Invisible Health in Milan: a Bocconi and Naga Study on Undocumented Migrant Women
They arrive on their own, with diplomas and degrees that are of no use here. They look for jobs, but often only find undeclared work as cleaners or caregivers. And when they get sick, they end up in charity-run assistance. This is the reality of undocumented migrant women, as captured in a new study, Labor and health of undocumented migrant women: evidence from a large primary care outpatient clinic in Milan, Italy, by Carlo Devillanova (Bocconi) and Anna Spada (of Naga, a charity), published in the Frontiers in Human Dynamics journal.
The survey—the largest ever conducted in Italy on this group—was conducted on 7,463 medical appointments by 3,000 women who turned to Naga’s free clinic in Milan between 2022 and 2025. Nearly all of them excluded from the National Health Service, they live in a limbo of legal, employment, and health insecurity.
“These women represent an extreme laboratory of inequality,” explains Carlo Devillanova, associate professor of economics. “They are educated, often mothers, but trapped in invisible jobs and a network of barriers that damage their health.”
Young, educated, and without rights
More than half of the sample is unemployed, 55% live with friends or relatives, and 92% do not have a valid residence permit. Two-thirds arrived in Italy less than a year ago, mostly from South America: 47% from Peru. Yet over 60% have at least a high school diploma.
This is wasted human capital, that a system unable to welcome these people cannot absorb. “These are women who work in private homes or in the informal economy, without any protection, often with grueling hours and fear of being even seen,” comments Devillanova.
The most common diagnoses: back, anxiety, and heart problems
Sixteen percent of visits are for prevention and reproductive health, followed by muscle and skeletal disorders (11%) and urinary tract infections (10%). But the most disturbing part emerges in the long run: one in seven women develops a chronic disease—diabetes, hypertension, respiratory problems—during subsequent checkups. “At first, they come for acute disorders or gynecological visits, but over time, chronic conditions emerge,” explains Devillanova. “The lack of access to primary care means that problems are discovered late and treated less effectively.”
Among older patients, the risk of cardiovascular disease is 30 times higher than among younger women; the risk of endocrine disorders is six times higher. Yet it is women over 45 who are least likely to undergo preventive check-ups.
“Guarantee primary care for all”
The message of the study is clear: excluding undocumented migrants from primary care is a public health mistake. “Guaranteeing everyone access to a family doctor,” says Devillanova, “would reduce avoidable hospitalizations and costs to the system. It is not a matter of charity, but of healthcare efficiency.”
Behind the numbers are young women, often with children, who fall ill while keeping the daily lives of others going. Invisible to the law, but indispensable to society.
