Prisoners’ dilemma

In 2012, when Amnesty International visited the Nauru Regional Processing Centre, then recently reopened by Julia Gillard as prime minister, the organisation’s refugee expert, Dr Graham Thom, said: “Offshore processing on Nauru and Manus Island will only serve to break vulnerable people in these ill-conceived limbo camps, who have fled unimaginable circumstances.”

Six years on, it’s a darkly prescient statement.

In that time, no amount of horror reported from Nauru – the epidemic of self-harm, the suicidal ideation in children – no personal story, no plea from any advocate has made either major party blink. Mandatory indefinite offshore detention remains the sentence for trying to seek asylum in Australia.

Perhaps now, though, as the doctors who treat those broken and displaced by the world’s worst humanitarian disasters plead that all refugee children on the island be medivaced to Australia with their families for emergency medical treatment, our government will listen to experts. As it should have all those years ago.

Psychiatrist Dr Beth O’Connor was Médecins Sans Frontières’ longest-serving mental health professional on Nauru until she left the island last month:

“I witnessed a harrowing deterioration of the mental health of asylum seekers and refugees throughout the 11 months I spent working on Nauru. Held in indefinite detention and effectively in a perpetual state of limbo for the last five years, these people have been stripped of any hope for a meaningful future, resulting in shocking levels of severe depression and anxiety in the population – with many having lost the will to live. The number of suicide attempts and incidents of self-harm we saw among our patients was alarming: at least 78 people engaged in self-harm or suicidal acts or had suicidal ideation.

“I was horrified by the deterioration of the children we treated on Nauru. When I first arrived on the island, there were children who would say hello in the settlements and play during consultations in the clinic. But, over time, they reached the point of complete social withdrawal. When I visited these children at home, they were resigned to their beds, not drinking or eating sufficient amounts, and were unable to toilet themselves. When I tried to talk to them, they would not respond. They would stare right through me. Children as young as nine told us they would rather die than live in a state of hopelessness on Nauru.

“We witnessed a decline in mental health of many of the asylum seeker and refugee patients in response to rejections of the US resettlement deal – leaving more than 70 people with no option to resettle elsewhere – the suicide of a respected asylum seeker and the five-year anniversary of people being on the island. They deteriorated rapidly, in many cases to a point that was worse than when we began treating them. When they came in for consultation, there was a dullness in their eyes – the spark that they used to have was gone. I never saw this spark return before I left the island.

“At the time of being told by the Nauruan government that we were ‘no longer required’ on the island, our team had over 100 people on the waiting list. Patients have told us that police have taken mentally ill refugees and asylum seekers to jail rather than taking them to the hospital. A system that criminalises mental health illnesses is not humane.

“Our team provided mental health care for our patients, aiming to develop their coping mechanisms and improve their resilience. But there is only so much we could do for our patients – we could provide therapy and antidepressants to people but unless they are in a safe environment that allows them to improve, they won’t improve. You can’t treat mental health in isolation, you have to address the context too. There is no therapeutic solution for these patients as long as they are trapped on Nauru. I am extremely worried that the withdrawal of MSF’s psychiatric and psychological health care will claim lives.

“We ask for the immediate evacuation of all refugees and asylum seekers off Nauru. The Australian government must take urgent steps to ensure that all asylum seekers and refugees are moved to an environment conducive with good mental and physical health. We cannot accept that this level of harm continues unabated.”

Lifeline 13 11 14

Scott Morrison (02) 9523 0339

Bill Shorten (03) 9326 1300

This article was first published in the print edition of The Saturday Paper on October 20, 2018 as "Prisoners’ dilemma".

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