Health service in Italy’s poor south at mercy of Covid and crime

A public health management crisis in Italy’s poorest region has left Rome scrambling to contain coronavirus in the most vulnerable part of the country’s hospital system already weakened by vast debts and infiltration by organised crime.

Giuseppe Conte, Italy’s prime minister who was praised for his response to the first wave of the pandemic, has been embarrassed by the loss of three regional health commissioners in the southern Calabria region in just two weeks.

The mess has refocused national attention on the stark contrast between the well-funded and administered public health service in Italy’s northern regions and the deeply indebted and struggling hospitals of the country’s south, which up until October had been all but spared from a significant outbreak. 

The first departure took place in early November when Saverio Cotticelli, then Calabrian regional health commissioner, was fired by Mr Conte after admitting on television that he was unaware that it was his responsibility to draw up a local emergency plan to tackle the virus.

In his place came Giuseppe Zuccatelli, who resigned just days later after footage emerged of him claiming that people were safe from Covid-19 unless they engaged in prolonged kissing. His replacement was Eugenio Gaudio, a former rector of Rome’s Sapienza University. 

Then Mr Gaudio informed the government that his wife did not want to move to Calabria, a region located at the toe of the country’s boot-shaped peninsula that ranks closer to Romania in terms of GDP per capita than the north of Italy. Calabria’s unemployment rate of 21 per cent is more than double the Italian national average.

Mr Conte apologised to Calabria and pledged to act faster to address the lack of leadership but no replacement has yet been found.

Prime Minister Giuseppe Conte has been embarrassed by the string of bungled regional health appointments © Angelo Carconi ANSA pool/LaPresse/AP

It is only the most recent example of the poor administration of the health system in a region that sadly in the eyes of many Italians has become synonymous with the activities of the ’Ndrangheta, the country’s most feared and powerful organised criminals.

The corruption and infiltration of the Calabrian health budget is a core criminal activity for the ‘Ndrangheta, which over the past two decades has grown in strength and wealth to eclipse the far more famous Sicilian Cosa Nostra.

While all other Italian regions have direct responsibility for their public health systems under the terms of the country’s system of devolution, Calabria is an exception because Rome was forced to take direct control a decade ago following the discovery that large parts of it had been infiltrated by organised crime.

Since then there have been repeated further discoveries of ’Ndrangheta infiltration of parts of the Calabrian health system. Rome last year took over the local health authorities of Reggio Calabria, the largest city in Calabria, and Catanzaro, the second largest, as a result of evidence that organised criminals had managed to win lucrative contracts to supply hospitals. 

Emilio Viafora, president of Federconsumatori, a large Italian trade union-connected consumer association, wrote an angry open letter to Mr Conte, blaming him for “debilitating the already fragile democracy of the region suffocated by an increasingly invasive presence of the ‘Ndrangheta”.

The vulnerability of the Calabrian health system has concerned medical practitioners and public officials since the start of the pandemic, with many fearing that a Lombardy-style outbreak would result in human catastrophe. Data compiled by Italy’s health ministry before the pandemic show that Calabria had 2.9 hospital beds per 1000 inhabitants, compared with four in the wealthy northern region of Emilia-Romagna.

So far, the worst-case scenario has not come to pass. The number of Covid-19 related deaths in Calabria as of Thursday was 254, a fraction of the 21,212 recorded in the far larger Lombardy.

But the rapid accelerations of new infections has alarmed Italy’s central government. For more than a month Calabria has been placed under the strictest possible public health restrictions under Italy’s regionally tiered system of lockdowns.

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Health service in Italy’s poor south at mercy of Covid and crime

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Mr Conte’s government has judged the situation in Calabria to be serious enough to draft in a nongovernment organisation that normally operates in war zones in Africa to construct field hospitals in the region.

Last week, as Calabrians digested news of the latest bungled appointment of their health chief, one of the region’s leading politicians was placed under house arrest by Italian police after being accused of collaborating with a powerful mafia family to launder money through a network of pharmacies.

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