Abstract Issue Lampedusa island is a crucial Italian entry point for migrants and the only health facility is the outpatient clinic that relies on the helicopter transfer to the mainland for urgencies. When the influx of migrants -and of tourists- increases, the health demand burden rises. Moreover, the plurality of the actors involved in migrants’ reception and assistance makes healthcare organization complex. In 2023, 115.000 arrivals were recorded with an increase of pregnant migrants transferred by helicopter; moreover, the lack of an EMTs-equipped ambulance and coordination gaps between actors were raised. Description of the practice Also paving on law 50/2023, in 2023 INMP and other institutions promoted a multimodal strategy to support healthcare in Lampedusa. A needs assessment grounded on settings and processes field observation and key stakeholders’ structured interviews was designed. Hence, an equipped ambulance service was set in September 2023 and an obstetric triage (ObT) procedure for pregnant migrants was tested. Further, operational protocols for migrants’ health have been drafted and enclosed in a MoU signed between key institutions, and a dedicated Committee monitoring protocol implementation was also set. Results Until now the ambulance has carried out 242 operations, mostly in response to community requests and ObT has led to using helicopter solely for real Ob urgencies. Also, the MoU has improved the coordination between actors, and the monitoring Committee-just settled-has already identified new priorities such as of defining a procedure for pregnant migrants requesting pregnancy termination. Lessons A multimodal strategy based on field assessment, enhancing coordination between actors and rolling-out of shared procedures has improved the effectiveness, efficiency and appropriateness of healthcare in Lampedusa, requiring a slight increase in resources. Remarkably, the healthcare reinforcing results in beneficial also for the general population. Key messages • Massive influx of migrants in Lampedusa has required strengthening health services on the island. • Evidence-based interventions based on needs assessment have improved healthcare for both migrants and the general population.