Healthcare and clinical ethics in Australian offshore immigration detention

Abstract

Part of Australia’s ongoing efforts to deter asylum seeker boat arrivals, offshore immigration detention has been widely criticised since its reintroduction in 2012. These environments undermine the principles that would normally drive clinical and ethical decision-making, resulting in circumstances that are uniquely problematic and compromising. In addition to the more general complaints about Australia's policy of mandatory immigration detention, riots, violence, abuse, self-harm and a number of deaths have been reported in offshore centres. Centring on a number of recent inquiries, this article provides a review of the literature, focusing on the uniquely problematic issues faced in Australia's offshore immigration detention centres.

Keywords:

• refugees
• asylum seekers
• clinical ethics
• immigration detention
• healthcare

Disclosure statement

The author previously worked for the Australian immigration detention healthcare provider, International Health and Medical Services as a Counsellor from 2011–2015.

Note on contributor

Ryan Essex is a PhD Candidate at The Centre for Values, Ethics and the Law in Medicine, The University of Sydney. His present research focuses on healthcare in Australian immigration detention. He formerly worked for International Health and Medical Services (IHMS), the immigration detention healthcare contractor as a Counsellor.

Notes

1. J. Phillips and H. Spinks, Immigration Detention in Australia (Canberra: Parliamentary Library, 2013).

2. Refugee Advice and Casework Service, Chronology of Recent Changes Affecting Asylum Seekers, http://www.racs.org.au/wp-content/uploads/RACS-FACT-SHEET-Chronology-of-legal-changes-affecting-asylum-seekers-8.7.2014.pdf.

3. Gabrielle Chan, ‘Bill Shorten Wins Freedom to Use Boat Turnbacks, but Leadership Split on Issue’, The Guardian Australia, 2015, http://www.theguardian.com/australia-news/2015/jul/25/bill-shorten-wins-freedom-to-use-boat-turnbacks-but-leadership-split-on-issue.

4. Matthew Doran, ‘More Than 600 Asylum Seekers Turned Back under Sovereign Border in Last 18 Months, Peter Dutton Confirms’, Australian Broadcasting Corporation News, 2015, http://www.abc.net.au/news/2015-08-06/dutton-confirms-asylum-seekers-sent-back-to-vietnam/6676780.

5. Department of Immigration and Border Protection, Immigration Detention and Community Statistics Summary: 31 July 2015 (Canberra, 2015).

6. Department of Immigration and Border Protection, Immigration Detention and Community Statistics Summary: 31 July 2014 (Canberra, 2014).

7. Jane McAdam, ‘Asylum Seekers: Australia and Europe – Worlds Apart’, Alternative Law Journal 28, no. 4 (2003): 193–5.

8. Michael Dudley, ‘Contradictory Australian National Policies on Self-Harm and Suicide: The Case of Asylum Seekers in Mandatory Detention’, Australasian Psychiatry 11, no. 1 suppl (2003): S102–8.

9. Australian Human Rights Commission, Asylum Seekers, Refugees and Human Rights (Sydney, 2013); Australian Human Rights Commission, Human Rights Standards for Immigration Detention (Sydney, 2013); Australian Human Rights Commission, Human Rights Issues Raised by the Transfer of Asylum Seekers to Third Countries (Sydney, 2012); Australian Human Rights Commission, Human Rights Issues Raised by the Transfer of Asylum Seekers to Third Countries (Sydney, 2012); Australian Human Rights Commission, The Forgotten Children: National Inquiry into Children in Immigration Detention (Sydney, 2014).

10. Melissa Bull et al., ‘Sickness in the System of Long-Term Immigration Detention’, Journal of Refugee Studies 26, no. 1 (2013): 47–68; J.P. Green and K. Eagar, ‘The Health of People in Australian Immigration Detention Centres’, Medical Journal of Australia 192, no. 65–70 (2010); Aamer Sultan and Kevin O’Sullivan, ‘Psychological Disturbances in Asylum Seekers Held in Long Term Detention: A Participant-Observer Account’, Medical Journal of Australia 11 (2001): 593–6; Peter Young, ‘Mental Health Screening and Outcome Measures in Immigration Detention’ (paper presented at the The Royal Australian and New Zealand College of Psychiatrists’ annual Congress, 13 May 2014).

11. See Dudley, ‘Contradictory Australian National Policies’; Australian Human Rights Commission, The Forgotten Children.

12. The Border Crossing Observatory, ‘Australian Border Deaths Database’, http://artsonline.monash.edu.au/thebordercrossingobservatory/publications/australian-border-deaths-database/ (2016).

13. See Australian Human Rights Commission, The Forgotten Children. Also, M. Willacy, M. Solomons, and M. McDonald, ‘Hamid Kehazaei Case: Seriously Ill Asylum Seeker Forced to Wait More Than 24 Hours for Medical Transfer’, Australian Broadcasting Corporation News, 2014, http://www.abc.net.au/news/2014-12-08/ill-fated-asylum-seeker-forced-to-wait-for-medical-transfer/5952756; Robert Cornall, ‘Review into the Allegations of Sexual and Other Serious Assaults at the Manus Regional Processing Centre’ (2014); Robert Cornall, ‘Review into the Events of 16–18 February at the Manus Regional Processing Centre’ (2014); Phillip Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’ (2015); Australian Parliamentary Select Committee, Taking Responsibility: Conditions and Circumstances at Australia's Regional Processing Centre in Nauru, Select Committee on the Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru (Canberra, 2015).

14. Rebecca de Boer, Health Care for Asylum Seekers on Nauru and Manus Island (Canberra: Parliamentary Library, 2013).

15. Department of Immigration and Citizenship, Detention Health Framework: A Policy Framework for Health Care for People in Immigration Detention (Canberra, 2007).

16. Ibid., 14.

17. Australian Parliamentary Select Committee, Taking Responsibility.

18. Ibid., 80.

19. Rosalind McDougall, ‘Reviewing Literature in Bioethics Research: Increasing Rigour in Non-Systematic Reviews’, Bioethics 29, no. 7 (2015): 523–8.

20. Australian Human Rights Commission, Immigration Detention on Christmas Island: Observations from Visit to Immigration Detention Facilities on Christmas Island (Sydney, 2012).

21. Christmas Island Medical Officer’s Letter of Concern, The Guardian Australia, 2013, http://www.theguardian.com/world/interactive/2014/jan/13/christmas-island-doctors-letter-of-concern-in-full.

22. Cornall, ‘Review into the Allegations of Sexual and Other Serious Assaults’; Paul Farrell, ‘Not Seen, Not Heard, Often Not Reported – the Harrowing Stories of Australia's Detainees’, The Guardian Australia, 2015, http://www.theguardian.com/australia-news/2015/jun/10/not-seen-not-heard-not-reported-the-harrowing-stories-of-australias-detainees.

23. Nicholas Procter, Suresh Sundram, Gillian Singleton, Georgia Paxton and Andrew Block, ‘Physical and Mental Health Subcommittee of the Joint Advisory Committee for Nauru Regional Processing Arrangements Nauru Site Visit Report 16–19 February 2014’ (2014).

24. Australian Human Rights Commission, The Forgotten Children.

25. Human Rights and Equal Opportunities Commission, A Last Resort: National Inquiry into Children in Immigration Detention (Sydney, 2004).

26. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

27. Australian Parliamentary Select Committee, Taking Responsibility.

28. Ibid.

29. Procter et al., ‘Physical and Mental Health Subcommittee of the Joint Advisory Committee for Nauru Regional Processing Arrangements Nauru Site Visit Report 16–19 February 2014’.

30. Australian Human Rights Commission, Immigration Detention on Christmas Island.

31. Australian Parliamentary Select Committee, Taking Responsibility.

32. Ryan Essex, ‘Ethics, Foreseeability, and Tragedy in Australian Immigration Detention’, Journal of Bioethical Inquiry 12, no. 4 (2015): 537–9.

33. Farrell, ‘Not Seen, Not Heard’.

34. Australian Parliamentary Select Committee, Taking Responsibility.

35. Christmas Island Medical Officer's Letter of Concern.

36. Daniel Hurst, ‘Return Asylum Seekers to Offshore Detention “as Soon as Possible”, Officials Urged’, The Guardian Australia, 2015, http://www.theguardian.com/australia-news/2015/oct/06/return-asylum-seekers-to-offshore-detention-as-soon-as-possible-urged-officials?CMP=share_btn_link.

37. Paul Farrell, ‘Immigration Department Defied Advice Not to Transfer Babies Back to Nauru’, The Guardian Australia, 2015, http://www.theguardian.com/world/2015/jun/11/immigration-department-defied-advice-not-to-transfer-babies-back-to-nauru.

38. Deborah Zion, Linda Briskman, and Bebe Loff, ‘Psychiatric Ethics and a Politics of Compassion’, Journal of Bioethical Inquiry 9, no. 1 (2012): 67–75.

39. Ryan Essex, ‘Human Rights, Dual Loyalties, and Clinical Independence: Challenges Facing Mental Health Professionals Working in Australia’s Immigration Detention Network’, Journal of Bioethical Inquiry 11, no. 1 (2014): 75–83.

40. Guy Coffey, ‘“Locked up without Guilt or Sin”: The Ethics of Mental Health Service Delivery in Immigration Detention’, Psychiatry, Psychology and Law 13, no. 1 (2006): 67–90; Linda Briskman, Deborah Zion, and Bebe Loff, ‘Care or Collusion in Asylum Seeker Detention’, Ethics and Social Welfare 6, no. 1 (2011): 37–55; Linda Briskman, Deborah Zion, and Bebe Loff, ‘Challenge and Collusion: Health Professionals and Immigration Detention in Australia’, The International Journal of Human Rights 14, no. 7 (2010): 1092–106; L. Briskman and D. Zion, ‘Dual Loyalties and Impossible Dilemmas: Health Care in Immigration Detention’, Public Health Ethics 7, no. 3 (2014): 277–86.

41. Farrell, ‘Not Seen, Not Heard’.

42. David Isaacs, ‘Nauru and Detention of Children’, Journal of Paediatrics and Child Health 51, no. 4 (2015): 353–4.

43. Australian Human Rights Commission, The Forgotten Children.

44. Australian Parliamentary Select Committee, Taking Responsibility.

45. Amnesty International, ‘What We Found on Nauru’, 2014, http://www.amnesty.org.au/refugees/comments/30726/.

46. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

47. Australian Parliamentary Select Committee, Taking Responsibility.

48. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

49. Amnesty International, ‘This Is Breaking People: Human Rights Violations at Australia’s Asylum Seeker Processing Centre on Manus Island, Papua New Guinea’ (2013).

50. Cornall, 'Review into the Allegations of Sexual and Other Serious Assaults'; Cornall, 'Review into the Events at the Manus Regional Processing Centre'.

51. Australian Human Rights Commission, Immigration Detention on Christmas Island.

52. Lucy Fiske, ‘Riotous Refugees or Systemic Injustice? A Sociological Examination of Riots in Australian Immigration Detention Centres’, Journal of Refugee Studies 27, no. 3 (2014): 382–402.

53. Christmas Island Medical Officer's Letter of Concern.

54. Ibid., 4.

55. Australian Human Rights Commission, The Forgotten Children; Australian Parliamentary Select Committee, Taking Responsibility; Procter et al., ‘Physical and Mental Health Subcommittee of the Joint Advisory Committee for Nauru Regional Processing Arrangements Nauru Site Visit Report 16–19 February 2014’.

56. Australian Parliamentary Select Committee, Taking Responsibility; Procter et al., ‘Physical and Mental Health Subcommittee of the Joint Advisory Committee for Nauru Regional Processing Arrangements Nauru Site Visit Report 16–19 February 2014’.

57. Australian Parliamentary Select Committee, Taking Responsibility.

58. Ibid., 63.

59. Australian Heads of Schools of Social Work, We’ve Boundless Plains to Share: The First Report of the People’s Inquiry into Detention (Australian Council of Heads of Schools of Social Work, 2006).

60. Coffey, ‘“Locked up without Guilt or Sin”’.

61. David Marr and Oliver Laughland, ‘Australia’s Detention Regime Sets Out to Make Asylum Seekers Suffer, Says Chief Immigration Psychiatrist’, The Guardian Australia, 2014, http://www.theguardian.com/world/2014/aug/05/-sp-australias-detention-regime-sets-out-to-make-asylum-seekers-suffer-says-chief-immigration-psychiatrist.

62. Coffey, ‘“Locked up without Guilt or Sin”’.

63. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

64. Australian Parliamentary Select Committee, Taking Responsibility.

65. Cornall, ‘Review into the Allegations of Sexual and Other Serious Assaults at the Manus Regional Processing Centre’.

66. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

67. Australian Parliamentary Select Committee, Taking Responsibility, 161.

68. Ibid., 100.

69. Ibid.

70. Department of Immigration and Border Protection, Immigration Detention and Community Statistics Summary: 31 July 2015.

71. Australian Human Rights Commission, The Forgotten Children.

72. Ibid., 29.

73. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

74. Australian Parliamentary Select Committee, Taking Responsibility.

75. Procter et al., ‘Physical and Mental Health Subcommittee of the Joint Advisory Committee for Nauru Regional Processing Arrangements Nauru Site Visit Report 16–19 February 2014’.

76. Christmas Island Medical Officer's Letter of Concern.

77. Human Rights and Equal Opportunities Commission, A Last Resort.

78. See Australian Human Rights Commission, The Forgotten Children; Moss, ‘Review into the Regional Processing Centre in Nauru’; Australian Parliamentary Select Committee, Taking Responsibility; Procter et al., ‘Physical and Mental Health Subcommittee of the Joint Advisory Committee for Nauru Regional Processing Arrangements Nauru Site Visit Report 16–19 February 2014’.

79. Australian Parliamentary Select Committee, Taking Responsibility. Karen Zwi and Sarah Mares, ‘Stories from Unaccompanied Children in Immigration Detention: A Composite Account’, Journal of Paediatrics and Child Health 51, no. 7 (2015): 658–62.

80. Procter et al., ‘Physical and Mental Health Subcommittee of the Joint Advisory Committee for Nauru Regional Processing Arrangements Nauru Site Visit Report 16–19 February 2014’.

81. Australian Parliamentary Select Committee, Taking Responsibility.

82. Ibid., 108–09.

83. Bridie Jabour and Daniel Hurst, ‘Nauru to Increase Visa Cost for Journalists from $200 to $8,000’, The Guardian Australia, 2014, http://www.theguardian.com/world/2014/jan/09/nauru-visa-to-cost-8000.

84. Jason Om, ‘Immigration Department Aware of Sexual Abuse Allegations against Children for 17 Months but Failed to Act, Say Former Nauru Workers’, Australian Broadcasting Corporation, 2015, http://www.abc.net.au/news/2015-04-07/nauru-letter-of-concern-demands-royal-commission/6374680.

85. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

86. Australian Human Rights Commission, The Forgotten Children.

87. Eliza Borrello and James Glenday, ‘Gillian Triggs: Tony Abbott Says Government Has Lost Confidence in Human Rights Commission President’, Australian Broadcasting Corporation, 2015, http://www.abc.net.au/news/2015-02-24/gillian-triggs-says-brandis-wants-her-to-quit-rights-commission/6247520.

88. Paul Farrell, ‘Police Carry out More Raids on Save the Children Staff at Nauru Detention Centre’, The Guardian Australia, 2015, http://www.theguardian.com/world/2015/oct/22/police-carry-out-more-raids-on-save-the-children-staff-at-nauru-detention-centre.

89. Oliver Laughland, ‘Coalition Disbands Advisory Group on Asylum Seeker Healthcare’, The Guardian Australia, 2013, http://www.theguardian.com/world/2013/dec/16/tony-abbott-disbands-advisory-group-on-asylum-seeker-healthcare.

90. Australian Parliamentary Select Committee, Taking Responsibility, 125.

91. Khanh Hoang, ‘Border Force Act Entrenches Secrecy around Australia’s Asylum Seeker Regime’, The Conversation, 2015, https://theconversation.com/border-force-act-entrenches-secrecy-around-australias-asylum-seeker-regime-44136.

92. George Newhouse, ‘Let Me Clear up the Government’s Clarification of the Border Force Act’, The Guardian Australia, 2015, http://www.theguardian.com/commentisfree/2015/jul/08/let-me-clear-up-the-governments-clarification-about-the-border-force-act.

93. Moss, ‘Review into Recent Allegations Relating to Conditions and Circumstances at the Regional Processing Centre in Nauru’.

94. Australian Parliamentary Select Committee, Taking Responsibility, 38.

95. Australian Medical Association, ‘Position Statement: Health Care of Asylum Seekers and Refugees – 2011’, https://ama.com.au/position-statement/health-care-asylum-seekers-and-refugees-2011; Australian Psychological Society, ‘Psychological Wellbeing of Refugees and Asylum Seekers in Australia: A Position Statement Prepared for The Australian Psychological Society’, 2011, https://www.psychology.org.au/Assets/Files/Position-statement-refugee-2011.pdf; The Royal Australian and New Zealand College of Psychiatrists, ‘Position Statement 52: Children in Immigration Detention’, 2011, https://www.ranzcp.org/Files/Resources/College_Statements/Position_Statements/ps52-pdf.aspx.

96. Louise Newman, Michael Dudley and Zachary Steel, ‘Asylum, Detention, and Mental Health in Australia’, Refugee Survey Quarterly 27, no. 3 (2008): 110–27; Z. Steel, S. Momartin, C. Bateman, A. Hafshejani, D. Silove, N. Everson, and S. Mares, ‘Psychiatric Status of Asylum Seeker Families Held for a Protracted Period in a Remote Detention Centre in Australia’, Australian and New Zealand Journal of Public Health 28, no. 6 (2004): 527–36.

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98. Brian Owler, ‘Speech to AMA Forum on Health of Asylum Seekers’, Australian Medical Association, 2016, https://ama.com.au/media/ama-speech-prof-owler-ama-asylumseeker-health-forum.

99. Michael Dudley, ‘Helping Professionals and Border Force Secrecy: Effective Asylum-Seeker Healthcare Requires Independence from Callous Policies’, Australasian Psychiatry 24, no. 1 (2016): 15.

100. Paul Farrell, ‘Detention Centre Staff Speak Out in Defiance of New Asylum Secrecy Laws’, The Guardian Australia, 2015, http://www.theguardian.com/australia-news/2015/jul/01/detention-centre-staff-speak-out-in-defiance-of-new-asylum-secrecy-laws.

101. Michael Safi and Paul Farrell, ‘AMA Joins Protest against Asylum Law that Can Jail Detention Centre Staff’, The Guardian Australia, 2015, http://www.theguardian.com/australia-news/2015/jul/01/ama-joins-protest-against-asylum-law-that-can-jail-detention-centre-staff.

102. Calla Wahlquist and Warren Murray, ‘Baby Asha: Immigration Minister Confirms Community Detention in Australia’, The Guardian Australia, 2016, http://www.theguardian.com/australia-news/2016/feb/21/baby-asha-community-detention-negotiations-follow-hospital-protests.

103. Paul McNeil, ‘Public Health Ethics: Asylum Seekers and the Case for Political Action’, Bioethics 17, no. 5–6 (2003): 487–502.