Refugee Council of Australia
Children with backs towards camera and arms crossed in front of fence

Australia’s man-made crisis on Nauru

Breaking children

As of 29 August 2018, an estimated 109 children are held on Nauru. The ASRC and National Justice Project, among other legal partners, together have secured the transfer of 25 critically ill children through legal action, either through a court order or because the government conceded to legal pressure.

The details are especially harrowing when we look at the children of Nauru. We have heard of children swallowing razor blades and stones, trying to overdose, hanging themselves, attempting to jump from high places and dousing themselves in petrol. Children are hallucinating, withdrawing socially, repeatedly expressing a wish to die, unable to speak or speaking in a flat tone, and live in constant fear. Many bang their heads and bodies regularly and repeatedly against walls in their distress. The former director of mental health services on Nauru, Dr Peter Young, has said that offshore detention amounts to torture.

These children cannot be treated on Nauru, as there are no inpatient mental health facilities for children. Instead, those children who repeatedly attempt suicide are locked into small compounds and watched by security officers, who physically restrain them to prevent them from harming themselves in their distress.
The causes of this are also well-documented: the compounding effects of prolonged detention, including feelings of hopelessness and helplessness; pre-existing trauma; separation from families; and bullying and harassment and feeling unsafe in the local community.

Children have also been physically and sexually assaulted by those paid to protect them. There have been reports of incidents of centre staff sexually assaulting a child, choking a child, hitting at and spitting on children, and other physical assaults and threats to children.
Nauru is not equipped to deal with child abuse, with an official report finding that responses to child abuse were inadequate in just under 70% of cases, while 20% of incidents couldn’t even be reviewed because of lack of data. Despite Nauru belatedly developing a child protection system in 2016, UNICEF has concluded offshore processing cannot be in the best interests of a child.

Yet the abuse of children is now at fever pitch. In 2018, reports began surfacing that children on Nauru were developing a rare psychiatric condition called ‘Traumatic Withdrawal Syndrome’ (also known as ‘resignation syndrome’). Professor Louise Newman, former government advisor and psychiatrist, has explained that:

Traumatic Withdrawal Syndrome is found in children exposed to ongoing trauma where they feel hopeless and helpless resulting in a giving up on engagement with the world. There is an urgent need for treatment with a medical and mental health team in a high level hospital facility with capacity for intensive care, re-feeding and support for psychological recovery.

Traumatic Withdrawal Syndrome

Information provided courtesy of Professor Louise Newman and Dr Vernon Reynolds

Children on Nauru are displaying symptoms of Traumatic Withdrawal Syndrome with mental health conditions worsening due to prolonged illness and non-treatment.
Traumatic Withdrawal Syndrome is a rare condition and a syndrome of extreme severity that can be life-threatening.

It is most commonly seen in children and young adolescents, and has the clinical features dramatic social withdrawal, with severe reduction or inability to walk, talk, eat, and drink, self-care or socialise. It is most often seen in girls aged 7–15 years, but has been documented in males and in a patient as young as 4 years and through the adult age range.
A similar syndrome has been found in overwhelmingly traumatic environments such as people seeking asylum in Sweden, referred to as Resignation Syndrome.

Generally accepted criteria for diagnosis include:

  • Partial or complete withdrawal in three or more of the following domains: eating, mobilisation, speech, attention to personal care, including self-toileting
  • Active resistance or non-response to acts of care and encouragement
  • Social withdrawal

No organic condition accounts for the severity of the degree of symptoms. No other psychiatric disorder could better account for the symptoms.

The science suggests there is a trauma related neurobiological overdrive process resulting in sympathetic and parasympathetic nervous system hyperarousal. This leads to maximal internal physiological arousal and maximal behavioural withdrawal.
This isolate/withdrawal response to trauma is well known as a component in the Flight/Fight/Freeze triad of responses to very stressful situations. In this group of people the options for Flight are unavailable and the options to Fight have been suppressed and drained from the individuals and families.

The increasing prevalence of this Freeze-Isolate-Withdrawal response is predictable in circumstances of sustained detention and trauma which include the following factors:

  • Pervasive uncertainty
  • Lack of freedoms – strong external controls and little internal control or choice, which create feelings of extreme helplessness
  • Ongoing re-traumatising experiences
  • Little or no opportunity for positive emotions These factors affect all family members and undermine the parent’s ability to buffer and support the child to cope with traumas.

The endangered state of the patient requires hospitalisation. Parents – who also suffer trauma related mental health challenges – are currently caring for children with TWS in the home environment, struggling to get food and water into their bodies in states of withdrawal.

We estimate there are at least 30 children on Nauru currently experiencing symptoms of Traumatic Withdrawal Syndrome, but some staff members and clients on Nauru are reporting significantly higher numbers.

Most children on Nauru have symptoms of mental health conditions, including suicidality that are at risk of escalating and compounding into symptoms of TWS.

Yet the Australian Government has resisted transferring these children to Australia for treatment. Health workers on Nauru say there are 50 requests for overseas medical transfers that Australian Border Force are actively blocking. Courts are ordering the transfer of children in catastrophic circumstances. Since December 2017, 25 people have been transferred to Australia as a result of legal intervention, all suffering life-threatening symptoms.

These actions have been necessary as the Australian Government continually rejects medical advice and refuses to process doctors’ requests for transfers. As Dr Vernon Reynolds, a child psychiatrist and whistleblower, said:

I treated severely unwell children that I repeatedly recommended for transfer to a specialist hospital. Instead they were left for months to deteriorate further. Such neglect cannot be justified and is morally and ethically wrong.

The following is a list of publicly reported cases of children with life-threatening mental and physical symptoms. The ASRC has a record of all incidents of critically ill children transferred for emergency medical care to Australia.
[table “104” not found /]
Children have also stopped going to school, in the face of bullying and harassment by local children and their teachers. Service providers estimated in 2016 that, since the closure of the Save the Children school in mid-2015, only about 5-15% of children were attending school. Amnesty International reported that no child was attending school by September 2016.

All the kids at school, they say, ‘Refugee, refugee, refugee.’ They don’t say our names. They hit us. And when we try to talk to the teachers, they don’t say, ‘Why are you Nauruan kids hitting the other kids?’ They say to us, ‘Why are you fighting with the Nauruan kids?’ We try to explain, but they don’t listen.

– Child on Nauru

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