Open letter from detention centre employees alleges Australian government knew of physical and sexual abuse of asylum seekers on Nauru more than a year before it acted.
Asylum seeker children play in the dirt at the Australian-run immigration detention centre on Nauru. Photograph: Supplied
The federal government has been aware of physical and sexual abuse of asylum seekers on Nauru for more than a year but failed to take appropriate action, workers from the detention centre have alleged.
In an unprecedented move, 23 current and former medical staff, teachers, social workers and child protection staff have signed an open letter calling for the removal of all asylum seekers from Nauru to Australia. They have also called for a royal commission into sexual abuse on Nauru and into the government’s response.
Transfield immigration staff told they can be fired for using Facebook
The three-page letter says comments by immigration minister Peter Dutton that there was a “zero tolerance” attitude to sexual abuse “do not reflect the attitude or actual response” on Nauru.
It says Dutton’s request for asylum seekers to come forward and report sexual assaults could put them in further danger because of the close-knit nature of the detention environment.
The recent review led by former integrity commissioner Philip Moss found some allegations of sexual assault at the centre were substantiated. The review has now sparked a federal Senate inquiry to further investigate allegations of abuse at the centre.
Some of the workers were also due to appear on ABC’s Lateline on Tuesday evening.
The letter says: “We are a group of current and former employees from the Nauru detention centre who have first-hand knowledge of the conditions in which children and adults are detained.
“We would like to inform the Australian public that the government and the Department of Immigration and Border Protection [DIBP] has been aware of the [allegations of] sexual and physical assault of women and children on Nauru for at least 17 months, long before the Moss review was ever commissioned.
“[DIBP] and all service providers were informed, in writing, of several of the assaults detailed in the Moss review in addition to many other assaults not mentioned in the report.”
The letter was signed by former and current staff and workers from Save the Children and International Health and Medical Services.
Former Save the Children workers named on the letter include Jesse-James Clements, Viktoria Vibhakar, Tobias Gunn, Jarrod Kenney, Hamish Tacey and E Maree.
Named former staff from International Health and Medical Services include Dr Peter Young, Dr Rodney Juratowitch and Dr Michael Gordon.
A number of other current and former staff from Save the Children and the Salvation Army have signed the letter, but chose to remain anonymous.
The incidents it highlights include one from November 2013 in which a boy was sexually assaulted by a detention centre employee. Guardian Australia has previously reported on the case, and obtained documents that show the service provider Transfield filed an incident report at the time.
The letter says that on this and other occasions, the immigration department was made aware of the allegations through incident reports, meetings and minutes from Save the Children meetings, but that it chose not to act.
“Despite this knowledge, the DIBP chose to keep this child in the detention centre where he was assaulted and remained at risk of further abuse and retaliation. Indeed, this child was subjected to further incidents of abuse while he was in detention.”
The letter says Dutton’s comments encouraging asylum seekers to report abuse when the Moss report was released posed further risks as they continue to live in close proximity to the alleged perpetrators. The signatories allege this will place them at future risk of assaults.
“It is not safe to expect women and children to report abuse to authorities and then require them to live in close proximity to the [alleged] perpetrators,” it said.
“To do so places them at risk for repeated assault, retaliation for reporting the abuse, and exposure to repeated reminders of the assaults that they suffered which further delays their recovery from trauma.”
The letter says the sexual exploitation of vulnerable women by detention centre staff – another allegation raised by Moss – was reported to the Department of Immigration 16 months before the Moss review.
“However, DIBP refused to remove these women from the unsafe detention environment.”
The letter calls for the closure of the Nauru detention centre.
“In order to protect asylum seekers, and in particular women and children from further abuse, we immediately ask for the transfer of all asylum seekers in the Nauru detention camp to Australia. We also request the Australian people support a royal commission into abuse allegations in the Nauru detention centre.”
The Senate inquiry into events on Nauru is now accepting submissions, and is likely to hold public hearings in April and May. Some former detention centre staff are preparing submissions, which will be protected by parliamentary privilege.
Tensions have once again boiled over on the island of Nauru, amid growing protests and clashes between islanders and refugees. Max Chalmers reports. WARNING: This article contains images of a distressing nature.
At least three refugees living in the community on Nauru were hospitalised overnight after a stone throwing attack knocked a couple off a motorbike, and a young woman attempted suicide in the Anibare camp.
Around 10pm a group of refugees were attacked while riding motorbikes, with a man in his late 20s struck in the head by a rock, causing him to crash the bike and leaving him “badly injured”, according to a friend who visited him in hospital after the incident.
Images of the man show him bleeding heavily from his face.
New Matilda understands both the man and his wife remain in hospital, and that Nauruan police have questioned them, as well as another group of witnesses.
“It’s very common for the locals to throw stones, it happened to my friend last night… it’s common it’s, not something unusual,” one refugee said.
After hearing of the incident refugees and locals gathered at the hospital, with police on hand to prevent conflict between the groups.
In a separate incident that took place a short time after the stone throwing, a young Iranian woman was also left hospitalised after attempting to commit suicide.
Refugees who know the woman told New Matilda she had suffered severe back ache in recent months, preventing her from basic tasks, including shopping and cooking.
They said she had only been offered painkillers, and had become desperate for proper treatment.
One of these friends, who lives on the same block in a different room, had been caring for the woman last night, but was forced outside to make a call.
When she returned, the woman was in the bathroom.
“I call her, are you hearing me, and she didn’t answer me, and I was worried,” the friend, also an Iranian, told New Matilda.
“I opened the door and I saw her… she was bleeding, she was awake.”
“She was lying on the floor, her head was on the toilet, and she was not good, she was, how can I say, her face was completely yellow. She was not feeling good at all.
“I called other friends and I called the ambulance and police and anyone I know.”
According to the friend, Nauruan police arrived first, followed by an ambulance a full hour after the incident took place.
“Everything here is slow. The life here is nothing for them, the refugee, are not important here. No-one care about us,” they said.
The friend accompanied her to Nauru’s only hospital in the ambulance, crying as they travelled.
After being given painkillers, both returned to the Anibare camp in the early hours of Tuesday morning, where the injured woman is now resting.
An image from Nauru overnight, in which a young woman attempted suicide.
As New Matilda revealed last week, former Minister for Immigration Scott Morrison had been left ‘shit-worried’ after a video informing asylum seekers they would never be settled in Australia caused escalating protests in September last year.
While these concerns related to the situation in the centre, tensions have also been steadily building in the Nauruan community as refugees are processed and released.
Protests have become a regular occurrence, with the Nauruan government issuing restrictions on where they are allowed to take place. Images seen by New Matilda (below) show women and children protesting today, holding banners that read “we are refugee women, we are not attacker” and “stop violence against women and children”.
Refugees are currently negotiating for the right to protest outside the Australian High Commission.
In menacing letter, locals warn refugees against stealing jobs and fraternising with island women
Refugees on Nauru have been threatened again by locals, told to stop stealing jobs, having affairs with local women, and to leave the island or face “bad things happening”.
In an menacing anonymous letter left at the houses of all resettled refugees on Nauru, the “Youth of Republic of Nauru” warned refugees would continue to be attacked if they stayed on the island.
“Refugees are taking over all our job opportunities and spreading over our small congested community, making our lives miserable.
“Second big and very important issue is that Nauru is a conservative country, it is not a multicultural country so resettling refugees means that in[tro]ducing different culture from different countries [is a] mistake and the wrong decision of a few corrupt people from Nauru Government putting the lives, culture, customs, values of Nauru local people in danger.
“Our women, girls and teenagers are interested in refugees because of their skin, colour, face, and handsomeness. Our wives, sisters, and daughters are in contact with refugees and having affairs with them. We can never see our women having fun with refugees and neglecting locals.”
Another man was stoned and then beaten by a group of local men, and taken to hospital with serious head injuries and his sight damaged.
“We warn refugees to go away of our country [sic] and just to hell with all you concerns, if not, get ready for the bad things happening and waiting ahead,” the letter said.
Refugees awoke on Monday morning to find the letter had been left at all the refugee camps, and at resettlement homes at Fly Camp, Anibare Lodge and Ijuw Lodge.
The threat is reflective of the growing tensions between local Nauruans and the transplanted refugees, many of whom are Iranian Muslims and Christians.
Local Nauruans resent the Australian government-funded accommodation given to refugees, which is luxuriant by island standards, with running water and 24-hour-a-day electricity.
As well, several refugees have found jobs on Nauru, mainly low-paying, manual labour positions. But on an island with 90% unemployment, this has been fiercely resented.
But the largest tension, Guardian Australia has been told, is over refugee men fraternising with island women, which has angered locals.
The letter is condemnatory of the Australian government dumping its “rubbish [refugees]” on Nauru, but is also reflective of Nauruans’ growing disaffection with their own government, widely seen as a corrupt cabal that has bankrupted the once-wealthy island state.
The Nauru government ran out of money in September and had its bank accounts frozen over unpaid debts. The government is almost entirely dependent on Australian aid to survive.
“We warn our corrupt government as well as Australian government to take away your rubbish [refugees] and leave our country, otherwise there can be worse situation for refugees [than] you can see these days. Our group network is working and keeps watching on all the activities of the refugees.”
The letter, which has been written on a computer and has no handwriting on any part of the document, issues an ultimatum to refugees: “We warn all the refugees working … to quit the jobs and stay back [out] of our community and also stop walking around in the island.”
One refugee on the island told Guardian Australia: “Refugees are so scared, frightened that nobody would leave the camp. All the parents … worry about their children because the kids need to go to school but safety and security … is a big concern.”
The Nauruan government has made efforts to defuse local hostility. The country’s president, Baron Waqa, told parliament after the child refugees were beaten: “I’m disheartened that the refugees are being attacked by the locals verbally and physically.”
The Australian government maintains that the welfare of refugees resettled on Nauru is a matter solely for the Nauru government.
But several arms of the United Nations, including the committee against torture, have told the Australian government that it is wrong, and that Australia has “effective control” of the camps and the living conditions, and that it is legally responsible for what happens to resettled refugees.
Victoria Martin-Iverson from the Refugee Rights Action Network said Nauruans were entitled to complain about their government’s deal with Australia, but that they should not take their anger out on the refugees.
“Both the citizens of Nauru and the asylum seekers are victims of the Australian government’s appalling human rights violations. Refugees are not safe on Nauru and must be brought back to Australia.”
As asylum seekers are released into the community on Nauru, tensions have begun spilling over, with four boys hospitalised over the weekend. Max Chalmers reports.
Unaccompanied minors released from detention centres on Nauru and living among the community are today fearing for their lives after a series of violent attacks over the weekend which saw at least four young teens hospitalised, as tensions between islanders and asylum seekers escalate.
New Matilda has learned four underage asylum seekers were hospitalised on Sunday night after being attacked while returning to their accommodation from a day at the beach.
Asylum seekers involved in the incident, aged between 15 and 17, told New Matilda a group of Naruan men pulled up to them on two motorbikes as they made the two hour walk back to their housing.
The men are believed to have been intoxicated and began ridiculing the boys.
“They were swearing; fuck Afghanistan, fuck your religion, fuck refugees,” one of the boys told New Matilda.
According to the boys involved, the men stole and destroyed several phones, before attacking them.
“They punch me, they slap me – I was wearing a singlet, they broke my singlet,” one boy said.
“They gave us warning say ‘we will kill you’, and that time I felt very scared, no one can help us, and I don’t have a phone.”
“Everywhere was dark, they were big, big men.”
Multiple death threats were made.
A young unaccompanied minor on Nauru was one of four boys assaulted by Naruan men and hospitalised over the weekend.
“They [said] that Save the Children [an NGO working on Nauru] and Immigration are not able to protect you from us. This is our country and we can do what we want,” another boy interviewed by New Matilda said.
The violence forced two of the boys to flee to the beach, while the remaining two escaped to a separate location.
New Matilda understands the boys were eventually able to contact Save the Children employees. They were located by staffers, before being contacted by Australian Immigration officials and local police, and then taken to hospital.
One boy’s injuries were serious enough to result in an overnight stay.
Before being found, the boys hid behind a large rock on the beach.
“Same as Afghanistan, it’s not safe here. I was very scared,” one said.
“We came from Afghanistan for peace, not for fighting, not for beating.”
Dianne Hiles, Chair of asylum seeker advocacy group ChilOut, criticised Minister for Immigration, Scott Morrison for sending children to Nauru.
“We’ve had concerns all along about the conditions in which people are being held on Nauru,” Ms Hiles said.
“The whole ethical responsibility for the state and wellbeing of these young people rests with our government. They’re financing the situation; they’ve set it up.
“Whatever the reason for the attack, these boys have been injured and there has been a huge failure in protecting them. Whoever the guardian is has not been able to keep these boys safe.”
Morrison is the legal guardian of all unaccompanied minors in Australian immigration detention, but abrogates that duty once children are moved to Nauru, as is standard practice under Australia’s current policy of offshore detention and processing.
New Matilda understands it has now been exactly one month since all unaccompanied minors held in detention on Nauru, numbering just under 30, were released from closed detention into the community.
They are being housed in three separate areas spread across the island.
One of the unaccompanied minors assaulted recently on Nauru.
Initially overjoyed to be free after a lengthy period of detention on Christmas Island and then Nauru, the group’s morale has collapsed after realising the inadequacies of settlement on the tiny island nation.
The unaccompanied minors have been provided with a small allowance on which to live each week, but say it is inadequate.
Travel around the island is hampered by a lack of buses. Water shortages are frequent, forcing minors to replenish toilets with seawater.
Their release has also increased tensions with locals and asylum seekers are reporting frequent abuse and threats, including during shopping visits and travel around the island.
“The young people, the old people, when they are driving and we are walking they are showing the middle finger to us,” one asylum seeker said.
“We need to escape and ignore… it’s very, very painful. Someone is doing something very bad and you’re not able to do anything.”
A group of locals has been established to assist the asylum seekers settle, and provide a point of contact.
Tensions inside the detention centre have also been high in recent weeks with reports of self-harm surfacing after it was announced asylum seekers on Christmas Island may be eligible for Temporary Protection Visas in Australia, while those already transferred to Nauru will not.
The new settlement deal with Cambodia has also inflamed the situation.
Like all asylum seekers settled on the island, the unaccompanied minors will eventually be moved on as Australia’s deal with Nauru only guarantees them a place on the island for five years.
There are reports of separate incidents of unprovoked violence against unaccompanied minors on the island, but New Matilda has not been able to independently verify them at this stage.
Afraid for their immediate safety, young asylums seekers say they remain very frightened, and are pessimistic about their future.
“Now we don’t know where we should go. We came from Afghanistan to save our life, now we don’t know where to go from Nauru to save our life,” one said.
The teenager made a plea to all Australians.
“Please, you can’t play with our future, you can’t play with our lives. [The Australian government] are playing now. I want to feel safe, just, I want to see my future bright, not like here.”
Hiles said the situation was an indictment on Scott Morrison.
“Young Hazara boys in particular are at huge risk in Afghanistan. Apart from being a persecuted minority, they are actively sought out and killed and they’ve usually lost family members,” she said.
“They come here, they generally qualify for protection, but we continue to choose to make life as harsh as possible for them.
“We should not be treating young boys like this.”
Save the Children provided the following statment a short time after deadline:
Save the Children is appalled by any instance of assault on refugee children in Nauru. Unaccompanied child refugees are some of the most vulnerable – far from home, family and friends, many already witness to horrors no child should go through. These children deserve every protection that can be offered.
Save the Children is working flat out to provide the best possible support to the children in our care. However, Nauru is a small and remote island nation with a small population and limited resources, and Save the Children maintains it is not a sustainable solution for refugee children, particularly those unaccompanied by any family.
New Matilda is seeking comment from Minister Morrison’s office.
Australian immigration minister will later this week seal controversial agreement to move refugees from Nauru to southeast Asian nation.
Cambodia and Australia will sign a controversial refugee resettlement deal later in the week, which will facilitate the transfer of refugees who have arrived in Australia and been transferred to the tiny island state of Nauru to be resettled in the impoverished southeast Asian nation.
Neither Australia nor Cambodia has shared details of the deal with the United Nations Refugee Agency (UNHCR), despite serious concerns it will break international law.
The Cambodian government said on Wednesday that Australia’s immigration minister, Scott Morrison, will sign a memorandum of understanding (MOU) between the two governments on Friday.
Morrison later released a statement confirming the two countries would sign an MOU later in the week but gave no further details on the content of the deal.
According to a statement released by Cambodia’s ministry of foreign affairs and international co-operation, Morrison will pay a two-day visit to Phnom Penh starting on Friday and will co-sign the memorandum with Cambodia’s interior minister, Sar Kheng, at 3pm.
Negotiations between the two countries began in February, when Australia’s foreign minister, Julie Bishop, paid a visit to Cambodia.
But the full details of the deal have not been publicly disclosed and refugee advocacy groups, as well as the UNHCR, have expressed concern about the welfare of the refugees upon their arrival in Cambodia.
Vivian Tan, a UNHCR press officer in Bangkok, said in an email to Guardian Australia on Wednesday that she did not have the details of the agreement, because the UNHCR has not been a party to it, but have “expressed our concerns to officials of both governments based on what we know about it”.
“The UNHCR is worried about the adverse precedent being set by this type of arrangement that in the first instance, transfers asylum-seekers who have sought Australia’s protection to Nauru, in conditions that have previously been described as harmful, then relocates refugees recognised in Nauru to Cambodia.
“Asylum-seekers should ordinarily be processed, and benefit from protection, in the territory of the state where they arrive, or which otherwise has jurisdiction over them,” Tan added.
She said the UNHCR is also concerned that the practice of relocating refugees to other countries “where they may not be able to access fundamental rights” enables countries to divest themselves of their responsibilities as regards the 1951 Refugee Convention.
Human rights groups and legal bodies in both Australia and Cambodia have said they have not been consulted on its contents.
Numerous groups have voiced serious concerns that the resettlement deal is in violation of Australia’s international obligations under the Refugee Convention.
At present, refugees coming to Cambodia rely heavily on support provided by NGOs such as the Jesuit Refugee Service. It assists with helping new arrivals find accommodation, attend language classes, and also provides small start-up loans.
However, Cambodia has a poor record with regard to its duty of care toward refugees. In December 2009, on the eve of a $1bn investment deal with China, Cambodia forcibly deported to China 20 Uighurs whose applications for asylum were still being processed. Of these, two were children and one of the women was pregnant. The decision was met with outrage from Amnesty International and the World Uyghur Congress.
Hanson-Young said that the Greens have received advice that the Australian government would need to get the resettlement deal approved by parliament.
Elaine Pearson, Australia director at Human Rights Watch, said it was “disgraceful” that the agreement was “being rammed through in secret, with no public consultation despite concerns raised by Cambodian civil society”.
“Australia is undermining refugee protections by sending people to a country that is both ill-equipped to handle refugees and has an awful track record of not protecting asylum seekers,” Pearson said.
Sister Denise Coghlan, director of the Jesuit Refugee Service in Phnom Penh, said the news of the impending MOU was “stunning,” particularly because of a failure of the Cambodian government to consult with civil society groups.
She said she had not seen the MOU, but understood it to be accompanied by two other documents; an implementation guideline and another, more detailed, daily plan.
When asked if the Jesuit Refugee Service had been consulted, she said: “Absolutely not. It was a secret – it sort of came out of the blue between Julie Bishop and [Cambodian prime minister] Hun Sen [in February].”
“I didn’t expect to be consulted, and maybe because the whole thing is shrouded in secrecy. I’m not sure any civil society was consulted. It would be good to consult the refugees,” she said.
Sr Coghlan did meet with Greg Kelly, an official sent over by Australia to begin working as a counsellor at the Australian Embassy in Phnom Penh, in August.
“I presented him my reservations about the [deal] and said I was quite pessimistic, whereas he was hoping to be optimistic
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.”
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