La Strada SiCura: “Social, Humanitarian and Migration Medicine”

La Strada SiCura is a community founded in Trieste, Italy, by a group of doctors with the goal of eliminating health discrimination. The community is a newly established NGO who targets disadvantaged groups such as migrants. Their work is mainly located near the train station of Trieste, offering treatment opportunities and material support such as food and clothing to migrants walking through the Balkan route. We talked to the community about their organizations and their areas of activity. 

Could you tell us briefly about the foundation of “La Strada SiCura” within the context of the COVID-19 pandemic?

La Strada SiCura was born as a project of migrant, social and humanitarian medicine under the strong need, produced by the covid19 emergency, to act to protect the right to health of vulnerable populations, such as migrants and the homeless. 

Italy was the first country, after China, to be greatly impacted by the global health crisis caused by covid19: this brought on the need to find extremely rapid solutions for both health and social situations to prevent the spread of infection and to guarantee adequate hygiene measures for people living on the streets and in transit. 

In this context, between March and April, our group was born. We considered it of essential importance to act as quickly as possible and so we started to target the effects of the pandemic on certain categories of people, specifically those left behind by the institutions.

The covid19 emergency was a decisive push to found our association, however, it must be said that an important source of motivation stems from the willingness to pursue a global concept of health. This not only concerns medical needs but is represented by a set of factors that affect the patient and that must be taken into account in order to achieve physical and psychological well-being. These factors include: culture, history, country of origin, life goals and migratory plan, religion, and economic status among many others.

What are your main activities? 

Our main activity takes place in the street near the central train station of Trieste, one of the first cities of Western Europe on the border with Slovenia which is often the point of passage and arrival of migrants who undertake the Balkan Route. The station is a real crossroads between people who arrive, depart and decide to remain; it is a meeting place for a multitude of people, cultures and stories. 

At the station we work as doctors to prevent health discrimination, to report the existence of double standards of care between the resident and foreign populations, to bring medical materials and care and to disseminate information on the prevention of contagion to homeless people and migrants in the street. 

After about a month, we also started to work in emergency centers for unaccompanied foreign minors, where children under 18 years of age are taken in to carry out the mandatory 14 days of quarantine before they can access the centers for minors that will take care of their integration and education.  Here we offer medical examinations for a range of milder pathologies and support the centers in dealing with non-urgent health situations. 

The other main activity is of a digital nature and is carried out through our website: in the blog we deal with various topics with health as a central theme, but we also cover health-related topics such as culture, economics, politics, and religion.  

Your work is based on practice by its nature. You take this work out of your cabinets and move it to the streets. How was this experience?

Working in the street certainly demonstrates the difficulties of operating in an environment lacking the ambulatory comforts we are familiar with. One of our main objectives is to use the medical practice acquired in hospitals and to adapt it to the precarious and unpredictable context of the street, as well as to the complexities and needs of the patients we meet and visit. Working in the street forces us to have more spirit of adaptation, faster problem solving abilities and the ability to make medical decisions not only on the basis of the disease but also considering the patient’s migration plan, legal status, culture and country of origin. 

This is achieved through constant work of mediation, presence and dialogue that allows us to obtain a transcultural approach which is focused on the individual in a global sense, not only strictly medical. 

La Strada SiCura is a recent organization born in challenging circumstances. However, in one month you have reached an important number of people in need. How do you evaluate your work? And what are your projects for the future?

In recent months we have been trying to address the total lack of action of the health institutions, and so our work resonates greatly. We want to give dignity of care to those who don’t have it. As we pointed out in our April report, during the peak of the pandemic we visited almost 200 people and this work continues daily even now. About the future? We are working in a dynamic way and are attentive to how the scenarios change day by day. We have short- and medium-term projects in place: training projects, discussion round tables, and field activities. In reality, our goal is to no longer be essential.

What are the effects of the COVID-19 pandemic on migrants depending on your observations in the field?

The last month and a half of work has been particularly intense, not only because of the COVID-19 health crisis which has introduced important challenges for the prevention and protection of the health of the most vulnerable groups, but also because of the complex situation that the health crisis has produced on the Italian-Slovenian borders. In fact, more and more violations of human, health and legal-international rights are taking place. For example, the practice of pushbacks, often in chains, from Italy to the Balkan countries and even as far as Turkey, the concerning increase in border surveillance carried out by informal armed and dangerous militias, and the increase in controls by government authorities. All of these factors produce an “accordion” migrant flow of arrivals onto the Italian territory: one day we may see the arrival of 20 people, other days not even one. In fact, many are intercepted, stopped, persecuted, driven back, often in difficult sanitary conditions. This makes our work unpredictable and of an emergency nature. 

Witnessing this discrimination, our presence on the street increasingly calls us to take a position of health activism. 

Among our future projects, we hope to set up a free access social medicine clinic in the street, which will not only become a point of reference for health needs, but also a crucial centre for the observation and testimony of the migrant, humanitarian and social health situation. 

You define your work as “social, humanitarian and migration medicine”. What does this understanding of medicine means to you?

Daniele: Humans exist as individuals only if they interact, engage and learn from each other. In a vision of man as a complex system of emotions and relationships, it’s easy to see how the social dimension becomes a fundamental factor for health. 

Medicine is a powerful and transversal instrument that allows us to create intimate and complicit relationships with people, and is the one I have chosen to engage with world around me. 

Dimitra: Social – Public health must be accessible to everyone and must take care of the individual in his or her totality. Humanitarian – We are not diseases but human beings who live and grow in a cultural and social environment that influences us deeply. Migrant – In the world in which we live today, migrant medicine becomes central to any medical activity because it requires an understanding and a response that takes into account the life and culture that we carry within us and makes us who we are.