Asylum seekers, Australia’s retraumatisation policy, and healthcare ally work

This post will be submitted to The Angry Black Woman’s Carnival of Allies.

As white people working on being allies people of colour, we can’t speak for or on behalf of POC. What we can do is speak out to each other against oppression, speak about what we have seen and read, and point to and highlight the work of fellow allies as well as the voices of POC.

The United Nations Committee Against Torture has been raising serious questions about Australia’s compliance with anti-torture obligations. You can read more about the briefing here at Amnesty International.

Map of Australia’s detention centre locations [Source: Immigration Dept]

Rudd’s closure of the Nauru island detention centre was applauded by Amnesty, as was the government’s commitment to time limits on detention and stated intention to consult on introducing a Bill of Rights. But why has the Rudd government stopped short of fully overhauling the mandatory detention policy? What about the new, enormous Christmas Island detention centre – the “Indian Ocean Solution”, 2600 km northwest of Perth in the offshore “excision zone”, which denies asylum seekers the rights they would have on the Australian mainland? The former government claims this was constructed as a “deterrent” and for “contingencies”. What plans does the Rudd government have for it?

Greens Senator Kerry Nettle visits Christmas Island in this video:

Have the conditions improved inside centres, especially Villawood, where there was a death recently after the alleged delayed provision of healthcare? Has there been any urgent, detailed, transparent review of health and healthcare of detained asylum seekers?

The most recent Human Rights & Equal Opportunity Commision Summary of Observations following the Inspection of Mainland Immigration Detention Facilities (2007) reveals some of the conditions within Australian detention centres. Some improvement was found in mental healthcare, and in the provision of leisure programmes for children in detention. However, they found a number of major problems. Their recommendation for the demolition of the bleak, prison-like Stage I at Villawood, the largest centre, was ignored. The suspension of excursions from Villawood has led to distress and unrest. In one case, a man was informed that his girlfriend was in hospital following a car crash, but was denied permission to visit her, leading to substantial distress and thoughts of self-harm. Nonsensically, detainees are forbidden from enrolling in any substantive educational courses that may lead to a qualification. It was also found that the length of detention was causing severe physical and mental health problems for detainees. One particularly disturbing finding was that ill Villawood detainees at risk of suicide or self-harm were still being shifted into the prison-like, punitive, inappropriate Stage I observation area, further away from medical staff and supervised by strangers.

Reason for current detetentions [Source: Immigration Dept]

Which leads me, at last, to the actual purpose of this post: an infodump and roundup to point to some of the ally work that has been done by healthcare workers and researchers who have been speaking out about the health of detained asylum seekers over the past decade.

The Human Rights & Equal Opportunity Commision 2001 National Inquiry into Children in Immigration Detention- “A Last Resort?” outlines some of the conditions that detainees were subject to deep in the Howard era. This is what the Rudd government needs to repudiate utterly; this is the damage we need to undo. A psychologist quoted in the report outlines the effects of long term detention on asylum seekers:

Family roles break down significantly. We actually started time-lining the break down of individuals. We classify the first three months as being a state of euphoria, hope, dreams. The next three months, as they are going through all of their interviews and there is anxiety starting to build up. After six months we start to see a deterioration in the emotional and psychological well-being of individuals, a significant start in the increase of self-harm. Be it hunger strikes, emotional anxiety, psychological disturbances developing, increased requests for assistance for sleep, which is an indication of depression, medication for depression, more active involvement in disturbances and in self-harm. So, yes, I have seen people age on a daily basis. I have seen middle aged men become old men in months.

Other health staff spoke out on children and parenting in detention:

I can only say that the longer that they spent, the worse the effects that I saw. And that was in some way dependant on the age and the support, whether they were an unaccompanied minor or whether they simply still had the support of their parents, or even a parent. But in my experience at Woomera I would have to say that anyone who had been there longer than three months would be at grave risk, I believe, and did develop symptoms.

[...]

Detention as a process impacts on the ability of people to live normal autonomous and self-directed lives. For families in detention there are ongoing tensions that arise in parenting when everything from discipline, cooking, and family gatherings are controlled by a range of prescribed processes and procedures ordered by artificial timelines. Within this environment parents are significantly deprived of their authority and their independence as family units. Their roles as breadwinner or primary carer is undermined by forced dependence on a system over which they have no control.

[...]

[At Woomera, an ACM officer noted that the nine-year-old girl, described in the previous section on separation, was providing much of the care for her five younger brothers. She described the impact on the child as follows:]

Resident [nine-year-old girl] is becoming increasing[ly] withdrawn, her attitude towards staff is becoming progressively more negative. She lacks a confidant[e] and has no effective outlet to express her emotions. She appears tired and depressed. She provides much of the fundamental child care needed for her 5 younger brothers and lacks the support she needs in order to effectively cope with such responsibility.

[...]

Since January 2002 a total of 50 reports of self-harm have been raised on 22 children, ranging in age from 7 years to 17 years. These incidents included hanging attempts; self-harm by cutting arms or ingesting shampoo; and persistent depression and/or suicidal thoughts. The most frequent incidents occurred with children who are 10 and 12 years of age.

There are many more case studies in the report. The report also has harrowing statements from detainees:

[A child detained at Curtin told the Inquiry of the stress caused by witnessing self-harm:]

My world has become like upside down, because I have never seen things like this, I see people who bury themselves alive one day. I wake up in the morning, I see people have buried themselves, I see people go on the tree and just jump down just like that and I see people who cut themselves, I see officers hit woman and children with batons, or use tear gas. I just, it’s too much for me, I don’t know why and sometimes I wonder you know, it is very stressful to me.

Immigration detainee and physician Aamer Sultan and Villawood visiting psychologist Kevin O’Sullivan teamed up to explain some of the issues of psychological damage to asylum seekers under detention centre conditions in the Medical Journal of Australia: “Psychological disturbances in asylum seekers held in long term detention: a participant-observer account” (MJA 2001; 175: 593-596).

The detainees originated from 10 countries, with most being from Afghanistan, Iraq, Iran and the former Yugoslavia. The average period of continuous detention was two years, with the longest period being three years and 10 months. Most were men (85%), and over half were married (55%), with most of these being separated from their spouses on fleeing to Australia. Despite rejection of their refugee claims, over half reported being victims of gross human rights violations before arriving in Australia, enduring abuses such as physical torture (58%) and the murder or disappearance of immediate family members (30%).

All but one of the detained asylum seekers displayed symptoms of psychological distress at some time. At the time of the survey, 85% acknowledged chronic depressive symptoms, with 65% having pronounced suicidal ideation. Close to half the group had reached the more severe tertiary depressive stage. Seven individuals exhibited signs of psychosis, including delusional beliefs of a persecutory nature, ideas of reference and auditory hallucinations. Due to the severity of their psychological symptoms, hospitalisation has been recommended for some of these people by the centre health staff, but authorities have not approved this, except in medical emergencies after incidents involving self-harm. A few have been deported without receiving any appropriate care.

Sultan and O’Sullivan subsequently exchanged sharp letters with Philip Ruddock after his attempt to publicly discredit them in the Journal.

Harold Billboe, a psychologist who worked at Woomera detention centre doing as many as 150 consultations in a week, lost his contract after speaking out against inhumane conditions at the centre. He states that he may have been dumped “because he was labelled a ”care bear”, too much of a detainees’ advocate.” The SMH reported:

Harold Bilboe will remember the day he counselled seven men who were cut down after trying to hang themselves using bed sheets off the palisade fence at the Woomera detention centre. Two of them, Iranians, had been accepted as refugees by the Refugee Review Tribunal (RRT). They said they could not bear any longer the wait for police clearance documents from countries they travelled through that the Australian Government was demanding. [...] Bilboe said the group had ”just feelings of helplessness; they were saying, ‘Why is it taking so long? Do we have to kill ourselves, do we have to die here?”‘

[...]

Bilboe claims a riot and hunger strike in Woomera last December were caused because a group of Afghans were told they could not apply for refugee status and their options were to go home or stay at Woomera. He claims an immigration officer apologised to him in January for telling the Afghans this, and for the trouble it had caused.

Bilboe explains the ”screening out” process. ”During that [first interview], detainees have got to say the magic words. There are phrases they have to use … they’re in fear of their life, they are requesting asylum, they have to state in some way the nature of the fear of going back to the country they have left and then they basically go into the story about how they came.

”Often the answers [to how they came] will be ‘by boat’ but that’s not the right answer. ” … This is when the problems really started, when they’re screened out, they’re all segregated. You’re not allowed to tell them they have been screened out, you’re not allowed to tell them their rights. ”You’re not allowed to tell them they … in actual fact can … reapply.”

[...]

Bilboe says, although it was never mentioned or spoken about by immigration staff, he believed there were deliberate go-slows on processing by the Government. ”I know of one detainee who was in detention for 16 months [over a] police clearance,” he says.

Mortmartin led a collaborative team from the Service for the Treatment and Rehabilitation of Torture and Trauma Survivors and the UNSW Psychiatry Department, looking at the effects of institutionalised retraumatisation within the asylum seeking process. They presented evidence from their ex-Iran and Afghanistan clients that holders of Temporary Protection Visas experience poorer mental health than those awarded Permanent Protection Visas: “A comparison of the mental health of refugees with temporary versus permanent protection visas” (MJA 2006; 185 (7): 357-361)

All TPV holders who had been in immigration detention centres in Australia identified detention experiences causing serious/very serious stress. More than 95% of ex-detainees reported serious/very serious stress regarding fears of being sent home, being told by officers that they should return to their country of origin, and language difficulties while in detention. Other items endorsed as causing serious/very serious stress by more than 90% of the sample included separation from families, being interviewed by immigration officers, not receiving adequate medical treatment, exposure to acts of violence and brutality, seeing people make suicide attempts, and several items related to poor conditions in detention. Items endorsed at a lower level were nevertheless noteworthy, including being assaulted by officers (81%), being handcuffed during transport (71%), being woken during the night for head counts (85%), being forced to use unhygienic toilets (81%), and solitary confinement (60%).

Karen J Zwi et al presented the case study of a seriously distressed imprisoned child who needed protection, but couldn’t get it, because of the government’s mandatory detention policy – in contravention of the United Nations Convention on the Rights of the Child. “A child in detention: dilemmas faced by health professionals” (MJA 2003; 179 (6): 319-322):

Under the Children and Young Persons (Care and Protection) Act 1998 (NSW), healthcare workers in New South Wales are mandated to report children at risk of harm to the NSW Department of Community Services, so that appropriate protective measures can be instituted. This child fulfilled the criteria for reporting, and various attempts to report him were made. Child protection is governed by state legislation and could not be activated, as detention centres are a federal responsibility. Furthermore, the Minister for Immigration has certain guardianship rights with respect to asylum-seeker children, creating difficulties for state welfare authorities.

The ethical dilemma of returning a child to an aversive environment is not unusual for health professionals. When the environment is known to be abusive, healthcare workers can call on nominated child-centred agencies to assist in maintaining children’s wellbeing. However, this was not possible in this case, as detainee children are not subject to Australian child protection legislation, and their welfare is not systematically monitored.

Kardamanidis and Armstrong wrote in 2006 on “The price of health care for Medicare-ineligible asylum seekers in the community” (MJA 2006; 184 (3): 140-141). They noted that not all asylum seekers in the community have access to financial recompense for medical expenses, either for outpatient or hospital care. The Victorian State Government has since offered free public hospital care for asylum seekers in need, but the general issue of access to community healthcare remains unresolved. (There is some more background on this issue here at ANZ Health Policy.)

Henry, Houston and Moody of the Social and Public Health Economics Research Group at Curtin University, Perth appealed to colleagues in “Institutional racism in Australian healthcare: a plea for decency” (MJA 2004; 180 (10): 517-520)

Fourthly, public compassion must be built into the Australian social fabric. The “fair go”, if it ever existed, has gone, but Australia needs a leadership that will articulate that fair go. The philosopher Martha Nussbaum argues against “impoverished models of humanity” with “numbers and dots taking the place of women and men”. She continues: “. . . when one’s deliberation fails to endow human beings with their full and complex humanity, it becomes very much easier to contemplate doing terrible things towards them . . . if you really vividly experience a concrete human life, imagine what it is like to live that life, and at the same time permit yourself the full range of emotional responses to that concrete life, you will . . . be unable to do certain things to that person. Vividness leads to tenderness, imagination to compassion.”

Finally, our call is for a more compassionate society. Attitudes to asylum seekers, to Aboriginal people, to people who are in any way disadvantaged, are linked. Social attitudes need to be more compassionate to all who are disadvantaged, and not just to Aboriginal people.

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In this Australia — this divided, divisive, racist, socially unjust society that we have built — we now need institutions and policies that will unbuild it. We need to acknowledge that the “fair go” is struggling to survive, if not already dead. Fairness and compassion need to be once again the guiding principles of our leaders and our democracy. Only then can we build a society where decency can become the fundamental in addressing Aboriginal health.

There will be no sudden breakthrough; there is no magic pill. Decency, however, is a good place to start.

The Australian Medical Association has, at least until recently, been a vocal supporter for asylum seekers’ right to adequate healthcare and living conditions. Mukesh Haikerwal made these remarks in his Presidential statement in 2006:

Over the past year we continued our strong support for better health services for refugees and asylum seekers. That process was fuelled by discussion at National Conference last year.

We have since launched a Position Statement on the Health Care of Asylum Seekers and Refugees.

Raising awareness of this saw the Victorian government being the first to allow hospitals to treat refugees and asylum seekers openly – and for free. We supported the Petro Georgiou bills and chalked up a big win with the Government introducing an item for refugee health assessments, but this is just a start.

Unfortunately, we don’t seem to have heard from the AMA on this issue since Haikerwal lost his office to Rosanna Capolingua.

But, with all this going on, what did it take for the mainstream media to spark public interest in detention trauma, in Australia’s torturous system? The unjust detentions of an educated, relatively privileged man (Mohamed Haneef), and a case of mistaken identity – a white woman with schizophrenia (Cornelia Rau). The other victims, the women and children of colour who have been detained under torturous conditions, who are still suffering: these people remain nameless in the public eye, mostly-ignored tokens merely labelled “womanandchildren”.

And, lastly, a NonAlly Blooper Award: to Opposition Leader Brendan Nelson, who panned the 2020 Summit’s backing for greater support for asylum seekers as part of an unwelcome return to the “political correctness” of the 1990s.

Related Posts:

• Severely injured asylum seekers and the right to privacy by Lauredhel
• United Nations: Elder’s heatstroke death in police van possible torture or inhuman punishment by Lauredhel
• Referendum Roundup, and Indigenous Health “Report Card” by Lauredhel
• Tracking The Intervention: Discarding and devaluing Aboriginal work by Lauredhel
• Northern Territory Aboriginal people seek refugee status with UN by Lauredhel