Cultural mediation & the experiences of people in transit in Italy Emilie Venables, Qualitative Researcher, MSF MSF Scientific Day, Johannesburg, 2016

MSF in Europe Support to migrants landing in Lampedusa in 2002 Search and rescue in Mediterranean since 2015 Medical and psycho-social support in Greece, Serbia, France and Italy Training of fishermen in Tunisia in search & rescue In 2015, European policies led to a dramatic worsening of the refugee crisis

MSF in Rome MSF provided support to two transit centres in Rome in 2015 Tented camp and ‘Baobab Centre’ Daily visits to provide information and assistance Psychological First Aid (PFA)

Methodological approach Qualitative research to explore people’s needs and experiences – August 2015 Participant observation 20 in-depth interviews Interviews transcribed word-for-word by hand: no audio-recordings Challenges: lack of privacy, mobility, other priorities

People in transit Majority of people were Eritrean Men, women and children – including unaccompanied minors Arrived in Italy after crossing Sahara and Mediterranean Sea Onward travel to other European countries Stayed in the centres for a few days

Migrant experiences Long, harsh journeys from countries of origin Eritrea, Sudan, Ethiopia, Libya Majority were Eritrean, escaping persecution and forced military service in their own country Experienced traumatic events in country of origin and on their journeys: Torture, beatings, imprisonment, sexual violence, witnessing death, separation from families, kidnapping Dangerous land and sea crossings Confusing and stressful arrival in Italy

“The situation was tough when I arrived “The situation was tough when I arrived. I missed so much information because I couldn’t remember it. We just couldn’t believe that we had arrived safely. All I cared about was arriving here safely. I wish we could just go and arrive where we want to go.”

Providing medical and psychological services in transit Many people did not want to access health-care services in an Italian facility Fear of being ‘fingerprinted’ and registered Fear of beginning treatment that prevents them from travelling Do not want Italy to be their final destination

What are people’s main needs? Health needs Informational needs Skin irritations and scabies Exhaustion, stiffness and general pain Dental treatment Treatment for wounds and injuries Psycho-social support and counselling Geographical information How to buy train tickets Legal rights & implications of finger-printing How to access money How to contact family members How to access resources in transit centres

“I don’t need anything else now…everything I need is here.” Recognition of needs People did not recognise their right to have needs Expressed contentment when basic needs were met: clothes, shelter and food Compared current situation to rest of their journey Did not want to ‘complain’ Fear and suspicion in accessing formal services and structures Struggled to express needs because of language and cultural barriers “I don’t need anything else now…everything I need is here.” 22 year old Eritrean male

What is cultural mediation? Cultural mediators work with migrants to build trust Essential to the work of MSF and other NGOs in Europe Creates links with communities Provision of: Information Reassurance Familiarity Psycho-social support More than direct translation Cultural mediators understand the backgrounds of their beneficiaries.

When is cultural mediation needed? MSF uses cultural mediators across all activities with migrants in Europe: During search and rescue activities On landing During transit During psycho-social support sessions During medical consultations

Building trust Difficult for people to know who to trust…especially in transit Dependent on ‘people who speak my language’ Open to exploitation Reliance on informal networks across Europe Cultural mediation helps build trust

Challenges of cultural mediation in Europe Not enough trained cultural mediators Numerous languages required (Tigrinyha) Limited courses in cultural mediation available Cultural mediators may be working simultaneously for different organisations Work context can be difficult Cultural mediators may be facing their own trauma

Conclusions Providing support to people in transit in Italy is complex Challenging to provide services when needs or rights to health-care not recognised More recognition of the role of cultural mediators required Qualitative research has a role in improving quality of operations and understanding beneficiary population