In one case, a female detainee who complained about bullying was the target of a planned sexual assault by a group of men, and yet she and her relatives were knowingly kept in a tent near the men who had made the threats.
The tent leaked water, and was near electrical infrastructure, creating a life threatening situation.
The anonymous workers report that criminal background checks are not always completed on local Nauruan staff, thereby increasing the risk to children.
It is noted that criminal and other background checks in local employees are not mandated in the contract to run the detention centre.
“It is particularly concerning given there have been several employees accused of physical, verbal, and the sexual assault of children,” the workers wrote.
A spokeswoman for Immigration Minister Scott Morrison says the subject matter raised in these anonymous allegations is “very serious”.
“The department is working with Save the Children and the government of Nauru to determine the veracity of these anonymous claims and to what extent they are credible or relate to current practice,” the spokeswoman said in a statement.
“The department has also asked Save the Children if any such concerns have been raised by any of their staff and to provide a response to the government on the allegations made.”
The Government has stated for weeks that it is awaiting the outcomes of the Human Rights Commission inquiry and any supporting evidence in the final report.
“The [Save the Children] submission addresses matters that are outside the terms of reference of the AHRC inquiry,” the statement added.
The report states “many children are living in knowingly unsafe circumstances,” due to what the Save The Children workers describe as the “unyielding and harsh” stance of the DIPB (Department of Immigration and Border Protection).
Staff say they are actively discouraged from advocating the removal of children, “except in the most extreme cases of documented harm”.
The anonymous workers say children in detention are exposed to traumatic situations every day, such as self harming events and violence, which serves as triggers to past traumatic events.
‘Blocked toilets with faeces on the toilets’
The report further outlines a lack of access to food, a lack of supervision, and young children being separated from their families across the network of detention centres.
Basic sanitation and hygiene is also a major problem according to the report, with the workers describing the family camp (OP3) as “overflowing”.
“There are outbreaks of lice, gastroenteritis and school sores that are difficult to contain due to the use of common showers, common eating areas and close living conditions,” the workers wrote.
The report states there are only two toilets for the new classroom at the detention centre for 200 children and local staff members cannot be relied upon to show up to work consistently to perform the cleaning of the facilities.
“There have been multiple times that the OP3 has ‘run out’ of water, resulting in overflowing and blocked toilets with faeces on the toilets or on the floor of the toilet,” the report said.
Greens Senator Sarah Hanson Young says the submission is explosive and that child detainees should be removed immediately from the Pacific Island nation.
“It outlines sexual, physical, verbal abuse and a significant lack of child protection inside the detention camp,” she said.
“It is unbelievable to think the Government cannot act in the face this evidence.”
Mr Morrison has agreed to give evidence to the inquiry into children in Australian immigration detention on a date yet to be set.
The inquiry is expected to report to the Government before the end of the year.
Guardian Australia exclusive: Doctor responsible for mental health of people in detention becomes the most senior figure to condemn system from within, saying immigration department deliberately harms vulnerable detainees in a process akin to torture.
The chief psychiatrist responsible for the care of asylum seekers in detention for the past three years has accused the immigration department of deliberately inflicting harm on vulnerable people, harm that cannot be remedied by medical care.
“We have here an environment that is inherently toxic,” Dr Peter Young told Guardian Australia. “It has characteristics which over time reliably cause harm to people’s mental health. We have very clear evidence that that’s the case.”
Young is the most senior figure ever to condemn the detention system from within. Until a month ago he was director of mental health for International Health and Medical Services (IHMS), the private contractor that provides medical care to detention centres on the Australian mainland, Christmas Island, Nauru and Manus Island.
Young has extensively briefed Guardian Australia about a system he says is deliberately harsh, breaks people’s health, costs a fortune, compromises the ethics of doctors and is intended to place asylum seekers under “strong coercive pressure” to abandon plans to live in Australia. “Suffering is the way that is achieved.”
He believes this process is akin to torture: “If we take the definition of torture to be the deliberate harming of people in order to coerce them into a desired outcome, I think it does fulfil that definition.”
Young strongly criticised the immigration department for:
• Delays that endanger health in bringing patients to Australia from Manus and Nauru: “It is seen as undesirable because it undermines the idea that people are never going to Australia and also because of the concern that if people arrive onshore then they may have access to legal counsel and other assistance.”
• Leaving people in detention who are acutely suicidal: “Trying to manage them in a non-therapeutic setting like that is just inherently futile. It’s not going to work.”
• Returning patients with less severe problems to detention despite medical advice that they cannot be expected “to fully respond to treatment in an environment that was making them sick”.
• Misusing patient information. “People disclose a lot of personal information which is then recorded in notes which are then available to non-medical people for other purposes.” Young says the dual role of IHMS staff treating detainees but reporting to the department raises fundamental ethical problems for doctors in the system.
• Displaying an obsession with secrecy: “Speaking out of turn is clamped down on whenever it occurs … they continue to maintain the fantasy that they can keep everything a secret.”
• Reluctance to gather and use mental health statistics that might “result in controversy or threaten the application of the policies of deterrence”.
• Directing doctors not to put in writing that detention has led to deterioration in their patients’ mental health. IHMS doctors ignored the direction. Young said they saw evidence all around them of detainees “sick because they are there and getting sicker while they remain there”.
Guardian Australia contacted IHMS and the immigration minister for comment, neither responded.
The Manus camp particularly appalled Young. “When you go to Manus Islandand you walk down what is called the ‘walk of shame’ between the compounds and you see the men there at the fences it’s an awful experience,” he says.
“You have to feel shame. You have to understand what that feeling is about in order to be able to be compassionate. By feeling the shame you stay on the right side of the line.”
Young told Guardian Australia IHMS figures had shown for some time that a third of adults and children in the detention system had what he called “a significant-level disorder”. If they were living in Australia, that would require the care of specialist medical health services. The figures only got worse as detainees stayed longer in detention: “After a year it approaches 50%.”
In a belligerent appearance before the inquiry, the secretary of the immigration department, Martin Bowles, accused the president of the Human Rights Commission, Gillian Triggs, of making “highly emotive claims” about health problems in the detention system. He had not heard evidence of the problems provided by Young and other IHMS doctors earlier in the day.
His hand shook as he confronted Triggs. When his evidence produced laughter he demanded the room be silenced. He refused to answer some questions and retreated at times behind a wall of bureaucratic prose.
But Bowles did not deny a link between prolonged detention and mental illness. He called this a “well-established” issue and insisted his department was doing “everything it humanly can” to provide “appropriate medical care” to address the mental health problems of detainees.
Young told Guardian Australia that was impossible: “The problem is the system.”
Young is confident that in his time at IMHS the men and women working for him made better assessments of detainees’ health and delivered much better treatment than in the past.
“But you can’t mitigate the harm, because the system is designed to create a negative mental state. It’s designed to produce suffering. If you suffer, then it’s punishment. If you suffer, you’re more likely to agree to go back to where you came from. By reducing the suffering you’re reducing the functioning of the system and the system doesn’t want you to do that.
“Everybody knows that the harm is being caused and the system carries on. Everybody accepts that this is the policy and the policy cannot change. And everybody accepts that the only thing you can do is work within the parameters of the policy.”
The window of reasonableness closes
Young arrived in the system in 2011 at a crucial moment: the high court was about to knock back the Gillard government’s proposed “Malaysia solution” and, as the boats arrived in ever-increasing numbers, the detention system was bursting at the seams. So the government began processing detainees quickly and releasing large numbers into the community on bridging visas. “The problems that we were seeing from a mental health perspective decreased massively.”
Young has been a psychiatrist for nearly 20 years, most of that time working in public health. He joined IHMS believing the detention system was problematic but confident that good could be done from the inside. “I felt that given the experience I had I could work between the immigration department and IHMS and the detention health advisory group to bring about positive change.”
The year before Young’s arrival, the immigration department had been put on notice once again that prolonged detention harms mental health. Professor Kathy Eager of Wollongong University reached that conclusion in a study commissioned by the department itself.
“There is,” she wrote, “almost universal criticism of the policy of detaining asylum seekers, particularly in terms of the mental health implications.”
Her findings were backed by the department’s independent Detention Health Advisory Group (Dehag), the Australian College of Mental Health Nurses and the Australian Psychological Society. In 2011 the Royal Australian and New Zealand College of Psychiatrists declared: “Prolonged detention, particularly in isolated locations, with poor access to health and social services and uncertainty of asylum seeker claims, can have severe and detrimental effects.”
While detainees were being rapidly released, Young observed attitudes towards them improved throughout the system. They were not treated as prisoners.
Their mental health was generally good: “These people are actually quite robust and psychologically healthy individuals despite all the suffering that they have been through.”
“You just can’t overstate how things changed so rapidly when the policy changed,” Young says. Once again the system treated them as prisoners. The impact on their mental health was as predicted: fine for a few months, then increased depression, anxiety and stress.
“Most people have a level of resilience which allows them to function fairly well for a few months, but after that time there is a steady deterioration … after six months the cumulative harms accelerate very rapidly.”
Uncertainty does the worst damage, Young says. Then comes hopelessness. “They are constantly given a message that they are on a negative pathway, meaning their claim is not going to be accepted. This is despite what we know about the outcomes of processing in the long term, which is that greater than 80% of people are found to be genuine refugees.”
And they have so little autonomy. “Just the day-to-day daily lives that they experience living in the detention system means that they have very little control over what they do. It makes things particularly difficult for people who are there with their children as well. Their capacity to act as parents and to make decisions on behalf of their families is so restricted.”
Young sees immigration detention as inherently more harmful than prison. “In prison those with mental health problems generally improve. People are more well on their release than when they entered. What we see in detention is the opposite of that. Over the course of time in detention, they get sicker.
“We don’t have families in prisons. Secondly, when people go to prison they go through a recognised independent judicial process. It’s not arbitrary. This is an arbitrary process and people see it as being unfair and that is another factor.
“Also, when people are in prison they have a definitive sentence so they know there is an end point. This is not like that at all. This is indefinite.”
Each quarter IHMS presents the department with figures on the health of detainees. The data for July to September 2013 showed a third of those held in detention for more than a year were experiencing extremely severe depression; 42% were suffering extremely severe anxiety; and 42% were extremely stressed. The report notes these figures are consistent with internationally published research: “The pattern shows the negative mental health effects of immigration detention with a clear deterioration of mental health indices over time in detention.”
Abbott takes power
“People didn’t really take Rudd seriously,” Young recalls. “But everybody was saying when the Libs get in it’s really going to get tough. So there was a building up of expectation that things were going to get worse, which made it worse in itself.”
When the change came in late 2013, there was no radical shift in policy. “Everything just got harsher.”
Relations between the department and its independent health advisers were already rocky. Dehag had been set up in 2006 at a time of acute embarrassment after it was discovered that a schizophrenic Australian resident, Cornelia Rau, was being held in the detention.
She was thought to be German, was desperately ill and the immigration department refused to release her for treatment. She was finally identified naked in the yards of the Baxter detention centre.
Dehag had an independence the department came to regret. Its dozen members were nominated by peak medical authorities, including the Australian Medical Association, the Mental Health Council of Australia and the professional colleges for nursing, general practitioners and psychiatry. The experts were at the table but the department found itself dealing with people who could neither be corralled nor muzzled.
“It’s always been a very tense relationship,” says Louise Newman, director of the centre for developmental psychiatry and psychology at Monash University. Newman chaired the group for a time. “At every meeting until they disbanded us we would make a statement that we did not support mandatory detention or prolonged detention of any form, that it was damaging and that it created problems that we could not fix.”
Young, who sat in on the group’s meetings, confirmed the experts’ fundamental objection to detention: “That’s been the baseline position that they have always held and they have always presented.”
The group watched with concern as the Gillard government reversed its policy of swift release for asylum seekers. Newman sees the second round of detention as worse than the first because it came as the evidence of harm was even more firmly established. “They replicated the very conditions that they have admitted contribute to mental harm and deterioration,” she said.
“It’s seen as collateral damage. The department does what it can to reduce it but in the name of the greater good of border protection and deterrents it doesn’t really matter. We’re saving lives by sending people mad.”
The group drove change. “The department was very pleased to use things that we brought in, so any positive reforms that have gone on in the system in terms of screening people and healthcare and health standards were all done by Dehag.”
But Newman alleges the department later sabotaged medical screening of asylum seekers for signs of torture and trauma. “We argued that no one who had been tortured should be detained or particularly not in remote places. The departmental doctors decided the best way to get around that was not to do the screening, so they didn’t find out who was tortured. They stopped it on Christmas Island so people could be shipped away before it was even known if they were trauma survivors.”
Tension between Dehag and the department intensified after Bowles was appointed secretary of the department in 2012, Newman says. Bowles is not a doctor but for much of his career was a health administrator before joining the defence department. He is one of a group of former army and defence figures who now hold the most senior positions in the immigration department.
Bowles announced a review of Dehag, which he renamed the Immigration Health Advisory Group (Ihag). He failed in manoeuvres to change its membership but imposed a former military doctor, Paul Alexander, as its chairman. “It was meant to be a much more controlled group,” Newman says.
Bowles wanted the experts to withdraw from public debate. Young says: “They wanted the thing to be more watertight.” The experts were not accused of leaking. “But they expressed views in public which were relevant to the business before the committee.” They continued to do so. The most vocal was Newman.
The experts and the department continued to be at loggerheads over the standard of care for detainees. Newman says Dehag and Ihag always argued that detainees had to be looked after “regardless of visa status” while they were in Australian hands, and it was an ethical obligation on all medical practitioners working in the system to provide care to Australian standards.
But once Nauru and Manus reopened, the department began to demand treatment be pegged to the much lower standards of care on those islands. There would have to be exceptions – no inpatient mental healthcare is available on Manus or Nauru – but the department’s wish was to lower the general standard of care for detainees in those camps.
At what was to be the last meeting of Ihag in August 2013, the issue was debated at length. An impasse was reached, says Newman. “The department at a very high level from secretary down argues the Australian government is not obliged to provide our standard of care to these people.”
But experts insisted that standards must be maintained and that the department’s plan was an ethical minefield for doctors. “Clinicians who go along with it are absolutely compromised,” says Newman.
Ihag experts continued to work in the system, but they never met as a group after Abbott’s victory in the federal election of September 2013. A long pattern of suddenly cancelled meetings ended with no meetings called at all. In mid-December the experts received letters thanking them for their service. They were dismissed. Alexander was now to be the sole adviser on medical matters to the renamed Department of Immigration and Border Protection.
Scott Morrison, the new minister, issued a statement: “The large membership of the group made it increasingly challenging to provide balanced, consistent and timely advice in a fast-moving policy and operational environment.”
Young says: “That doesn’t wash at all. Ihag had consistently told the department things it didn’t want to hear and the department had pretty transparently sabotaged the operation of it for more than 12 months.”
The chiefs of peak medical bodies, including the AMA’s Dr Steve Hambleton, expressed shock at Ihag’s demise. Abbott condemned the generally negative reporting of the move as “a complete beatup by the ABC and some of the Fairfax papers”. The prime minister declared: “This was a committee which was not very effectual.”
The rising tide of data
Morrison had been in the job only a few months when he assured Australia that mental health problems among detainees were on the wane. In mid-December, Nine News reported: “Immigration minister Scott Morrison yesterday said diagnosed mental health problems among detainees in Australia had fallen from a peak of 12% in 2011 to the current rate of 3.4% as a result of greater resourcing.”
Young is scathing about Morrison’s figures. “That’s not a prevalence rate. It never has been. It’s a pale shadow of what the real prevalence rate is because of the way that data is derived.”
Young says Morrison was ignoring the figures revealed by regular screening and instead using a count of visits to GPs or psychiatrists where mental health problems were raised. “It doesn’t take into account people who may have a disorder who are not seeing either of those two categories of clinicians.”
Gathering better statistics was one of Young’s key ambitions in his time at IHMS. The department dragged its feet on his proposals to use new measures to screen mental health problems. “There seemed to be a fear that it would result in controversy or threaten the application of the policies of deterrence,” Young says.
But the chief psychiatrist finally got his way and the new measures were used for the first time in the first quarter of this year. Young presented these figures to the Royal College of Australian and New Zealand Psychiatrists in May. They confirmed the long-established pattern: about a third of all those in detention had clinically significant problems – and the longer the detention, the worse the problems.
Half those who had been detained for 19 months or more were extremely or severely depressed; 40% were extremely or severely stressed; and 40% were extremely or severely anxious. The worst scores were gathered on Manus and Nauru. But the figures show a common pattern across the whole detention system.
In a PowerPoint presentation provided to Guardian Australia by the college, Young concludes: “All show linear deterioration in mental health status over time in detention.”
Young’s staff were also collecting figures on the impact of detention on children. “Changing to instruments more appropriate for children has been something the department has dragged their feet on for quite a long time.”
He told Guardian Australia: “This is not the only instance where data which has been seen as controversial or just difficult to understand has been buried.”
But Triggs requested the figures be given to her inquiry. They show across the mainland detention system a large number of children showing emotional distress or related symptoms. Young considered the figures a sign of serious problems that needed urgent consideration and action. Some of these children are those that IHMS doctors reported as showing issues of self-harm, regression, aggression, bed-wetting and despair.
When Bowles was questioned at the inquiry, he did not deny his department issued instructions to IHMS to withdraw the figures but was at pains to suggest to the commission that they remained under consideration by the department. He said: “I have no doubt that most of this sort of reporting is mainstream.”
Giving evidence to Triggs’s inquiry was Young’s last assignment for IHMS. As his three years with the commercial providers drew to a close, he decided to make a professional and public assessment of the detention system once he was free to do so.
“As a medical practitioner your duty is always to your patients and the people you look after,” he says. “To them you have a broader moral and ethical responsibility. In this case you see harm being done and as the primary duty of a doctor is to do no harm, your duty is to speak out against that harm – to say that harm should not be done.”
One of the planes arrived at around noon on Saturday. Eyewitness sources told Guardian Australia that many of the Tamil men had rips in their shirts after they were forcibly put on the plane.”
“They were traumatised,” said a Nauru source.
Contractors are understood to have expressed concerns that there is not enough space to house them all on Nauru.
It is understood that the asylum seekers will be processed in the OPC1 camp – which does not hold families. It is likely they will then be moved to the family camp.
Morrison told the Australian newspaper that he made the decision to move the asylum seekers – who spent nearly a month on board a Customs vessel before being sent to Curtin – after they had all refused to meet Indian consular officials after advice from their lawyers. However, a lawyer working for the asylum seekers, George Newhouse, denied the Tamils’ legal team had advised them to boycott the Indian officials.
Newhouse told Guardian Australia he had not been informed of the decision to transfer his clients. “Our clients have been disappeared to Nauru,” he said.
Lawyers from the Human Rights Law Centre who are also assisting the group said the transfer was a deliberate move to prevent legal scrutiny and that they had been asked to prepare a defence to prevent the group being moved to Nauru just hours before it went ahead.
“Since last Sunday, we have been urgently seeking to speak to all 157 people to give them advice about the proposed visit by Indian officials and the Australian government’s plans for them,” said the Executive Director of the Human Rights Law Centre, Hugh de Kretser.
“We were allowed to speak to only four of the 157 clients this week in telephone interviews of one hour or less.
“At around 4.30pm yesterday, the two clients we were able to speak to, asked us to examine legal options to prevent a possible transfer to Nauru or Manus Island. A few hours later, all 157 were secretly sent away.
“It highlights the government’s deception, secrecy and willingness to undermine the rule of law in Australia.”
Guardian Australia has also seen a letter sent to the Australian government solicitor by the asylum seekers’ legal team. It urges for a “cooperative approach” between the Indian high commission, the Australian government and the asylum seekers’ lawyers.
It requests access to the asylum seekers to inform them of the ongoing high court case and “any other matters relevant to any visit or interviews by Indian High Commission officials”.
“After our clients have received that advice we would hope to be able to engage in a cooperative approach concerning any interviews. It is of course imperative that agreement on these matters be reached prior to any interview process by Australian or Indian Government officials commence,” the letter states.
Morrison told the Australian: “Going back to India, where they are likely to have family and friends, is no longer an option for those who were living there. They passed up that option when they chose not to meet with Indian consular officials in Australia.”
A number of asylum seekers detained in the family camp on Nauru have begun peaceful protests over conditions at the centre. Nauru sources said on Saturday that three Somali women had self-harmed on Friday night as part of the protests.
The asylum seekers departed Pondicherry in southern India on 11 June, meaning they spent a month and a half at sea. Morrison had tried to negotiate with Indian authorities to hand them straight back without landing the asylum seekers in Australia.
Former Nauru detention centre worker Kirsty Diallo told the inquiry that one asylum seeker was so desperate for clothes for her daughter that she stitched her a dress from a mosquito net after managers consistently failed to provide her with clothes.
The president of the AHRC, Gillian Triggs, said the report, written by five independent medical experts and obtained by Guardian Australia, articulated issues of “profound concern” to the inquiry being conducted by a statutory, independent body.
The AHRC is not permitted to visit Australia’s offshore detention centres as it does not have extraterritorial jurisdiction, but Triggs said the conditions for child asylum seekers offshore and the Australian government’s decision to send children offshore were part of the inquiry’s remit.
The report notes that children are inadequately health screened and up to 50% of those on Nauru could carry latent TB. It also raises serious concerns that there is no clear child protection framework on Nauru and that most pregnant women are suffering from depression.
Triggs said the evidence in the report supported many of the inquiry’s observations of children in mainland detention and on Christmas Island, adding: “If it is true that they are being given very cursory health checks then that again underpins the point that they are being held in a way that cannot be justified on any rational or practical basis.”
The chief executive of Unicef Australia, Norman Gillespie, said that the report confirmed their “fears for children and pregnant mothers in Australian immigration detention”.
“That children are being exposed to chronic diseases, delayed treatment and deteriorating health while under the protection of Australia is of great concern,” Unicef Australia’s advocacy manager, Amy Lamoin, said.
“The government must uphold its responsibilities and ensure that children in its care have access to adequate standards of health care and protection. We request the minister respond in full to this report and explain how he will ensure the safety and health of the children under his care.’
Both the United Nations and Amnesty International have been refused entry to the Nauru detention centre in recent months, and the centre’s operations are cloaked in secrecy.
The coordinator of Amnesty Australia’s refugee campaign, Graeme McGregor, said one of the organisation’s principal concerns with the report was that it would not have been made public if it had not been leaked.
“That is extremely concerning and it really shows the secrecy surrounding this policy of offshore detention and what it may, in fact, be hiding. Amnesty were denied access to visit Nauru earlier this year and this is exactly the kind of thing we were afraid of – that the denial of access was being used to hide this kind of abuse.”
McGregor continued: “In particular we’re concerned about the lack of processes and protections for children who have been subjected to physical or sexual abuse, and really we feel that failures of this policy mean that if a child was being sexually or physically abused that nothing effective can be done about it, and also that the public in general would never find out about it.”
On Friday the immigration minister, Scott Morrison, said the report, which was filed about two months ago, was “of some time ago”. Morrison told reporters that the commander of operation sovereign borders, Lt-General Angus Campbell – who is not medically qualified –had given him a “very positive report” of the centre’s conditions subsequently.
Greens senator Sarah Hanson-Young said the leaked report revealed a “mental health crisis in the Nauru detention camp”.
“This damning report reveals the truth of Nauru and the horrific conditions that children are being exposed to on a daily basis,” she said.
“There is no paediatric life support on the island and conditions in the Nauru hospital are clearly unacceptable.”
Hanson-Young also provided photographs of conditions inside the maternity ward, which she said “show the true condition” in Nauru’s only hospital.
Sophie Peer, of the child asylum seeker advocacy group ChilOut, said the report revealed that the lives of child asylum seekers were being put at risk on Nauru.
“There is no excuse for endangering the life, health and safety of a child,” Peer said.
“We have never believed the line that offshore detention is about saving lives. Now we have even more detailed evidence that Australia is in fact putting lives at risk.
“Without question it is time to put aside political point-scoring and get people out of this dangerous detention facility. If this is not done, the result could be fatal.”
ChilOut said it believes there are more than 40 unaccompanied children detained on Nauru, and expressed particular concern, as does the report, about their safety and welfare.
Ian Wishart, the chief executive of Plan international, a global child rights NGO, said: “These children are being denied their most basic rights to healthcare and protection on our government’s watch. Australia has a legal and moral obligation to do better.
“Children are the innocents in all this. The majority do not make the decision to come to Australia, and nor are they able to stand up for the rights every single parent in Australia would expect for their own children.”
• Barely any screening for communicable diseases in children; none for under-11s
• Children at ‘significant risk’ of sexual abuse
• Most pregnant detainees are depressed
The desperate state of healthcare offered to asylum-seeker families, children, babies and pregnant women inside the Nauru detention centre can be revealed for the first time in a comprehensive report produced by five independent clinical experts, obtained exclusively by Guardian Australia.
Observations in the report include:
Children in the Nauru detention centre are not adequately screened for disease, resulting in the likelihood that many are carrying undiagnosed blood-borne diseases and up to 50% are carrying latent tuberculosis.
There are no paediatricians employed in the centre and no paediatric life support available on Nauru.
There is no clear child protection framework for children inside the centre and it is unclear what child protection checks are undertaken for Nauruan staff. This, according to the report, “places them [asylum seeker children] at significant risk of sexual abuse”.
Most pregnant women are suffering from depression.
Immunisation courses are not properly completed, increasing the risk of transferable diseases.
In a 14-month period between 2012 and 2013 there were 102 cases of self-harm, including 28 hanging attempts by 18 detainees; 6.3% of the asylum seekers are on psychotropic medication to treat mental illness.
There were 53 medical transfers to Australia in 2012-13 at a cost of $85,000 a transfer, with the report also noting that these can take up to 36 hours to complete.
Living conditions are “crowded, hot and humid” with children having “limited meaningful play”. Children play with stones.
There is an apparent significant risk of groundwater
contamination as a result of poor waste management at the detention centre.
There are nine 17-year-old unaccompanied minors on Nauru
The 56-page document, completed by the “physical and mental health subcommittee of the joint advisory committee for Nauru regional processing arrangements”, was not meant for public consumption and was filed for review to the Nauruan and Australian governments, who chair the committee.
It outlines substantial problems created by the Coalition government’s rapid offshore transfer policy for asylum seekers and was written after a site visit to Nauru in February.
It is understood that many of the 18 recommendations noted by the independent experts are being considered by both the Nauruan and Australian governments but the health subcommittee does not have the power to enforce any of its findings.
A spokeswoman for the immigration minister, Scott Morrison, did not respond to detailed questions but said: “The majority of recommendations in the report were supported by the department and either already acted upon or subject to planned service improvements as identified by the department’s chief medical officer.”
She did not say which of the recommendations had been acted upon.
Guardian Australia understands that many of the issues articulated in the report are still current.
‘Critical issues’ with child health screening and medical facilities
Children under 15 do not receive blood testing, meaning there is “extremely limited screening for communicable/infectious diseases”, according to the report. Children are not examined for mental health issues and IHMS, the private medical provider running services in detention, does not employ a paediatrician.
The report notes a “lack of resuscitation support for infants and children” in the centre and states that there is just one paediatrician employed by the island’s only hospital who speaks “minimal English”.
The subcommittee was also unable to verify if children detained on Nauru had been health screened at all before being transferred from Christmas Island under the government’s “rapid transfer” policy, which mandates that asylum seekers are moved offshore within 48 hours.
“The lack of child health screening in detention healthcare (overall and prior to transfer) means the physical and mental health conditions are likely to emerge in children after transfer and communicable diseases and developmental issues will remain unaddressed,” the report says.
It adds that pathology results for any child who is screened on Christmas Island are unlikely to be available owing to the rapid transfer. Medical groups have strongly criticised this policy.
The report notes there are no facilities for blood culture tests in the centre. “The evacuation time [from Nauru to Australia] is reported to be 24-36 hours, during which time an acutely unwell neonate [newly born baby] would deteriorate and could die,” the report states.
The report notes it is likely that up to 50% of children have latent tuberculosis, with “their risk of developing active tuberculosis increased by young age, recent migration and social stressors, all of which are relevant in this setting”. The report adds that multiple children will have undiagnosed blood-borne diseases, including hepatitis B.
It states that the care available for children and newborns is “not in keeping with an Australian community standard of care” and there is no memorandum of understanding in place with the hospital on Nauru despite the fact it provides a backup to the detention centre in complex cases.
“To put this in perspective, a hospital with around 20-30 staff on a given day that serves a local population of 10,000 people is providing backup to a health centre with around 50 staff on a given day, that provides healthcare to 2,300 people,” the report says. “It is unclear how use of the RoN [Republic of Nauru] hospital by people from the RPC [regional processing centre] affects local access to care, including to resources such as neonatal care, dental care and optometry services.”
Guardian Australia submitted detailed questions to IHMS, the private medical service provider. It declined to comment.
Child protection ‘a major concern’
There is no clear child protection framework in the detention centre. While service provider have “measures” to perform police checks or working-with-children checks on Australian staff, there are inconsistent requirements across agencies. It is also unclear what checks local staff, who constitute 53% of the workforce, have to undergo.
“Detention, and the grouping of large numbers of children and adults in crowded living conditions, without normal social structures or activities, risks exposing children to physical and mental violence and places them at significant risk of sexual abuse,” the report notes, adding that unaccompanied minors are at particular risk.
The report says that not a single stakeholder in the centre has a clear child protection policy in place and adds that unaccompanied minors, whose legal guardian duties are enacted by a Save the Children manager, have no clear framework to report abuse:
“… it was unclear how decision-making or acting in ‘best interests’ might occur [for unaccompanied minors], what legal training had been undertaken, which legal framework would be utilised, whether the organisation had protocols for management and decision making in sentinel events (eg sexual assault) and whether there was a plan for long-term review and support of children’s rights.”
The report says service providers reported they would refer child protection issues to the Nauru police, but adds: “Nauru does not have a child protection framework.”
Guardian Australia contacted all service providers in the detention centre asking them to detail their policies on child protection. A spokesman for Transfield Services, which manages the detention centres on Nauru, said all Australian staff were assessed by the Australian federal police before working in the centre. The spokesman said all Nauruan staff “undergo a Nauru police check and sign a statutory declaration. They are also trained in the DIBP’s [Department for Immigration and Border Protection] protocols for handling children.” The spokesman said other checks were carried out but declined to go into detail as to what they were.
A spokesman for Save the Children, which provides childcare in the centre, said child protection was the organisation’s “No 1 priority” on Nauru.
“A child safeguarding protocol and code of conduct prepared by Save the Children is in place on Nauru and is mandatory for all service providers. It outlines child-safe recruitment techniques, including working with children checks and/or police checks for positions involving contact with children, and detailed incident reporting and investigation procedures.”
The spokesman said all Save the Children staff – Australian and Nauruan – were required to undergo police or working-with-children checks and sign a code of conduct.
With regards to the subcommittee’s observations on Save the Children’s guardianship role for unaccompanied minors, a spokesman said: “The manager and all staff responsible for the supervision of unaccompanied minors are trained on the decision-making processes and reporting procedures. All incidents are reported in accordance with the regional processing centre guidelines and the protocol.”
Seven cases of self-harm a month and high rates of depression among pregnant women
The report describes a “critical issue” of self-harm with an average of seven episodes each month between September 2012 and November 2013.
In that period there were 28 attempted hangings and five attempts at throat slitting. Twelve asylum seekers made more than one attempt at self-harm; 10 of those people had escalating histories.
Sixty adults were taking psychotropic medications at the time of the visit, constituting 6.3% of the detention centre’s population.
Thirty-three of the 53 medical transfers off Nauru in 2012-13 were related to mental health issues.
There were 15 pregnant women on Nauru at the time of the visit, with five who had been transferred to Australia for care. Mental health staff reported that most pregnant women had “consistently high” scores of depression on the Edinburgh postnatal depression scale. “Most women scored around 24, where the cut point for detecting significant depression is 10,” the report says.
The report also notes there is no facility for advanced paediatric life support at the Nauru hospital and only one incubator. Women experiencing pregnancy complications are transferred to Australia to give birth.
The spokeswoman for Morrison was asked whether the government would abandon its rapid-transfer policy. She said: “There have been no recent rapid transfers to offshore processing centres. There has not been a successful people smuggling venture to Australia in almost six months.
“Transfers are occurring in a planned schedule that take into account any matters that have to be addressed.
“There has been no change to government policy since the commencement of Operation Sovereign Borders and the government is not considering any changes to these policies.”
The report contains many more details about the state of healthcare provisions inside the detention centre. Guardian Australia has published it in full here. The report was not given to Guardian Australia by any members of the subcommittee and none wished to comment.
The first asylum seekers to be granted refugee visas on Nauru have been released into the community.
Thirteen asylum seekers have been given refugee protection, including an Iranian family and four single men.
They have now been released from Australian immigration detention on the island and given five-year visas.
They will be given the option of settling in Cambodia if a resettlement deal between Australia and that country is signed as expected.
Seven people received negative assessments, including four people in two families and three single adult men. They remain, for now, in detention.
The Iranian family was met by Save the Children staff at the Anibare Lodge family accomodation, while the single men are being housed at a separate site.
Nauru’s government says refugees who resettle in the community are free to move around the island and seek employment.
The first refugee determinations come nearly two years after the former Labor government began sending asylum seekers who arrived by boat to the tiny Pacific island nation.
There are now more than 1,100 asylum seekers in the Australian-run detention centre on Nauru.
The Nauruan government says the refugees will be supported by a buddy system to help them integrate into island life.
It says they are settling into temporary accommodation and will soon move to more permanent and more suitably located housing.
The Nauruan government is expecting to deliver another 21 refugee determinations today.
Struggling Nauru can’t take in extra people: MP
Nauru opposition MP Mathew Batsua says it does not make sense for the struggling nation to be taking the refugees but the country would do its best to accommodate them.
“We’re a small country, we have many issues ourselves. We’re struggling with infrastructure issues, health issues, education issues, so to take on extra people doesn’t make sense for us. We think we’re too small and we haven’t changed our position at all,” he said.
“I think culturally, because we are obviously worlds apart in terms of what we use and the ways of life in the Pacific versus where they came from, religion-wise, I think Nauruans in general are very accommodating and hospitable people. We are willing to give people a chance if they are able to settle in.
He says the Nauruan government needs to be more forthcoming with information about how the resettlement will work.
“The government are behaving in ways that are detrimental to Nauru, ways that are detrimental to the representation of Nauru. They are being very secretive which is totally contrary to what we believe our role should be.
“We need to be open to show the international community we can do this well and we can do it in an open manner.”
Amnesty International says the Nauru government has refused its request to inspect the centre.
Amnesty International has accused the Nauruan government of trying to avoid public scrutiny of the treatment of asylum seekers on the Pacific Island.
Amnesty says the Nauruan government has declined a request to tour the Australian-run immigration detention centre, citing “the current circumstances” and it being “an incredibly busy time”.
Amnesty’s refugee spokesman Graham McGregor says the human rights group wanted to view conditions at the Nauru centre, which currently houses 1,177 asylum seekers including women and children.
“It is extremely unusual for us to be denied access to a detention centre and in fact we visited the Manus Island detention centre, as you might recall, back in November last year,” he said.
“So we, as part of that work, similarly put in a request to visit the Nauru detention centre and we received a refusal.”
Amnesty International’s Manus Island report, which was published in December, described conditions in the PNG centre as cruel, inhuman, degrading and violating prohibitions against torture.
“We have good reason to believe there may be similar human right abuses taking place in Nauru,” Mr McGregor said.
“Certainly what has leaked out about the Nauru detention centre has been extremely concerning, particularlythe recent allegations of water shortages and allegations that children at the facility are being physically abused.”
Amnesty says it’s is being ‘cold shouldered’
Amnesty International says the request to visit the detention centre was put to the Nauru justice minister David Adeang in early March.
He says the minister responded that the Nauru processing centre “was incredibly busy and that they felt that a visit by Amnesty International at this time may appear premature”.
A proposal for alternative dates was ignored, according to Mr McGregor, and “enough time has passed that we would feel we are being cold shouldered.”
He has accused Nauru of trying to hide conditions for the asylum seekers.
“[The refusal] did follow some other steps that have been taken recently by the Nauruan government to try and prevent public scrutiny of conditions inside the detention centre,” he said.
“For example, back in February of this year, the Nauruan government increased the visas for journalists to visit the country from $200 to $8,000, which was a pretty clear sign they simply didn’t want people coming and reporting on what was going on there.
“We did have a little hint there that the Nauru government was not comfortable with that sort of scrutiny, but again we were still surprised by their response.”
Mr McGregor says he does not accept that it is too busy at the centre for an Amnesty International inspection.
“I would imagine conditions at these detention centres are always pretty busy,” he said.
“They are very crowded, they are handling a very difficult system, a very difficult population of people who have a lot of mental health problems, a lot of existing trauma, a lot of health conditions.
“On Nauru, of course, you have children and pregnant women there as well. It is always going to be a busy time.”
Human rights inspectors from the United Nations Working Group on Arbitrary Detention had wanted to investigate the conditions of the asylum seekers sent by Australia, but had to cancel at the last minute.
The Nauru government questioned whether the UN team was trying to use the Pacific island nation as a publicity stunt.
A government spokesman told the ABC earlier this month that, “given the way they have gone about this, it is reasonable to question whether this is merely another publicity stunt by a group with a political agenda”.
The ABC has been told the first refugee determinations at Nauru’s offshore immigration processing centre are now a couple of weeks away.
The asylum seekers are being told that people found to be refugees will be settled in Nauru on a visa for a period up to five years.
They are being warned not to break any laws or take part in protests while awaiting a decision.
While the first refugee determinations are due to be handed down soon, the detainees are being urged to be patient.
Amnesty International says it will keep asking Nauru for access to the immigration processing centre.
The ABC has sought comment from the Nauruan government.
A spokesperson for Australia’s Immigration Minister Scott Morrison said: “We are not aware of any such decisions (on rejection of access), we have not been consulted on any such decisions, and this is ultimately a matter for Nauru.”
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