Death and dying in offshore detention
In their hundreds they gathered on a small, floodlit soccer pitch in the middle of Nauru’s Regional Processing Centre. This was their vigil for Fariborz Karami, a 26-year-old Iranian asylum seeker who, three days earlier, on June 15, had been found dead in his tent. A suspected suicide.
There was food, music and candles. On a large screen was projected a carousel of images of the dead man. Before his death, Fariborz was an enthusiastic soccer player. The fit and smiling images belied a man who in April had been determined in his mental health assessment to be severely traumatised. His family – Fariborz is survived on Nauru by his mother, wife and younger brother – said he had been kidnapped and threatened with execution in Iran when he was 10.
Fariborz’s 12-year-old brother had become a desperate advocate for the mental health of his family. In a video he made earlier this year, published by Guardian Australia, he pleaded with the Australian government for their transfer. His mother had also made repeated appeals, in a series of reports sent to the centre’s managers. In one correspondence, his mother wrote: “Again and again, I am asking you help me. I request you to help myself and my kids. So far, with all misery, in any way we could, we tolerated our situation and trusted you. We were sure that you will shelter us. But it has became opposite. Bit by bit we die down. Physically and mentally we are deteriorated. Many time I begged you help. But each time you gave me repetitive answers.”
Those on Nauru have expressed concern for the health of Fariborz’s young brother. There are also recent reports of children attempting suicide. Fariborz’s was the 12th death of a refugee or asylum seeker on Manus and Nauru since 2013. His apparent suicide came three weeks after a 52-year-old Rohingya man, Salim Kyawning, took his own life. Others had died by illness, accident, medical negligence or murder.
“The two recent suspected suicides on Nauru and Manus were foreseeable and indeed predicted,” Dr Nina Zimmerman tells me. Zimmerman is a forensic psychiatrist who in 2016 was contracted by the United Nations High Commissioner for Refugees to conduct mental health assessments in the offshore camps. “For years, the mental health impacts of incarcerating men, women and children indefinitely have been well documented. For years, the Australian government has been made aware that locking up a highly traumatised group of individuals in a setting where they have minimal access to mental health care and face indefinite incarceration leads to high rates of depression, worsening of or the emergence of post-traumatic disorders, attempted suicide and, tragically, completed suicides. Organisations including the United Nations and Amnesty International have highlighted these issues repeatedly. The near-universal hopelessness and helplessness that has been witnessed in the populations on Manus and Nauru provides a tragic backdrop against which suicides are inevitable. As a forensic psychiatrist, the impacts of incarceration are familiar. What is unique about the situation in the offshore detention centres is that the population has committed no crime … Unfortunately, opening the gates at Nauru did little to give the refugees and asylum seekers any meaningful liberty. The majority remained living in the camps – many in tents in compounds that were certainly carceral in appearance.”
A few days after the vigil for Fariborz, a handful of those who attended were transferred to the United States. It was bittersweet, the contrast overwhelming. Increasing numbers are now being relocated under the Obama-era resettlement policy – so far, a little more than 300 have been flown to the US – but more than 1600 remain. It’s understood that no Iranians have been transferred. Meanwhile, Fariborz’s family remains out of contact, mourning intensely.
Dr Sara Townend refers to herself as an ordinary, if busy, GP and mother. She had never before involved herself with political advocacy. Based in Sydney, she has a decade’s experience with children and terminal adults. “The beginning of life is sacred, the end of life is sacred,” she tells me.
Last week, Townend read Guardian Australia’s report on “Ali” – a 63-year-old Hazara man currently occupying a hospital bed on Nauru. Ali is dying – he suffers late-stage lung cancer. His prognosis is for just months. A recognised refugee, who can reasonably expect persecution if returned to Afghanistan, he has previously been offered financial incentive by the Australian government to do so. The government also offered to move Ali to Taiwan, which he rejected on the grounds that he didn’t know anyone there, and could not be guaranteed a translator nor the fulfilment of Shiite death rites. Doctors told Guardian Australia the situation on Nauru was “totally inadequate” for a man requiring advanced palliative care. Requests to transfer Ali to Australia were rejected by our government. Townend was appalled.
“It hurt so much to read of this man’s situation because I work so hard for my own patients to make their deaths the best they can be,” Townend told me. “I work with adults who are dying, and with children who are dying. Even here in Australia with excellent palliative care available, a good death is challenging to achieve. I could not bear to think of this man dying alone in a room without family or community or appropriate medical expertise. I could not believe this was a deliberate act of exclusion by my government.”
Townend sent the article to a few colleagues. Then she wrote to Peter Dutton. She created a petition for doctors to commend to the Australian government Ali’s transfer here. At time of writing, there were more than 2000 signatures.
The Australian Medical Association – the peak body for doctors, and a signatory to the petition – made the same appeal. In a statement, AMA president Tony Bartone said: “The AMA has always held that all people who are under the protection of the Australian government have the right to receive appropriate medical care without discrimination, regardless of citizenship or visa status. They should be treated with compassion, respect and dignity.”
Townend is heartened by the medical community’s response, if not by our government’s. “It seems like they have been holding to such a hard line for so many years, they’ve forgotten to listen with their hearts.”
I suspect that any private equivocation or public compromise about this policy – to allow even the slightest tenderness – undermines both the righteous certitude required to maintain it and the policy’s design as a repellent to those contemplating voyage by sea. How else to view the government’s refusal to allow a terminally ill man to die here?
The maintenance of this policy has never been defined by a simple stoicism – a government sombrely but determinedly choosing the lesser of two evils. There has been petulance, pettiness, errant provocation. There has been bureaucratic demoralisation. There has been a consistent refusal to acknowledge the policy’s flaws – a reticence normally broken only for Senate estimates or flashes of irritable pique.
It is now seven years since then Opposition immigration spokesman Scott Morrison criticised the Labor government’s decision to fly refugees from Christmas Island to attend the Sydney burial of relatives, killed when their boat was smashed on the island’s rocks. Those relatives included a 10-year-old boy orphaned by the wreck.
Morrison later offered a partial apology. “There is a time and a place … if you step over the mark I think you have got to say so, and I’m prepared to do so, but the government should not take that as a leave pass.”
While Morrison may have rued the public cost of flying an orphan to the burial of his parents, as immigration minister he would cost the public much more when he defamed Save the Children teachers working on Nauru in 2014. Excited by unsubstantiated reports, Morrison publicly claimed teachers were coaching asylum seekers to self-harm, and were otherwise improperly engaged. Nine teachers were deported, none of whom received an explanation from Morrison’s department. After serial refusals to apologise, as part of two confidential settlements – one with Save the Children, the other with the individual teachers – Morrison did just that. Reviews found the allegations to be without justification, and his department publicly regretted any “hurt and embarrassment” caused.
Reflective stoicism hasn’t defined the maintenance of this policy – but rather irritable, callused and slanderous attacks on its opponents. And it has been callused. Callused with respect to its physical derivative: callused in there being a necessary hardening of tissue to continue the thing at hand. Callused in there being a deadening of feeling, an unresponsiveness to much but the prospective public objection to the cost of transferring Ali here.
I wonder how many of these notional objectors squealed about the cost of Morrison’s slander, or, for that matter, the enormous total cost of offshore detention. Of course, political objections to cost are rarely the actual matter. Generally, we all accept the necessity of government spending. The issue is on what we spend it. There’s the rub. What costs do we accept?
The government’s offshore policy – and its power to deter – is surely not undermined by recognising the dignity of one of its terminally ill subjects. It is impossible to think Ali’s transfer to our country might suddenly encourage a fresh spate of boats. Rather, it would be a specific and humane exemption to the prevailing intransigence, the intransigence that challenges one man’s death while it allows, even causes, another’s.
On Wednesday, the Nauruan government cancelled events for World Refugee Day. At least it was an honest gesture.
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This article was first published in the print edition of The Saturday Paper on Jun 23, 2018 as "Hearts in darkness". Subscribe here.