The policies and practices of the Federal Government obstruct medical professionals trying to provide healthcare to refugees and asylum seekers in detention, and it needs to end.
Watching the COVID-19 outbreak unfold in the Park hotel, Melbourne, it is hard not to feel disillusionment as a medical professional. Over the last week, almost half of the refugees detained at the hotel have been confirmed as positive COVID-19 cases, and the inability of the Australian Border Force and contracted companies like Serco to effectively manage and respond to the medical needs of those in immigration detention is clear.
Delays in establishing infection control procedures, testing those with COVID-19 symptoms and in vaccine administration (practices that are relatively routine in other healthcare settings) have resulted in an avoidable and catastrophic outbreak that will have a multitude of health-related consequences for the vulnerable individuals affected.
The opposition of the Australian medical community to conditions that hamper access to basic healthcare in immigration detention – in both offshore and onshore settings – is well publicised. But what are the actual barriers faced today by everyday health professionals trying to improve access to healthcare in Australian immigration detention during the COVID-19 pandemic?
Here in Darwin, one can draw some comparisons to the recent detention of 15 refugees in a compound adjacent to the Mercure Darwin Airport Resort. Their imprisonment for over 12 months in appalling conditions drew significant local outrage.
Importantly, it emphasised the chasm that often could not be bridged between the Border Force and the contracted International Health Medical Services (IHMS) responsible for managing the refugees’ many medical conditions, as well as doctors in the wider Darwin community trying to advocate for improved and escalated care.
A lack of immediate action in cases where the risks of acutely deteriorating mental health of refugees were voiced, resulted in tragic cases of preventable self-harm. Attempts made by doctors and advocates to contact IHMS and the Federal Government to ensure one-to-one care and arrange immediate transfer to an emergency department were met by unacceptably delayed responses.
Barring the physical and figurative barrier of the compound fence, immediate ambulance transfer and assessment by a specialist mental health team (in either the community or a hospital setting) are the standards of care expected in any other similar circumstance.
Symptoms consistent with infection, acute and chronic pain were managed with pain killers without further investigation. Recommendations that were made for time sensitive imaging and investigation into symptoms of serious underlying conditions such as coronary artery disease were ignored.
Abrupt increases, decreases and complete cessation of vital medications including antipsychotics and those regulating blood pressure were reported; requests for transparency in medication prescription and administration were requested by doctors in the community, have remained unaddressed. There were unnecessary delays in administering COVID-19 vaccinations, to those who would have otherwise received vaccines months earlier.
An open letter, signed by more than 400 healthcare professionals and prominent refugee health advocates, calling for their immediate release in February, went unanswered.
Health professionals like myself, as well as non-medical advocates of the Darwin Asylum Seeker Support and Advocacy Network (DASSAN) met on more than one occasion with politicians at the local and state levels.
Despite their support of the cause, we were told that ultimately, this was the jurisdiction of the Federal Government.
Where does the jurisdiction of duty of care to people in need of basic medical attention begin or end? It was unfathomable as a doctor to accept that my jurisdiction ended at a fence, less than a ten-minute drive to the doorstep of an Australian public hospital. Worse still is the knowledge that the Federal Government and IHMS, a company contracted with taxpayer money, are not held accountable for their medical negligence.
Even when transfers to a hospital setting occurred, health professionals reported pressure to discharge refugees back to their detention facility. A tenet of discharge is the knowledge of a safe discharge destination. In the cases of hospitalisations in detainees in the Park hotel outbreak, it is hard to imagine that doctors will not face similar pressures, and feel the weight of the ethical dilemma the Federal Government has forced us to.
Though the refugees detained in Darwin were recently released, most were not released into the community. The mammoth efforts of DASSAN volunteers were instrumental in securing this. However, many of their medical conditions – for which they were initially transferred to Australia to manage, under now defunct Medevac legislation – remain untreated.
Multiple professional medical bodies and refugee advocates have called for the release of those held in Australian immigration, particularly during the COVID-19 pandemic. We have asked for the minimum standard of medical care, delivered to any other member of the general population, to be provided to those detained for seeking safety. The Federal Government have demonstrated, time and time again, that their system of immigration detention makes this responsibility impossible.
The treatment of the Biloela Murugappan family, resulting in the hospitalisation of an Australian born child, chillingly illustrates this.
Hundreds have gathered around the country to call for the release of those imprisoned in the Park hotel, Melbourne. While I watch, I can only reflect that from the time of the Border Force Act 2015, the Australian medical community has spent years working against an immovable entity to ensure the most basic human right is preserved for refugees and asylum seekers in detention.
Will the Federal Government please come to the table?
Dr Nilanthy Vigneswaran is an Infectious Diseases doctor, based in Darwin.
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