After more than five years on Nauru, Ashkan watches as his partner, Nima, descends into a catatonic state, denied medical treatment by Australia. By Abdul Karim Hekmat.
I am not a ‘death meat’ of Australia
For the past month, Nima has been bedridden with severe depression and trauma. He has recently stopped talking and eating, communicating only with his fingers. The one-bedroom house he shares on Nauru with his partner, Ashkan, is always dark. His eyes can no longer tolerate light. “He is lying on a bed like a corpse,” Ashkan, a Kurdish refugee, told me last week. “Too sick even to go to toilet himself.”
I wrote about Ashkan and Nima a year ago, for The Monthly. The two men have been on Nauru for more than five years. Both have been recognised as refugees. Nima fled Iran, where homosexuality is punishable by death, but instead of securing asylum in Australia he found himself on Nauru, where homosexuality is also illegal. He and Ashkan, who met on Nauru, have experienced harassment and homophobic attacks. They have both attempted suicide and live virtually imprisoned within their home.
Ashkan told me Nima’s health began to deteriorate more than a month ago. He asked repeatedly for an assessment and intervention from International Health and Medical Services (IHMS) – the organisation contracted by Australia to provide health care for asylum seekers on Nauru. A doctor from IHMS visited twice last month, on August 12 and 14, but offered no clinical assessment or treatment. On August 28, Ashkan wrote on an IHMS form: “My partner is in an extremely bad shape and needs urgent mental health [support]. Previously, I hoped to be able to take care of him myself but I now realised that is impossible.”
Ashkan explained that Nima “had deteriorated badly”. He was deeply anxious, throwing things and asking again that the lights not be turned on, day or night. “Please see him urgently,” Ashkan wrote. “I am very worried about him.” Not receiving any response, Ashkan filled out another IHMS self-referral form on September 3, describing the situation as “frightening” and “very very urgent”.
Last week, IHMS asked Ashkan to call an ambulance, which he did, but the operator refused to send help unless police were called first. Eventually, paramedics came without the police. In hospital, Ashkan explained through an interpreter that Nima’s mental health had deteriorated in the past three weeks. He said that despite the fact Nima’s cognition worked, he had stopped speaking and communicates only with his fingers. They kept Nima in the hospital for an hour, put him on a drip, then discharged him with a prescription for oral rehydration therapy – a type of fluid replacement used to treat dehydration, often due to diarrhoea. “I came home and searched what this is for: it’s diarrhoea powder. This is a joke. How this is going to help treat him?” Ashkan said. “His problem is mental and he needs a proper treatment, people to look after him. I am going crazy myself in this dark room and one person to deal with all. I am not in a good state myself.”
Nima is not alone. There are about 900 refugees and asylum seekers left on Nauru without proper medical care, including 102 children. Some are so broken and without hope that medical attention alone can’t help. A new report, “Nauru: A man-made refugee crisis”, jointly compiled and published by the Refugee Council of Australia and Asylum Seeker Resource Centre, says the mental health of refugees in Nauru is worse than in some war zones. “Australia’s policy has traumatised children so much that they are giving up eating and trying to kill themselves,” the report says. “Australian courts are increasingly forced to step in so that people can get the medical treatment they urgently need, as the Australian Government repeatedly ignores doctors’ advice and does everything it can to avoid people being transferred to Australia.”
In the three years I have been speaking with Nima and Ashkan, this is the worst their situation has been. Nima may have developed a condition that psychologists call “resignation syndrome”. Louise Newman, professor of psychiatry at the University of Melbourne, has seen it in children, where it “presents as a progressive social withdrawal and reluctance to engage in usual activities such as school and play”. Writing for The Conversation last month, she said, “There’s serious concern about the use of Nauru as a processing centre and the adequacy of health services.”
Similarly, Dr Nick Martin, who has worked on Nauru, told me “Nauru is a wholly inappropriate place to look after the health of these people. Nauru hospital is woefully ill equipped to care for these patients who are psychiatrically and physically unwell.”
On Monday, September 10, after repeated calls from Ashkan, a doctor from IHMS visited Nima’s home with an interpreter but they refused to go inside the room. Ashkan, who couldn’t understand why they wouldn’t come in, pleaded with them to take Nima to the regional processing centre – RPC1 – where the IHMS clinic and staff are based. “Look after him,” Ashkan pleaded. “I can’t do it by myself.”
The doctor said they would discuss Nima’s situation with their teams and inform Ashkan of the outcome within 24 hours. On Tuesday, IHMS called Ashkan and said they could not take Nima to RPC1. They did not give a reason. “I don’t know why they don’t help him. They come here and say, ‘We are worried about [Nima’s situation].’ They go and say, ‘We can’t.’ I don’t understand this. Maybe they take orders from above.”
Martin told me that decisions about medical intervention or evacuation of refugees on Nauru is mostly at the whim of the Australian Border Force and the management of IHMS. He said evacuation deadlines set by the doctors were frequently “reached and breached” by the Australian Border Force. He told me that he came across a refugee “close to death”, who was “appallingly” cared for at the Nauru hospital and “left untreated for weeks”. The refugee could not be treated in Nauru. “I had to fight every step of the way, spending hours talking to ABF and my boss [at IHMS]” to get this man out of Nauru. “I said to my boss, ‘I will resign over this – it’s a duty of care and its unacceptable to treat this man like this.’”
The man was eventually brought to Australia, but lost his pancreas due to misdiagnosis in Nauru and the delayed transfer. “The consequences of not providing good health care for these people, who are stuck in Nauru, and who are suffering resignation syndrome could be dire,” Martin told me. “Ultimately, it’s Australia’s responsibility, which still has a duty of care to these people that they’ve incarcerated for five years.”
Anna Brown, a director of legal advocacy at the Human Rights Law Centre, worked for more than two years to get Ashkan and Nima off Nauru. She approached the offices of then prime minister Malcolm Turnbull and foreign minister Julie Bishop. Both referred her back to the then minister for immigration and border protection, Peter Dutton. Brown told me he was “unresponsive”, “unsympathetic and “not compassionate”. She asked Tim Wilson, then the Human Rights Commissioner, to raise the case with Dutton. “We ask that you raise their case with the Minister for Immigration and Border Protection,” she wrote. “We would also welcome your advice on the best way to establish a dialogue with the Minister in relation to having [Nima and Ashkan] relocated to a place that is safe and accepting of them.” Through Tim Wilson, she wrote to Dutton directly, reporting the violence Nima and Ashkan experienced on Nauru – bashings, verbal abuse and harassment. “As you would be aware, male to male sexual conduct is criminalised in Nauru … Our clients have been found to be refugees and in need of protection. Their current situation in Nauru is extremely unsafe and, given the escalating nature of the assaults on them, they genuinely and legitimately fear for their lives. Our clients seek urgently to be removed from Nauru to the safety of Australia.”
Brown’s appeal to Dutton included a letter in Farsi from Nima, detailing the abuse, harassment and rape he had suffered in Iran and how this nightmare had continued in Nauru. “I and my partner have been bashed multiple times and harassed by the local people … we never feel safe in Nauru,” Nima wrote. “We are scared.”
Nima appealed for Dutton to intervene in his case. Brown received a reply from Dutton’s department a month later. “The Minister appreciates the time you have taken to bring this matter to his attention and he has asked that I reply on his behalf,” Kingsley Woodford-Smith, the Australian Border Force’s assistant commissioner of detention and offshore operations wrote. “Regarding your request for [Nima and Ashkan] to be transferred to Australia, the Minister has instructed that he does not support this request and reaffirmed that [Nima and Ashkan] should continue to explore resettlement in Cambodia. It is important to note that the Government of Nauru has permitted [Nima and Ashkan] to remain in Nauru for up to 10 years, pending resettlement in a third country.” The letter said that “while I note that your clients recently experienced some unpleasant behaviour from other refugees and local Nauruan your clients have been accepted as residents of Nauru and are subject to the local laws of Nauru”. The letter also noted that Nauru is a signatory to the Refugee Convention and “Nauru is required to provide persons it deems to be refugees with an environment free from persecution”.
I started speaking with Nima in April 2016, nearly a year after three locals had beaten him and Ashkan with clubs. He told me he had rarely stepped out of his room for a year. “I don’t want anything else, just to walk freely,” Nima told me. “Is it such a big demand to want to walk down the street without somebody throwing rocks or stick at you, or spit or stare at you with hate?” They retreated to their closet-sized room, too traumatised and fearful to leave. “You can put up with one or two or three times,” Ashkan told me. “[But] you will be killed one day.”
Since a Nauruan man broke into their home one night, they no longer feel safe there, either. They called the police but nothing happened. They locked the door, covered their windows. Nima was under heavy medication, was seen regularly by a psychologist and psychiatrist. He had nightmares and sleepless night. “My sleep is very little. I go to sleep at 3am and then, after two hours, I wake up. I see a lot of bad things in my dreams; I wish I had not slept.”
When we first spoke, Nima was funny, clean shaven and looking forward to a life beyond Nauru. He was eloquent and hopeful. Now, he carries a defeated expression. His beard is tangled and his partner says he is forgetful and unable to wash himself. “I am not ghoste mordeh, a death meat, of Australia,” Nima has told me. “I want to ask why the Australian government is torturing me. If she does not want me, give me to another country. I have to have a life. I came to Australia with high expectation. I hoped Australia is a good country … I came with this hope. They put me in a place where they abuse me. I don’t have strength anymore. I am tired.”
Nima was suicidal before the Australian-United States refugee deal was announced. Briefly, it pulled him out of depression. But the deal has not changed his circumstances. “When we were in Iran, we lived under [President] Ahmadinejad,” Nima has told me. “When we fled Iran to come to Australia, we encountered Tony Abbott and then – what’s his name? – Scott Morrison, and, after, Peter Dutton. They told us to send us to America and now face Donald Trump. They play like a toy with us. We are human being, like every everyone else, we have also hope but they killed our hope, they took our lives, made us gone mad, made us sick and made us mental.”
Now, Nima is bedridden and without medical attention. Over the phone, I can hear Ashkan’s voice shaking. “The Australian government destroyed his life, and our lives,” he says. “I agonise over seeing suffer like this. I don’t know how to get him back, where to go, who to ask for help. I am losing my partner.”
Some names have been changed to protect identities.
Lifeline 13 11 14
This article was first published in the print edition of The Saturday Paper on Sep 15, 2018 as "I am not a ‘death meat’ of Australia".
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