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A medical staffer looks out from an emergency medical tent in Brescia, northern Italy. A medical staffer looks out from an emergency medical tent in Brescia, northern Italy, March 12, 2020 (AP photo by Luca Bruno).

Why Italy’s South Holds the Key to Its Coronavirus Recovery

Tuesday, May 19, 2020

In early March, Lombardy, Italy’s most prosperous region, was fast becoming the epicenter of a global pandemic. As the number of coronavirus cases spiked above 7,000, with more than 350 deaths, the Italian government moved to quarantine the worst-affected towns in Lombardy and the rest of northern Italy, a move that was almost unthinkable at the time, with police setting up checkpoints to control traffic in and out.

Yet as the world focused on Italy’s north, Filippo Anelli, the president of the country’s national federation of doctors, saw another crisis coming. “If Lombardy has been brought to its knees,” he said, “imagine what would happen in the south.”

Anelli’s warning pointed to the significant and longstanding inequality between northern and southern Italy. While Italy’s health system consistently ranks among the best in the world, a 2019 report by the European Commission noted that “people in the south are twice as likely to encounter a sub-standard healthcare experience than people in the wealthier north.” There are just 95 health care workers for every 10,000 residents in the south, compared to 117 per 10,000 residents in the north. Before the coronavirus outbreak, roughly two-thirds of Italy’s 5,300 ICU beds were in its central and northern regions.

With meager resources and weaker infrastructure, many expected that the virus that had wreaked havoc in the country’s richer areas would simply devastate the south. When the central government announced the lockdowns, politicians across the south began to appeal directly to northern Italians, asking them to stay put. “Do not bring this virus to your brothers, sisters, grandparents,” pleaded the governor of Puglia, Michele Emiliano. The president of Calabria, Jole Santelli, was equally direct: “Coming here threatens our territory and all our loved ones. Our health system can’t handle it. Don’t do it.”

More than two months later, Lombardy still accounts for over a third of Italy’s cases, and nearly five times as many as every southern region combined. For the most part, the health systems in the south have, luckily, withstood pressure from the pandemic—aided at least in part by the national government’s aggressive lockdowns and creation of special isolation wards in hospitals for COVID-19 patients.

But now, as the quarantine measures gradually lift, Italy will be forced to confront some difficult realities. If the country as a whole is to recover, it will have to finally address the underlying economic and social imbalances that have historically favored its more prosperous north. If it does not, it may be pulled back under the weight of its divisions, further empowering criminal and corrupt forces that have plagued the country for decades.

Il Mezzogiorno

The pandemic has painfully exposed the inequalities in Italy’s health care system, but they are emblematic of deeper fissures. Il Mezzogiorno, as Italians call the south, accounts for one third of the population but just 22 percent of GDP. In contrast, the three northern regions of Lombardy, Veneto and Emilia-Romagna alone provide 40 percent of the country’s total economic output.

The gap in economic prospects for southern Italians compared to their northern compatriots is just as stark. The majority of claimants for Italy’s basic income program come from the south, where unemployment stood at 18 percent before the pandemic, compared to 5.9 percent in the north. Twenty-two percent of families in southern Italy live in relative poverty; just 6.6 percent do in the north.

If Italy as a whole is to recover, it will have to finally address the underlying economic and social imbalances that have historically favored its more prosperous north.

When it comes to health care, these persistent disparities manifest in a “two-track care system,” says Dr. Giovanni Ianniello, a surgeon and president of the Benevento Medical Commission, in the southern region of Campania. Of the 8.8 percent of GDP that Italy spends on health care, only 6.5 percent comes from public funds, far below other wealthy European countries. And these funds are not distributed equally. In the north, the state spends roughly $2,150 annually on health care per capita, compared to just $1,700 in the south. As a result, northern Italians, who are generally wealthier and better able to meet out of pocket costs, also receive superior state-subsidized care.

In 2005, the Italian government launched an ambitious plan for a wholesale restructuring of the national health service in order to reduce debt, trim staff and improve care. Years later, six of the seven regions whose health systems are still undergoing that restructuring are in the south. Impractical targets and a lack of resources have meant that many southern regions have been unable to meet the plan’s stringent demands. The consequence, according to Ianniello, “has been yet another reduction in the quality of the south’s public health offering.”

This has led to an increase in Italians going north for their health care, exacerbating the problem. Poorer regions not only have to pay richer ones to care for these so-called health migrants, but they also lose valuable doctors, nurses and other medical personnel looking for better opportunities elsewhere. Luca Bianchi, the director of the Association for the Industrial Development of the Mezzogiorno, says this transfer of resources “has strengthened the systems that are already more durable, while undermining those that are weakest.”

These imbalances did not emerge on their own. The divide between the north and south goes back deep into history. The century that followed the country’s unification in 1861 was, in fact, similarly characterized by the continual redistribution of resources away from the south and toward the north. But on the back of a postwar “economic miracle” in the early 1960s, land reform, investment in new industries and public works projects sought to align the southern economy with the productive might of the north. Over the course of the next decade, the gap in regional per capita GDP shrank for the first time in Italy’s history. Even as economic development stagnated in the following decades, particularly during economic crises in the 1970s and 1980s, steady improvements in quality of life triggered an era of continued social progress.

However, these promising improvements came to an abrupt end after the 2008 financial crisis. Around this time, the Northern League, Italy’s far-right nationalist party—now known simply as the League—began a push to abandon “solidarity with the south” in a campaign that vilified southerners and immigrants.

This notion of economic disentanglement quickly went mainstream. According to Bianchi, the country’s largest political parties adopted the view that if Italy’s “economic locomotive were able to grow without the deadweight of the south,” the effects would trickle down to the less prosperous regions. Political leaders, including the League’s Matteo Salvini, have pushed policies that, since 2010, have increased public spending in the north, while decreasing it in the south. The net effect has been a deterioration in social infrastructure in the part of Italy that needs it most.

These campaigners underestimated “the interdependence between north and south,” Bianchi says, and, as a result, have turned Italy’s economy into one of the most sluggish in Europe. At the same time, a combination of weakness, corruption and mismanagement on the part of southern leaders has eroded what little political will was left to bridge the gap between the country’s two halves.

People shopping in Naples, Italy.
People line up to buy fruit and vegetables at a shop in Naples, Italy, April 27, 2020 (AP photo by Andrew Medichini).

Italians across the country will now have to make a choice between division and solidarity. The pandemic may not have devastated the south as Anelli feared, but differences in standards of care among southern regions are still a major concern. Hospitals in Naples have been equipped to deal with the pandemic like those in the north, but the same can’t be said of hospitals in Calabria or Molise, which have had shortages of personnel and ICU beds.

Ianniello, for his part, sees solidarity winning out. “Everyone has given body and soul to protect our fellow citizens,” he says. “Even as we mourn the loss of colleagues, there’s a sense of unity among doctors around the country that makes us stronger.”

The sense of solidarity is “somewhat unexpected,” says Federica Virga, a journalist in Palermo. “We’re all sharing a common problem that isn’t limited to one territory. It makes you feel close to people you don’t even know because we’re all working together to reach the same objective.”

Giuseppe Comodo, a frontline medic near Salerno, in the southern region of Campania, sees it differently. “Italy’s emergency system wasn’t ready for a catastrophe like this,” he says. “Bureaucratic indolence,” he adds, has led not just to avoidable mistakes like delays in the delivery of protective personal equipment, but has put people at risk and may even have cost lives.

These preventable deaths infuriate him. “What I can feel is rage for the people who died and didn’t need to.”

The Real ‘Social Timebomb’

The public health emergency has yet to fully pass, but political leaders are growing concerned about a so-called “social timebomb” in the south that could explode if the post-lockdown recovery isn’t swift enough. March and April saw increasing reports of supermarket robberies and looting in southern regions that some warned might forecast “unrest.”

While many of these accounts are true, the way they have been reported, under sensationalist headlines, perpetuates “convenient stereotypes” that depict southern Italians as lawless, rebellious and criminal, says Eleonora Bommarito, an anthropologist from Sicily. There are undoubtedly exceptions, but “people are, for the most part, respecting the rules, because everyone feels a sense of responsibility,” she adds. “They know this is what needs to be done.”

Southern Italians are no strangers to sacrifice, having perfected over centuries l’arte di arrangiarsi—the art of getting by. In Bommarito’s words, “there’s a certain resilience that characterizes us.”

The response from Rome has inspired some confidence among Italians in il Mezzogiorno. The government has committed some $433.5 million in food vouchers, along with an additional $4.8 billion in regional aid. This is on top of a $27 billion rescue package approved in March, which includes a freeze on layoffs and one-time payments of $650 for the self-employed. The reward for Prime Minister Giuseppe Conte was a 15-point jump in his approval ratings in April to 65 percent.

Yet as well intentioned as the central government’s initiatives are, they haven’t been without setbacks. Some regions have criticized the chaotic rollout of the relief programs, such as delays in financial disbursements and confusion over benefit eligibility requirements that have left many would-be recipients in limbo. Equally troubling, upwards of 20 percent of the southern Italian economy is informal, meaning a significant number of people don’t qualify for help, further depriving those already on the margins.

While many do feel a shared responsibility for slowing the contagion, there is still a sense that the real difference in the south continues to be made at the local level. Palermo, for example, has earmarked $5.4 million to help families buy essentials, while already cash-strapped regions from Puglia to Campania have extended lifelines to businesses. Communities have set up online campaigns to encourage support for local businesses, and teachers regularly donate meals to students in disadvantaged areas.

“Good leaders understand the needs of their constituents and how quickly things can get out of hand,” says Virga, the journalist in Palermo. Failure to address those needs could test the limits of people’s patience, Leoluca Orlando, Palermo’s veteran anti-mafia mayor, warned in an interview for La Repubblica in March. “People will say the state is fighting the virus but taking away our bread,” he said.

The risks of that are significant in southern Italy, where temporary stopgaps aren’t enough to offset the endemic hardships. In the absence of a concerted effort to improve governance and social services, old forces like the mafia may try to fill the void from the pandemic. “The real social timebomb,” Bommarito says, is the flipside of that classic southern resilience. “It won’t be a revolution with pitchforks, but a subtle return to the old ways of solving problems.”

In the absence of a concerted effort to improve governance and social services, old forces like the mafia may try to fill the void from the pandemic.

The supermarket robberies provide a telling example, as they bear the subversive imprint of organized criminal activity. Police have investigated reports that the mafia may have worked behind the scenes to incite, or at least sanction, some of the raids to then redistribute the food and essential items among needy Italians, in order to present itself as a charitable benefactor. After similar crimes took place in Palermo, Orlando denounced them as the actions of “mafia sharks taking advantage of desperation.”

Always the opportunist, Italy’s mafia has a notorious history of exploiting everything from financial crises to natural disasters to curry favor among people who feel neglected. It has profited off calamity while projecting itself as a kind of stabilizing force. It infiltrates areas where legal economic structures are in dire straits, extending readily available credit and liquidity to struggling businesses. Those that come under its “management” are sustained by illicit capital while the mafia, in turn, can hide behind their legitimacy. An estimated 2 million small and medium enterprises throughout Italy are vulnerable to these types of takeovers.

The mafia lends this helping hand to establish a system of patronage, essentially buying support by filling in where government action is, or is perceived to be, missing. For those who feel they may have nowhere else to turn, it offers itself as an ever-present lifeline. In the 1980s and 1990s, Orlando recalls, “unemployed laborers would publicly praise the mafia that had provided jobs.”

“The mafia knows how to appeal to people,” Bommarito says. “It understands its territory and is better organized than most political parties.” That’s why the threat it poses is so insidious, not just for the immediate risks to law and order, but for its long-term ability to displace democratic institutions and appeal as a parallel state.

“At election time, people will remember that help from the mafia bosses arrived before that of the government,” Nicola Graterri, a public prosecutor in Calabria, said in an interview last month on the Italian news program Speciale TG1.

While the mafia’s power base is in the south, the effects of organized crime will not be contained there. As Roberto Saviano, an Italian writer who has reported extensively on the mafia and now lives under 24-hour police protection, explained recently, the mafia, when powerful, undermines governance far outside Italy’s borders.

“The mafia dominates rough areas with force, but embezzles and reinvests where the economy is healthiest,” Saviano said. That includes places like Milan, Lombardy’s capital, as well as foreign cities like London and Berlin. So it pollutes the entire market, undercutting competition, eroding the legitimate economy and expanding its foothold to new frontiers. The economic crisis brought on by the pandemic could be another opportunity for the mafia to bolster its reach.

And it isn’t the only subversive actor on the prowl. Anarchist and neofascist groups—veteran agitators in Italian politics—also see an opportunity to pit a supposedly disinterested elite against the struggling population it has abandoned. This not only undermines civic confidence but, as with the mafia, also engineers a convenient, if false, alternative: The state doesn’t care about you, so come join us.

A New Social Contract

This isn’t to say that southern Italians are helplessly at the mercy of dark forces pulling the strings of social unrest for personal gain. Nor is it to suggest that organized crime is the only problem the south faces. Rather, the situation reflects both the dangers of a weak national response, as well as the scale of the challenge ahead.

The sheer size of the north’s economy means it will inevitably take a bigger hit from the pandemic. Nonetheless, the south is at far greater risk in the long run due to its systemic problems. Competitive but financially vulnerable businesses in the south will need state support to stay afloat.

But even vital economic interventions would only solve part of the problem. For Bianchi, the director of southern Italy’s development association, the country’s post-coronavirus recovery must be an “opportunity for national restoration” to overcome lingering inequalities, with education and health the key pillars of a renewed social contract.

Some 50 percent of 14-year-olds in the south struggle with reading comprehension, and upwards of 60 percent have difficulty in math. Raising education standards is as much a matter of addressing disadvantages as it is providing an adequate public service, and will therefore require solutions both big and small, from building better schools to enhancing teacher training and expanding free meal programs.

People line up to board the train in Milan, Italy.
Passengers board a train to Naples as lockdown measures ease, Milan, Italy, May 4, 2020 (Photo by Claudio Furlan for LaPresse via AP).

As for health, Ianniello, the doctor from Benevento, says that public health workers in southern Italy do all they can with the resources they have, but that deeper reforms are needed. “We’ve learned we need a single system run by the central government that ensures equitable distribution of resources and that is capable of reacting the same across the country.” That also means greater transparency and accountability when things go wrong.

More investment in social infrastructure would put public services back at the heart of strategic decision-making. That demands solving old problems like improving transportation from north to south, while keeping up with the pace of change by upgrading high-speed internet connections, strengthening southern links with the north’s productive engine and creating opportunities for innovation to attract talent and money.

Driven by necessity during the lockdown, the south introduced things that are taken for granted elsewhere: working from home, digital commerce, distance learning. These will have to become regular fixtures once the country fully reopens.

So, too, will overcoming one of southern Italy’s most stubborn imbalances: the gender employment gap. Although the number of women in the workplace is at a 40-year high, the female employment rate throughout Italy is 20 percent lower than that of men. What is worse, only around a third of women in the south are in some form of employment, compared to more than 60 percent in the north. Addressing these imbalances would not only have the obvious benefit of improving prospects for women, but would also revitalize the job market and break the south’s social and economic malaise.

For any of this to materialize, however, southern Italy will have to finally untangle the grip of its shadowy enemies. A tragic history of political assassinations in the 1980s and 1990s has taught il Mezzogiorno that the best way to combat the influence of the mafia is to talk about it, demystify it and bring it into the open. These strategies of vocal defiance have become all the more important in order to secure the south’s place in Italy’s post-pandemic recovery.

National unity can’t just be empty rhetoric rolled out in times of crisis. It must be accompanied by a genuine effort to overcome the fault lines that have held back all of Italy.

Magistrates from Naples to Palermo are leading this charge, calling for businesses to be barred from receiving any of the roughly $434 billion in government-backed loans, which were unveiled in April, if they have personnel under investigation for organized crime or financial crimes. The magistrates also want the use of these funds to be tracked, to guard against corruption and the mafia, and to prevent criminal infiltration of businesses at a time when they are most vulnerable.

Civil society has also stepped up the pressure, fighting to reclaim the spaces that have fallen victim to criminality. There are new programs to collect data and information on the mafia to share with authorities. And a new series of nationwide video conferences seek to educate Italians on how to expose, monitor and resist attempts by organized crime to exploit recovery efforts.

All these changes would fundamentally reconfigure southern Italy and sustain the spirit of solidarity that has grown from the pandemic. The underlying challenge is as much a question of institutional capacity as it is of political will. Many see an enormous opportunity that could permanently transform a country dogged by governmental instability and economic stagnation.

After all, as Bommarito says, the coronavirus pandemic has had a somewhat equalizing effect. “We’ve learned that things can be just as bad in the north as in the south.”

But the fact is that the north still has more resources with which to cope. National unity can’t just be empty rhetoric rolled out in times of crisis; that would simply perpetuate the same fractures that have always divided Italy. It must be accompanied by a genuine effort to treat its ailments and overcome the fault lines that have plagued one half of the country, but held back all of Italy.

Alessandro Lanuto is a freelance journalist and independent researcher based in London whose work focuses on European politics, poverty, crime and security.