“We were busy assembling a merry-go-round for children: I fell from a truck and broke my arm. I was in hospital for two days, then I went back to the Ex-MOI. The people from MSF helped me obtain a healthcare card and see a doctor. They then accompanied me to the hospital for the operation and physiotherapy. They also helped me when I decided to report my employer who had not reported that I had been the victim of a workplace accident. Not speaking Italian, means you can’t manage to do anything on your own”.

M., 21 years old, arrived in Italy few years ago from Guinea. Now he lives at Ex-MOI, an informal settlement in the city Turin. At the end of 2016, MSF introduced a programme aimed at facilitating the access to healthcare for the residents of one of Italy’s largest informal settlements, the former wholesale fruit market (MOI) in Turin.

Here at least one thousands of men, women and children, mostly coming from sub-Saharan Africa and the Horn of Africa, were living in inadequate conditions, overcrowding, no heating, and frequent disruptions in water and electricity supplies, and were faced with different economic and language barriers to access the national health care system.

MSF operators and volunteers went into the buildings to inform the residents of MOI, about the rules and procedures related to accessing healthcare through the Italian National Health Service (SSN). When MSF started our intervention, seven out of ten people did not have a healthcare card, and eight out of ten did not have a general practitioner at the time of their initial contact with MSF.

As a result of MSF’s activity, 469 people have been assisted since the start of the project up until 31 December 2018. In 2017, an agreement was signed with the Local Healthcare Service (“Azienda Sanitaria Locale - ASL”) for the “City of Turin” to consolidate the interventions started by MSF.

Two residents from the former MOI that were already involved in MSF activities, were identified as cultural mediators to facilitate the procedures regarding registration with the SSN. As a result, the time required to finalise registration, with the concurrent allocation of a general practitioner, has come down from two months to one week.

In 2018, the agreement between MSF and the healthcare local centre was extended to include the Municipality of Turin, with the intention of facilitating the registration required to access the SSN and with the additional objective of integrating regional social-healthcare services directed at the more vulnerable sections of the population.

“I was held in a detention centre in Libya. Men and women altogether in the same large room. Sometimes they would come and take one of the young girls. We prayed to God that they would be brought back. There are people here that take care of me. They come with me to the hospital for my check-ups. It is my first pregnancy. I am expecting a girl. I hope that she will be able to live in a quieter place than this. One that is more peaceful. My baby will be called Testimony."

At the end of 2016, MSF introduced a programme aimed at facilitating access to healthcare for the residents of one of Italy’s largest informal settlements, the former wholesale fruit market (MOI) in Turin. Here at least one thousands of men, women and children, mostly from sub-Saharan Africa and the Horn of Africa, were living in inadequate conditions, overcrowding, no heating, and frequent disruptions in water and electricity supplies, and were faced with different economic and language barriers to access the national health care system.

MSF operators and volunteers went into the buildings to inform the residents of MOI, about the rules and procedures related to accessing healthcare through the Italian National Health Service (SSN). When we started our intervention, seven out of ten people did not have a healthcare card, and eight out of ten did not have a general practitioner at the time of their initial contact with MSF.

As a result of MSF’s activity, 469 people have been assisted since the start of the project up until 31 December 2018. In 2017, an agreement was signed with the Local Healthcare Service (“Azienda Sanitaria Locale - ASL”) for the “City of Turin” to consolidate the interventions started by MSF. Two residents from the former MOI that were already involved in MSF activities, were identified as cultural mediators to facilitate the procedures regarding registration with the SSN.

As a result, the time required to finalise registration, with the concurrent allocation of a general practitioner, has come down from two months to one week. In 2018, the agreement between MSF and the healthcare local centre was extended to include the Municipality of Turin, with the intention of facilitating the registration required to access the SSN and with the additional objective of integrating regional social-healthcare services directed at the more vulnerable sections of the population.

Adephine speaks in slow, hushed tones. She tugs at her mother, Elisabeth, sliding behind her, as soon as the gathering of people at this remote MSF health clinic in Tanzania swells.

A refugee camp can limit people’s movement, but it can do little to dash the hopes and aspirations of a 12-year-old girl from breaking through its dim and bleak confines. Adephine often lets her imagination fly outside the Nduta refugee camp, in north-western Tanzania, where she has been living since January 2017, when her mother fled violence in Burundi. In a place far away from the camp, she dreams of becoming a doctor one day.

As she says this, she grows in confidence, and her eyes stare you straight in the face. In the camp, she receives lessons in English, French, basic mathematics and science, but says, with a touch of gloom, “we often get punished in the school, and I don’t like it”.

It’s not only these daily chastening experiences that threaten to dampen the spirit of children like Adephine, but the grinding toil of living in a place where rationing is the norm can snuff out any lingering traces of ambition. Adephine’s father, and her two siblings, only joined the family in the camp later, when registrations had stopped.

“My husband is not registered, and so he cannot receive assistance”, says Adephine’s mother, Elisabeth. “We share the food we receive among us”. A small patch of land around their modest two-room abode in the camp provides for a few green vegetables and beans. “But this is not enough”, says Elisabeth.

Over 230,000 Burundians, spread across three camps in Tanzania, will remain dependent on much-needed humanitarian assistance until longer-term solutions are found. But, for now, they desperately need support. This little-spoken crisis continues to be dismally funded, revealing major gaps in the humanitarian response. Limited food, poor living conditions and weak wastewater management are a recipe for disease outbreaks. The Nduta refugee camp, where MSF is the main healthcare provider, recently witnessed a peak in diarrhoea cases, but our teams were able to swiftly respond and staunch the spread of the disease.

Back in the health clinic, Adephine is playing with a strip of capsule. “When we are sick, we can have treatment”, says her mother, Elisabeth. But she wishes they had more variety in the food they received in the camp. Sitting together, Adephine, her younger sister, Rachel, and Elisabeth appear composed. What the future holds for them remains shrouded in uncertainty. But with those dreams that take one far away, there is always that smallest of relief to take flight, even briefly, and escape the biting reality of the camp.

“We are farmers, and today we are a family of six. Two years ago in Rakhine, Myanmar, the army started arresting all the men. My son Irshadullah was 20 years old then. We were all hiding in our houses, and could not go anywhere, not even to collect food. One day the army came to our house and started taking my 16-year-old daughter with them; my son came out of hiding to intervene.”

“They shot him dead. We had to flee.”

“I am not as old as I look. Ever since I got diabetes, I started losing weight. My condition has gotten worse in the last three years. My husband and I are old, we cannot work. It would be nice to cook a big fish but that is not possible, we have no extra money.”

“Today I am in pain. I feel dizzy and my heart is beating fast. I have an infected leg.”

“It is safe in the camps. We can fast here, and pray. At least the Myanmar army will not come in the night and arrest us. But Myanmar is my homeland, that’s where all my ancestors are buried. You can all go home, but I cannot, we have to stay in a small hut in a camp.”

“I dream of my home when I sleep. One day we will return to Myanmar or maybe some other country where there is peace.”

“I am a farmer. As a child, I remember running into the forests to hide from the officials and locals in Rakhine state, Myanmar. They would take our money and produce from the farms. They would also beat us up. I am fleeing Myanmar for the third time in my life. I must have been 10 or 11 years old when we first ran away from our homes in the 1970s. Then we stayed here in Kunyapalong for two more years before we returned; we were told it would be safe to return.”

“It has always been hard to live in Rakhine. The harvests would be taken away. The government would arrest the males and often we had nothing to eat. We ran away to Bangladesh a second time in 1992. Here I met my future wife, Khatija. I was 23 years old when we got married. My first-born child, Salim was born in this country. He was only 40 days old when we were forcefully returned to Myanmar.”

“I have often been picked up from home or the market by the Myanmar army. They would take us into the jungles and make us carry heavy loads for 7-8 days. If I dropped the load, I would get beaten up.”

“Life went from bad to worse more than two years ago. The government said we were all armed extremists and closed the mosque and madrassa [religious school]. They stopped us from farming and curbed all cultivation. We could not earn money, people were arrested, killed and our women were gang raped. On the morning of Eid Al Azha, they killed my eldest child, Salim. He was around fifteen years old.”

“We left our house and ran here for safety. We walked for 14 days before reaching the camp. I am happy here, I can at least sleep peacefully. My children can study. We are not allowed to go outside the camp and find work, money or new clothes. I want to return to Myanmar with full citizenship and the right to move freely.”

“We are surviving here, but we can’t see when we will return to our country.”

“My name is Marilyn Díaz. I arrived in Tibú [in Colombia] a year and a half ago. I went to MSF because I was told that there was an ‘assistance for Venezuelans’ day. I approached them because I had physical problems and because my son was virtually not eating. I arrived in the morning and had to wait until the afternoon, but they took care of me and my son too. He was underweight; they gave him ready-to-use food and got his condition under control. At first we went every week and then every fortnight. Fortunately he is much better now.”

“When we first came to MSF, I was pregnant. I was tested and they gave me medicines and vitamins and told me to come in for monitoring. I gave birth three days ago and I’ve come back today to get contraceptives. I gave birth here at the hospital and everything went well.”

“Other Venezuelans had scared me, telling me I wouldn’t receive care [in Tibú]. They said I should go to Cúcuta because here they’d let me die as they don’t provide care for Venezuelans. I have a ‘special residency permit’ but I am still waiting to get health insurance. When my labour pains started, I came to the emergency room and fortunately they treated me quickly and everything went well.”

“I come from Zulia state. We decided to come here because the situation was difficult. My husband is a barber and it wasn’t working out. His job didn’t bring in nearly enough. I also worked selling breakfasts in the street, but I couldn’t earn even a basic wage. My husband left first, then he returned to get me, and I came here with him and our son. I haven’t returned to Venezuela since. I’d like to go back, but it just isn’t possible because the situation there is getting worse.”

“That’s why I told my dad to come here too. He used to have a job transporting passengers, but the time came when they couldn’t get hold of tyres, batteries or spare parts. Now he works here selling coffees. He has an established route around the local businesses and fortunately it gives him enough to pay the rent and bills.”

“Despite that, he has had malaria three times in four months. Each time we have come here and they’ve taken care of us and given us medicines. The doctor told him that it’s spread by mosquitoes and gave him a net to protect himself. We think it’s is because a neighbour stores a lot of water in a tank and there are many mosquitoes, but we can’t do anything about it right now.
We are surviving here, but we can’t see when we will return to our country.”

People flee their countries for various reasons and, depending on their motives and the perspective of the country to which they flee, may be classified either as migrants or refugees and receive services accordingly. Venezuelans who flee to Colombia suffer a double blow, for on top of the difficult circumstances that caused them to leave, on arrival they are guaranteed neither healthcare, food nor security.

This group of people have fled a country in crisis for a country in the midst of armed conflict and other violence. MSF cares about people’s humanitarian needs irrespective of international legal definitions. Beyond the labels of ‘migrant‘ and ‘refugee’, it is essential that there is an immediate and effective response to the humanitarian needs of this group of people.