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

2. 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

3. 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)

4. 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

5. 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

6. 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

7. “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.”

8. 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

9. 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

10. “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

11. 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.

12. 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

13. 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

14. 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

15. 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