Doctors and medical practice shouldn’t be instrumentalized by political choices

It is known that at least 1,220 women, men and children lost their lives in the central Mediterranean in 2022, counting more than 20,000 deaths in the central Mediterranean since 2014. At the same time, so far in 2022, more than 20,700 asylum-seekers, refugees, and migrants have been reported as rescued or intercepted by the Libyan authorities. Meanwhile NGO ships continue to fill the void left by states in the central Mediterranean. 

What is happening in the Mediterranean Sea is the results of EU policies on migration starting from the EU –Turkey deal in 2015 and the MoU between Italy and Libia signed in 2017 when the Italian authorities have also started taking measures, including seizing ships and launching criminal as well as administrative investigations to address actions by NGO-deployed vessels considered to exceed their rescue-at-sea activities. From “Angels” to “Vice Smugglers”: the Criminalization of Sea Rescue NGOs in Italy | SpringerLink 

It represents a new chapter of a long-lasting campaign of criminalization of solidarity and violation of human rights of people on the move carried out by the Italian Government. 

As demonstrated by official data collection and analysis, there is no relation between presence of NGO vessels and new departures. Sea rescue NGOs : a pull factor of irregular migration? (eui.eu) 

Despite government influences and changes in decrees, the role of NGOs has continued to remain less than 15% of total landings: according to official sources, almost 9 out of 10 migrants reach the Italian coast without the help of NGO boats.  

This campaign against SAR operations carried out by NGOs and civil society vessels is not only an Italian matter but is backed up by other Med Countries: Greece Malta & Cyprus who have recently issued a shared statement on a dispute over a deal for Europe to jointly help asylumseekers. Italy, Greece, Malta and Cyprus say they can’t take so many migrant arrivals | Millet News  

Recently tensions between Italy and France has also raised based on new measures to manage SAR operations approved by the Italian Government. 

Providing assistance to people in distress at sea (search and rescue – SAR) is a duty of all states and shipmasters under international law. Core provisions on SAR at sea are set out in the 1974 International Convention for the Safety of Life at Sea (SOLAS), the 1979 International Convention on Maritime Search and Rescue (SAR Convention), and the 1982 UN Convention on the Law of the Sea (UNCLOS). 

The rules on rescue operations at sea are laid down in the United Nations Convention on the Law of the Sea, an international treaty that provides in Article 98 the “obligation to render assistance” to “anyone found at sea in distress”. Italy is among the countries to have joined this treaty and has signed the Dublin Convention provides that the country of first entry into the European Union is the one responsible for examining the asylum application presented by the migrant. 

Specifically on November 4th, the Italian Ministry of Interior together with the Ministry of Defense has issued a decree-law requesting doctors of MoH to carry out selective dismemberments based on medical vulnerability. 

The selective disembarkation process, based on the medical conditions of the survivors, and the delay in disembarkation carried out by the Italian authorities are inhumane, unacceptable and illegal.  

Under international maritime law, survivors rescued at sea must be disembarked in a place of safety within a reasonable time. The relevant legal instruments and guidelines do not condition disembarkation in a place of safety on the existence of medical conditions or other reasons. 

Beside being against all International regulations (see below) this decree puts the medical practice at the center of a political choice that is against medical ethics.

As a medical association MdM cannot remain silent and condemns the instrumentalization of doctors and medical practice. 

Since the establishment of the latest Italian government, the campaign of criminalization towards search and rescue operations run by the civil fleet in the Mediterranean Sea has resumed. These dynamics were already known during Salvini government when legal proceedings were opened between 2016 and 2019, mainly against NGOs operating at sea. 

The Italian Government, through the Ministry of the Interior, the Ministry of Transport and Sustainable Mobility and the Ministry of Defense, is once again carrying out activities of criminalization and contrast to search and rescue operations in the Mediterranean Sea that some humanitarian organizations conduct to make up for the lack of institutions. 

The Decree of 4 November 2022 of the aforementioned Ministries prohibits one of the ships in question from “stopping in Italian territorial waters” “beyond the deadline necessary to ensure rescue and assistance operations for people in emergency conditions and precarious health conditions“. 

Government conduct is also contrary to the principles enshrined in the 1951 Geneva Convention on Refugees and, in the first place, to the principle of non-refoulement (Article 33). 

The illegitimate attempt to disembark only some of the shipwrecked and reject all the others without distinction outside national territorial waters is, objectively, a form of collective refoulement, prohibited by art. 4, Protocol 4 to the ECHR; activity, for which Italy has already been condemned in the past. 

As MdM denouce another alarming aspect which we consider unacceptable from an ethical point of view.  According to the above-mentioned decree-law the selection of shipwrecked people is based on health screening to be carried out by Maritime, Air and Border Health Unit’s doctors. This means that it is requested to doctors to select those individuals who “deserve” to desembark. 

We therefore do not understand how having spent months and years in Libya suffering torture, rape and violence of all kinds, and being forced to attempt the crossing of the Mediterranean on precarious boats without food and water, such as to determine in many cases death on board from asphyxiation, crushing trauma, hypothermia, hunger and dehydration cannot be considered a condition of sufficient vulnerability. 

  • We request to the Italian Governement and to the MoH in particular to withdraw the Interministerial Decree of 4 November 2022, in compliance with the prohibition of collective refoulements 

We request to EU member states: 

  • That all coastal States respect their obligations under international conventions, cooperating for the success of rescue operations and the rapid identification of a safe port of disembarkation for shipwrecked persons 
  • A predictable mechanism of disembarkation of survivors is established that ensures timeliness and disembarkation in a place of safety, where the safety of life of survivors is guaranteed and their basic human needs can be met.
  • Develop a European public search and rescue mission in the Central Mediterranean, the deadliest migration route in the world to date.

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