The international humanitarian medical organisation Médecins du Monde (MdM), which has been providing health services to irregular migrants at Malta’s open centres since April, made harsh criticisms yesterday on the migrants access to health care services.

Moreover, the organisation found that the “deplorable” living conditions in Malta’s open and detention centres contributed towards, and were many times responsible for, a host of

physical and psychological ailments typical of people who were vulnerable, detained and lived in overcrowded conditions with unsatisfactory sanitation.

Such ailments include a range of dermatological, respiratory and psychological afflictions – often brought on by living conditions at detention and open centres.

The medical NGO’s final report of its mission in Malta, entitled Everybody just tries to get rid of us, found that “the precarious living conditions in the open centres are a relevant factor for the development or aggravation of a variety of different diseases and disorders”.

Conditions at detention centres, meanwhile, “remain detrimental and do not conform to standards set for people deprived of their liberty”. Among the main areas of concern are the existing overcrowded conditions, the “appalling” sanitary facilities, a total lack of meaningful activities and a restriction in the amount of fresh air and sunshine.

Among the living conditions of most concern were that many detainees, including children, enjoyed access to fresh air and sunshine for just two hours a week – as pointed out in the case of Lyster Barracks at Hal Far, severe overcrowding, a lack of suitable sanitary facilities and basic furniture such as chairs and tables, and the fact that hundreds of people lived in cramped tents and common rooms all year round.

Yesterday, the NGO called for an immediate improvement in terms of overcrowding at Malta’s open and detention centres, a restriction of cohabitation between the sexes to a minimum, the provision of drinking water for pregnant women, lactating mothers and babies, as well as giving all detainees the rights to regular meaningful activities and to go outside.

Vulnerable people, it was exemplified in yesterday’s report, were detained at Lyster Barracks, divided into groups of five, and each group was given one hour of out-of-doors time twice a week.

Referring to conditions at the Hal Far “tent city”, the NGO found the fact that no one was responsible for the maintenance of sanitary facilities as holding the potential for a “deplorable standard of hygiene”. The presence of rats at the open centre was also regularly observed.

The NGO also cites that up to 24 people are housed in a single military tent, with temperatures reaching 40 degrees Celsius in summer and falling to eight degrees in winter, while rain regularly penetrates the tents in the winter months.

The situation is expected to deteriorate further as the population at the tent city is expected to grow from the current 700 or so asylum seekers to close to 1,000 in the near future.

The sharing of rooms and tents by up to 25 people at both Hal Far and Marsa compounds health problems by creating conditions in which skin conditions such as scabies, as well as minor and major communicable diseases, are spread.

Many times men are housed together with women and babies, which presents a serious concern about sexual harassment.

The organisation called for an immediate change to Malta’s detention policy, which, it said, sees men, women and children being detained for a maximum period of 18 months in what it described as a “clearly inhumane practice that harms the somatic and psycho-social health of the detainees”.

Another area of concern was the fact that vulnerable asylum seekers such as pregnant women, children and babies were sometimes detained for up to six weeks and more.

MdM called on the authorities yesterday to ensure that pregnant women, mothers with babies and children are not detained any longer than the absolute minimum period of time. The NGO listed a series of examples in which babies and pregnant mothers were kept in detention, against the government’s own policies, for some two months.

While the government’s policy towards vulnerable people was, overall, “commendable”, much still needed to be done.

In addition, the NGO pointed out that there was no clear procedure for identifying migrants as vulnerable on medical grounds. It called on the authorities to extend the definition of “vulnerable persons” to include individuals with chronic health problems, including those related to mental health.

The ward for migrants at Mount Carmel Hospital, meanwhile, “leaves a lot to be desired”, with patients being locked up all day without any access whatsoever to fresh air.

Also speaking yesterday, Fr Paul Pace from the Jesuit Refugee Services added: “There is no provision of any mental health service in detention, even though it is obvious that detention and its accompanying uncertainty, even in the best of conditions, creates high levels of stress, anxiety and sleeplessness.

“This is exacerbated by the fact that many detainees have been through traumatic experiences on their way here. Yet there is no psychiatric nurse, much less a psychiatrist, who visits the detention centres regularly. The conditions in the ward reserved for immigrants at Mount Carmel hospital leaves a lot to be desired; inmates are locked up all day with nothing to do and with hardly any access to fresh air.”

In addition to its work at the open centres at Marsa and Hal Far, the organisation had also wanted to offer a range of medical services at the detention centres, a request denied by the government. Moreover, the NGO says, it was even denied access to detention centres.

Asked on what basis the NGO had been denied access to detention centres, MdM medical coordinator Dr Niklas Luhmann explained that he had requested such permission some two-and-a-half months ago, but had not received a reply or an explanation from the Justice and Home Affairs Ministry.

“We regret very much that we were not able to help improve and support the health care being given at detention centres.”

Replying to the point yesterday, the Justice and Home Affairs Ministry explained it had told the Immigration Principal that there was no problem with the NGO visiting detention centres, and that since medical treatment was being provided by a private contractor at detention centres, it had recommended the NGO offer its services at open centres instead.

Health care at Malta’s detention centres is being supplied by a private organisation, Medicare Ltd, which supplies the services of a doctor and nurse from Monday to Friday between 8am and 1pm at a cost of Lm35,000 per year, and MdM called on the government to institute a similar arrangement for the open centres.

The NGO also raised serious concerns over the fact that single men and women were being held in detention together at Lyster Barracks. The organisation called on the government to ensure that single women were at no time held in detention with men.

Since April, MdM had provided primary health care and prevention services for asylum seekers and refugees at the Hal Far and Marsa Open centres for 10 hours a week. The NGO had carried out 410 medical consultations over the last four months, during which time it had systematically collected data on the main occurring pathologies and problems of public health and conducted face-to-face interviews with 167 asylum-seekers on their main problems in accessing free medical and specialist care in Malta.

The survey’s results show a variety of problems in access to free medical care and treatment for asylum-seekers. The report also underlined that, through its services, MdM was able to ease such problems, while also preventing and treating different diseases, with the effect of lessening the load on St Luke’s Hospital and government health centres.

Although asylum seekers are screened systematically for tuberculosis upon arrival in Malta, MdM said yesterday that no such screening is undertaken in relation to HIV/AIDS or other sexually transmitted diseases. Nor are there any preventive activities such as the distribution of male condoms, educational activities or peer-to-peer support.

During its time in Malta, the NGO held preventive workshops for women with a focus on sexual and reproductive health at a number of Open Centres in Arabic, French and English, while condoms were also handed out to males.

Dr Luhmann notes frequent reports by asylum seekers of discrimination when it comes to accessing medical care. “We have observed there are colleagues in Malta who do their best, but many migrants feel they have been discriminated against. This is a problem in that they are not always accessing the best medical care in the public

service – the title of the report says it all.”

In accessing health services, the NGO found that some medical doctors in Malta “feel an antipathy towards asylum-seekers and that an important fraction of doctors try to get rid of asylum-seekers as quickly as possible.

“We witnessed as well that most of the doctors put on one or two pairs of gloves for whatever the medical examination. Even in cases of chronic illness, the patients were not provided with appropriate follow-ups.”

The NGO adds that regularly doctors were found to be unaware of the entitlements of asylum-seekers, which are the same as those of a Maltese Pink Card holder, and many times do not write prescriptions on prescription paper that denotes free medication.