This appalling state of mental health is manifested in protracted and chronic poor physical health. Such a complex and highly vulnerable group suffer from many different conditions, some pre-existing, others psychosomatic, and others such as infectious diseases that result from the environment and poor nutrition.
Although Australia spends a fortune on health facilities on Nauru (an estimated A$865,000 a year on each person), the people there still receive critically inadequate medical treatment. This is evidenced by testimonies and countless reports, as well as the independent reviews of the Australian Medical Association and Doctors for Refugees.
Nauru, with its small population, is simply not equipped to provide the services needed by a highly vulnerable and complex community. People cannot even get basic needs such as glasses or some medications for existing conditions on Nauru. It lacks the facilities or the staff needed to treat many more complex conditions, and the competence even to deal with the more straightforward problems. According to a senior doctor there:
To compare the RoN facility to anything remotely resembling an Australian hospital, even in a remote outback town, was unrealistic. There had been a significant cash injection and a building program, widely lauded by the Australian government. I think more than $26 million had been spent, and you could indeed see the shiny new porta-cabins containing operating theatres, a shiny new pharmacy and office spaces. … It was, of course, only half the story. The emergency department and wards remained in the older buildings, with inadequate equipment, poorly trained staff and creaking infrastructure. The sparkling new pharmacy routinely ran out of basic drugs, not all doctors were medically qualified. There were no pathologists on the island and no way of conducting post-mortems. Any deaths were not investigated, and the deaths I heard about were quickly hushed up, even if serious concerns were raised by our staff. We again ran the risk of being deported if we upset the staff by pointing out any of the glaring mistakes being made. … The number of things [done at the local hospital to a Nauruan] that were done incorrectly, ignored, just plain screwed up, due to incompetence and ignorance, wilful or otherwise, was astounding. It painted a picture of a hospital utterly ill-equipped to deal with what should have been a fairly straightforward emergency presentation.
– Dr Nick Martin
The needs of many of the women create particular problems for Nauru. For example, women who have experienced female genital mutilation or require gynaecological surgeries cannot be treated on the island. Women who need a pregnancy terminated (which is illegal in Nauru) wait an “absolutely brutal” 20 weeks on average (when they can feel the baby move).
Obstructing medical care
The inadequacy of health care on Nauru is compounded by a cruelly restrictive policy on transferring people for medical treatment. Omid Masoumali, who lit himself on fire in front of the UN officials, could have survived in an Australian hospital, but wasn’t even given a bedsheet in the Nauruan hospital. It took 26 hours to evacuate him to Brisbane, where he died.
This is because it is the Australian Government, not doctors, which ultimately decides whether a person can be transferred for medical treatment. Although the process formally involves a Nauraun Overseas Medical Referrals Committee, it is in the end the call of the Australian Border Force. Although the Australian Government states that it has not ‘denied’ any requests for medical transfers in the past five financial years, this contradicts the evidence from those on the ground. Sources indicate that there are around 50 Overseas Medical Transfer requests by doctors being blocked.
Even the former head of the Australian Border Force has conceded that it has obstructed transfers. As Dr Nick Martin, a doctor who worked on Nauru, put it eloquently:
Nothing happens without the Australian Border Force allowing it. They were where delays came from: ABF had held up evacuations for my critically-ill patients before. They seemed to work in committees. There was never a name you could pin things on. They used terms such as ‘the delegate’ or ‘the committee’ to guarantee anonymity and avoid accountability. I had the name of their chief medical officer. I had met him, he was amicable enough. I wasn’t sure if they listened to him, but he was a contact at least. … I … started typing up the referrals, … starting the ball rolling on a process that would take months and was reliant on a load of rotating staff to keep the momentum, or else it would be lost again. I had calculated an average of four referrals that were needed to get a patient seen once at the Nauru hospital and then only one in four after the patient was seen would have any kind of clinical report or note on file that I could then use to convince their committee that the patient needed transfer.
These decisions have become increasingly cruel. Public pressure in 2016 through the #LetThemStay campaign meant that over 400 people already transferred to Australia have not been returned offshore, despite the failure of a High Court challenge to prevent their return. The Australian Government is now taking extraordinary and extremely expensive steps to prevent people from being transferred to Australia, for fear that courts may prevent them from being returned.
This is reflected in the significant decline in the number of medical transfers since 2014-2015, despite the fact that more prolonged detention is likely to result in more complex health issues. In February 2016, the Australian Government started transferring people from Nauru to Papua New Guinea to avoid legal action. One of those transferred to Papua New Guinea was a young African woman who had been raped while unconscious, and fell pregnant. She was transferred to Port Moresby without her informed consent, even though abortion is illegal in PNG, and against the advice of five medical experts. One expert warned that she could develop extreme psychotic symptoms if she was not able to have a termination. Yet it was only by court order that this woman was eventually transferred to Australia.
In mid-2017, a change in policy meant that traumatised women needing abortions, in a country where rape was common, would not be seen by Australian doctors and referred to the Australian government, but rather to the Nauruan Overseas Medical Referral committee. As abortion is illegal in Nauru, doctors were put in an impossible position, and women were effectively denied the choice of an abortion. Given their mental health issues, there were serious risks that people would self-harm or try to induce an abortion themselves. Three pregnant women with serious mental health issues were reported to have been denied termination as a result of this policy, a move condemned by the Australian Medical Association.
In September 2017, Australia signed a deal with Taiwan (which is not a signatory to the Refugee Convention) to transfer people there. By 30 August 2018, 30 people had been transferred to Taiwan, including a 55-year-old Iranian women needing heart surgery and her 17-year-old son. The Government also tried to force a 30-year-old pregnant Somali woman, who had been subject to female genital mutilation, to have an abortion in Taiwan. It was forced to transfer her to Australia by court order.
The Government has also gone to court to prevent a critically ill baby and his parents from being transferred to Australia instead of Taiwan, despite the risks involved. Australia has even tried to force a 63-year-old Afghan refugee dying from lung cancer to move to Taiwan for palliative care, and offered him $25,000 to return to Afghanistan. He was only transferred to Australia after an intense campaign by medical staff, the public, and even government officials.