{"id":4775,"date":"2026-05-18T15:36:12","date_gmt":"2026-05-18T14:36:12","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4775"},"modified":"2026-05-18T15:36:12","modified_gmt":"2026-05-18T14:36:12","slug":"for-whom-the-cry-for-help-tolls","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/05\/18\/for-whom-the-cry-for-help-tolls\/","title":{"rendered":"For whom the cry for help tolls?"},"content":{"rendered":"

By Nicola Cocco, Valentina Marchese and Federico Nicoli<\/p>\n

 <\/p>\n

“Who is here on the shore? Who is watching this shipwreck from the mainland? Is it really just me, no one else?”<\/em><\/p>\n

Vincent Delecroix, Small Boat, 2023<\/em><\/p>\n

 <\/p>\n

On February 2, 2026, the NGO Mediterranea Saving Humans<\/a> reported that up to 1,000 people could be missing at sea during Cyclone Harry \u2014 yet another tragedy at Europe’s borders. The Lancet editorial “Help us, please”<\/a> by Richard Horton aptly captures the political, social, and moral disorientation that health professionals face when discussing the rights, health, and lives of migrant people. Migration is not an acute emergency: it is a complex, structural, and dynamic phenomenon. Yet populist political leaders \u2014 particularly in Italy over the past two decades \u2014 have distorted this reality, deploying what amounts to institutional racism<\/a> to justify ever more security-oriented policies.<\/p>\n

The concept of “crimmigration”<\/a> \u2014 the convergence of criminal and immigration law \u2014 increasingly governs migration in Europe, with migrant people reduced to what Giorgio Agamben calls “bare life”: bodies to be blocked, confined, or expelled. These dynamics leave deep marks on the lives and health of migrant people, from barriers to healthcare access to the psychopathogenic conditions<\/a> of immigration detention centres. The term “alien,” now diffuse in political and media discourse, reinforces dehumanization<\/a> and constructs a racist and class-based division between “us” and “them.”<\/p>\n

From the perspective of migration medicine, four policy areas continue to jeopardize the lives and rights of migrant people across Europe:<\/p>\n

First, the Libyan detention system<\/a>, sustained by EU Frontex and funded by European governments (including the Italy\u2013Libya memorandum, renewed since 2017), in which migrant people are detained and returned to exploitation networks in documented violation of their rights. Second, the failure to provide sea and land rescue, compounded by the criminalization of NGOs and volunteers<\/a> saving lives in the Mediterranean \u2014 a sea that has become a cemetery. Third, the marginalization and detention<\/a> of undocumented migrants in places that several authors have described as “torturing environments,” harmful to both physical and mental health. Fourth, the externalization of borders<\/a>, exemplified by the Italy\u2013Albania agreement, which transfers the detention of migrants to third countries in a colonial logic, converting human beings into “unwanted bodies” to be removed beyond the reach of European legal protections.<\/p>\n

Together, these four burdens constitute what some authors have termed “migranticide”<\/a>: a political-cultural tendency aimed at rendering migrant people invisible, spanning social marginalization, detention, and death at sea. The upcoming implementation of the European Pact on Immigration and Asylum<\/a> in June 2026 \u2014 based on marginalization, detention, and expulsion \u2014 threatens to entrench these dynamics further. The European Commission’s proposed Regulation on Returns, already renamed the “Deportation Regulation” by critics, has prompted more than 200 European organisations<\/a> to call for its rejection.<\/p>\n

Implications for medical practitioners<\/strong><\/p>\n

These policy developments raise urgent ethical questions for healthcare professionals. The Italian Society of Migration Medicine (SIMM), working for over 30 years on migrant health and barriers to care in Italy, has directly confronted these questions. A central concern is the role of doctors and health workers in immigration detention centres \u2014 the Centri di Permanenza per il Rimpatrio (CPR)<\/a>, and their Albanian counterparts. SIMM has called on the medical profession to refuse participation in practices of marginalization and invisibilization, and specifically to refuse to certify migrants as “fit for detention” in places that evidence shows to be harmful to health.<\/p>\n

This position is grounded in foundational medical ethics: the duties of beneficence and non-maleficence cannot be suspended by administrative or political context. A BMJ analysis<\/a> has made this explicit: doctors should not declare anyone fit to be held in immigration detention centres. When detention environments are demonstrably psychopathogenic and linked to torture<\/a>, clinical certification of “fitness” becomes complicity in harm \u2014 a direct violation of the physician’s ethical obligations, regardless of whether the detention itself is legally sanctioned.<\/p>\n

SIMM’s call has found institutional resonance. The Italian Federation of Medical and Surgeons’ Orders (FNOMCeO)<\/a> and the National Order of Psychologists<\/a> have both endorsed the ethical and professional concerns raised by medical practice in these settings. This convergence of scientific and professional bodies on a bioethical question \u2014 should clinicians participate in systems that systematically damage health? \u2014 is rare and significant. It reflects a broader recognition that institutional racism produces not only social harms, but specific, documentable health harms that implicate clinical practice directly.<\/p>\n

The question extends beyond detention. Healthcare professionals treating migrant patients face structural barriers \u2014 discriminatory access policies<\/a>, administrative complexity, cultural and linguistic gaps \u2014 that are themselves products of crimmigration policy. Navigating these barriers ethically requires professionals to recognise that clinical neutrality is not morally neutral: silent compliance with systems that harm patients conflicts with the core obligations of medical practice. Professional bodies and medical educators have a responsibility to prepare clinicians for these dilemmas explicitly, rather than treating them as peripheral.<\/p>\n

Dehumanization \u2014 the ideological foundation and practical outcome of institutional racism in migration policy \u2014 demands a clear response from the health professions. As The Lancet<\/a> has noted, the far-right turn in European politics constitutes an evolving health crisis. Healthcare professionals are not bystanders to this crisis: they are called upon as practitioners, as witnesses, and as advocates. To answer Horton’s cry for help, we must first name what is happening \u2014 and then refuse to be instruments of it.<\/p>\n

 <\/p>\n

Authors:<\/strong> Nicola Cocco, Valentina Marchese and Federico Nicoli<\/p>\n

Affiliations: <\/strong>Italian Society of Migration Medicine (SIMM), Italy<\/p>\n

Conflict of interest declaration: <\/strong>None declared<\/p>\n","protected":false},"excerpt":{"rendered":"

By Nicola Cocco, Valentina Marchese and Federico Nicoli   “Who is here on the shore? Who is watching this shipwreck from the mainland? Is it really just me, no one else?” Vincent Delecroix, Small Boat, 2023   On February 2, 2026, the NGO Mediterranea Saving Humans reported that up to 1,000 people could be missing […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":503,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8064,8057,8111,1],"tags":[],"class_list":["post-4775","post","type-post","status-publish","format-standard","hentry","category-justice","category-medical-ethics","category-migration","category-uncategorized"],"yoast_head":"\nFor whom the cry for help tolls? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/05\/18\/for-whom-the-cry-for-help-tolls\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"For whom the cry for help tolls? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Nicola Cocco, Valentina Marchese and Federico Nicoli   “Who is here on the shore? 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