In a pandemic context, information sharing and prevention measures - as well as the containment of positive cases - are extremely important. This is especially true for informal settlements. Aiming to uphold the rights of all people, particularly those that are socially excluded and living in informal settlements, INTERSOS acts as a bridge between healthcare institutions and communities. Its interventions are temporary, functioning to empower local institutions and services.

INTERSOS works to ultimately enable individuals and institutions to interact with each other independently. In particular, it supports public institutions in their efforts to improve their intake capacities and to lower access barriers (e.g. bureaucratic; cultural; linguistic; practical). As a key part of the INTERSOS approach, volunteers with lived experience play a big role: they are trained to be part of the safety net, as there cannot be safety without the empowerment of the beneficiaries themselves.

• Vulnerable people in situations of extreme social exclusion, both Italians and migrants;
• Society as a whole (thanks to early prevention of COVID-19 and containment of positive cases).

In the informal settlements and squats in which it works, INTERSOS:

• guarantees the provision of primary health care via mobile care units;
• disseminates health information among community members;
• facilitates access to public health services;
• offers various health education courses according to the main needs of each community (e.g. mother and child education).

Since March 2020, INTERSOS mobile teams have been carrying out medical examinations to prevent COVID-19 infection, distributing hygiene-sanitation kits, teaching prevention measures and fighting misinformation. Prevention and risk-containment protocols were partially modified to ensure enforceability and effectiveness in the context of informal settlements.

INTERSOS strategies are based on active involvement. For instance, the organisation trains health representatives from within the communities in which it works. Different approaches are adopted according to the characteristics of each informal settlement, including:

Housing squats, Rome:

Already active in Rome since 2016, INTERSOS supports the regional health system in implementing COVID-19 preventive measures.

In each informal settlement, community 'health promoters' are trained to support health authorities in the management of suspected positive COVID-19 cases. They learn how to coordinate with health authorities and how to enact protocols for the containment of positive cases. Following this training communities are able to organise themselves, follow relevant operating procedures and communicate directly with health authorities. Outbreaks can therefore be promptly contained.

Rural informal settlements, Foggia region (Apulia):

Since 2018 INTERSOS has been working to support seasonal agricultural workers forced to live in precarious sanitation conditions. Thanks to the ongoing presence of INTERSOS workers in the area, they were able to establish relationships of trust with locals and provide them with medical examinations and information from the pandemic's onset.

In situations of extreme vulnerability, cultural mediation is essential and people sharing the same culture of origin are preferable. In rural informal settlements, the number of people changes with the seasons. Unlike urban squats, these communities are characterised by a certain individualism, and INTERSOS therefore cannot rely on internal solidarity. Therefore in areas of work such as contact tracing, for example, members of the community are paid as an incentive to work. They are community mobilisers - people living in the community that are already involved in other projects - and they are paid for being in charge of contact tracing as well as committing to undertake a year of training.

© Giulio Piscitelli

Since March 2020:

• 315 hygiene-sanitation kits distributed in Rome and 3419 in the Foggia region;
• 1872 COVID-19 clinical risk assessments carried out in Rome and 299 in the Foggia region;
• 1953 medical check-ups carried out in Rome and 1651 in the Foggia region.

In addition:

• Early intervention prevented the spread of COVID-19: containment of positive cases and outbreaks under control;
• Successful empowerment of individuals and active involvement of communities in informal settlements: the community is actively involved;
• Creation of a model approach to local medicine that could continue to exist beyond the pandemic-induced state of emergency.

Appointed as an external evaluator, the Action Research for Co-development (ARCO) Lab of the University of Florence will assess the intervention in the Foggia region. The results will be published in October 2021.

Consistently with its general organisational approach, INTERSOS operates mainly on private contributions. Public contributions are received for projects aiming to strengthen public services.

During the ongoing COVID-19 pandemic, INTERSOS interventions have drawn on a mix of public and private contributions. In Rome they are funded by private contributions; in Foggia they draw on public contributions (e.g. the Su.Pr.Eme Project).

© INTERSOS