Doctors who have worked in immigration detention show no sign of being silenced, despite the possible prosecution of those who speak out. By Sophie Morris.

Detention centre doctors stare down prosecution

Australian Medical Association president Brian Owler had planned to visit Nauru this week to see for himself whether healthcare in the Australian-run detention centre was up to scratch.

As his departure date approached, there were delays and complications with approvals. It’s not clear to Owler whether there were genuine logistical challenges, or other factors at play.

Just last month, during a speech at the National Press Club, the Sydney neurosurgeon accused the government of trying to intimidate doctors with legislation that includes two-year jail sentences for “entrusted persons” who disclose details of immigration detention.

Owler is still hoping he can tee up another date to visit Nauru, as he calls for the restoration of independent assessment of health facilities in offshore detention centres. “If healthcare is up to standard, then clearly there shouldn’t be an issue with that,” he says.

Already, other doctors who have visited Nauru have sounded the alarm about conditions and care. They are vowing to continue to do so, despite the provisions of the Border Force Act, which took effect last month after passing parliament with bipartisan support.

“I’m not going to shut up about it,” says David Isaacs, a prominent Sydney-based paediatrician who visited Nauru for five days in December, at the invitation of International Health and Medical Services (IHMS), which provides medical care to those in immigration detention.

Isaacs looks like a paediatrician from central casting. He has a broad grin and wears a cable-knit grey vest. It’s hard to imagine this beaming face posing for a prison mugshot. And Isaacs hopes it never comes to that. The government says it is inaccurate and highly misleading to suggest it ever could, but doctors are not convinced by these assurances.

They do not take it lightly, these doctors, when they urge the government to prosecute them. They know well what imprisonment can do to a person, how it can rob them of reason, and erode physical and mental health. They have seen the effects on asylum seekers detained in Australia and offshore, including children.

The stories spill out of Isaacs, about psychological damage to children in detention and grave health concerns, as well as less threatening conditions, which take on a more serious hue in that environment.

“I have talked about a child who tried to hang himself at the age of six and I’ve talked about another boy who has sewn his lips together at 15,” says Isaacs.

Within weeks of the Border Force Act taking effect, he publicly detailed his concerns at delays in treatment of a toddler on Nauru whom he had identified as having signs of tuberculosis. While visiting Nauru, he also treated another child for typhoid.

He was one of more than 40 doctors and health and social workers who last month warned the government in an open letter that they intended to flout the new restrictions on speaking out.

“We are aware that in publishing this letter we may be prosecuted under the Border Force Act,” they wrote, “and we challenge the department to prosecute so that these issues may be discussed in open court and in the full view of the Australian public.”

It’s a challenge that has not been taken up and some signatories feel they have already won an important victory.

“No one wants to be prosecuted,” says Brisbane-based GP John-Paul Sanggaran, who blew the whistle on the poor healthcare available for asylum seekers on Christmas Island after working there in late 2013. “But we are prepared to take a risk and I feel at one level we have already won. They were aiming to shut everyone up by threatening prosecution and jail.

“But the day the letter came out, the news wasn’t pomp and ceremony around the border commissioner and the ceremony they had [to launch the Australian Border Force], the news was: we’re not going to be silenced. It’s important for people going forward that there is this letter there, where people are challenging the government to prosecute and the challenge is unmet.

“If I was working in immigration detention and was watching that, I’d be thinking: these guys did it and got away with it, maybe I should speak up.”

Asked about the open letter on July 1, the new Border Force commissioner, Roman Quaedvlieg, said he sincerely doubted there would be any action against the signatories. He said the provisions of the legislation relating to disclosures by entrusted persons had been “over-interpreted somewhat”. They were not, he said, designed to target whistleblowers.

“They’re no different to provisions that are currently in play for many security enforcement agencies,” he said. “This is about the leaking of classified information that can compromise operational security for our officers. It’s not about people having a right to be outspoken and communicate a range of things.”

1 . Dutton assures protection

Immigration and Border Protection Minister Peter Dutton insists doctors and other officials would be protected by the Public Interest Disclosure Act, which provides some security for those who speak out, if they have lodged a complaint internally that has not been adequately dealt with.

“While the government will take action to protect operationally sensitive information, such as personal information or information which compromises the operational effectiveness or response of our officers, the airing of general claims about conditions in immigration facilities will not breach the ABF Act,” Dutton says.

But these assurances have done nothing to appease the AMA, which argues that, if the provisions are not going to be used against doctors and other health professional, these workers should be explicitly excluded from the threat of prosecution.

Isaacs knows he won’t be invited back to Nauru. He’s conflicted about whether doctors should try to provide those in immigration detention with care, or if this makes them complicit by lending legitimacy to a system that he believes condones and even systematises child abuse.

“The moral dilemma for doctors, nurses, teachers, and others is: do I help these people, despite the fact that what’s being done to them is torture? There’s a general rule in medicine: you do not condone torture. At Abu Ghraib, people said what we’re doing was not torture because there were doctors there watching saying it wasn’t. I do think doctors should continue to go there and try to help and prevent the worst things happening, but I’m very fearful.”

Those who do not have the protection of the powerful doctors’ lobby feel even more exposed and some social workers who have previously worked with those detained on Nauru have chosen not to return. In the past, the government ruthlessly pursued Save the Children staff who went public with claims that children detained on Nauru were being sexually assaulted and that nothing was being done about it.

Alanna Maycock, a nurse who accompanied Isaacs to Nauru in December, has thought about the repercussions if they are prosecuted and jailed and what it would mean for her family and two young children.

She had already spoken out about the degrading conditions, including a lack of sanitary pads, and how women and children had to shower with only a thin curtain separating them from male guards, in an environment she believes is open to abuse. Maycock decided she would stop talking about Nauru when the Border Force Act took effect from July 1. With this in mind, she cancelled invitations she had accepted to speak at public gatherings in the second half of this year.

“Then John-Paul [Sanggaran] got in touch, saying I’m thinking of doing this letter. We looked at it and thought, this is quite powerful. By inviting the government to prosecute all of us, it’s issuing quite a challenge,” she says. “So I decided to rebook the appointments I had cancelled.”

2 . Ethically untenable

For psychiatrist Peter Young, the former director of mental health services at IHMS, the Border Force Act is “the final nail in the coffin of the possibility of being able to do anything ethical or useful” by working within the detention centres.

“You can either advise people to break the law, which is an unjust law, or you can say, ‘This law now makes it untenable to work within a system, where it goes against the medical ethical guidelines and the capacity to do your job effectively.’
I think we’ve reached that point,” he says.

“Ideally, the people in detention centres do need treatment and do need to be seeing doctors, but those doctors do need to be able to operate ethically and to be able to speak out and be independent and not be under the control of the Immigration Department. If they can’t do those things, they become less helpers and more enablers of a system which is deliberately designed to cause harm.”

Paul Bauert, director of paediatrics at Royal Darwin Hospital and vice-president of the Australian Paediatric Society, who frequently speaks for the AMA on asylum-seeker issues, was not a signatory of the open letter, but is prepared to continue raising his concerns.

Bauert has not visited the offshore centres but frequently sees children who have been brought from Nauru for treatment or are detained at Wickham Point, near Darwin.

“The situation these children and their families find themselves in leads to all sorts of aberrant behaviour and aberrant development in children,” he says. “These children are being damaged and that damage is likely to be lifelong for many of them.

“We are in a situation of saying, ‘There’s a direct relationship between the trauma this child is subjected to at the moment and the damage that has been done. It is our concern that, if we send them back to where you’ve referred them from, that more damage will be done.’ ”

It’s a stark diagnosis. The doctors show no signs of being silenced. Indeed, they have used the introduction of the Border Force Act to once again air their concerns. But those who have spoken out are also unlikely to be invited back into detention centres. Already, some have observed that IHMS is increasingly contracting foreign doctors to visit the offshore centres. They are said to cost less and be less likely to cause trouble.

This article was first published in the print edition of The Saturday Paper on August 15, 2015 as "Doctors ordered".

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Sophie Morris is The Saturday Paper’s chief political correspondent.

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