Foreign-born doctors reignite Italy’s citizenship debate

Of note:

When the Italian government labeled Sicily a high-risk region last month over fears that the island’s limited resources would hamper its response to the second wave of the pandemic, Rumon Siddique got ready to help.

The region, one of Italy’s poorest, is struggling with a lack of doctors and nurses — and Siddique, a 29-year-old junior doctor born in Bangladesh and trained in Italy, has the necessary skills to step in. But because he doesn’t hold Italian citizenship, he’s unable to apply for open positions.

He was puzzled to learn that Sicilian authorities had instead asked the government of Cuba to deploy 60 health care workers.

“The paradox is that we already have doctors here, without having to ask Cuba,” said Siddique, who works at the Paolo Giaccone University Hospital in the Sicilian capital Palermo. “There are many foreign doctors already living in Italy, willing to fill that void. But because they don’t have Italian citizenship, they are often forgotten.”

At the height of the first wave of the pandemic, medical personnel from abroad, including teams from Cuba, Romania and Norway, were deployed in the hardest-hit northern regions of Italy. During the second wave, several regions have asked NGO workers, junior doctors — who have yet to complete their training — and retirees to prepare themselves to help out if needed.

In March, the government issued the so-called “Cure Italy” decree, which allowed hospitals and regional authorities to hire non-EU staff with legal permission to live and work in the country.

But many institutions have continued their decades-long practice of requiring either Italian or EU citizenship in their job openings, excluding foreigners trained and educated in Italy, even as the country’s intensive care units began filling up again this fall.

That has triggered a discussion on labor rights, with several immigrants’ organizations calling on the government to ensure the law is followed.

But beyond that, with first- and second-generation immigrants finding citizenship a core obstacle to employment, foreign doctors have reignited a longstanding debate on who gets to have an Italian passport — and the rights it bestows.

Paths to citizenship

In Italy, citizenship is acquired mainly through blood ties, as is the case throughout the European Union.

Most EU citizens attain that status through jus sanguinis, a principle that allows parents to pass on their citizenship to their children. Some EU countries allow for a limited version of jus soli, which in its unrestricted form — used in the United States, for example — bestows citizenship on anyone born in the country. Naturalization is usually possible via other routes, albeit subject to conditions.

But acquiring Italian citizenship without ancestral ties or marriage is a particularly lengthy process. The country is one of only five EU countries requiring non-EU citizens to document 10 years of residency to qualify for naturalization. (The EU average is seven years, according to 2018 data.)

Under the current citizenship law, which dates back to 1992, children born to immigrants can apply for citizenship — but only if they apply between ages 18 and 19, and if they can prove uninterrupted legal residency in Italy for their whole lives up to that point.

For children not born in Italy, like Siddique — who arrived in 1999 — naturalization often depends on the status of their parents. As he was already 18 by the time his parents could prove 10 years of uninterrupted legal residency in the country, he wasn’t eligible to apply as their dependent.

He could apply individually as an adult, a route open to all immigrants after 10 years, but it’s a long and difficult path: The waiting time can be as long as four years. Applicants also need to prove regular employment or income — a vicious circle for medical staff that face difficulties obtaining steady employment due to their nationality. (A trainee scholarship, like Siddique has, is not enough.)

There have been efforts to change that. First- and second-generation immigrants have started pushing for citizenship rights, and in 2016 Matteo Renzi’s centrist government made an attempt to reform the 1992 law.

His coalition’s proposal — dubbed ius culturae (Latin for “cultural right”) to contrast with jus sanguinis, “blood right” — aimed to grant automatic citizenship to all children who are either born in Italy or arrived before the age of 12 and who completed at least five years of Italian schooling.

But the vote on the proposal was postponed in summer 2017 amid fierce opposition from both within the coalition and the far right, as the national mood on immigration shifted, with tens of thousands of migrants and refugees arriving in Italy that year.

Then, in early 2018, a populist coalition comprised of the anti-establishment 5Star Movement and the far-right League took power and enacted what critics have labeled as xenophobic laws. The new government also made it harder to apply for Italian citizenship by introducing longer approval times and higher application costs.

These days, the 5Stars — who have been since 2019 in a coalition with the center-left Democratic Party — are striking a different tone. The two parties have been involved in discussions to formally reopen the debate on citizenship reform by mid-2021.

“We recognize it is a lost opportunity when qualified doctors, or valid workers of any field, don’t have the same labor rights as Italians,” says Simona Suriano, a spokesperson for the party.

“We don’t have any prejudice regarding the ius culturae, times are now ripe to extend citizenship rights to those who mainly grew up and studied in Italy,” she added. “But I don’t think either that we would agree to go beyond that and accept, for instance, a ius soli model like that of the U.S.”

‘A loss for Italy’

Italy’s aging population means that the country’s medical staff shortage — more than 10,000, according to 2018 data — is only going to become more acute.

Foreign-born medics could boost their numbers, however. About 77,500 foreign-born health care professionals are qualified to work in Italy, according to data collected by the Association of Foreign Doctors in Italy (AMSI).

They include 22,000 doctors and 38,000 nurses, with the majority working in the private sector as only 10 percent of them managed to access the struggling public health care sector, said Foad Aodi, AMSI’s president.

“There have been around 13,500 [openings] for health care professionals across Italy since the pandemic, but we keep being excluded. We don’t want to take the jobs from Italians, we only ask to integrate in the country we’ve chosen to call home,” Aodi said.

After ASGI, the lawyers’ organization, sent a letter to the Italian interior ministry complaining that many regions were still not complying with the “Cure Italy” decree, some hospitals and regions changed their stance and opened jobs to non-EU applicants.

Yet Alberto Guariso, an immigration lawyer with ASGI, said the organization has found at least seven of Italy’s 20 regions are still not implementing the decree. Even in regions that changed their stance after ASGI’s intervention, the options often remain limited for foreign medics.

For example, Tuscany opened jobs for non-EU nationals recently. “But in terms of rights, it is insignificant,” says Hamilton Dollaku, an Albanian nurse and trade unionist based in Florence, who currently works in the private sector. “It offers a one-year contract with no possibility of renewal. It works through direct calls only” — meaning employment is dependent on the hospitals’ needs — “and many foreigners will rightly refuse.”

Byzantine hiring practices and a lack of suitable positions also present challenges to Italian medicine graduates. But the discrimination is a major factor in pushing foreign-born staff and students to seek their fortunes elsewhere in droves, said Siddique.

“It only damages the image of Italy’s health care system and disrupts our lives, forcing many of us to leave for elsewhere in Europe,” he said.

Plus, he pointed out, it’s a waste of money if the very institutions that spend thousands of euros on training him and others without EU citizenship don’t benefit from their investment.

“We are talking about €150,000 for every [medical student] for the whole duration of studies,” says Siddique. “Excluding us is a loss not just for us, but also for Italy.”

Source: Foreign-born doctors reignite Italy’s citizenship debate

About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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