Focus ROMI.HR

Roma who came to Italy throughout the centuries had enough time to integrate in Italian society, although with many difficulties and challenges due to historical developments that put these communities at the very margins of society. Conversely, those who arrived in more recent years are still deeply in the middle of the process of integration, which, as it has been written, is proceeding quite slowly, with harmful consequences on the Roma population.

It is well-known that the majority of Roma in Italy have been living for a long time in poor conditions: their settlements are often outside of cities, sometimes without running water and unsafe electricity grids and unsafe gas pipelines. Their isolation has tragic consequences also in other aspects of their lives: for example, the distance from city centers and schools often discourage parents and children from attending classes; the discrimination they have to face in several different contexts encourages Roma to remain in their “echo chamber”, in the sense that they can only interact among themselves, reinforcing the sense of separation between Roma and non-Roma and pushing away any actual possibilities of deeper connection between the two groups. The same logic applies for any job seeking process: due to general low levels of education, sometimes accompanied by Roma’s lack of proper knowledge of the Italian language, often puts them in a disadvantaged position whenever applying for jobs, especially whenever they are competing with Italians.

As it has been remarked in the previous articles of this series about the conditions of Roma in Italy, any problem experienced by these communities is deeply interconnected with all the others: it would be almost impossible to improve the living conditions of Roma without offering them a serious educational program or the chance of being selected for job positions that could let them earn their living in more “formal” ways. Clearly, the same logic applies to the analysis of the health conditions of Roma in the country.

There is no very recent data on the health conditions of Roma in Italy. An interesting, although quite outdated report from the Ca’ Foscari University in Venice released in 2016, found out that Roma people generally suffer from considerably worse health conditions compared to the rest of the population, mainly due to the lack of specific national and local policies that aim precisely at reducing this gap. The report is based on a study which collected relevant data on the health conditions of 1142 Roma living in the outskirts of Milan between January 2009 and December 2010. Among the most common pathologies that affected Roma, the most frequently diagnosed ones were related to the respiratory system, including different kinds of infections to the upper airways (namely, the nasal cavities, sinuses, pharynx and larynx). Other recorded diseases included the orthopedic ones, together with illnesses affecting the gastroenteric apparatus and teeth diseases. Arguably, the majority of these pathologies can be linked to the poor living conditions in settlements: indeed, Associazione 21 Luglio, an Italian organization that works actively to improve Roma lives, refers to these diseases as “ghetto pathologies” because they are caused, more often than not, by poverty and precarious hygienic and sanitary conditions. 

However, just a general overview of the problem won’t likely be enough to actually grasp the gravity of the problem, because different groups of people are often affected by different diseases. The first example in this sense concerns Roma children, whose levels of vaccine coverage are far from homogenous across Italy. There have been vaccination campaigns organized by local authorities to target specific issues, such as the measles epidemics that broke out between 2006 and 2008 in various Italian regions, because clinic tests had shown that only a small percentage of Roma children had been adequately vaccinated against this disease. Moreover, the already mentioned lack of complete and updated is a significant problem in this respect as well, because it is incredibly challenging to reach out to all those who should be vaccinated against some pathology if their vaccination record is missing or, even worse, they are not even recognized by the healthcare system. As an example, in 2013, following the first National Strategy for Equality, Inclusivity, and Participation of Roma and Sinti (Strategia Nazionale di uguaglianza, inclusione e partecipazione di Rom e Sinti), the National Institute for the Promotion of Health among Migrant Populations (Istituto Nazionale per la promozione della salute delle popolazioni Migranti, INMP) developed a project to raise awareness on the importance of vaccines among Roma. The first step of their action concerned obviously a research for data, and the result was quite discouraging: according to an official document, the only available information they had access to dated back to 1997, and it showed that only 30% of Roma living in Italy were properly vaccinated against infectious diseases that are particularly dangerous during childhood.

A similar discussion can be developed when talking about female and reproductive health. The abovementioned 2016 report remarks the lack of sufficient data on pregnancy and delivery among Roma women, therefore it is much harder to understand the general trend at the national level. However, various researches carried out locally all show that the majority of Roma women skipped the recommended health checks during pregnancy, and that only 3 out of 76 interviewed women attended birth classes. Interestingly enough, the whole sample for the study gave birth in the hospital, but only few mothers regularly attended health check-ups to make sure that their children are growing up correctly. Additionally, a 2012 research showed that Roma women tend to declare worse health conditions than men: according to these data, 81.3% of interviewed men described themselves as healthy, whereas only 72% of women did so. 

Lastly, men and, in a smaller fraction women, often have to deal with various addictions, mainly alcoholism. Unfortunately, the available data is insufficient to offer any kind of analysis, because sources only report this tendency without providing more detailed information on the problem. Surely, a major role here is played by marginalization, as well as widespread psychical distress affecting Roma. A 2010 document published by the Italian Red Cross, also pointed out the sharp increase in the number of Roma with serious drug addictions, without significant differences in terms of age or gender.

However, one should not forget that “health” is a very broad category that encompasses both physical and mental wellbeing. Even though there is even less available data in this respect compared to the previously analyzed ones, it is not hard to believe that forced evictions, marginalization, discrimination and, more generally, the very tough living conditions to which Roma are subject can have a brutal impact on their mental health. This is especially true among children and teenagers, who are more likely to develop traumas and various symptoms related to depression, as well as hallucinations, panic attacks, major anxiety, and insomnia. 

Now, a question may arise: is there any other factor that may be influencing Roma people’s health? An answer may come by looking at the Italian legislation on how to access national healthcare for foreigners. In general, regular and irregular migrants are equated to Italian citizens in terms of their possibility to obtain emergency care as well as essential treatments, and are able to participate in preventive medicine programs. Obtaining a residence permit or the Italian citizenship is clearly the easiest way to access the National Healthcare System (Sistema Sanitario Nazionale, SSN), because it means that patients will be recorded in the database, and doctors will be able to get all the relevant information on their conditions, including pathologies, needed medicines, allergies, and so on. However, in Italy the whole system is significantly decentralized, meaning that healthcare is provided locally and that regions can have different regulations and/or specifics on how to provide said healthcare. Although the approach is not bad per se, it makes data collection on Roma health way harder. Therefore, this must be kept in mind for the following paragraph.

According to a 2007 study, Roma tended to refer to emergency rooms for any health problem, because they are rarely aware of all the alternative ways to get professional support. For example, many Roma do not have a general practitioner/family doctor they can refer to, and who generally work as a filter between patients and hospitals. Other factors include the immediate and urgent need for medicines, which can be easily available in hospitals rather than in pharmacies, and the scarce diffusion of preventive measures, which often end up in critical conditions that need immediate treatment. Moreover, we must not forget how hard it is to understand complex information and procedures when they are given in Italian, a language in which many Roma are not fluent. In rare cases, cultural and linguistic mediators may be assisting doctors and nurses in their job, but this is still more of an exception rather than normality.

Recently, Roma’s poor health has been placed under the spotlight by the Covid-19 pandemic. As many probably remember, Italy was particularly affected by Covid-19, with thousands of deaths and hospitals almost collapsing because of how heavy the influx of ill people was. Thus, a large-scale vaccination process was urgently needed, to reduce the number of infected people and to protect them from the most serious symptoms. However, many Roma are, somehow, invisible to the eyes of administration, because their documents may be expired or even non-existing, or simply because their address has changed and not updated. This, summed up with language barriers and general biases, exposed them to a massive diffusion of Covid-19, and, once again, vaccination programs were set up by locally-active organizations which decided to administer vaccines also to vulnerable groups. Among them, the most notorious one is Comunità Sant’Egidio, which administered more than 25.000 vaccines to homeless, migrants, and Roma in Rome.

Clearly, the National Strategy for Equality, Inclusivity, and Participation of Roma and Sinti 2021-2030 (Strategia Nazionale di uguaglianza, inclusione e partecipazione di Rom e Sinti 2021-2030) could not overlook all these issues. Hence, there are four main objectives that should be achieved to guarantee better health conditions and an overall improvement of Roma lives, these being: carrying out systematic studies on Roma health and access to healthcare, to finally updated the available databases; training social and health workers on Roma’s approach to medicine, healthcare, and on the most frequent pathologies that affect them; developing consistent cooperation between health workers and cultural mediators to ensure that Roma can have the help they need to access the sanitary system; and developing educational programs to explain Roma how to access healthcare, what are the figures they should refer to to get the professional help they need, and introduce them to basic health checks that could improve greatly their living conditions. The point on data collection is actually quite important because it goes beyond the mere possibility to produce statistical analysis: indeed, without updated and consistent data it is impossible for any decision maker to produce informed policies that can actually improve Roma people’s living and health conditions.

In conclusion, it is even more evident that an impactful intervention to boost integration of Roma in Italy and to ameliorate their current status can only come by addressing all the different issues that are affecting them (housing, education, employment,...) in a coherent and cohesive way. Otherwise, everything will keep on being in the hands of thoughtful people and organizations which will try to implement temporary projects. However, nothing permanent will likely come, and no significant result will be achieved in the long term for Roma communities, which deserve instead to be treated with dignity, respect, and equally to all other groups.