Regional detention centres still without independent medical oversight

By Chloe Potvin | 08 Nov 13

By Chloe Potvin.

This article is a part of our October focus on Institutions – you can access more content from this issue here.

This month marks a year since the Australian Human Rights Commission, Australian Medical Association and the Greens called for the urgent establishment of an independent body to monitor the health of asylum seekers in detention.

Consisting of a panel of medical and mental health experts, the body would report on conditions inside the Manus Island and Nauru processing centres, inquire into deficiencies in health care and make recommendations for improvement.

But to date, there is no such plan for the independent oversight of refugees’ health and care, or safeguards for their medical needs in offshore centres.

The Immigration Health Advisory Group (IHAG) was established earlier this year as a replacement to the Detention Health Advisory Group (DeHAG), but there is support for a body, separate to the departmental group, that “can provide the results of its review and monitoring to the Secretary of the Department of Immigration and Citizenship, the Chief Medical Officer of the Department and the IHAG on health service provision and risk mitigation strategies.”

A damning report from the UNHCR, testimonies from whistleblowers and recent investigations by journalists and human rights groups have begun to reveal the unlawful, harsh and inhumane conditions in Australia’s remote, offshore processing centres.

The latest outcry by medical experts and refugee advocates has been for a pregnant asylum seeker being held on Nauru who requires specialised care that is not available at the facility. Other pregnant women, as well as mothers and newborns, on the island are living inside tents that can reach 50 degrees Celsius, though tents are equipped with electric fans to make the conditions slightly more tolerable. But so far Immigration Minister Scott Morrison has replied with a firm response that there will be “no exceptions” – despite concerns, pregnant women, mothers and newborns are to remain on Nauru.

Even as accounts of self-harm, suicide attempts, assault and violence emerge there is still an enduring lack of accountability and transparency about what is happening in the camps.

In July, a freedom of information investigation by the Guardian Australia uncovered that the joint committee established to oversee the processing times of detainees on Manus Island and monitor the proper standard of treatment of asylum seekers housed in the centre has never convened. It was agreed that the committee would meet no less than once a month. Set up in September of 2012, it is the only oversight body that has been forged between representatives of the Australian and Papua New Guinea (PNG) governments.

In September, another freedom of information request also exposed failures by Serco and G4S to provide performance reports on the care, welfare and health of asylum seekers on Manus Island.

The provision of health care for asylum seekers on Manus Island and Nauru is governed by a contract between the Commonwealth of Australia and International Health and Medical Services (IHMS) – a private commercial contractor. Tabled in the Senate in September 2012, the contract was not published online and, although it is available from the Senate Table Office, most of the details have been redacted. What is known is that IHMS was paid $22 million for six months from 14 December 2012.

IHMS also holds two contracts for the provision of health care in Australia’s immigration detention facilities, both on the mainland and on Christmas Island. The value of the contracts has been estimated to be around $769.3 million.

The contract between IHMS and Australia that governs the provision of health care on Nauru and Manus Island stipulates that IHMS must ensure a sufficient level of care to maintain optimal health, and which is largely compatible with the standard of heath services available in Australia.

Yet apart from dire media reports and pejorative statements from staff on the appalling conditions, there is little information publicly available on which to judge if this objective is being met. There is also a lack of reporting and accountability measures in the contract which makes it difficult to access IHMS’s performance. There is no abatement system in the contract to penalise for underperformance.

Earlier this year, ABC Four Corner’s “No Advantage” program highlighted the concerns about access to heath care and former staff spoke of the conditions inside the Manus and Nauru centres as “totally inadequate”.

John Vallentine, a doctor and former IHMS employee on Manus Island, attested that there was an appalling lack of medical supplies and equipment. While discussing the centre’s conditions he said: “The people really ought not to be there. They ought not to be in Manus Island … Almost from the day I arrived it was obvious to me that it was not a clinic that would work in its current state.”

Vallentine also explained that medication, basic equipment and oxygen are not stockpiled in sufficient quantities at the clinic, and that there is a 24-hour delay for a medical evacuation by air.

According to the World Health Organisation, PNG has the lowest health status in the Pacific region. It is ranked as the highest country at risk of malaria in the western Pacific region and Manus Island, where approximately 800 asylum seekers are currently being held, has the greatest number of confirmed malarial cases in PNG. The most common form of malaria on the island, plasmodium falciparum, can be fatal for children and pregnant women if treatment is not received within 24 hours.

There is also a high risk of multi-drug resistant tuberculosis, typhoid and hepatitis A. The hot, wet location also adds the possibility of dengue fever.

In their November 2012 review of the Nauru Offshore Detention Facility, Amnesty International raised concerns about the physical wellbeing of asylum seekers on Nauru who are experiencing extreme heat and lack of shade, shortages of water and temporary accommodation in tents.

Poor water quality and sanitation has already resulted in an outbreak of gastroenteritis among 100 detainees on the island and a larger medical crisis could be looming after part of the Nauru Hospital burned down in August this year. The x-ray, pharmacy and medical reserves were all lost.

The arrangement set out between the Australian and Nauruan government about the treatment of asylum seekers on Nauru stipulates use of the hospital in order for IHMS to provide acute and emergency care. Yet, as the evidence suggests, the local health care services are limited. The ability of health services on Nauru to provide mental health services has also been called into question when it was revealed the island has only one psychiatric care nurse and one visiting psychiatrist.

Such evidence compels us to question: how will DIAC and IHMS fulfill their duty of care to asylum seekers in the future and how will they be held accountable if there is not an open and transparent system?

As more asylum seekers are being processed outside of the public eye there is a clear need for an independent medical panel to ensure that each person’s human right to sufficient physical and mental health care is being met.

The irony also remains that even if IHMS and the Australian government commit to improving health services and camp conditions, so long as the current policies and system of prolonged restrictive detention remains, people’s health is unlikely to significantly improve.

Chloe Potvin is a Sydney-based multimedia journalist interested in global politics, human rights and activism.