Italy is fighting its second wave of Covid-19, and it’s worse than the first. There are more than 35,000 new daily cases, with outbreaks all over the country, including in southern regions that often lack sufficient healthcare infrastructure.
For years, the country has faced a shortage of healthcare workers (link in Italian), and the pandemic is making the situation worse.
According to the unions representing healthcare workers, the Covid-19 emergency has left the country with a shortage of as many as 73,000 health workers. Existing personnel continues to be stretched thin. The national government, as well as regional governments and individual hospitals and clinics, opened up emergency recruiting, but with a lack of qualified candidates to hire, they have had to recruit inexperienced new graduates, and retired healthcare workers to replenish their ranks.
In the past few days, chyrons running along the bottom of popular TV shows have announced temporary emergency openings for 200 civil protection doctors (who are deployed nation-wide on an as-needed basis) on top of those required by individual hospitals and regions, detailing the conditions of employment.
But there is a group that continues to be mostly left out of consideration: foreign professionals.
According to Italy’s laws, the only non-Italians that can be hired in public roles (which include most healthcare workers) are European citizens, their relatives, or foreigners who have a long-term residency permit (so-called “permesso di soggiorno“), which is acquired after living in Italy for at least five years continuously with specific income, employment, and housing requirements. Only a minority of foreigners in Italy hold a long-term permit.
Those working and living in Italy with temporary permits, no matter how long their total time of residence in the country, wouldn’t be able to apply. This can include second-generation immigrants born in Italy, since Italy doesn’t recognize a right to citizenship to children of foreigners born in the country unless they, and their parents, maintained uninterrupted legal residence in Italy since their birth and until they turned 18.
Regulations are different across Europe. The European Union (EU) set some minimum parameters for member states in terms of hiring immigrants in the public administration—notably making all EU citizens, long-term immigrants, and refugees, eligible for employment. Regulations about immigration status vary by country, and in several EU countries, children born in the country have an easier path to citizenship.
Employment rules in the healthcare sector also vary according to the country. In countries such as Belgium or Germany, healthcare workers aren’t always hired by governments as they are in Italy, so there is a lot more flexibility in recruiting, says Vincenzo Costigliola, a doctor and the president of the European Medical Association. Germany, for instance, has a specific recruitment path open for foreign healthcare specialists.
But compared to Italy, even public employment can be easier for immigrants in other EU countries. In France, for instance, foreigners with short-term permits can be hired in public-sector jobs, at least on a contract.
In March the Italian government introduced a temporary change, allowing the recruitment of immigrant healthcare workers holding temporary residency permits, too, for the duration of the Covid-19 emergency, a move immigrant rights advocates criticized as opportunistic.
There is another barrier, too. In order to qualify to be hired, foreigners must certify their degrees are equivalent to Italian ones. This is done on an individual basis, rather than as an automatic procedure, and is a bureaucratic step that can be long and expensive. In March, this requirement, too, has been suspended for healthcare workers, who during Covid are allowed to apply for the jobs with the degree they acquired internationally, without further steps.
Yet in most cases, the requirements listed in the job postings have not taken into account the newly introduced exception, says Paola Fierro, a lawyer from ASGI, an organization researching immigration policy. Many hospitals, regions, and even country-wide job postings continue to be closed to most immigrants.
In some cases, she says, one of the two requirements is still maintained, and in others, both still are, despite the March regulation. There are even cases, where the call for application contradicts itself, allowing temporary residents to apply only to specify later that the jobs are not available to them.
Things are even more complicated when it comes to doctors, whose role is considered managerial. The law says only Italian or EU citizens can hold public managerial roles, pretty much banning non-EU doctors from being hired in the public sector. Whether the current provision for healthcare workers applies to doctors, too, seems a matter of interpretation, and changes depending on the hiring committee.
“There is stratospheric confusion,” says Fierro. Decisions regarding immigration status when it comes to access to public healthcare recruiting, she adds, are essentially discretional. While Covid-19 has exacerbated the emergency, the root cause is actually in Italy’s government’s unwillingness to open public sector access to all documented immigrants. Old laws banning all non-citizens from public employment were updated in 2000, in line with EU requirements. But political opposition to providing equal treatment to all immigrants has so far prevented the expansion of the benefits to temporary-permit holders.
According to AMSI (the association of foreign doctors in Italy), there are over 77,000 foreign healthcare workers living in Italy, including 22,000 doctors and 38,000 nurses. Many of them studied in Italy, benefiting from public investments in their education, yet only 20% can access public employment.