Pregnant woman in Lampedusa

The incident

“I was in Lampedusa, a smaller island of Sicily in the middle of the Mediterranean Sea. I was working there as cultural mediator at the local centre for migrants. I was accompanying a pregnant woman to the hospital, because she was complaining of stomach pains.

When we got to the hospital, the Nigerian woman sat down and waited for other patients from the island to be visited first. I was shocked when I realised that migrants would always be the last patients to be visited by the doctor. The migrants would always be last in the line, in any case and regardless of their situation, because they could not afford to upset the indigenous population, as they were their hosts.

It was surreal to think that because of their origin, migrants were expected to move to the side and to the end of the line to avoid “problems”, such as citizens complaining about them, or refusing to help them, blocking their access to services for instance.

The pregnant woman I was accompanying had on previous occasions been visiting the hospital without my companionship. To me, it was incredible to witness how she already knew that she had to let the people from Lampedusa be first in line. Likewise, I was shocked that the people from Lampedusa did not even care about her presence and her acute situation (being pregnant and feeling pain in the stomach). Thus, she was suffering in silence.

The line was not too long. However, we had to wait for everybody to go first, before we could get into the consulting room.

I tried to reflect on and understand the behaviour of the people from Lampedusa. I tried to put myself in their shoes. I understood that they must have had difficulties to be seen by a doctor in the past, because the migrants are many and take up a lot of the consultation time with doctors, or at least used to before more doctors were sent to the island to face the issue. I understood that for them, the inhabitants of the island, it could be even harder to understand the point of view of the others, of the migrants.”

1. Identities of the actors in the situation

The narrator is an official mediator at the reception centre of Lampedusa in Sicily, Italy.  He is a 29 years old heterosexual man, liberal-democrat and Catholic. He could be described as open-minded, respectful of diversity, especially when the diversity concept is related to ethnic differences.

Actors involved apart from the narrator:

The other actors in the incident are:

  • A group of inhabitants of the island of Lampedusa, locals. They could be described as not very well educated. They are of different ages. They are most likely all Catholic.


  • A young woman from Nigeria, with a fairly good educational background and about 27 years old, pregnant. The woman is familiar with the formalmedical procedures and the health issues in her situation. She is also familiar with the informal procedures which in practice imply that the Lampedusa inhabitants would always be first in the queue for medical care and treatment
2. Context of the situation

The incident takes place when the narrator’s task is to support the woman in undertaking a hospital visit to check on her pregnancy. The narrator and the woman are not related to the group of inhabitants of Lampedusa. But in the situation, all the people are either patients themselves or accompanying patients to the local hospital.

The concrete situation has seen a series of emotional variables and hospital practices together in a special place like Lampedusa, where high flows of refugees have been arriving over the past 10 years or so. From the social/psychological point of view, there was a meeting between a frustrated migrant woman with a shocked mediator, and the inhabitants of the island for too many years influenced and tired of the migration flows to the island. This kind of meeting is full of tension, dictated by the coexistence in such a small island. The hospital is the emblem of these tensions because when health is at stake, no one wants to take a step back and it is inevitable that this type of incidents happens. In any case, the severity of the emergency must be the criterion upon which deciding who receives medical treatment first, and no influence should be played on the decision by the skin colour or origin of the patient.

3. Emotional reaction

The narrator´s main feeling was that of uneasiness with the situation, as he would experience the situation from the perspective of the pregnant women

Furthermore, the narrator would feel fear that the woman´s pain would get worse because of the long wait.

Finally, the narrator felt annoyance and resentment because of the hierarchical queuing practice that had developed between inhabitants and refugees in the access to the hospital and medical care.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

1) Empathy and exchange of perspective

The narrator tried to reflect on the situation in order to understand the behaviour of the people from Lampedusa, trying to put himself in their shoes. He understood that they must have had difficulties to access medical attention, because of so many migrants, and the medical structure inside the reception centre for migrants are inadequate, which makes it necessary for them to access the local hospital.

On the other hand, the narrator would expect the people to be more empathic and considerate towards a pregnant woman. He would expect everyone to know that pregnant women have to be carefully assessed because of their particular condition, and because an emergency may rapidly emerge, even without clear symptoms.

2) Human respect for diversity and tolerance

The role of mediator is focused on respect for diversity and tolerance. By working in Lampedusa and at the reception centre, he decided to get involved with refugee and migrant issues. The main objective was to improve the encounters between different cultures and to learn as much as possible from foreigners around him. He would expect some difficulties in this work, but this incident hits him strongly.

This frustration is all the greater, because he was wanting to show to the world that it is the characteristic for people of Lampedusa to be tolerant, fair and inclusive to newcomers, who may differ in terms of opinions, beliefs, practices, racial or ethnic origins etc. Instead, he was forced to realise that the reality is too different from the hope, which he basically built on the reading of manuals about equity between different people.

3) Equal access to healthcare

To work and practice under extreme conditions – like those of the refugee situation in Lampedusa – turned out to be an important test for the narrator to understand how the native people answer to the needs of other human beings. The narrator´s initial goal was to help refugees/migrants in all life situations. He was confident that an honest behaviour should be shown in such a delicate situation. However, by witnessing the opposite reactions in practice, he experienced a profound disappointment and undermining of his ideals.

4) Human dignity

The severity of the situation also threatened the concept of human dignity.  Human dignity is unbreakable and it must be respected and protected. The dignity of the human person is not only a fundamental right in itself. It also constitutes the basis of fundamental rights in international law. For this reason, it must be respected, even where a right is restricted in a situation of emergency, as with the case of refugees in Lampedusa. From the narrator´s perspective, human dignity is one of the most important human rights because from this one, all the other fundamental rights derive. In this case, it was undermined by the critical context of Lampedusa. However, in the narrator´s opinion, a critical context cannot be a justification to violate such a fundamental right.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The image that emerges from the situation is very negative – especially because this kind of queue management at the hospital has become a common practice. The narrator blames both the local citizens and the hospital itself for the practice in place.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

1) Identity

The group of people who caused the shock in this incident are stressed by the high numbers of migrants who strongly influence their daily life by their mere presence. Especially the tourist sector has been negatively influenced by the migration flows and the results are difficult to accept by the inhabitants. From their perspective, the values of identity, serenity and quiet life conditions are threatened by the presence of migrants on the Island.

2) Health and Security

The people of Lampedusa in the incident exhibit an attitude and behaviour that characterise people who, for too long, had to deal with refugee emergency cases which largely overshadows emergency cases of indigenous residents.

In some periods of the year the people of Lampedusa experienced that the number of refugees on the island would exceed the number of inhabitants. Health is an issue where everyone needs to feel unconditionally safe. The inhabitants do not see any other alternative than to pass on the pressure to those most vulnerable, the refugees and migrants.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

The hospital is a focal point for the tensions between citizens and migrants on the island, because when health is at stake, no one wants to take a step back and it is expected that this type of incident happens. However, even though the inhabitants may be under a strong pressure, a human emergency situation like that of the pregnant woman should have first priority and ensure access to the necessary medical care and treatment.

From this perspective, the incident highlights several elements of violation of the mutual respect and understanding between people and between patients and healthcare institutions. In terms of professional practice, the management of migrants at the hospital is alarming.

It is, of course, unacceptable that refugees and migrants have to wait more for proper care and treatment because of the scarcity of medical facilities within the reception centre where they are hosted. The lack of facilities as well as the reaction of the indigenous population expose serious problems in the intercultural perspective – and the dream of mutual respect across diversity. In terms of mutual respect and intercultural understanding, the forced practice of precedence for the inhabitants of Lampedusa is a serious testimony that the excessive number of migrants on the island has developed into a dangerous and intolerant atmosphere.

Ultimately, the incident reflects the urgent need for the healthcare system and the political system to take responsibility and provide the basic services for all people on the island – inhabitants as well as refugees and migrants. Thus, the incident is a severe reflection on the lack of European and international support and accountability to the acute refugee situation in Lampedusa and other places.

The feelings of the inhabitants are not merely an issue of citizens’ rights. It is, first and foremost, a question of maintaining adequate structures to ensure that everyone has access to appropriate medical treatment, regardless of their background. This is a responsibility of the political sector and its capacity to provide efficient health structures and services to meet the total needs.