IN Australian politics, the plight of asylum seekers has been a subject of fierce debate, generating a range of policy responses and rhetoric.
Amid the various twists and turns in asylum seeker policy, an ongoing concern has been the health impacts of indefinite detention. Medical practitioners, mental health experts, and human rights bodies have consistently raised concerns about the damaging mental health consequences of immigration detention.
An enduring strand in this discussion has been the need to strengthen transparency and accountability in the provision of health care to detainees. Despite the profound health risks posed by detention, there is currently no independent body to systematically monitor the provision of health and mental health services in immigration detention facilities.
Alongside the ongoing concerns raised by the AMA and others, a succession of parliamentary inquiries and reports from human rights bodies have documented systemic shortcomings in the provision of detention health services. Earlier this year, the final report from a Parliamentary inquiry into Australia’s immigration network concluded that acute mental illness is widespread among detainees, and that “mental health services are severely inadequate to deal with the quantum and severity of cases”.
Many of the shortcomings documented in this report are reminiscent of the findings of the 2005 Palmer Inquiry, which recommended that an Immigration Detention Health Review Commission be established to carry out external reviews of health and medical services provided to detainees. The inquiry recommended that it have a statutory basis, and that it be appropriately resourced and staffed “with a core of experienced people with relevant skills”.
The Federal Government decided not to implement this recommendation, but instead established the Detention Health Advisory Group (DeHAG), which is now defunct but is in the process of being revived under the new title of the Immigration Health Advisory Group (IHAG). DeHAG has never been resourced or tasked to undertake the range of functions that the Palmer Inquiry deemed necessary, and has argued that its expertise and advice has been consistently underutilised and ignored.
The experience of DeHAG and the ongoing health problems within immigration detention underscores the need for independent and rigorous monitoring.
This has been given further impetus by the recent return to offshore detention on Nauru and Manus Island, where the physical conditions and remoteness pose unique service challenges and risks, particularly due to barriers in recruiting experienced onsite staff, and limited ability to refer detainees to external health services, including specialist mental health treatment.
Under the previous Pacific Solution, there was limited oversight of the conditions on Nauru and Manus Island, but the information that did emerge painted a grim picture of high rates of serious mental health issues, suicide attempts and self-harming.
The WHO has also identified Papua New Guinea as the highest risk country in the Western Pacific Region for malaria, with Manus Island, where the government proposes to send asylum seekers, having the highest numbers of probable and confirmed malaria cases in PNG.
The experience of immigration detention — both onshore and offshore — demonstrates the need for more robust and independent monitoring mechanisms. The AMA has called for the immediate establishment of a health panel that is independent of government and the Immigration Department, and empowered and resourced to investigate and advise on the health and wellbeing of asylum seekers in detention.
The independent panel should include members drawn from the medical, psychology, dental and nursing professions, and members specialising in public health and child health.
The constitution, powers and capacities of the panel should be codified in legislation, and should at least include the following:
- The power to access all places of detention, interview detainees and access all information relevant to the health and wellbeing of detainees, without hindrance and with the full assistance of the Immigration Department and its agencies
- Material and financial resources to monitor and investigate autonomously and effectively, and to engage appropriate health and medical expertise as deemed necessary
- Confidentiality of information provided by detainees
- The power to examine Immigration Department contracts with health and welfare service providers to ensure an appropriate range of services is contracted for, and the providers have the capacity to deliver them
- The power to publicly report on its monitoring, engage in dialogue with and submit proposals to competent authorities and to make recommendations about legislation.
Irrespective of the particular policy regime in place in Australia and shifting political dynamics, there will always be vulnerable people fleeing persecution and seeking asylum in countries such as Australia.
It is imperative that a robust and effective monitoring framework is established that can investigate and advise on the health and wellbeing of asylum seekers in detention.
Dr Steve Hambleton is the federal president of the AMA.
Posted 29 October 2012