When a virus (Covid-19) attacks human rights: The situation of asylum seekers in the medico-legal setting

The Covid-19 pandemic – like other disasters – strikes hardest on the most vulnerable people such as refugees and asylum seekers and requires a coherent, effective and inclusive international approach to protect everyone’s life, irrespective of their legal status.¹ Since Covid-19 appeared in Italy for the first time, in the central Mediterranean Sea, humanitarian relief efforts have stalled, leaving most asylum seekers detained in Libya indefinitely or left to die at sea. Services to asylum seekers have been slowed down or suspended, and workers from humanitarian non-governmental organisations are redirected to support the Covid crisis.

There are millions of refugees and migrants in camps and detention centres around the world. Resettlement procedures have been suspended by the United Nations. UNHCR reports that 34 countries hosting large refugee populations have seen the local transmission of SARS-CoV-2.²

Refugees and migrants are potentially at increased risk of contracting diseases, including Covid-19, because they typically live in overcrowded conditions without access to basic sanitation.³

In a Lancet paper, the leaders of WHO are calling for more attention for refugees and migrants, including in humanitarian settings, who are facing the interruption of essential supplies of food, medicine and help from humanitarian workers.⁴

The situation is the same in Italy where the overcrowded reception structures (CAS, CARA, HUB, CPR and hotspot) are not able to protect asylum seekers’ health.

It is built into the system dealing with requests for asylum that the legal medicine institute of the University of Palermo guarantees irregular migrants the right to access a forensic clinical service available for all victims of violence, torture and female genital mutilation.⁵

From May 2018 to March 2020, about 118 asylum seekers who alleged that they were victims of torture were medically evaluated, and each of them was provided with medico-legal certification which is taken into account when they request a grant of political asylum from Italian territorial Commissions.

The interviews and clinical examination carried out according to the Istanbul Protocol can put a strain on the migrant who has to recall the serious trauma suffered which requires the applicant to establish a good and trusting relationship with the forensic doctor. However, this relationship of trust is threatened by long bureaucratic delays which often cause the migrant to deteriorate into a spiral of anxiety and discomfort with regard to his future.

To date, the Covid-19 pandemic has increased the sense of despair and bewilderment among hundreds of migrants who, according to the International Conventions in place, are deserving of refugee status and who feel abandoned by the system.

Since the beginning of the official lockdown for Covid-19, this medical legal service, which is not expressly focused on strictly medical and health purposes, has been discontinued and all legal processes related to obtaining asylum status or other forms of protection have been frozen. Indeed, on 12 March, the Italian government suspended interviews for refugee status determination (RSD), and appeal hearings of rejected asylum requests given court closures.

This led to a block in the regularisation system of migrants, increasing their vulnerability and exposing them to specific health risks: the migrant without a residence permit, in cases of mild illness (fever, mild cough), does not go to routine health facilities, but in the most serious cases, he/she has no alternative to the emergency services contrary to all the protocols in place that aim to contain the spread of the virus. Irregular migrants are afraid to go to hospital because they could face a check that would lead to expulsion or to detention in a stay centre for repatriation. The migrant is forced to improvise housing solutions, in often degraded and unhealthy environments, shared with other people.

The need to regularise the status of hundreds of thousands of people as soon as possible should be clear: contain the risk of contracting the virus, so that they can take advantage of public health services in case of suspected symptoms and do not become another vehicle for transmission of Covid-19.

This pandemic can only be controlled with an inclusive approach, capable of protecting the right to life and health of each individual. Migrants and refugees, and especially those without official documents, are vulnerable and at risk of exclusion, stigma and discrimination. It is vital that everyone, including migrants and refugees, is guaranteed access to appropriate medical services and considered within national response plans to Covid-19 which provide access to preventive measures, tests and therapies. This will not simply protect the rights of refugees and migrants, but will also protect public health and contain the global spread of Covid-19.