The psychologists aboard Sicily's refugee ships

On four quarantine ships docked in Sicily, a small team of psychologists is working to support migrants stuck in limbo.

A Red Cross worker in PPE waits on one of the ships at night

Since April, thousands of people on the move have passed through the commercial ships docked at Palermo on the Italian island of Sicily. The national authorities have repurposed these four ships — each one able to hold up to 700 people at a time — as quarantine centers for the newly arrived. Some have spent years making the arduous journey from sub-Saharan Africa to reach the Italian coast; others have come from Iraq, Iran, Bangladesh, and Pakistan.

Upon arrival in Italy, the migrants and refugees are taken straight to the ships, where they may spend three weeks or more and must provide two negative COVID-19 tests before being allowed to disembark. Italian Red Cross volunteers and staff members also live and sleep on the ships for three weeks at a time, providing health screenings, cultural mediations, and food distributions.

Among them is a small team of psychologists who support the mental health needs of the people on board.

The Red Cross team welcomes people aboard the ship

The Red Cross team welcomes people aboard the ship

The Red Cross team welcomes people aboard the ship

After a difficult and dangerous journey, many of those on board exhibit signs of anxiety, post-traumatic stress, depression, and other emotional disorders. In some cases, there is also evidence of physical torture and violence.

The majority of those arriving on board are men, aged between 20 and 30, although there are also some women and children. Until recently, that included unaccompanied minors, but a change of policy from the Italian authorities means they will no longer be quarantined on the ships.

Adriana Mangiacaballi, a staff psychologist with the Italian Red Cross, was in the middle of her second mission on the quarantine ships when she spoke to Devex. There were around 200 people, plus the Red Cross team, on board at the time, including approximately 20 children with family members and 20 children traveling alone.

The quarantine procedure can be disorientating. With the adults, the aim is to create a safe space — despite their confinement on the ship — for reflection and discussion through one-on-one or group support sessions. The previous day, Mangiacaballi had carried out 50 one-on-one sessions, she said, reflecting the significant emotional and mental health needs of those on board.

With the children, Mangiacaballi organizes music, dance, and art-based activities to provide them with “a sense of normality” and allow her to observe their emotional state.

Red Cross staff and residents on board the ship

Red Cross staff and residents on board the ship

Red Cross staff and residents on board the ship

In their first days on the ship, most people are reluctant to speak about their experiences and worries. But while some come across as passive and distracted, others are emotional, sometimes overreacting to small issues, said Erika Belfiore, a volunteer psychologist who spent time on one of the ships earlier this year. Over time, there are noticeable changes, though.

“As a psychologist, you have to work a lot on yourself, think about your emotions"
Erika Belfiore, volunteer psychologist

“I can observe a sort of gradual change in their nonverbal behavior. … I perceived that day by day … their body [language] was more relaxed, their eyes more vivid,” she said.

Erika Belfiore

Erika Belfiore

The ship's residents take part in a group psychotherapy session

New arrivals take part in a group psychotherapy session

Migrants play a game of chequers abroad the boat

Residents play a game of chequers

The ship's residents take part in a group psychotherapy session

New arrivals take part in a group psychotherapy session

Migrants play a game of chequers abroad the boat

Residents play a game of chequers

Many people report physical symptoms, such as stomach pain, headaches, or difficulty sleeping, that are related to their emotional distress. The psychologists try to support them in accepting or coping with their situation while working with other team members to help them track down and speak with family members back home — a cause of anxiety for many.

Post-traumatic stress — an anxiety disorder caused by distressing events, which often leads to flashbacks, insomnia, and emotional difficulties — is also common. Many have lost all sense of hope or trust in others, Mangiacaballi said.

For some, it has taken several years to reach Italy, and they have witnessed or suffered violence en route — particularly in Libya, where the situation is extremely difficult for them, she said. There have been extensive reports of migrants and refugees facing arbitrary detention, torture, and sexual violence at the hands of state and nonstate actors as they travel through Libya, the key departure point for those hoping to reach Italy.

A resident of the ship is given a health screening

A resident of the ship is given a health screening

A resident of the ship is given a health screening

A resident of the ship is given a health screening

The already complex work of building trust with this group is made harder for the psychologists not only by language barriers, but also by the new need for personal protective equipment and social distancing. New arrivals are grouped together based on the results of their initial COVID-19 tests and confined to different parts of the ship. Everyone has to wear a face mask and observe social distancing rules in common spaces.

The team members write greetings in different languages on their white PPE overalls and use other nonverbal communication techniques in an attempt to make people feel welcome when they first arrive, Belfiore said.

Translators — often former migrants who now work with the Red Cross — support the psychosocial sessions and play a crucial role, she said. Since they better understand what they have been through, and in many cases where they have come from, they can use words and behaviors that help create a safe space for them and can build a link with the rest of the Red Cross team.

With many people coming from places where there is little awareness of psychological symptoms or a stigma around this, the psychosocial sessions also avoid talking about “mental illness” or digging into traumatic episodes in great detail, which is better done in a different environment. Instead, the focus is on wellness and dialogue, Belfiore said. And while they might be slow to open up at the beginning, many soon become eager to participate in the group sessions, Mangiacaballi added.

Like the rest of the staff members and volunteers on the ship, Mangiacaballi works seven days a week and is on call 24 hours a day. At 60 years old, she tries to find moments to rest throughout her busy day, which starts at 7 a.m. and involves leading support sessions for both those in quarantine and Red Cross team members.

The staff and volunteers are exposed every day to very difficult situations. Without support, they might burn out before the end of a three-week mission, she said.

Psychologist Adriana Mangiacaballi on board a ship

Adriana Mangiacaballi

Adriana Mangiacaballi

A Red Cross staff member speaks with a resident

A Red Cross staff member speaks with a resident

Being stuck on the ship for that length of time is a strange and, at times, difficult experience, Belfiore acknowledged. “As a psychologist, you have to work a lot on yourself, think about your emotions. … It's important to maintain ... emotional borders as you are immersed in a situation,” she said. “So I work a lot on myself to try [to stay in] the right position to help others, but also to preserve my wellness.”

The experience is a transformative one, she said, in part because of the strong sense of community and mission. The psychologists are with the new arrivals through a very difficult transition period, which can have an emotional impact, she added.

Mangiacaballi said she had looked forward to returning for her second mission — even at the end of a particularly tough day, seeing smiles on faces helps, she said. And after those weeks together, it can be emotional to say goodbye.

"Translators — often former migrants who now work with the Red Cross — support the psychosocial sessions and play a crucial role"

Recently, as a group of five people from Tunisia prepared to leave after 30 days on board, they told a medical team the last few weeks had been a journey from “sorrow to joy.”

“This ship is like my house, my family. It is a community,” one said.

Residents form a sense of community while on board

Residents form a sense of community while on board

After leaving the ships, most people are transferred to reception centers, where some will apply for asylum. These centers are run by the Italian authorities, but the Red Cross and other organizations provide support and services, such as helping people gain information on missing relatives or reconnect with family back home.

A psychologist remains part of the Red Cross’ core team in supporting the migrants and refugees in these centers, where many will remain for a considerable length of time as they await news of their future.

Some will be turned away — people who left their home country to escape poverty don’t qualify for asylum and will be held in a detention center before being deported.

For those granted asylum, it will be the start of a challenging new life in Europe.

Text: Emma Smith
Photography: Emiliano Albensi and Italian Red Cross
Production: Jessica Abrahams