The current government has formulated an immigration law that severely limits the number of immigrants able to receive legal status in Italy and stay there. Since 1999, MSF has worked in Italy to provide health care to illegal immigrants and boat refugees.

Although Italy has a well-developed health care system, statistics on immigrants' health are worrisome. The perinatal mortality rate is an alarming 10.8 percent among all of the country's undocumented immigrants and a much lower 0.33 percent in northern Italy and 0.83 percent in southern Italy. A recent study also suggests that immigrants are 35 times more likely to develop tuberculosis (TB) than native-born Italians.

In 2003, MSF opened clinics for immigrants lacking legal status in various regions of the country including Rome, Lombardy and Sicily. The clinics operate as part of the country's national health care service and use anonymous codes to protect patient identities and in that way reduces barriers for people without legal status. MSF hopes these clinics will broaden access to the health care system for this vulnerable group of people. Eventually MSF hopes to hand over the clinics to the national heath care service.

Because of its location, Sicily is the most popular point for boat refugees to land in Italy. Many are fleeing from conflict or other dangerous situations in their home country and risk their lives during their voyage across the Mediterranean Sea. On Lampedusa, a small island south of Sicily, an MSF nurse provides medical care at a reception center set up to help newly arrived refugees. In this way, MSF helps more than 9,000 people a year.

MSF also offers emergency medical aid to refugees arriving on Sicily's southern coast. An MSF mobile unit remains on standby 24 hours a day so that the team can reach newly arrived immigrants to provide aid and to explain important aspects of Italy's immigration policy.

In addition, approximately 400 asylum seekers are now living in the rundown Tiburtina train station in the center of Rome. They are refugees from Sudan, Ethiopia, Eritrea and other African countries living in Italy without legal status. The sanitary facilities at the station are vastly inadequate: there is no running water, no electricity and no heat. In October 2003, MSF began providing medical care to these asylum seekers. The team also participated in an advocacy action calling for a permanent, humane solution to this dire situation. The action was held as the station is currently being rebuilt and the station's owners plan to evict all of the asylum seekers sometime in 2004.

In southern Italy where agriculture is the main economic activity, thousands of illegal immigrants work as seasonal farm help. The workers are asylum seekers or undocumented refugees. Their living and working conditions are often dismal and they have limited access to health care. During 2004, MSF plans to explore the health needs of this group of workers.