4 November 2013
The health of those who seek asylum – our role
Asylum seekers are amongst the most vulnerable of the world; displaced, enduring long unknown journeys, often dealing with the effects of trauma, torture and poverty. In addressing these issues, it’s hard to disengage from the politics. As many seek asylum on Australian shores, most often whilst being held indefinitely in remote detention centres, issues arise surrounding their mental and physical well-being.
Of particular concern is the health of children. Past and current Australian governments seem determined to expand the capacity of off-shore detention, and the health and protection of children seeking asylum remains the responsibility of those governments. In the delivery of that care, nurses make up a large portion of the professionals who provide services to these children and their families.
In June, the Department of Parliamentary Services acknowledged that, whilst it is not ideal, the most recent figures showed 1326 children are now in community detention and 1731 remain in remote immigration detention. Australia’s Human Rights Commission found, “many children in detention have suffered from a range of mental health problems, including anxiety, bed-wetting, nightmares, emotional numbing, hopelessness, disassociation and suicidal ideation”. These children are protected under the United Nations Convention on the Rights of the Child, to which Australia is a signatory. The country is therefore obligated to provide appropriate living standards and both mental and physical healthcare.
The provision of such care to asylum seekers on Nauru and on Manus Island, Papua New Guinea, is governed by the Heads of Agreement between the Commonwealth of Australia, represented by the Department of Immigration and Citizenship (DIAC), and International Health and Medical Services (IHMS). The Australian Government outlines that health services provided should be transparent and of a “standard and range of healthcare that is best available in the circumstance, and utilises facilities and personnel on Nauru and Manus Island”. However, information available suggests the capacities of both the Nauru and PNG healthcare systems are limited and not up to international standards.
Experience shows us that off-shore detention and regional processing facilities expose asylum seekers to environmental and infrastructure deficiencies. Having detainees live in such close proximity presents significant risks to health,particularly the transference of disease and infection.
Far from being acceptable living conditions for any person, this environment poses particular threats to the health and development of children. Main concerns surrounding the provision of adequate health services, particularly on Nauru and Manus Island, include a lack of mental healthcare and engaging activity, increased risks of communicable diseases, the threat of malaria (particularly on PNG, where there is a 94 per cent risk of infection), inadequate supply of vaccinations, lack of medical accountability and measurement of the standards of care, and the inability of professionals to act autonomously.
IHMS is to provide onsite care 12 hours a day, seven days a week, and emergency services after hours. Nurses’ roles within the IHMS include staffing registered nurse clinics, nurse immunisation and vaccination services, health promotion services and radiography-trained nursing services. Nurses provide care to asylum seekers both on- and off-shore and are instrumental in the primary care given to this vulnerable group of people.
The Immigration Health Advisory Group (IHAG), made up of independent health professionals, provides expert advice to the Secretary of DIAC on the health of asylum seekers in detention. ACN’s representative, Sandy Eagar, nurse manager for the NSW Refugee Health Service, is a member of IHAG who regularly inspects Australian immigration detention facilities, including those that house families and unaccompanied minors. She evaluates the health assessment process, facilities and levels of staffing, including the contribution of nurses.
So far, IHAG has not been given access to Nauru or Manus Island, with the exception of one visit to Manus Island by representatives from the Detention Health Advisory Group (IHAG’s predecessor). As a result of this visit, pregnant women and children were moved from Manus to community detention within Australia. It was deemed unacceptable for them to be held on either Manus or Nauru. Under the new government, this position has been reversed. From October 1, this group of people, including a woman in her 22nd week of pregnancy, have begun transfer to Nauru.
Asylum seekers are subject to a mere 48-hour health assessment when transferred to off-shore detention. Because of this, concerns arise as to whether issues may have been missed, and also about how issues will be managed in inadequate conditions. As the number of asylum seekers in off-shore detention is sure to increase, nursing staff numbers will need to be bolstered. The lack of external and independent scrutiny of the off-shore processing centres remains a concern and ACN will maintain a watching brief as the situation unfolds.
The NSW Refugee Health Service is also coordinating the NSW Refugee Health Nurse Program on behalf of NSW Health. In addition to providing on-arrival assessments for newly arrived off-shore refugees, the Refugee Health Nurse Program has begun to look at the discharge planning and documentation of people exiting detention, and the wider implications this process has for nurses across the health system. Issues of healthcare for asylum seekers continue long after they receive their visas. The provision of safe care within the Australian community is a priority.
“The nurse-led model of care highlights the valuable role nurses play in refugee health, their insights into the determinants of health beyond basic clinical examination and their ability to communicate across a cultural spectrum,” Eager says. “Nurses quickly engender the trust of our patients, some of whom have come from situations that are, quite frankly, beyond our reckoning. The refugees’ resilience and determination to reclaim their futures inspire me every day to play our part in assisting them in their settlement journeys.”
There are numerous opportunities for nurses interested in refugee health. They range from the state-based Health Department programs and non-government agencies such as the Australian Red Cross through to private companies such as IHMS and Médicins Sans Frontières. Other opportunities for nurses lie in their own sphere of clinical practice – Australia has a proud tradition of settling refugees into our communities. As Eagar reminds us, “they may be the next antenatal patient, a newly diagnosed diabetic or the child who has fallen off their trike”.
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