THREE weeks ago, Dr Tony Bartone, President of the Australian Medical Association (AMA), wrote to Prime Minister Scott Morrison calling for the evacuation of refugee and asylum seeker children and their families from Nauru. This letter was swiftly rebuffed.
At the time, over 100 children were still on the island and many of them were critically ill. Just over a dozen children have since been evacuated under order of the Federal Court, which is testament to the seriousness of the health crisis.
It is important for doctors to understand why and how this crisis has occurred, especially as we have tolerated a policy of offshore processing for 5 years.
The Regional Processing Centre in Nauru was opened in 2012. Of the asylum seekers sent to Nauru, over 1000 remain, of whom 800 have been assessed as genuine refugees. Two-hundred are still waiting to have their claims processed.
The Australian Government continues to be responsible for the health care needs of these refugees and asylum seekers. Doctors working with International Health and Medical Services have long provided outpatient medical care, . While we can argue as to whether or not Australia should care for these asylum seekers, or whether there are “worthier” causes in Australia, the reality is that we are legally and morally obliged to care for them, and already spend far more than we would if these people were living in our community and accessing established health services.
Health care services in Nauru are limited by the size and remoteness of this small population. Australian doctors are familiar with the issues around providing care to remote areas, and medical transfer is essential. Doctors in Australia can arrange such transfer based on clinical need and without needing to first apply to a government agency. Nauruan national patients are frequently transferred off-island for complex care.
Increasingly, refugee and asylum seekers patients requirements for medical care not available on Nauru have led to cases being brought to the Federal Court. This has caused significant delays in care, and a huge legal cost to taxpayers. The Federal Court has always found in favour of upholding medical recommendations.
The Nauruan government has also frustrated the delivery of medical care by refusing to issue exit visas to patients whose medical transfer had been ordered by an Australian Federal Court and, more recently, evicting Médecins sans Frontières — vital providers of quality psychiatric services for both Nauruans and the refugee and asylum seeker population.
The Australian Government has also thus far ignored all offers for independent audit or oversight of the administrative decisions made in Nauru around the health care of refugees and asylum seekers. Both the Royal Australian College of General Practitioners (RACGP) and the AMA have offered independent assessment.
Medical independence and audit of decisions relating to clinical practice and outcomes are essential in any health system. In a setting where two different governments appear to be obstructing delivery of health care and clinical oversight, an inevitable health crisis affecting dozens of people has developed.
Nauru has been billed as a tropical paradise where Nauruan children have no issues. The reality is that the Pacific Islands have extraordinarily high rates of mental illness and double the global rate of suicide. It is impossible to compare the outcomes of Nauruan citizens with those of the asylum seekers and refugees that Australia has transferred there, as the rights, privileges and opportunities accessible by these groups are not comparable.
In rejecting Dr Bartone’s concerns regarding the health of these children, the Prime Minister noted that 1200 people had died at sea before this policy was implemented. We acknowledge that the government has a duty to assess those who seek asylum and to reduce the incidence of deaths at sea. But as a profession, we must reject the notion that denying children their fundamental right to health care is a necessary policy, or the only policy that can achieve those broader goals.
In the past 3 weeks, we have seen an unprecedented response to Prime Minister Scott Morrison’s rejection of Dr Bartone’s call for change. A majority of medical colleges and societies, including the Royal Australasian College of Physicians, the Royal Australian and New Zealand College of Psychiatrists, the Australasian College for Emergency Medicine, the Royal Australasian College of Surgeons, the RACGP, the Australian College of Rural and Remote Medicine, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Australasian Society of Lifestyle Medicine and the Australian Medical Students Association, have publicly voiced their concerns around this health crisis, with many calling for the evacuation of children and their families from Nauru. We are proud to report that over 5000 individual doctors and medical students – almost 5% of the medical workforce in Australia – have, in just 2 weeks, signed an open letter to the Prime Minister also calling for change. This letter has not had widespread institutional support, but has spread via social media, text messages, and email from doctor to doctor because so many in our profession genuinely care about protecting the right to health, regardless of who the patient might be. This unheralded statement from the medical profession will not be easy to ignore.
The failing of successive governments to protect the health of vulnerable children has created a moral vacuum, and the medical profession has both a duty to and a history of wresting leadership in these situations.
Doctors are the custodians of health in this country, and we have both a responsibility and a mandate to demand that our government does not compromise health care standards for some, lest they do so for all.
We are proud to be part of this campaign, which is not only a pressing health care issue, but has clear implications for ongoing health policy in this country.
The open letter to Prime Minister Scott Morrison will be delivered to his office on Monday October 15, but will remain available for any doctors who wish to add their voice to this issue at: www.doctorsmakechange.org
Dr. Neela Janakiramanan is a Plastic and Reconstructive surgeon in Melbourne. She has a Masters in Public Health and believes in the importance of equitable access to healthcare.
Dr Sara Townend is GP in Sydney, with an interest in palliative care.