing treatment and jeopardizing their health as well as permit continuous transmission of the infection. Key element to avoid such risks was the engagement in multi-lateral discussions with key people so that relocation could be halted until treatment completion or supported through the provision of sufficient medicines to complete therapy.  

Another problem was the saturation of the service which resulted in a wide temporal gap between the two phases of the intervention (i.e., screening and diagnosis). This, together with the distance between migrants’ shelters, where asylum applicants were hosted and screened, and the healthcare facility, where diagnosis and care were provided, resulted in people not able to comply with medical appointments. 

Multidisciplinary is the key
Many care providers have a narrow vision of the problem faced when caring for vulnerable populations. As a result, some key supportive measures may be neglected thus undermining the effectiveness of the entire intervention if adjustments are not introduced. In our case, the distance among facilities and the lack of coordination had negative effects. This taught us that a multidisciplinary team, with physicians, nurses, social workers, lawyers, and urban planners, is necessary to achieve results and better care for migrants. 

The principles learned are currently being applied to another vulnerable community in Milan: homeless people. To date, the diagnosis of both TB infection and disease can take place directly in homeless’ shelters. This will ultimately allow more people to be well taken care of and not to fall ill in the future. 

Advocacy matters, but also vision
Every intervention that seeks to alleviate illness or unhealthy conditions among vulnerable communities requires funds and visibility to reach its goal and provide access to health for every person, especially those whose rights are denied.  

Apart from advocacy aims, it is enriching to see major health issues from a different angle as it helps in covering the multiple aspects that such a complex phenomenon entail. Therefore, our experience in Milan should be seen as a starting point for a wider discussion on how to improve health of migrants and refugees at all levels and how to ensure they can access the best possible care and prevention interventions. 

Conclusions
Given her extraordinary commitment and achievements and her love for the poor, marginalised people, Mother Cabrini has been made by the Catholic Church the Patron Saint of Immigrants. Her entire life was devoted to efforts in relief of the sufferings and the struggle for survival of migrants and other vulnerable people around the world. Today, with scientific evidence applied to field operations, we have the responsibility to ensure that her vision is translated into the most effective interventions for all those who are marginalised in society and yet have a full right to access health with dignity through that spirit of solidarity and social justice that Mother Cabrini herself championed. 

**The International Health Commission (IHC) is a collaboration of health professionals and MSCs that provide guidance to strengthen the MSC sponsored health ministries.  Prof. Mario Raviglione is a member of the IHC and together with Dr. Simone Villa , they illustrate for us a contemporary and intelligent example of the outworking of the charism in improving the health and lives of migrants and refugees.** 

Prof. Mario C. Raviglione, M.D.is a Full Professor of Global Health at the University of Milan and Honorary Professor at Queen Mary University of London. In 2003-2017, he was Director of the Global TB Programme at the World Health Organization. 

Prof. Raviglione graduated from the University of Turin in Italy in 1980 and trained in internal medicine and infectious diseases in New York, as Chief Medical Resident at Cabrini Medical Centre, and in Boston, as an AIDS Clinical Research Fellow at Beth Israel Hospital, Harvard Medical School. 

Currently Prof. Raviglione is the Director of the Global Health Centre and Coordinator of the on-line Master degree program in Global Health (MGH) at the University of Milan. 

Dr. Simone Villa, M.D.,  is an Italian medical doctor and research fellow at University of Milan where he works on the EU Patient-cEntric clinicAl tRial pLatform (EU-PEARL) project concerning the drug R&D of drugs against TB. Currently, his work is focused mainly in the field of TB, especially in vulnerable groups (e.g. homeless, migrants), and COVID-19.  Dr. Villa has graduated from the Medical School of the University of Milan in 2018 and is currently an MGH student of the on-line course held by Prof. Raviglione at the University of Milan.  


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