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Manus Island claims to have a properly equipped hospital, but for detainees requiring more than just a painkiller, the facilities are grossly inadequate. By Behrouz Boochani.

Manus Island’s appalling health care record

In the dead of a silent night, heavy and dark, when the Manus prison smelled like death, residents of the corridor in Delta 2 woke up to the yelling of a terrified young man. “I went blind,” he screamed. “I went blind.” Aimlessly, the man was running towards fences in the prison.

Arian, 20, is a Kurdish man who has been imprisoned on Manus for three years. Every night he wakes up in fear of losing his eyes, and for a few minutes, he spreads that fear everywhere. Panic sweeps through the crowd. He has suffered pterygium for a long time and, day in, day out, he sees and feels that he is going blind. Now, he is just one step before blindness. Each day he is here, his nightmare gets closer to reality.

There is another bed, right under Arian’s. One ominous morning, the man in that bed, Amoo Absul, woke to find five of his teeth had fallen out. This incident brought to 14 the number of teeth he has lost since he arrived on Manus. Like an old man, he rubs his hollow upper gum against his lower gum; his palm is filled with black teeth. Amoo Absul, an Iranian man in his 30s, has been in searing dental pain for nearly three years. He has lost his teeth one after another and now he has to endure the suffering caused by hunger. These are but two examples of the patients in Manus prison, men whose bodies, whose wellness, are the victims of a lack of medical facilities.

Everything, however, started from a damned night for me as a person who sleeps in front of these two men who suffer severely. As usual, I was walking and smoking near the fences. All of a sudden, a monster made of iron collapsed on my head. I did not understand anything more at that moment. Later, I realised that a basketball pole had fallen and struck me on the skull.

I was in shock. How was I alive and why am I alive, I was thinking. I went to International Health and Medical Services (IHMS) for about two weeks and saw doctors several times. I felt they did not really want to help me because they did not have any medical equipment to test my head. They were only guessing whether I was okay or not. I used a lot of painkillers at that time.

They put my name on a list to go to Port Moresby and told me I must wait. I know the people on that list and they are never given any treatment – even some are sent to Port Moresby hospital and are returned to Manus without treatment. After two weeks I stopped asking IHMS for help. Now I have headaches and I use Panadol constantly. I can get my tablets from the gate every day. 

Sometimes I wake suddenly, because of too much pain. I feel scared of IHMS because they are using my pain to put me under pressure. I am sure that they will leave me with my pain.

What can be said about Manus prison patients is that they have stayed in a gradual death across a medical system provided by the private contractor here, IHMS, and the policies of the Immigration Department. IHMS has not been able to provide proper services. Yet there are dozens of people here who suffer from infections, from joint and internal diseases. Hot and humid weather, intense psychological pressure and shortage of sanitary facilities have infected many refugees. Three hundred people take pain pills daily. 

Up to six months before the uprising in February 2014, the sanitary facilities were so poor that a variety of diseases spread among refugees exposed to poor toilets and dirty bathrooms. It took two years for a dentist and optometrist to come to Manus. By this time, many had lost their teeth. The facilities as they are cannot treat this type of disease properly now, anyway. It was announced in the media that an equipped hospital has been established but it was a big lie because it is just a decorated hospital. In meek letters, IHMS say things such as: “It is indeed very unfortunate for all transferees that this service is currently not available due to equipment failure.” They say they are “working hard at having the dental service available in the near future”. And then the answer, the only real answer, the one they use to treat symptoms but never causes: “Should you be experiencing pain and discomfort, please submit a request for pain relief.”

The most advanced equipment in this building is an X-ray machine. There is no dialyser, no endoscope, PET, sonograph, infusion pump, ventilator, CT scan, MRI or ECG. This fake hospital accepts dozen of ill prisoners every day but they all return to the prison without any real treatment. Many walk with a cane or use wheelchairs. The view inside this clinic is similar to a field hospital in a war zone. I know some here who have walked with a cane for about three years and have taken thousands of painkillers. The fake hospital officials themselves confess that they have no facilities or equipment to help them. There are waiting lists for any type of disease in the IHMS office, and there are dozens on every list who have been waiting months for treatment. The doctors have no response but to say your name is on the list. But the waiting lists do not lead to treatment. At best, it means the patient is transferred to Port Moresby after being on the list for months or even a year. They are the lucky ones: just a few people have succeeded to pass this way.

The situation in hospital in Port Moresby is inhumane and critical, too. They imprison patients in a hotel room for weeks with strict rules: no smoking, no access to a phone. The hotel is protected by several armed guards, which creates a stressful environment for patients. The patient stays there until an armed car takes them to meet a doctor. After all this, the few patients who make it there are often returned to Manus without treatment. Patients claim the goal of taking them to Port Moresby is a show to calm them down. They say the goal is not treatment. 

I can point to one refugee who was attacked by locals in February 2014, who was taken to Port Moresby but returned without proper treatment. Locals had tried to cut off his head and he has terrible scars across the back of his neck. Now he has severe pain and can only take pills. His neck nerves are critically damaged; the gash of a sword can be seen below his hairline, pocked either side by clumsy stitches. His treatment was only ever superficial.

In another case, a 70-year-old Bangladeshi was held in a Port Moresby hotel room for six months and finally immigration was forced to transfer him to Australia. So far, a few patients have been transferred to Australia but most of them are returned to Manus after a short time. With this situation it is clear that the main policy on Manus Island is not to treat the refugees but to force them to return to their country by means of pain.

This is an important point: that issue of medical treatment as a human right is under the influence of political goals and a bigger system named Immigration and has become a sideshow in practice. In other words, IHMS is an important tool for Immigration to put refugees under pressure. For example, if doctors determine a patient needs special care or should be operated on, his transfer to Port Moresby or Australia would be done only by permission of Immigration. Hence it shows treatment is under the influence of politics and Manus prison is beyond usual prisons, because in all prisons in the world, when a prisoner gets ill, the doctors attend to the issue independently.

Another point: there are many doctors who have worked only a few days or months here and, when they understand they cannot help patients and have no independence, have abandoned the island forever. But there are still doctors who are doing useless work for several years. Sometimes I feel like asking why. 

The Department of Immigration spends billions of dollars on offshore processing. It is worth asking how, with all that wasted money, they cannot equip a hospital of the prison to decrease the costs of transferring patients and security forces to Port Moresby. The answer is clear: Care here is not meant to be easy; people are not supposed to be treated. In Manus prison, pain is there to send you home.

A spokesman for the Department of Immigration and Border Protection said: “General practitioner, nursing and mental health care clinics are open at the Manus [regional processing centre] seven days a week. The medical centre at the Manus [regional processing centre] includes a full dental suite. There is also after-hours medical staffing to respond to any after-hours medical emergencies. These services are supplemented by visiting health practitioners, including the monthly deployment of a dentist and dental assistant and a tele-health service, where required.”

This article was first published in the print edition of The Saturday Paper on Apr 16, 2016 as "‘In Manus prison, pain is there to send you home’". Subscribe here.

Behrouz Boochani
is a Kurdish journalist and writer from Ilam in Iran. He is being held on Manus Island.

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