"They say he was a handsome man and he came, he came from the sea. He spoke another language, but he knew how to love," sang Lucio Dalla in 4/3/1943, a reference to the wartime period when soldiers arrived from the sea and often had brief love affairs with young women in the cities where they landed. "That man" today would pass through the hands of another man who would offer him a different kind of love, welcoming him in order to care for him, as though he were a son: he is Pietro Bartolo, Lampedusa's doctor since the early 1990s. Most Italians came to know him through the documentary film Fuocoammare by Gianfranco Rosi, which won the Golden Bear at the Berlin Film Festival in 2016, in which he plays himself.

Above all, he is one of the key figures in recent Italian history, to the extent that President of the Republic Giorgio Napolitano awarded him the title of Cavaliere and President Sergio Mattarella that of Commendatore of the Order of Merit of the Italian Republic. Together with journalist Lidia Tilotta, Bartolo has sought to capture part of this story in a book entitled Lacrime di sale, published by Mondadori.

They say he was a handsome man and he came, he came from the sea. He spoke another language, but he knew how to love. And that day he took my mother upon a beautiful meadow. The sweetest hour before being killed.4/3/1943 by Lucio Dalla

Dr Bartolo was born on Lampedusa itself and since 1991 has run the island's medical centre, which lies in the middle of the Mediterranean, suspended between Europe and Africa, for many — too many — years. These are the years of migrant landings and of shipwrecks involving the so-called "carrette del mare" — unseaworthy old vessels — first, and then inflatable dinghies. Years in which he has seen and lived through everything. From singular joys to the most intense tragedies, all of which have left an indelible mark on his memory, like endless nightmares.

This interview with Bartolo was conducted during one of the many screenings of Fuocoammare organised across Italy — in this case by Emergency, at the Infopoint in Rome. An interview as intense as the emotions of a man who refuses to resign himself and refuses to grow accustomed. Who hopes to become unnecessary soon, that he will no longer be needed in Lampedusa, and who at the same time cannot build a shield to protect himself from a profession made up of a constant succession of emotionally gruelling moments. A man of the old school, who does not hide his fear but never steps back — never — because he knows what must be done in order not to lose one's humanity.

How many medical staff are there on Lampedusa? And how far does the care you provide extend to these people at the moment they land?
We're not a large team, but we've always managed and I believe we always will, albeit with great sacrifice. But I hope all of this ends soon and that we're no longer needed. There are three or four of us doctors directly dealing with migrants, split between the quayside and the small emergency unit, though we always regroup at the end of each landing. For as long as we're needed, we'll be there.

With the staff we have, we manage to cover pretty much all medical needs. We have a rescue helicopter that we use when necessary, to transfer people with more serious conditions — such as burns, what I call "dinghy disease" [see further on for an explanation, ed.], torture wounds, or severe cases of dehydration — to other hospitals in Sicily. Fortunately, though, they are not all ill. The majority are healthy people who don't need treatment. That said, there are times when we've found ourselves in a crisis situation, such as when I had to bring 68 people from the quayside to my medical facility, with all the difficulties and hardships that entailed.

"It is the duty of every man, to be a man, to help these people," you said in Fuocoammare. How would you describe those who do not help them, or worse, make their situation even more difficult?
Let me be clear: I do not share the approach of this government — nor of the previous one, for that matter — because the decision to reach agreements with Libya is, in my view, reckless, and it is increasing the number of concentration camps in that North African country; those places are genuine death camps. I believe this is the wrong path. We were outraged when the European Union chose to pay the Turkish government led by Recep Tayyip Erdoğan to block Syrian migrants at Europe's borders, and now we are doing something even worse. There is a major, fundamental difference between Turkey and Libya: whereas the former has refugee camps, the latter has concentration camps. Reception centres they are not. I can assure you that the people arriving in Lampedusa do not look as though they've come from first-rate facilities. We have rescued young men who arrived in a catastrophic physical state, having been subjected to violence and torture; young men arrived in a state of severe malnutrition who told us they had been fed rice dressed with used engine oil. All of this is happening in Libya, which today is governed by small groups of criminals who profit off the backs of these people until they have nothing left to take from them, and only at that point put them on dinghies and leave them to die at sea.

For anyone with a degree of sensitivity, the Italian government's policies towards migrants today look like absolute evil. Yet, and I imagine you know this better than anyone, the massacres of October 2013 were the product of policies very similar to those of today, as documented at the time by journalist Fabrizio Gatti. Would you confirm that? And why, in your view, are the NGOs — which are preventing exactly the kind of tragedies that occurred in 2013 — now being cast as the enemy?
As far as I'm concerned, NGOs deserve to be praised, to be admired, because they fill the void left by Europe and by Italy. The people working for these organisations have saved thousands and thousands of other human beings, and for that the NGOs deserve our gratitude. I remember the Lampedusa massacre of 3 October 2013 very clearly, because I was there, as always, and I found myself having to carry out hundreds of post-mortem examinations — we are talking about 360 people, including children and pregnant women — experiencing that moment of immense grief first-hand. Many of these things still come to me in my sleep; for me they are nightmares.

Following that massacre, Italy, in a gesture of great civilisation, launched the extraordinary Mare Nostrum operation on 10 October — which then paradoxically turned into something negative. From that moment on, human traffickers exploited the presence of Italian naval vessels and NGO ships near the Libyan coast and stopped buying and providing migrants with the so-called "carrette del mare" — the boats that were supposed to cross the entire Mediterranean and that could cost tens of thousands of euros. Those vessels also had people-smugglers on board to escort the migrants to Lampedusa. Those same traffickers took advantage of Mare Nostrum to start buying Chinese-made inflatable dinghies that cost very little and sink immediately, because sometimes they are not even proper dinghies — they are single-layer inflatable liferafts without a keel, carrying 100 or 120 people. So all it takes is a wave or a puncture to sink them. And so, paradoxically, shipwrecks increased and the death toll rose.

And from that moment on we came to know a new illness — when I already felt I had seen every kind of condition linked to the journey, though never anything infectious, as people so often want us to believe: it is the "dinghy disease." That is, chemical burns to the skin caused by contact with a mixture that forms when water and petrol combine. A treacherous, insidious mixture. Migrants are forced to refuel the dinghy's engine several times using jerry cans. It often happens that the petrol spills onto the floor and mixes with the water. Women are the first victims of this "disease" because they are made to sit on the floor to protect them from the risk of falling overboard, of being thrown out of the vessel, and so they are also the first to come into contact with this deadly mixture — or, at best, one that disfigures them for ever.

In your book I was struck by the parallel you draw between the migration of birds through the sky and that of people willing to cross seas and oceans just to go and live somewhere more welcoming, as birds do in winter. Why is it that migration for human beings — something that in nature is beautiful and extraordinary (think of whales or mammals that migrate thousands of kilometres) — does not have the same impact?
Migration has always existed in the animal world. The species that migrate do so in search of a better territory, of water and food. And human beings do the same, for the same reason — to seek a better, more dignified situation. The difference is that people who migrate do so above all for reasons brought about by other human beings; it is we ourselves who have put them in the position of having to migrate. We have brought wars, we colonised them, then exploited them, robbed them, enslaved them, starved them and forced them to leave. And yet we do not feel responsible for welcoming them, for helping them — in fact, we do not want them! But we have a duty — the duty — to help these people, because if we — we — are doing well, it is because we have taken their resources from them.

Also in the book you say you get angry when you hear the distinction made between economic migrants and refugees, as though the right to migrate belonged only to those who suffer direct violence, while those who are poor or are actually dying of hunger — the very reason other animal species migrate, incidentally — somehow deserved their fate. Why is there no room in politics for these people, in your view?
I hate this expression "economic migrant." An economic migrant is someone who is dying of hunger, of hardship, of destitution. I believe that everyone has the right to aspire to a better life — the asylum seeker, the refugee, those fleeing war, but also those fleeing hunger. For me there is no difference between dying of war and dying of hunger: dying is dying, full stop. That is why when I hear this distinction I get angry and ask myself how it is possible to make it. Indeed, personally, if I had to choose, I would rather die of war than of hunger. Because dying of hunger means living years of hardship and immense suffering.

How do you think we should respond, faced with the climate of closure we are living through and the verbal violence directed at human beings in need?
We certainly need to reason with our hearts as well. We need to bring out the fundamental values that give meaning to our lives — such as welcome and fraternity, respect for human rights, the right to life that we have denied them. Lately we have been bombarded with lies, false news — indeed, harmful news — that has done nothing but sow hatred, resentment and conflict among the poor who are experiencing social hardship. Entire electoral campaigns have been built on all of this, and elections have been won, because people are frightened by it all. People, in fact, are not bad, but they are badly informed and they react in the wrong way — though I do not blame ordinary people; I blame the politicians who have made the phenomenon of immigration their warhorse, and the journalists, or those who call themselves journalists, who have sown hatred every day by frightening and manipulating people. And the last electoral campaign was played out on the back of that fear.

Reading your words and listening to you, I have understood that one of the hardest things is to live everyday life — to wake up in the morning with the constant nightmare of reliving those moments. How do you manage? What drives you not to give up?
In these 28 years of great sacrifice there have been many moments in which I had doubts about what I was doing, above all when I found myself forced to carry out post-mortem examinations, which are the most terrible, atrocious thing a person can do — especially when I found myself doing them on children. And then I would ask myself: "Why? Why do I have to see all this, do all this, why do I have to endure all this?" And there I am seized by moments of great despondency, moments of suffering, of pain. I cry and I feel ill. Then I go home and my wife Rita reassures me and tells me that we are doing the right thing, and so I reflect on it and go back to doing what I have always done.

Fortunately, though, there are also the beautiful moments, which give you the strength to carry on, which give you the push forward — like bringing a child into the world, or when I save someone's life, when I manage to provide help and people are grateful for it.

Is there one particular moment you hold on to for strength, when strength fails you?
It happened to me that I had the fortune to discover, entirely by chance, that inside a body bag there was a person still alive. I was certifying the death and while I was holding the wrist of this young woman in my hands — for two or three minutes — I had the fortune to feel a very faint pulse. I could not even believe it. Immediately the race to the polyclinic began, where we intubated her, gave her oxygen, and after a quarter of an hour she "came back" to life. Of course, I had saved just one person, but I felt like a "hero" — even though I always believe that things should be done because it is right to do them. This person's name is Kebrat, and three years later she came back to visit me to thank me. She came all the way from Sweden just for me, to tell me: "Doctor, I am Kebrat, I am the girl you saved!" — and I did not even recognise her. These are the moments that give you the strength to carry on when you think you can no longer make it.