The last time Renato Natale was mayor of Casal di Principe, he lasted 11 months.

An avowedly anti-mafia politician in one of Italy's most infamous mafia fiefdoms, the odds were never in his favour. In March 1994, four months into his term, a local priest who had taken a stand against the Camorra was shot in the head while preparing for mass. Natale was one of the first on the scene and remembers "his body on the floor, his bloodied head", and conflicting instincts inside him that urged him on the one hand to flee and, on the other, to stay and organise the funeral. He chose the latter.

It would later emerge, through testimonies of jailed state witnesses, that local bosses had had a similar plan for him: not another execution-style killing, but a road "accident", targeting Natale on the bike he liked to use to ride around the town.

In the end, the local clan found a more prosaic way of ridding itself of the troublesome mayor, enticing three councillors from his majority to swap sides, dispatching his administration almost as quickly and efficiently as its many human victims.

"The Camorra decided to bring that to an end," says Natale. "But it could not bring to an end the hopes and dreams that were growing in the meantime."

The proof of that, perhaps, lies in the fact that now, more than 20 years after he was first elected, Natale is once more the "first citizen" of Casal di Principe, his feared and fearful hometown north of Naples, a place of which he was once quoted as saying: "Here, being mayor means getting up in the morning and making the sign of the cross." Earlier this month, after a campaign in which he vowed to pursue the town's "dream of normality", he won 68% of the vote in a runoff and was taken on a victory procession through the streets. In a central piazza, supporters erected a banner declaring: "Here, the Camorra has lost."

Asked by a journalist if he had a message for the town's criminal element, the grey-haired, bespectacled doctor took the megaphone and yelled, without hesitation and with the passion of a vengeance long in the making: "Vaffanculo." Fuck you.

News of Natale's election spread far beyond the boundaries of Casal di Principe, whose 21,000 residents have seen the town council dissolved for mafia infiltration three times since 1991. The loudest support came from Roberto Saviano, author of the book Gomorrah, which brought the misdeeds of the Camorra to international attention in 2006 and who is himself a son of the town – a place, he wrote, which makes Corleone, in Sicily, look like Disneyland. "Casal di Principe is in a new era," he tweeted. "The victory of Renato Natale is a rebirth. All of Italy must now look to [it], to its example."

Huge challenges face him, and failure could squander political capital built up over 20 years, yet Natale is optimistic about his town's future. Is it really, as pundits claim, a new dawn for the town labelled Gomorrah by the Italian press?

"Yes, they are right," he says, sitting in the office of the association he founded in 1994 to provide medical assistance to immigrants, sex workers and other marginalised people. "Even if some of these declarations in the media are stretching it a bit. There really is a new wind blowing in the town. This morning I held my clinic. The first thing everyone … did was congratulate me, saying, 'Finally, we can start to do something.'"

From the litter lying at the side of the streets to the haphazard residential construction, from the electrical wires sprouting out of crumbling walls to the fetid, green water of the central piazza's pool, the scars of bad, corrupt, governance in Casal are clear.

For years the town's political apparatus was a plaything of the local Camorra clan, which at its height was arguably the most powerful and violent syndicate within the notoriously powerful and violent Neapolitan mafia.

At least two of Natale's predecessors as mayor have been convicted of mafia-related crimes. He sees his re-election – this time with a resounding majority – as a sign that things have started to change.

But now the pressure is on to deliver – not easy when the council is insolvent. Natale has already asked the government in Rome for help, warning that unless he is supported, there will be little he can do to .

Federico Varese, professor of criminology at the University of Oxford, is also wary of overplaying Natale's transformative potential. "To see organised crime as an issue of people – as bosses who are put away and the hero who comes along and defies the bosses – is a wonderful story, but it doesn't change matters on the ground because if you don't change the conditions that give rise to these organisations … you don't take away the reasons why they exist," he says.

Those conditions can be defined as a near-absence of the state in certain areas, which presents clans with opportunities to "take up that slack", Varese adds.

"The problem is that there is a tendency in the Italian debate to see everything as a criminal issue and as an issue of people," he says.

"It's not a criminal issue. It's a civil issue, and an issue of the way society works. Heroes are wonderful and Saviano and especially [Natale] are great examples of people who are putting themselves … on the line. But I'm afraid you cannot have a world, a country, that only banks on its heroes."

Saviano has said that, while his schoolmate in Casal worshipped Che Guevara, his idol was Natale, whom he saw as an unwilling symbol of "commitment, resistance and courage" for the way he stood up to the Casalesi clan, which reigned in Casal di Principe from the late 1970s onwards.

As it enforced what he calls a "military dictatorship" on the town, the clan built itself up to become the economic powerhouse of the Camorra. In general, you didn't cross it. Don Giuseppe Diana, the courageous priest gunned down in his sacristy, was one who did. Particularly shocking to Italians because of the message it sent – in Natale's words, "we can do whatever we want, to whomever" – his assassination was the start of a civil resistance in Casal that, Natale says, has now come of age.

In recent years, that partial blossoming of civil society has been accompanied by a weakening of the local clan, whose main bosses are now behind bars. In a clear sign of shifting dynamics, one of them, Antonio Iovine, nicknamed O' Ninno – The Baby – recently decided to turn state witness and spill the secrets of the organisation to prosecutors. Leaked reports of his statements have been filling the newspapers for weeks, giving Italians an unprecedented glimpse into the criminal, entrepreneurial and political links that enabled the clan to rule the roost for so long.

"I'm not saying it has already been totally eliminated, but it certainly doesn't have that same capacity for pressurising and making its presence felt as it did in the past," says Natale, of the current state of the clan. Even so, it is hard to see how Casal – broke, traumatised and deprived – will ever emerge from the long shadow cast by organised crime. The Camorra is a notoriously adaptable and resilient organisation with huge power and economic clout that stretches far beyond its Neapolitan homeland. Can this town really turn the page? "Every now and then the Americans do one of those television series based on historical events. I had the chance to watch one, called The Borgias," says Natale, a self-declared "Catholic-communist".

"The Borgia family governed not only Rome but other parts of Italy, behaving a bit like our Camorristi. At that time … everyone said: 'Rome is an impossible city. We could never imagine it any different.' Now we have Pope Francis, who is a different matter altogether. The same thing happened with the Soviet Union, no? In 1989, when the wall suddenly fell, everyone looked at one another and asked: 'But what's happened?' It seemed impossible. Nobody could have predicted such a thing. But, as [murdered prosecutor Giovanni] Falcone used to say, 'No human phenomenon is eternal.'"This town never supported criminality completely and utterly. It was subjected to it. The population was often forced to stay shut up at home, but it never accepted it definitively.

"There is a kind of pride among these people, which made them suffer through having to keep their heads down.

"Today the Camorra, the mafia, have had their organisational capacity to a certain extent defeated, giving the people here an opportunity to raise their heads again. We – I mean the leaders, politicians – need to help this population, through legal and civil channels, to return it to its former pride."