Portal de Periódicos da CAPES

N auru and detention of children

2015; Wiley; Volume: 51; Issue: 4 Linguagem: Inglês

10.1111/jpc.12872

1440-1754

David Isaacs,

Education and experiences of immigrants and refugees

Australia has had controversial legislation for mandatory detention of asylum seekers since 1992 and legislation since 2001 allowing indefinite detention of such persons on the mainland, Christmas Island or ‘offshore’ on Manus Island in Papua New Guinea and on the small Pacific island nation of Nauru. Despite frequent protests from lawyers, doctors and humanitarian organisations that such policies infringe human rights and blatantly contravene the 1951 United Nations Refugee Convention, to which Australia is a co-signatory, both major political parties have persisted with these cruel policies. The clear aim is deterrence. Asylum seekers are demonised as potential terrorists or as economic migrants, callously and inaccurately referred to as ‘illegals’, and imprisoned indefinitely with no knowledge of when and where they will be released.1, 2 The reason for such poor morality is political: the issue of asylum seekers who arrive by boat wins and lose elections: votes are more important than morals. In late 2014, a paediatric refugee nurse and I were asked by International Health and Medical Services (IHMS) to spend 5 days on Nauru seeing children in consultation. IHMS are the private health-care providers contracted by the Australian Government to provide health care to asylum seekers in Australia and offshore. Our contract said we would not make any public statement or talk to the media about anything that concerns IHMS or the Department of Immigration and Border Protection. We considered carefully if we should go. In favour was our ability to treat children with acute problems, refer children with mental health problems to a child psychiatrist or psychologist and assess living conditions. The Government has drawn a deliberate veil over its handling of asylum seekers, particularly boat arrivals and the conditions in offshore detention centres. Workers sign strict confidentiality agreements and have been summarily dismissed for social media posts that offend the Government. Journalists have to pay $A8000 for a visa to visit Nauru. When Professor Gillian Triggs, President of the Australian Human Rights Commission (AHRC), was trying to gather information for her inquiry into children in detention,3 she was banned from visiting asylum seekers on Nauru because they were ‘not in Australia’ and therefore not under the jurisdiction of the AHRC. A major reason for us visiting was to see the conditions first-hand. Reasons against going were that this might implicitly condone behaviour we already knew was immoral and the knowledge that we might feel obliged to speak out publicly. We went in December 2014. We did not want to profit from our visit and agreed in advance to donate our earnings to our hospital Refugee Service. We were utterly appalled by the Nauru Processing Centre, a prison camp except in name, which was situated in the centre of the island where it was hottest and most humid (see Fig. 1). Living conditions were Spartan. Asylum seekers lived in lines of adjoining tents without privacy or running water. Many tents had mould on the canvas. Toilet and shower facilities were 30- to 120-m distance. At night, this was a fearsome walk under the eyes of huge, threatening guards. Many children and some women wet the bed rather than brave the walk. Sanitary arrangements for menstruating women were unsatisfactory. Movement was restricted by fences manned by guards. The asylum seekers were starved of information about their fate and all complained of being utterly helpless and powerless. They reported being treated with contempt and tormented by many of the guards. Later, I asked a family who were transferred from Nauru to Villawood Detention Centre in Sydney how the guards in the two places compared. ‘The difference between Villawood and Nauru was like the difference between an angel and a devil’, said the father. Health-care workers were usually more respectful, but a culture of gross injustice is insidious: IHMS staff referred to asylum seekers by their boat arrival numbers rather than by name. The children we saw had a variety of stress-related behaviour problems and somatic complaints. We saw examples of self-harm, the most chilling being a 6-year-old girl with strangulation marks from a fence-tie, whom we referred urgently to the visiting child psychiatrist. In trying to give some measure of hope, we talked of the pending AHRC report on children in detention3 and promised to publicise their plight when we returned to Australia. In this issue, paediatricians who work with asylum seeker and refugee children give their response to the AHRC report.4 Painting of the island of Nauru from Nauru Airport. The Nauru Processing Centre is in the centre of the island (where the phosphate rock is being mined). On our return to Australia, we were nervous about writing a media opinion piece, but our sense of outrage and our promise to the families trumped guilt at breaking our contract and fear of reprisal. A prominent human rights lawyer advised us it was legitimate to break a contract to reveal ‘iniquity’ and what we had witnessed was undoubtedly iniquitous. We decided to provide IHMS with a detailed report of suggested changes but also decided to publish an opinion piece and do subsequent media interviews. We met senior IHMS staff to discuss our report. They expressed disappointment we had gone to the media and felt betrayed. We said we thought IHMS tried hard in the camp and had done excellent work propping up Nauru health care services outside the camp (IHMS asked us to consult on some children at the Republic of Nauru Hospital), but we thought IHMS should protest more about conditions. The IHMS staff said their Government contract forbade them criticising Government policy and they preferred to work for change from within the system. The meeting ended with each of us acknowledging our respect for but disagreement with the others’ position. Doctors can be placed in a moral dilemma by injustice. Psychiatrists in the Soviet Union were strongly criticised for being complicit in State-based use of psychiatric hospitals to suppress political prisoners. Doctors at Abu Ghraib Prison were condemned for condoning torture. The former IHMS chief psychiatrist described the treatment of asylum seekers on Manus Island and Nauru as ‘akin to torture’.5 The Australian Medical Association6 and the Royal Australasian College of Physicians7 have described mandatory detention of children as child abuse. This raises moral questions for doctors working with children in detention, particularly in the most extreme conditions such as on Nauru.7 Although our first duty is to treat a child in extreme need, treating them does not change the underlying problem. Two major charities have different approaches to politics. Red Cross insists on political neutrality and never comments on local socio-political issues in order not to compromise access to people in need. Médecins Sans Frontières provides medical care always with the stated commitment to ‘speak out’ on political and situational problems impairing health. Both charities do wonderful work. As private contractors, IHMS have the potential conflict of money: criticism of the Government could cost them a lucrative contract. IHMS's approach is to provide best possible care while working from within. The alternative of refusing to provide care offshore without the right to speak out would probably see them lose their contract and they argue would disadvantage children. Individual doctors have to decide for themselves.8 Mandatory detention is immoral, but detention on Nauru is an abomination and paediatricians should protest long and loud until it is ended. I thank Alanna Maycock who accompanied me to Nauru, stood up to bullying guards and taught me about courage and recognising and confronting injustice. I thank my son Mark Isaacs for his bravery and for being an inspiration,1 and Philip Britton for helpful discussions.