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The Health of Foreign Romani Children in Italy: Results of a Study in Five Camps of Roma from Macedonia and Kosovo

15 December 2004

Lorenzo Monasta1

Introduction

The human rights situation of the Roma and Sinti populations in Italy is, from several perspectives, attaining crisis proportions. The plight of the Roma who arrived from Eastern and Southern Europe throughout the 1990s is of particular concern. The majority of them continue to live in unofficial or official camps throughout Italy2. The precarious conditions within the camps, the lengthy wait for regularisation of status and integration into Italian society, and the lack of co-ordination in policies undertaken by various local administrations call for thorough research into Roma access to social and economic rights in Italy.

Thousands of foreign Roma in Italy live in extremely precarious conditions. Whether they live in official or unofficial camps, Roma often find themselves in highly unsanitary environments. If one takes into account all of the foreign Roma now living in camps or other settlements within Italy (whether originally from ex-Yugoslavia or from other Eastern European countries) the total number of foreign Roma probably stands at over 20,000. Of these, Roma from Macedonia and Kosovo represent some 25-30 percent.

The camps for Roma are often located in squalid conditions on the outskirts of towns and cities. The majority of the camps lack sufficient personal hygiene facilities and most of the residents live in self-made shacks built out of waste materials. Moreover, it is difficult for many of the Roma to obtain documents which could give them access to housing and other social services available to Italian citizens and long-term residents. These factors have serious health implications for the residents of the camps and in particular for children.

In March 1999, the UN Committee for the Elimination of Racial Discrimination published a report in which the Italian government was criticised for their inadequate efforts to combat racial segregation and social discrimination of the Roma population who are excluded from access to basic services and participation in economic and social activities3.

Few epidemiological studies have investigated the relationship between the prevalence of diseases and the precarious sanitary conditions in the camps. What is more, no epidemiological studies have been found that include camps located in different Italian cities to allow for a comparison. There are studies regarding the various situations of 'gypsies' or 'nomads' in a particular city, but there is little common ground between them with regards to culture, life-style and living conditions. Researchers tend to lump Italian Sinti, Italian Roma, and foreign Roma of different nationality under the terms 'gypsies and nomads'. The very use of such terms does not allow for a full understanding of the culture and history of the aforementioned groups. For these reasons, it therefore became important to conduct a study on a population that was as homogeneous as possible, located in various Italian cities.

The results set out in this article are taken from a community epidemiological study on the relationship between living conditions and the state of health of children from 0-5 years of age living in five foreign Romani settlements inhabited by Khorakhané Romá originally from Macedonia and Kosovo.

Population and Methods

Mapping out of all the foreign Roma settlements in Italy gave rise to a list of camps from which those included in the study were selected4. The study was carried out in five camps, chosen for their different characteristics so as to represent the diversity of the country. These settlements, therefore, should not be taken as a representative sample of the various situations in which foreign Roma in Italy live. However, this selection allowed for a comparison between the living conditions and the state of health of the children in different environments and provided a basis for analysing specific policies relevant to the different conditions in the camps. In order to ensure that the population involved in the study was as homogeneous as possible, the only settlements taken into consideration were those inhabited by Roma from Macedonia and Kosovo.

The settlements chosen were: the camp in Via del Poderaccio in Florence, the camp in Via Rovelli 160 in Bergamo, the farmhouse called 'Camafame' in Via Chiappa in Brescia, the San Giuliano camp in Mestre/Venice and the Castel Firmiano camp in Bolzano.

The five camps studied are different in many ways: The time they were set up (ranging from 1990 for the camp in Florence to 1996 for the camp in Bolzano); their space (from 1500m2› in Bergamo to 7500m2› in Venice); the number of inhabitants (from over 300 in Florence to 80 in Brescia); the type of housing structure (brick structure in Brescia, self-built wooden bungalows in Bolzano and shacks in Bergamo, Venice and Florence); and the availability of sanitary facilities (unusable communal facilities in Bergamo, facilities for groups of families in Florence, and prefabricated units for individual families in Bolzano).

In gathering information various instruments were used. Before commencing the fieldwork, living in a camp was deemed necessary in order to strengthen contacts and knowledge from the inside, and from this to carefully prepare the research, the definitions and the instruments to be utilised. The fieldwork in the camps was carried out from the 10th of December 2001 to the 7th of March 2002 with a view to reducing the impact of the change in seasons on health conditions. The author conducted all of the interviews.

The main instrument was a questionnaire for a household survey. The questionnaire format was designed to allow the collection of epidemiological information regarding the health of the children, the habits and housing conditions of the families and access to health services.

The mother was the preferred interviewee in each family with children aged between 0-5 years. If the mother was not available, the interviewee chosen was the person who could most fully answer all the questions relating to the children. Where there were no children in this age group, a person was interviewed who could most fully answer the questions in the first part of the questionnaire which contained general questions about the habits of the family and the characteristics of the home. In each city, the interviews were carried out over a period of two or three days to ensure that the period referred to was clearly defined and limited.

Efforts were made to include all the families living in the camps covered by the study. In Florence, Mestre, Bolzano and Brescia some families were not included in the study because it proved impossible to locate them during the period in which the fieldwork was conducted. In Bergamo, several families were left out due to the degree of tension and severe instability – caused by overcrowding and poor hygienic conditions that permeated the camp and obviously hindered the research [Table 1].

Table 1: Number of families interviewed, of people officially at the sites and covered by the study, by city

                           Interviewed families                    People officially at the sites and covered by the study
City Number Percentage* Official Interviewed Difference
Florence 52 38% 314 304 -10
Bergamo 16 12% 156 85 -71
Brescia 13 9% 80 75 -5
Venice 24 18% 165 148 -17
Bolzano 32 23% 130 125 -5
Total 137 100% 845 737 -108

* The column indicates the percentage of the total number of families interviewed

A focus group, in which a guide comprised of eight questions was used, was held in each of the five cities with the mothers of children who had not yet reached their sixth birthday. This technique was used in order to look more closely into the health and illness of children and mothers' attitudes towards health issues. These issues cannot fully be tackled with techniques such as questionnaires and can benefit from assessments made in an interactive setting such as a focus group. These meetings were held in each camp after the interview work had been fully completed. The mothers of the children were identified during the interview and then invited to take part in the meeting.

Main Results and Discussion

Almost all of the camps considered in this study presented degrees of squalor. With regards to Florence, Brescia and Venice, the dumpsites were cleared next to the settlements only after the camps were set up. Aggressive and dangerous rats were seen in Florence, Venice and Bergamo, indicating unsanitary conditions. Furthermore, precarious housing structures don't always prevent the entry of rats, especially at night, and several attacks on children have been reported. The areas in which the camps were set up were often very poor prior to the construction of the camps and only aggravated the effects of the poor planning, lack of basic services and overcrowding in the camps.

The overcrowding in the camps of Bergamo and Florence was not simply a problem of habitability but also of safety. In the limited space of the housing units, highly inflammable materials and poor wiring systems could cause any domestic accident that would be fairly insignificant in a normal house to turn into a tragedy involving dozens of families. A camping gas burner that is knocked over, an electric heater that short circuits or a pan of boiling oil that tips over can destroy an entire settlement in an hour.

All of the camps were equipped with electricity, although in the Florence and Bergamo camps the wiring systems were in critical condition.

Only 39 percent of families had running water at home. Bathing was almost impossible in Bergamo where only two showers in dreadful condition were available; in Florence no showers were provided and in Venice showers were communal. In these three camps there were also serious problems regarding availability of hot water. During winter in Florence, the water pipes often froze, leaving the camp for days without water supply.

Throughout the research work being conducted in the five camps under consideration, 137 families were interviewed [Table 1]. In total, 737 people were included with an average of 5.4 people per family. Fifty-two percent of the people covered in the study were female (380/737).

On average, those interviewed had lived in these settlements – temporary camps both by definition and structure – for almost six years. This is enough time for children to be born, to grow, and to start going to school while their families continue to experience uncertainty regarding their status in Italy and the prospects of their integration into society at large.

The number of minors aged between 0-5 years was 167, distributed amongst 97 families. The age distribution of the children covered in the study is fairly regular, as is the gender distribution, with 48 percent males (80/167) and 52 percent females (87/167) [Table 2].

Table 2: Demographic characteristics of the children in the study from zero to five years, by city

City

Florence
N(%)

Bergamo
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Age            
0 14(20) 6(29) 3(15) 6(17) 4(21)  33(20)
1 10(14) 6(29) 3(15) 10(28) 3(16)  32(19)
2 9(13) 3(14) 6(30) 3(8) 4(21)  25(15)
3 16(23) 2(10) 2(10) 7(19) 3(16)  30(18)
4 13(18) 3(14) 4(20) 5(14) 2(11)  27(16)
5 9(13) 1(5) 2(10) 5(14) 3(16)  20(12)
Sex            
Male 34(38) 13(62) 8(40) 17(47) 8(42)  80(48)
Female 37(52) 8(38) 12(60) 19(53) 11(58)  87(52)
Total 71(100) 21(100) 20(100) 36(100) 19(100)  167(100)

 
Birth weight was recorded in 147 out of 167 children. Ten percent of the children had a birth weight of less than 2.5 kg (14/147). In Italy, according to reports by UNICEF and the World Health Organization (WHO), the percentage of children born underweight in the period 1995-99 was 5 percent. For comparison, countries with 10 percent of children born underweight include Egypt, Iran and Zimbabwe5.

The interviewees were asked whether, in the previous 15 days, the children had suffered from diarrhoea, coughing, skin complaints or other illnesses and whether and where the children had been taken to see a doctor with regards to each symptom.

Thirty-two percent of the interviewees (53/165) stated that their child had suffered from diarrhoea in the 15 days prior to the interview. The highest percentage was recorded in Brescia (50 percent, 10/20), while the lowest was in Bergamo (14 percent, 3/21) [Table 3].

No comparable data was found on the child population of Italy, but to provide an example, a study of more than 15,000 children under the age of five carried out in Bangladesh in 1999 produced a result of 9 percent (1424/15321).6

Table 3: Children who had diarrhoea in the 15 days prior to the interview, by city

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Yes 23(33) 3(14) 10(50) 11(31) 6(32) 53(32)
No 46(67) 18(86) 10(50) 25(69) 13(68) 112(68)
Total 69(100) 21(100) 20(100) 36(100) 19(100) 165(100)

Seventy-four percent of all the children who had suffered diarrhoea in the 15 days prior to the interview had been taken to see a doctor (39/53). Use of health services was highest in Bolzano and Florence with 83 percent, while Brescia had the lowest use at 50 percent (5/10) [Table 4].

Table 4: Children with diarrhoea taken to see a doctor, by city

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Yes 19(83) 2(67) 5(50) 8(73) 6 53
No 4(17) 1(33) 5(50) 3(27) 13 112
Total 23(100) 3(100) 10(100) 11(100) 19 165

With regards to diarrhoea, without considering the San Giuliano camp in Venice,7 the survey indicates that the proportion of children with diarrhoea in families that have lived in the camp for more than five years is greater than in those families which have lived in the camp for a shorter period. This result is uniform across all of the children's age groups and in all the remaining four cities. It would therefore be worthwhile to reflect on the possible effects a prolonged period of life spent in a camp would have on health, behaviour and habits.

Fifty-five percent of children had suffered coughing in the fifteen days prior to the interview. The percentage was highest in Brescia (70 percent, 14/20), and lowest in Bolzano (37 percent, 7/19) [Table 5]. However, it should be pointed out that the flu was widespread among the children in Brescia and gave rise to diarrhoea, coughing and vomiting.

Roma in the Largo Camesena camp in Italy, July 23, 2003. PHOTO: STEFANO MONTESIA lesser number of children were taken to see a doctor in reference to coughing and bronchitis (71 percent, 64/90) [Table 6] than with regards to diarrhoea, even if, or perhaps precisely because, coughing is more common than diarrhoea.

Both coughing and diarrhoea are very common symptoms throughout the camps and do not particularly affect children with certain characteristics.

In order to explore the prevalence of asthmatic bronchitis and asthma in general, the interviewees were asked if the children had ever exhibited wheezing or other respiratory difficulties, how many times the problems had arisen in the last 12 months, whether or not the child had ever been taken to see a doctor and what diagnosis had been made.
 


Table 5:
Proportion of children with coughing in the fifteen days prior to the interview, by city

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Yes 44(64) 10(48) 14(70) 15(42) 7(37) 90(55)
No 25(36) 11(52) 6(30) 21(58) 12(63) 75(45)
Total 69(100) 21(100) 20(100) 36(100) 19(100) 165(100)

Table 6: Proportion of children with coughing who were taken to see a doctor, by city

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Yes 33(75) 6(60) 8(57) 11(73) 6(86) 64(71)
No 11(25) 4(40) 6(43) 4(27) 1(14) 26(29)
Total 44(100) 10(100) 14(100) 15(100) 7(100) 90(100)

Twenty-three percent of the interviewees stated that the child had had wheezing or respiratory difficulties during his or her lifetime (38/165). The highest percentage was recorded in Florence (29 percent, 20/69), followed by Bolzano (26 percent, 5/19) [Table 7].

Table 7: Children who have had respiratory difficulties or wheezing during their lifetime

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Yes 20(29) 5(24) 3(15) 5(14) 5(26) 38(23)
No 49(71) 16(76) 17(85) 31(86) 14(74) 127(77)
Total 69(100) 21(100) 20(100) 36(100) 19(100) 165(100)

Seventy-four percent of these children (28/38) had had respiratory difficulties or wheezing at least once in the last year, while 21% had had at least four 'attacks' (8/38).

The percentage of children affected by respiratory difficulties in the previous 12 months is clearly linked with the camp of origin, with the risk increasing by five times if the child comes from Florence or Bergamo. These camps suffer the most from overcrowding and have the worst health-and-hygiene conditions.

Of the children who suffered from wheezing or other respiratory problems, 92 percent (35/38) had been taken to see a doctor; all the children in Bergamo, Brescia, Venice and Bolzano and 17 out of 20 in Florence had seen a doctor. This information is significant, both to understand the importance attributed to this symptom and to find out what diagnosis was made.

Of the 35 children who were taken at least once to see a doctor, 14 (40 percent) received a positive diagnosis of asthma or asthmatic bronchitis while another 2 were diagnosed with allergic bronchitis. All of the other children's respiratory difficulties were attributable to non-chronic health conditions.

Cross-referencing the variables on the diagnosis and on the number of times the child has had respiratory problems in the past year, one can obtain an indication of the prevalence of what is known as 'active asthma': this definition includes all those who have had an asthma diagnosis and have had respiratory difficulties in the past 12 months. In total, 12 out of 165 children are implicated (7 percent) [Table 8].

Table 8: Children with 'active asthma'

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Yes 5(7) 3(14) 0(0) 3(8) 1(5) 12(7)
No 64(93) 18(86) 20(100) 33(92) 18(95) 153(93)
Total 69(100) 21(100) 20(100) 36(100) 19(100) 165(100)

The prevalence of asthma recorded in the camps, as well as the persistence of asthma symptoms, is higher than the nationally recorded data.8 Cohort studies have shown that the degree of persistency of asthma symptoms during childhood is linked to the degree of decreased pulmonary function and to the asthma prognosis of the adult9.

What is more, the percentage of children with asthma varies according to the housing conditions. The lowest percentage of asthma cases were recorded in Brescia and Bolzano. These are settlements in which no presence of rats was reported nor cases of skin disease. Bergamo, which is the most crowded camp and has the poorest hygiene facilities, also exhibits the highest percentage of asthma cases, followed by Venice and Florence.

Interviewees were asked their opinion with regard to the most important causes of the children's illnesses. Answers were analysed by category and listed in order of importance. [Tables 9 and 10]

The perception of the inhabitants with regards to the relationship between the health of their children and the living conditions is very clear. On the basis of the camp of origin, the interviewees' answers vary as to the number and the types of "factors of diseases" not sure what this means. The more precarious the living conditions, the greater the number of factors of disease identified.

As can be seen from a summary of the factors that the interviewees hold to be the causes of illness, there is a wide range of opinions and a good analysis of the factors that could affect the health of children and adults alike. This is an important point as it underlines the fact that the residents have a good understanding of the problems that exist in the camps and therefore it should be easier to promote efforts to improve conditions.

It should be underlined that these categories were created after collecting, and on the basis of, the answers given by the interviewees.

With a few exceptions, the interiors of the living quarters were extremely well looked after and clean. Maintaining one's dignity in the squalid environment of a camp such as some of those studied can be an almost impossible undertaking that requires constant mental and physical commitment.

Commitment is also required in looking after the children who, as pointed out by the mothers during Focus Group meetings, are difficult to keep inside the home. The mothers claim that it is very easy for a child to fall ill in living conditions such as those existing in the camps.

Table 9: Answers regarding causes of children's illnesses at the camp

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Causes 49(94) 15(94) 7(54) 21(87) 13(41) 105(77)
Nothing 1(2) 0(0) 5(38) 3(13) 13(41) 22(16)
Don't know 2(4) 1(6) 1(8) 0(0) 6(19) 10(7)
Total 52(100) 16(100) 13(100) 24(100) 32(100) 137(100)

Table 10: Categories of answers regarding causes of children's illnesses at the camp

City Florence
N(%)
Bergano 
N(%)
Brescia
N(%)
Venice
N(%)
Bolzano
N(%)
Total
N(%)
Dirtiness 33(31) 12(35) 4(27) 21(44) 5(21) 75(33)
Cold 34(32) 8(24) 0(0) 9(19) 11(48) 62(27)
Precarious home 4(4) 4(12) 5(33) 8(17) 4(17) 25(11)

Presence of rats

20(19) 1(3) 0(0) 2(4) 0(0) 23(10)
Unclean air  8(7) 4(12)   1(7) 3(6)   1(4) 17(7) 
Over-crowding  4(4)  2(6)  2(13)  4(8)  2(9)  14(6)
Stagnant water  4(4)  3(9)  3(20)  1(2)  0(0)  11(5)
Total  107(100)  34(100) 15(100)   48(100) 23(100)   227(100)

Washing a child becomes problematic in view of the difficulties connected with the unavailability of hot water or the fact that the outside bathrooms are unheated.

The camps are seen as a source of squalor and instability, which makes it difficult to raise a family and to look after children as one would wish. The quality of the housing, the humidity, the difficulty in keeping children and the home clean, the lack of playing space for the children, and the difficulty in finding a permanent job while living in the camp are all obstacles faced on a daily basis.

The mothers complained of the lack of opportunity to bring up their children in a more dignified way, in a real house; in their own words, like 'Italian children'. The results of this study identify how entire families who have lived in highly precarious health and hygiene conditions, after many years in Italy, plead for normal integration into society. These conditions have a deleterious impact on the health of the children who were born into and grow up in such environments. The critical conditions of life inside the camps create difficulties and increase the degree of prejudice toward the Romani population. Over the years, the rights of these children, and in particular their right to the highest possible standards of physical and mental health, have been systematically infringed.

Since 2001, no systematic actions have been taken by national authorities to solve the problem of Romani camps in Italy. Some improvement of the living conditions in the camps included in this survey was introduced in 2002 and 200310. However, the general situation of foreign Roma in Italy has not improved in any significant way. New immigrants, mainly from Romania, are being placed again in official and unofficial camps.

In Bolzano, there has be no major change in the last two years. In July 2004, a fire destroyed three bungalows and damaged one. The families that remained without shelter received public housing apartments and one family received funds to repair the bungalow. The actual plan is to intervene and restructure the camp following a proposal from the Fondazione Michelucci from Florence.

Endnotes:

  1. Lorenzo Monasta is a researcher at the Center for Study of Tropical Diseases (CIET), University of Guerrero, Acapulco, Mexico. The author can be reached at lmonasta@ciet.org.
  2. Official camps are those formally recognised by municipalities and usually have basic services like water, electricity and toilets. To live in an official camp does not guarantee a decent standard of living or protection in the case of families without a regular residence permit, but it is usually a guarantee against eviction. Unofficial camps are tolerated illegal settlements, often with no services at all, where no protection is granted against eviction and expatriation.
  3. United Nations Committee on the Elimination of Racial Discrimination. Concluding Observations, Italy. 54th Session, 1-19 March 1999. CERD, 1999.
  4. Monasta L. Mappatura degli insediamenti di cittadini non italiani di etnia Rom sul territorio nazionale. Rapporto di ricerca del progetto. Dipartimento di Studi Sociali, Università degli Studi di Firenze. Giugno 2002.
  5. Unicef. La condizione dell'infanzia nel mondo, 2001 - Prima infanzia. Unicef 2000.
  6. Cockcroft A., Monasta L., Onishi J., Karim E. Baseline Service Delivery Survey – Final Report. Health and population sector programme, 1998-2000. Bangladesh. June 1999.
  7. In the case of the San Giuliano camp, the data regarding the number of years spent at the camp does not reflect the real situation: in fact, at the time fieldwork was being carried out, numerous families were transferred to the San Giuliano camp from other camps in the city as a result of a policy of gradual closure of the camps and concentration in one place of families not previously placed in camps.
  8. Monasta L. Studio epidemiologico in cinque insediamenti di rom stranieri: difficoltà respiratorie e prevalenza d’asma in bambini da zero a cinque anni. Epid Prev (forthcoming).
  9. A child with asthma but without persistent symptoms will have a higher chance of not having asthma in his/her adulthood compared with a child with asthma and persistent symptoms.
  10. In Florence a new camp, with prefabricated houses, was set up in July 2004 for the families of the Poderaccio camp: the new "village", still a temporary solution, less than 100 metres away from the old camp, has not been accepted well by the Roma. In the last two years, some families have been able to move to public housing apartments. The Poderaccio camp, a "transitory" solution that lasted 14 years, will be demolished and rebuilt to host the families who are now living in the Masini illegal camp. In Bergamo there has been a slow process of allocation of public houses that solved the overcrowding problem. In February 2003, new toilet facilities were built, but the hygienic conditions remain critical. In Venice, the San Giuliano was closed in 2003 concluding a project that demonstrated that a sustainable way out from "campland" was possible when institutions and NGOs work and plan together with the Roma. In two years, starting in 2001, two camps have been closed and housing solutions - public, private, renting and loans for buying - for all of the families have been found. The Camafame farmhouse in Brescia was closed in early 2003. It was declared uninhabitable after a fire. Some families were moved to another camp and some in regular apartments. Despite this, at the time of this writing, the general situation in Brescia remains precarious and tense, also because of the arrival of Romanian Roma in the last few years. In Bolzano, there has be no major change since the fieldwork in early 2002. In June 2004, though, a fire destroyed three bungalows and damaged one. The families that remained without shelter, received public housing apartments and one will get funds to repair the bungalow. The actual plan (September 2004) is to intervene restructuring the camp following a proposal from the Fondazione Michelucci from Florence.

 

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