Italy’s Migrant Detention System Under Medical Scrutiny

Repatriation detention centers (Centri di Permanenza per il Rimpatrio [CPRs]) in Italy hold foreign nationals awaiting removal from the country. Similar centers exist worldwide, but their health and medical-ethical implications receive far less scrutiny than migration policy debates. These issues have drawn attention following an investigation launched in July 2025, made public in February 2026, and expanded in September. Searches were conducted at the homes or workplaces of 23 doctors in nine Italian cities. Prosecutors in Ravenna, a city in northeastern Italy, allege that medical certificates were falsified to declare foreign nationals unfit for detention in CPRs. Italy’s National Federation of the Orders of Physicians, Surgeons, and Dentists (FNOMCeO; the country’s medical association and licensing body) expressed solidarity with the doctors.During the September 16 searches, only one of the 23 doctors, infectious disease specialist Nicola Cocco, a member of the Italian Society of Migration Medicine (Società Italiana di Medicina delle Migrazioni [SIMM]), was under investigation. He was accused of conspiring to issue false certificates. Cocco denies the allegation, saying the aim was to raise awareness of the harmful health effects of CPRs. On October 9, Italy’s Supreme Court of Cassation, the country’s highest appeals court, overturned, and sent back for reconsideration, the 10-month suspensions imposed on three doctors from Ravenna. A review court in Bologna must now re-examine the measures as the investigation continues.SIMM, including Cocco and Marco Mazzetti, contributed to this article. This involvement is disclosed in the interest of transparency.Beyond the legal proceedings, the central questions remain: What does medical fitness for detention mean? Can a person be certified as fit to enter an environment that may itself harm health? Is requiring doctors to issue such certifications compatible with their professional obligations?What the World Health Organization (WHO) and Literature SayThe evidence that immigration detention can harm health is substantial. In an evidence brief published in January 2026, the WHO reviewed research on the health consequences of immigration detention and concluded that detainees face significant risks to their health and well-being because of harmful social and environmental conditions.Regarding Italy, SIMM, in an appeal accepted by FNOMCeO and the National Council of the Order of Psychologists, Italy’s national psychologists’ council, described CPRs as harmful to health and said they put detainees’ health and lives at risk.Behind Closed Doors: Why Data Are Sparse in ItalyItaly has some information on detention numbers but little reliable data on detainees’ health. In the US, for example, detained migrants are “the only cohort of patients with federally sponsored healthcare for which federal health data is not released.” All available data, therefore, likely underestimate a complex situation.In Italy, limited transparency appears to be standard practice. In 2024, 5891 people entered Italian CPRs, whereas between 2014 and 2024, more than 56,000 passed through such centers. In 2025, there were approximately 546 people held in CPRs at any one time — less than 0.2% of the estimated number of people in irregular situations in Italy. For the rest, “the only information we have is what is collected when we manage to organize visits to the CPRs with members of parliament,” SIMM told Univadis Italy, which is part of the Medscape Professional Network. “In fact, no one is allowed into the CPRs other than the centers’ operators, the police, the judiciary, and the official oversight authorities,” added the expert, who preferred to remain anonymous. Requests to enter are often denied, whereas authorized visits may resemble guided tours in which visitors can speak with management but not detainees. Independent research is therefore extremely difficult.A monitoring report published in January 2026 by the Asylum and Immigration Committee (Tavolo Asilo e Immigrazione [TAI], an Italian civil-society monitoring network that includes SIMM) highlighted these limitations. The report is available in Italian only.During visits to 10 centers between September and December 2025, managing organizations provided incomplete documentation, fragmentary records, or no documentation at all. In some cases, even basic information on occupancy, nationality, and country of origin was unavailable. Delegations were not given the contracts governing operations at five of the 10 centers. TAI’s 2025 Italian-language report on the Gjadër detention center in Albania, which is linked to Italy’s detention system, also documents serious concerns.The critical events register, the main tool for documenting incidents, was reportedly unusable for analysis: In Rome and Milan, it consisted of a handwritten notebook, and in Rome, the last entry was more than a month old. It is therefore not currently possible to compile meaningful statistics: In Italy, there is no official number of critical events, self-harm episodes, or suicide attempts in CPRs. Furthermore, many events, such as self-harm itself, are not recorded because they are considered “ordinary.” Paradoxically, when critical events become so common that they are treated as normal, they disappear from the registers.Univadis Italy was unable to obtain comment on this issue from either the Italian National Institute of Health or the National Institute for Health, Migration and Poverty, a public institute focused on migrant and other underserved populations.Why Detention May Harm HealthContrary to common stereotypes, migrants are not inherently more likely to carry infectious diseases. Research has described the “healthy migrant effect,” whereby migrants are, on average, as healthy as or healthier than the populations in their destination countries. The European Centre for Disease Prevention and Control has also emphasized that although some migrant groups have higher rates of communicable diseases, they generally do not pose a health threat to host populations. Some infections, including HIV, may be acquired after arrival.Conditions in detention can change that picture. The WHO identifies multiple health risk factors, including overcrowding, poor hygiene and sanitation, inadequate food and water, limited access to healthcare, treatment delays, lack of recreation or education, prolonged isolation, extreme temperatures, discrimination, sleep deprivation, limited contact with the outside world, inadequately trained staff, and insufficient explanations for detention.Food quality and availability are recurring concerns in detention facilities in Europe and the US. Reports have also documented poor sanitation and unsafe living conditions. Language barriers can further restrict access to care; at least one study found that health outcomes were associated with detainees’ ability to understand the host country’s language or English.In a study of detention facilities in California, each additional adverse condition was associated with 39% higher odds of worsening general health (odds ratio [OR], 1.39). Sleep deprivation had an OR of 2.87, poor access to medical care had an OR of 2.19, and inadequate access to mental health services had an OR of 2.13.TAI monitoring of 10 Italian CPRs in 2025 documented several of these conditions simultaneously, including sleep deprivation, difficulty contacting family, restricted access to medical and mental healthcare, and experienced or witnessed violence. Food was also described as insufficient, monotonous, or inadequate. According to TAI, these conditions directly affect health, contributing to skin problems, joint pain, infections, and a widespread sense of degradation and loss of control over one’s body.How the Admission Screening Process WorksAdmission to an Italian CPR requires certification of fitness for detention, intended to exclude people whose health conditions make confinement unsuitable. However, monitoring reports suggest that these assessments often fail to identify relevant medical risks.TAI found that assessments focused primarily on excluding infectious diseases considered contagious or dangerous to the community. Examinations were sometimes rushed, superficial, conducted without language and cultural mediation, or performed in the presence of law enforcement. The Trapani CPR reportedly acknowledged that it did not conduct entry medical examinations.Italian CPR regulations require assessments to consider not only infectious risks but also psychiatric conditions and acute or chronic degenerative diseases that cannot be adequately treated in a restricted environment. In a 2021 report covering 2019-2020, Italy’s National Guarantor for the Rights of Persons Deprived of Personal Liberty (an independent oversight authority for people in detention or other forms of custody) said this requirement was frequently overlooked, with assessments limited largely to epidemiologic considerations. TAI similarly reported that physical health was prioritized, whereas mental health was largely ignored.The Guarantor also found that fitness certificates were sometimes issued by doctors working for facility operators rather than by the public health authorities responsible for these assessments. Examples included a doctor employed by the cooperative managing the Lampedusa migrant reception and screening center and Red Cross personnel assessing people arriving from a ship used to quarantine migrants in Gradisca d’Isonzo.Subsequent reassessments illustrate this distinction. At the Rome CPR, approximately 30% of detainees are reportedly released on health grounds, with four or five reassessments conducted each week. At the Gjadër center in Albania, every person for whom reassessment was requested before transfer was reportedly later deemed unfit by Italy’s border health authority and returned to Italy.Gaps in Medical Care and RecordsThe WHO has documented recurring barriers to healthcare in immigration detention worldwide, including staff shortages, delays in medication distribution, inadequate follow-up, late or absent screening, and language barriers. Medical records are often incomplete, poorly maintained, inaccessible to patients, or inadequately protected.In Italy, CPR health services are generally provided by private organizations managing the centers rather than directly through the National Health Service (Servizio Sanitario Nazionale [SSN], Italy’s public health system). SIMM has described CPRs as an exception to the SSN’s usual oversight of healthcare. According to the organization, care arrangements may prioritize keeping detainees compliant over ensuring their health. The National Guarantor also reported in 2021 that agreements intended to coordinate care between prefectures, the local offices of Italy’s Ministry of the Interior, and local health authorities were largely unimplemented.TAI found medical records to be missing, incomplete, or inaccessible. At Trapani, access was denied even when detainees had provided written authorization. None of the 10 centers visited had adequate access to a complete set of medical documentation, including admission assessments, medical records, critical incident logs, and medication administration records.Medication access is another concern. In a survey by Hampton and colleagues of clinicians who had treated people recently released from US detention facilities, respondents reported that patients had been denied medications for conditions including asthma, hypertension, heart failure, diabetes, epilepsy, depression, psychosis, and HIV. Specific cases included a patient with congenital hypothyroidism who was denied levothyroxine and patients with lupus, juvenile dermatomyositis, and glaucoma who could not access their prescribed treatment.The findings should be interpreted cautiously. The survey included 150 health professionals, 85 of whom reported observing conditions they attributed to detention. The results reflect clinicians’ experiences rather than diagnoses verified through medical records, and participants self-selected into the survey.Italian monitoring has identified similar concerns. At the Gjadër center, an asthma inhaler was reportedly confiscated from a detainee. The facility also lacked cardiology, specialist diabetes services, and dental services, which its management reportedly considered necessary even for its own staff.According to TAI, healthcare in Italian CPRs often consists of isolated interventions to address immediate emergencies, without adequate follow-up or medium-term treatment planning. Access to dental and psychological services is also limited.Infectious Diseases: Conditions That Favor OutbreaksOvercrowding, poor hygiene, and pests can facilitate the spread of infectious diseases, including chickenpox, scabies, tuberculosis, measles, mumps, pneumonia, and influenza. Malnutrition may increase susceptibility by weakening immune defenses. During the COVID pandemic, isolation measures sometimes discouraged people from disclosing symptoms, potentially increasing transmission.These risks extend beyond detention facilities. The WHO emphasizes that detainees’ health is interconnected with that of the wider community: Staff can introduce infections into facilities or carry infections acquired there back to their communities.Low vaccination coverage is another concern. US Immigration and Customs Enforcement (ICE) detention facilities have reported recurring outbreaks of vaccine-preventable illnesses, including influenza, chickenpox, and mumps, although the available data are filtered by ICE and may be incomplete.Italy’s CPRs have also reported poor sanitary conditions, despite operating below capacity. In 2025, the centers held approximately 546 people in 672 available places. TAI documented poor sanitation in Caltanissetta and Palazzo San Gervasio, persistent dampness and mold, missing mosquito screens and reports of bedbugs and other insects in Caltanissetta, inadequate ventilation in Milan, and broken internal windows in Palazzo San Gervasio.What Can Prevalence Studies Tell Us?A study conducted at the Corinth detention center in Greece between 2013 and 2015 analyzed the medical records of 4756 migrants, all men. Of these, 1427 (30%) used the center’s health services, and 15.9% of their diagnoses involved infectious and parasitic diseases. Of 80 migrants randomly tested, 13 (16.5%) tested positive for at least one form of viral hepatitis, seven of whom were positive for hepatitis B virus (HBV). The authors themselves caution that the sample tested is too small to establish whether communicable diseases were prevalent among migrants.Another finding comes from Nîmes, France. In a pilot study conducted at a single center in 2022, rapid testing of 345 prisoners revealed a prevalence of 4.64% for hepatitis C virus (HCV), 2.32% for HBV, and 0% for HIV. Because only 47.5% of eligible participants (345 out of 726) took part, the authors pointed out the risk of selection bias. For HCV, the prevalence is much higher than that in the French population (0.75%) and higher than that among French irregular migrants (0.8%). The prevalence of HBV, however, is comparable to that in French irregular migrants (3.1%) and lower than that in irregular migrants in Campania (the southern Italian region that includes Naples and Caserta), which reaches 9%. More than half (56%) of the people involved had never been screened for HIV, HCV, or HBV despite WHO recommendations.Italy has no published prevalence estimates for CPRs and no systematic screening program. According to SIMM, scabies is a prominent health concern, alongside bronchitis and other respiratory conditions. Although scabies is generally not severe, it requires coordinated management to prevent outbreaks. Isolation facilities are often inadequate, even though infection control may make isolation necessary. Tuberculosis is another concern and is sometimes identified during fitness assessments.Chronic Diseases: Detention Can Worsen Existing ConditionsThe WHO reported that inadequate living conditions can aggravate preexisting diseases among detainees. Reported conditions include poorly controlled diabetes, hypercholesterolemia, untreated hypertension and other blood pressure disorders, cardiovascular and gastrointestinal diseases, back pain, headaches, musculoskeletal problems, urogenital infections, and skin conditions.In the survey Hampton and colleagues cited earlier, the 85 clinicians who observed conditions attributed to detention estimated that they saw a total of 1300 patients with a detention-related problem. Of these, 19.5% had chronic conditions that worsened during detention, and 18.5% had inadequate living conditions (such as malnutrition or dehydration) that had worsened their general health.The Mental Health BurdenThe WHO evidence brief found a high prevalence of psychiatric disorders in settings where these conditions could be assessed. In the UK, one single-center feasibility study found that nearly 22% of detainees were at moderate-to-high suicide risk, although the study design may have introduced selection bias. A 2021 meta-analysis, which aggregated nine studies, indicated average prevalences among adults of depression of 68% (95% CI, 53%-83%), anxiety of 54% (95% CI, 36%-72%), and posttraumatic stress disorder of 42% (95% CI, 22%-63%).An updated systematic review by the Campbell Collaboration, based on limited evidence, found that detention significantly affected self-harm and social well-being compared to nondetained migrants and asylum seekers. The difference in psychological distress was not significant. Nevertheless, the findings suggested that detention compounds other postmigration difficulties rather than simply causing temporary distress.Poor physical conditions are not the only explanation. Research has found that mental health can deteriorate over time even in countries with comparatively good detention facilities, including Sweden and the UK. Immigration detention has negative consequences for mental health across facilities and populations. According to some studies, though not all, the damage to mental health persists after detention.Qualitative evidence also indicates that detention may affect staff mental health, though not to the same extent as detainees. In Italy, TAI reported that healthcare workers at the Gradisca center appeared to be getting insufficient rest.Psychotropic Medication and a Lack of StimulationItaly has no reliable estimate of psychiatric disorder prevalence in CPRs, either from official statistics or research. Under a directive issued by then Italian Interior Minister Luciana Lamorgese on May 19, 2022, people with psychiatric disorders should not, in principle, be admitted to these facilities.Nonetheless, TAI visits in 2025 found high proportions of detainees receiving psychotropic medication across multiple centers, ranging from about 25% to 80%. Monitoring teams reported improper administration of psychotropic drugs in all the centers visited, sometimes initiated by nursing staff without prescriptions or documentation in patients’ records. In Caltanissetta, substantial stocks of sedatives, antipsychotics, anxiolytics, and hypnotics were present despite the absence of a psychiatrist. Only three referrals to a mental health center were made over 2 months.SIMM has questioned whether psychotropic medication is being used to manage the consequences of confinement rather than to treat underlying conditions. Monitoring teams frequently observed detainees in markedly sedated states. TAI concluded that psychological illness was not being adequately addressed within CPRs. In 2026, the National Guarantor again documented people with apparent mental illness in the Turin center.The lack of meaningful activity may further worsen mental health. TAI describes Italian CPRs as places of indefinite waiting, without structured activities. Recreational areas often double as cafeterias or corridors with a single television, while outdoor spaces consist of concrete courtyards. In some centers, including Palazzo San Gervasio, detainees have reportedly stopped asking to leave, displaying what observers described as apathy and disengagement.Self-Harm and Suicide: What Italian Data RevealAn analysis of practices across 116 US detention centers by sociologist Beatriz Aldana Márquez and colleagues argued that suicide can be a predictable consequence of how detention facilities are organized. The authors noted that inadequate staff training in recognizing suicidal behavior and responding to emergencies can worsen mental health risks.Italian data also raise concern, although the lack of denominators means precise rates cannot be calculated. At the Gjadër center, the critical incident register recorded multiple episodes of self-harm or suicidal intent within a relatively small detained population. In Caltanissetta, more than half of the emergency department admissions in 1 month involved the intentional ingestion of foreign objects. The National Guarantor also documented five deaths across four CPRs over a little more than a year, when the average detained population was fewer than 600.Additional reports have reinforced these concerns. According to records reported by Altreconomia, the Gjadër CPR recorded dozens of incidents in its first 2 months of operation, mostly self-harm, suicide attempts, and protests. TAI argues that self-harm and suicide risk in Italian CPRs may be underestimated because such acts are sometimes not treated as evidence of severe distress rather than recognized as expressions of severe distress.One documented case illustrates the consequences of inadequate risk assessment. E.H., a Nigerian man born in 1999, died by suicide at the Brindisi CPR in 2019. According to the National Guarantor, he had arrived from a healthcare facility with documentation of psychiatric vulnerability, previous nonsuicidal self-injury, and suicide attempts. That documentation was reportedly considered only after his death.During visits between 2019 and 2020, the National Guarantor found that no CPR had a suicide prevention protocol. Later monitoring suggested that these gaps persisted in some centers. In 2025, Italy’s Council of State, the country’s top administrative court, ruled that CPR operating specifications were unlawful if they did not guarantee minimum standards of health protection and suicide risk prevention. Subsequent judicial and news reports, including the 2026 conviction of the former director of the Turin CPR in connection with the 2021 death of Moussa Balde, have further heightened concerns about detainee safety.Why CPRs Differ From PrisonsCPRs are intended to hold foreign nationals temporarily while their repatriation is arranged rather than to punish criminal behavior. When the facilities were established under Italy’s 1998 Turco-Napolitano immigration law as temporary detention centers, the maximum detention period was 30 days. Following subsequent legislative changes, the maximum period increased to 18 months in 2023.SIMM argues that this extension has transformed a supposedly temporary administrative measure into prolonged detention. Unlike prison inmates, detainees in CPRs may have no clear understanding of how long they will remain confined or what steps will lead to their release. This uncertainty may further undermine mental health.Staffing and qualifications also differ. According to SIMM, recruitment criteria for healthcare workers are often lax, with little emphasis on specialist experience or training. TAI reported that healthcare staff were commonly hired as independent contractors without specific expertise in migration medicine or cross-cultural mental health. Only some had experience working in prisons, reception centers, or other CPRs.During visits, one SIMM doctor asked healthcare workers why they had chosen to work in these facilities. Some declined to answer; others reportedly said they had never visited the dormitories where detainees lived. They worked in clinics treating injuries, self-harm, suicide attempts, and scabies without necessarily seeing the living conditions that might contribute to these problems.The organization also highlights a difference in access to care. Although prison health services are supposed to provide care equivalent to that available to the general population, CPRs often rely on an infirmary staffed by a doctor for only 3-5 hours a day, depending on the number of detainees. Patients may be referred to the public health system through emergency services.A SIMM doctor recalled, with some uncertainty, that ambulances entered one center 34 times in April 2023. He suggested that frequent emergency transfers might indicate both inadequate access to routine primary care and a high incidence of violent or other acute events.Are CPRs Compatible With Medical Ethics?According to TAI, “the observed health problems cannot be interpreted as an incidental or individual phenomenon but as the direct effect of a structurally inadequate context, characterized by isolation, infrastructural deficiencies, and systematic limitations on personal dignity.”This raises a fundamental question for clinicians: Can the principle of primum non nocere — first, do no harm — be upheld when doctors are required to certify that people are fit to enter an environment associated with harm? The issue was raised in letters published in The BMJ and The Lancet Regional Health - Europe in 2024 and 2026. In the latter, seven doctors argued that institutional environments that cause harm should not exist and that healthcare professionals should not be required to certify individuals as suitable for admission to them.There are examples of clinicians making a difference within CPRs. In Brindisi, according to TAI, healthcare staff promoted new medical assessments for detainees whose diseases or disorders were incompatible with detention despite previous certificates stating that they were fit to remain.However, SIMM told Univadis Italy that it questions whether providing humanitarian care within these facilities is compatible with medical ethics if it also serves to normalize the system. Some doctors, according to the organization, believe they can improve detainees’ circumstances through their work. Others argue that the harmful effects of the facilities themselves must first be acknowledged and challenged.This story was translated and adapted from Univadis Italy.