Italian paramilitary police say they have arrested convicted Mafia boss Matteo Messina Denaro in a private clinic in Palermo.

Messina Denaro was Italy’s number one fugitive, and he was arrested after 30 years on the run.

The head of the Carabinieri police force’s special operations squad said that Messina Denaro was captured on Monday at the clinic where he was receiving treatment for an undisclosed medical condition.

Messina Denaro was considered Sicily’s top Cosa Nostra boss even while he was a fugitive.

The 60-year-old was taken to a secret location by police immediately after the arrest, Italian state television reported.

Messina Denaro was the last of three top-level Mafia bosses who had eluded capture for decades.

He was tried in absentia and convicted of dozens of murders, and now faces multiple life sentences.

Messina Denaro is set to be imprisoned for two bombings in Sicily in 1992 that murdered top anti-Mafia prosecutors Giovanni Falcone and Paolo Borsellino.

Among other grisly crimes he was convicted of is the murder of a Mafia turncoat’s young son, who was strangled before his body was dissolved in a vat of acid.

The arrest on Monday came 30 years and a day after the capture of convicted “boss of bosses” Salvatore “Toto” Riina, in a Palermo apartment, after 23 years on the run.

Messina Denaro went into hiding in summer of that same year, as the Italian state stiffened its crackdown on the Sicilian crime syndicate following the murders of Mr Falcone and Mr Borsellino.

Italian Premier Giorgia Meloni tweeted that Messina Denaro’s capture is a “great victory of the state, which shows that it doesn’t surrender in the face of the Mafia”.

The Mafia boss who set the record for the longest time on the run was Bernardo Provenzano, captured in a farmhouse near Corleone, Sicily, in 2006 after 38 years as a fugitive.

Once Provenzano was in police hands, the hunt focused on Messina Denaro, but despite numerous reported sightings of the crime boss, he managed to elude arrest until Monday.

That all three top bosses were ultimately arrested in the heart of Sicily while they conducted decades of a clandestine life will not surprise Italy’s police and prosecutors. Law enforcement have long said that such bosses rely on contacts and confidentiality of fellow mobsters and complicit family members to move the fugitives from hideout to hideout, supply basic needs, like food and clean clothing and communication, and a code of silence known as “omerta”.

Riina and Provenzano lived out the last years of their life in the strictest of Italian prison conditions reserved for unrepentant organised crime bosses and refused to cooperate with investigators.

Messina Denaro was believed to have enjoyed a more comfortable lifestyle in his decades hiding from police, leaving some to speculate whether he might agree to cooperate with prosecutors in exchange for more lenient prison conditions.

During his years on the run, he had a series of lovers and passed time by playing video games, according to Italian media reports.

One of his girlfriends was arrested and convicted of having hidden him for a time while he was a fugitive. But while he had a weakness for women, Messina Denaro could be cruel, strangling a woman while she was pregnant, according to Italian media.

Wary of being tracked down by mobile phone use, Mafia bosses frequently resort to handwritten notes known as “pizzini”. When Provenzano was arrested in his rustic, almost primitive, hideaway in the countryside, police found a stash of such notes.

With the crackdown that began in the 1990s against Sicily’s Cosa Nostra, the island’s mafiosi started losing their dominance in Italy compared to other organised crime syndicates.

While the Sicilian Mafia was significantly weakened by a small army of turncoats, on the mainland, the ‘ndrangheta syndicate, based in the “toe” of the Italian peninsula, steadily eclipsed Cosa Nostra in reach and influence.

Unlike Sicily’s crime syndicates, the ‘ndrangheta draws its footsoldiers based on family ties, leaving it less vulnerable to turncoats. The ‘ndrangheta is now one of the world’s most powerful cocaine traffickers.

However, the Sicilian Mafia still runs drug trafficking operations. Other lucrative illicit businesses include infiltration of public works contracts and extortion of small business owners, who are threatened if they do not regularly pay “protection money”.