1. Italy of migrants

3. Recommendations to local health authorities, November 2012 State Regions agreement on migrants’ health management, December 2012 Legislative decree February 2014, n.18 on protection to migrants and victims of human trafficking Ministry of Interiors decree 20 October 2014, on regulations for immigration centres management Contingency Plan, Region of Sicily, 2014 Circular letters and DG’s decrees of 4° and 8° April 2014, and of 2° February 2016 Contingency Plan, State and Region of Sicily, 2016, draft Strengthening surveillance at entry points (ports, airports, land border offices, Uffici di Sanità Marittima, Aerea e di Frontiera – USMAF) PORTS: free health practice to ships/boats not coming from ‘affected areas’ (IHR definitions). Screening on board and before landing. Certificates issued by the State. H24 surveillance and reporting by port authorities, commercial and NGOs’ ships, Navy, Frontex mechanism AIRPORTS: same procedure, with additional residual disinsection (ZIKA outbreak and A. albopictus competent vector) at four accredited airports with dedicated health channels and bio-containment facilities (Rome, Milano, Catania, Pratica di Mare) Public health measures at entry points

6. Key points Rescue (SAR): any ship identified by the Coast Guard, receiving and responding to SOS Mare Nostrum: Coast of Libya, Mother ship with helicopter on search and rescue mission Concentration, transport, evacuation, Satellite ships for transport to hotspots Syndromic surveillance and free practice on board and/or at landing points First aid and stabilizing critical patients Police identification Triton: coastal border patroling, landing and transport (to hotspots) with EU compliant procedures

7. Key points Landing: POA identified by Interiors and managed by the Coast Guard : Before landing: syndromic surveillance and free practice Medical screening and referral to local health authority Possible hospital admission or referral to hotspots (health management contracted by Interiors to NGOs and charities) Specialized and hospital care managed by local health authorities and hospital trusts Transfers to regional authorities based on quota system (Fondo per l’Asilo e la Migrazione (FAMI- AFIM) da maggio 2015)

8. Key points Contigency Plans: PHAME 1 e PHAME 2 (Minsalute, WHO/EURO) (http://www.euro.who.int/en/health-topics/health-determinants/migration-and- health(http://www.euro.who.int/en/health-topics/health-determinants/migration-and- health) IHR (http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=3066&area=usma f&menu=vuoto(http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=3066&area=usma f&menu=vuoto) Global Health Security Agenda (http://www.globalhealth.gov/global-health-topics/global-health- security/ghsagenda.html(http://www.globalhealth.gov/global-health-topics/global-health- security/ghsagenda.html) Global Health Security Initiative (http://www.ghsi.ca/english/index.asp)http://www.ghsi.ca/english/index.asp G7 Framework Regional Committee WHO, 2015 WHA, 2016

22. KEY conclusions and challenges EU has recognized the migrants’ agenda as a commong EU challenge MS have been granted support, but still very fragmented and overlapping/competing between directorates Support comes from a variety of programmes/directorates and needs integration based on national plans with local focus on crisis areas: very easily moving to conflict situations National sovereignty vs EU contribution or EU management: NGOs’ role and identification of interlocutors for different EU initiatives (Horizon, DEVCO, ECHO, EEAS, SANTE, FRONTEX…) Preliminary joint work between EC and MS needed on criteria and eligibility NGOs’ implementing capacities within national framework and rule of conduct; SOP agreed at EU level and followed strictly by all partners Information systems must comply with national standards and strengthen national information frameworks WHO, IOM, MS????? Who does what and reports to whom?? National plans......