Many in the Australian medical profession would endorse the views of Dr Karen Phelps, GP, past president of the AMA and newly elected independent member for Wentworth, when she stated in her election campaign that she was ashamed of Australia’s inhumane refugee policies. (1)

This is the human face of a government which has been prevaricating about, at the very least, bringing sick and vulnerable children out of off-shore detention centres for medical care in Australia. This is in spite of being handed a petition by Dr Paul Bauert, Northern Territories paediatrician and long term advocate for refugees, signed by over 6000 Australian medical practitioners outlining their fears for the survival of these children. (2)

According to Dr Sarah Mares, Australia’s current immigration policies violate detainees’ human rights in multiple ways, including their right to health, by causing severe psychiatric distress and disorder in adults and children. (3)

Asylum seekers detained in off-shore detention centres have been found to have a high incidence of both physical and psychological problems. The facilities in these centres do not have the capacity to adequately address these issues which, while they may have been related to trauma in their own countries and trauma during their journey to seek a safe haven, are being further exacerbated by conditions in the detention centres and fears and uncertainty about their futures.

Those suffering such trauma need compassion and expertise to support them to heal. Child asylum seekers and refugees are particularly vulnerable to the impacts of trauma, negative detention environments and other post-arrival adversities including family separations and exposure to violence. (4)

Iranian Kurdish writer, poet and asylum seeker Behrouz Boochani, who has been held on Manus Island for 5 years, has recently published his book “No Friend but the Mountains”. In an amazing feat of endurance he painstakingly wrote on his smart phone, sending it out of the centre on WhatsApp to his translator, text by text. Over his time he has witnessed major events in the detention centre including rioting, murders, death, self-harm, suicide attempts, shooting attacks by soldiers and a standoff when refugees refused to be forcibly removed from the centre into what they believed was unsafe alternative accommodation. Written as a novel, it describes man’s inhumanity to man and what has been done in our name – our government’s ‘solution’ to a humanitarian problem. These are the conditions these children have lived in, some for their entire lives. (5)

This is not new news

Back in 2015, staff at the Royal Children’s Hospital in Melbourne protested outside the hospital about the government’s immigration policy. They had been involved in providing medical care for children and were very reluctant to send them back to those intolerable conditions. It is perhaps easier to argue in Parliament about statistics and the potential flood of refugees coming into Australia, but putting an individual human face to it, and the face of a sick child, surely asks us to look at our own humanity.

The AMA at the time backed the hospital, which said it would be unethical to send children back to unsafe conditions, noting the difficult position doctors are placed in when discharging children back into the environment that evidently caused the harm. At the time a RCH paediatrician, Prof Paul Monagle, said:

“What we see from children in detention is a whole range of physical, mental, emotional and social disturbances that are really severe, and we have no hope of improving things if we’re sending those children back to detention.” (6)

The World Medical Association in the same year condemned the Australian Government’s policy under which staff who make disclosures about asylum seeker healthcare could face two years jail. Such policies of secrecy have hidden from the Australian public the realities of the conditions in off-shore detention centres and the impact this has had on the men, women and children detained there. This has been an ethical and moral challenge for doctors and other staff involved. Fortunately, footage filmed on hidden mobile phones has been smuggled out and seen, offering a reality check. The footage is both powerful and shocking. (7)

Dr Sarah Mares, a child psychiatrist, published an analysis of data collected during a 2014 Australian Human Rights Commission Inquiry into Children in Immigration Detention, looking specifically at the children’s mental health.

She reported extremely high rates of mental disorder in adults and children. The K10 indicated severe co-morbid depression and anxiety in 83% of adults and 85.7% of teenagers. On the SDQ, 75.7% of children had a high probability of psychiatric disorder, with lower conduct and hyperactivity scores than clinic populations. 67% of parents had concerns about their infant’s development. (8) She stated:

“Multiple human rights breaches are identified, including the right to health. This is further evidence of the profound negative consequences for adults and children of prolonged immigration detention.”

This study was carried out on Christmas Island, an Australian administered territory and the average time of incarceration was 7 months. Let us extrapolate that to non-Australian administered territories in Manus and Nauru with incarceration times rising to 5 years and more…

Our ‘humanitarian solution’

These off-shore detention centres were our Government’s ‘humanitarian solution’ to the deaths that were occurring when asylum seekers attempted to reach Australia by sea, rather than going through official channels.

Surely too high a price to pay both for asylum seekers themselves and perhaps for Australia’s own soul. While New Zealand has offered to take those asylum seekers, Australia is not agreeing to this unless there is an agreement that they should never be allowed to enter Australia – so we are at a stalemate.

“These children do not have weeks” said this Saturday newspaper. Last week Labour and the Coalition Senators voted down a motion “to immediately bring every child in detention in Nauru to Australia for urgent medical and psychological assessment and treatment, along with family members of those being assessed and treated”.  A Liberal MP had said it was the only decision that could be made on humanitarian grounds. Where is our humanity, one well could ask?

“There is nothing humanitarian about saving people from sea only to leave them in an open prison”.(10)

In a rare and forceful statement last week, Medicins Sans Frontieres called for the immediate evacuation of all refugees on Nauru and an end to Australia’s off-shore detention policy. MSF had spent a year providing psychiatric services to both asylum seekers and local Nauruans, but last week were forced to leave, as was an Australian doctor. Said MSF Australia’s director, Paul McPhun:

“While many asylum seekers and refugees on Nauru experienced trauma in their countries of origin or during their journey, it is the Australian Government’s policy of indefinite off-shore detention that has destroyed their resilience, shattered all hope, and ultimately impacted their mental health.”

Separating families, holding men, women and children on a remote island indefinitely with no hope of protection, except in the case of a medical emergency, is cruel and inhumane.” (10)

Yesterday our new Prime Minister was still debating. There was still dissent in parliament, a failure to reach a solution and the Prime Minister refusing to “horse trade children.” (11)

Where are our hearts in this? Medicine at least has spoken, the AMA calling this a “humanitarian emergency requiring urgent intervention”. (12)

I applaud the work of Dr Paul Bauert in bringing this petition together, to Doctors for Refugees who work together for justice for asylum seekers, to Medicins Sans Frontieres Australia and to Behrouz Boochani for his courage in keeping his own humanity in an intolerable situation. Collectively we can influence change. Together we have power as doctors, a power to use with wisdom to bring loving true change to the world we all live in together.















  1. Whilst I wholeheartedly agreed with the removal of children from these conditions, I feel this needs to be expanded to all held in detention for this extended period of time. I understand that to Government it is seen as a deterrent. But there are human beings at the centre of this, human beings who have sought asylum from unsafe and dangerous homes, only to find themselves living in very poor conditions, which is contributing further to the deterioration of their physical and mental health but also loss of dignity and respect. In the future we will be apologising for the treatment of refugees who arrive by boat. The healthcare and social costs for this policy will be incalculable.


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