Romanians care for the elderly in Italy but long hours, loneliness and mistreatment lead to mental health problems.

Iasi, Romania and Rome, Italy – In a small room at the Socola Psychiatric Institute in Iasi, the biggest psychiatric facility in Romania, Ana* looks down. She has a strong voice but struggles to make eye contact.

A former patient, she was diagnosed with depression. Doctors said she had a case of “Italy syndrome”, a term used in the Eastern European country for the mental health problems acquired after working as a caregiver in Italy.

“I was very afraid to take the stairs,” said 49-year-old Ana, who left Romania for Italy in 2003. “When I had to cross the street, I was afraid, and I asked: ‘please, can you help me?’

“It was this fear of going out alone.”

It was initially difficult to decide whether to leave her children – one of her sons was just two years old when she migrated – but it was the only way to make money.

The children were raised by their father on the money Ana sent working as a “badante”, the Italian word used for women taking care of the elderly.

“I was 58kg,” she said. “After two months, I was 48.”

One employer, a 94-year-old woman, “talked badly” to her.

“I couldn’t sleep during the night. It was hard work, but I didn’t say anything,” Ana said.

Because she was alone in Italy, she didn’t go anywhere in her few free hours.

In Romania, her husband wasted the money she was sending. So later, Ana decided to hand financial responsibility to her sister. In 2012, she divorced. And 15 years after leaving Romania, she returned, unable to stand life in Italy any longer.

On TV, she saw a report about Italy syndrome, recognised the symptoms and went to see a doctor.

Ana worked in Italy for 15 years and returned to Romania with depression [Romina Vinci/Al Jazeera]

“Italy syndrome is a socio-medical phenomenon,” said Andreea Nester, a psychiatrist at Socola hospital. “Most of the time, it is a form of depression that is characterised by anxiety, apathy, psychic and physical asthenia, with inattentive states, associated insomnia, and a profoundly sad disposition, etched by a feeling of alienation.”

She explained that there are several leading factors.

“It is the genetic vulnerability of every person who emigrates … worsened by living in a new country with other cultures, with other traditions, not knowing the language.”

Cozmin Mihai, a psychiatrist at Socola, estimates that out of 3,000 depression patients a year, about 150 or five percent have Italy syndrome.

“Italy syndrome is not a scientifically recognised diagnosis,” said Donatella Cozzi, a researcher at Udine University, who visited the eastern Romanian city of Iasi to study the phenomenon. “The term was invented by two Ukrainian psychiatrists in 2005. It is composed by physical and psychological stress.”

According to a United Nations report, between 2007 and 2017, around 3.4 million Romanians left the country, representing 17 percent of the population – the second highest migration rate after war-torn Syria.

Tania Carnuta has worked in Italy since 2006.

A mother of four, Carnuta’s husband recently decided to divorce her, after 30 years of marriage.

“Italy syndrome starts at home,” she said. “They start to look at you like you are an ATM, a cash machine.

“You are stressed out here from work and you call home to calm yourself, to talk about your sorrow. But the ones at home don’t understand you.”

Tania Carnuta said her relatives at home failed to empathise with her situation in Italy [Romina Vinci/Al Jazeera]

In Italy, Carnuta’s relationship with her employer deteriorated when she started to demand her rights: a contract, holiday, money for food, a promised bonus.

“Three years I worked with the contract, the rest I worked illegally. The Italian state allows this, no checks are made,” she told Al Jazeera. “We can’t denounce them, complain, because we are automatically threatened that we are fired.

“You have to shut up and bear absolutely everything they say.”

This year, Carnuta was fired by her employer of more than 12 years.

“I never thought I’d have this Italy syndrome until I left this job,” she said.

According to her contract, she was to work 40 hours a week. However, she says this was not respected because she was living with her employer.

Claudio Piccinini, a coordinator for INCA-CGIL, an advice centre for one of the biggest unions in Italy, said that, according to Italian Institute of Social Security (INPS), there are 800,000 people working as “badante” in Italy with a legal contract.

The demand for their services is high in a country with 13.4 million elderly people and ranked by the UN the third globally in terms of life expectancy.

“There is a lack of flexibility in this type of work, there are no forms such as part-time,” said Piccinini.

“There is a misinterpretation of vitto e alloggio (living with employers) – it means that the family provides the worker with food and accommodation. The worker can theoretically get out all night; their working hours must be respected,” said Maddalena D’Aprile, a recruiter in Rome.

From her experience, D’Aprile said the abuse takes place on both parts.

“From the families’ side, there is very often this tendency to abuse the workers, to ask him too much, not to provide him with adequate housing, often not to give enough food. From the workers’ side, we have also heard terrible things, people who gave tranquillisers to the elderly to keep them calm.”

In Rome, the Saint Panteleimon Church is a Romanian oasis where women gather on days off to socialise, to seek advice, and to speak their native language.

“We are like a family here,” said Doina Matei, who moved to Italy 12 years ago.

After struggling financially in Romania, she migrated to Italy to fund her daughters’ university fees.

“He was yelling, talking badly with me,” she said, describing one of her employers with drinking problems.

Doina Matei was treated unfairly by an employer in Italy, where she has lived for 12 years [Romina Vinci/Al Jazeera]

At another job, Matei said: “For four months, she kept me in a corner where she said the pavement was not shining. Every day, she sent me in that corner, nothing could have been done, but I was doing what she was telling me.”

Her friend, Maria Gradinariu, followed her son to Italy, having had various jobs in Romania.

“In 16 years, I lost my mother, husband, father-in-law, mother-in-law, brothers, and we were never there with them,” she said.

“I came here to find a bit better life. We found only work, work and work again.

“We feel [Italy syndrome] because we are not free when we want, we are free as badante only Thursday afternoon and Sunday all day, but if they need us and we need money, then we stay.”

Back in Iasi, Ana now works in sales and hopes to avoid the symptoms that she faced in 2010.

“I talked to my doctor today, now I’m courageous,” she said. “I’m not letting myself down.”

* Name changed to protect her identity.

Maria Gradinariu said several of her family members have passed away while she worked in Italy [Romina Vinci/Al Jazeera]

This report was supported by Reporters in the Field, a programme of the Robert Bosch Foundation, together with the media NGO, n-ost.