Seeking asylum: health and human rights in Australia

The debate around the best response to the global issue of asylum seekers and displaced persons (see glossary in the Box) continues to arouse strong feelings in Australia. Annually, there are about 80 000 resettlement places available around the world, and Australia currently accepts 13 500 refugees under humanitarian resettlement programs. In our region, thousands of assessed refugees wait in Indonesia and Malaysia for resettlement places. Half of asylum seekers are women and children, many of whom have experienced violence, abuse and sexual assault.1

In the face of such worldwide need, Australia struggles with the arrival of so-called unauthorised persons seeking asylum, with over 9000 arriving this year.2 With a policy of indefinite mandatory detention, introduced in 1992, Australia is unique in its response to unauthorised arrivals. We now find ourselves in a highly politicised and divisive debate about both our international responsibilities and the very practical demands of providing health and mental health services to vulnerable populations. This debate challenges health professional groups to maintain a focus on the core values of practice and professional ethics. Over the past two decades, medical and health professionals in Australia have engaged in this complex area, where politics, health and human rights intersect. Since 2006, the medical colleges and key health groups, including the Professional Alliance for the Health of Asylum Seekers and their Children, have provided the Department of Immigration with advice regarding health and mental health needs of detainees. Such advice has repeatedly pointed to the impact of prolonged detention, particularly on children and vulnerable groups.3

A considerable body of research has consistently demonstrated high levels of mental disorder in detainee populations, as well as an association between length of time in detention and mental deterioration.4 Research commissioned by the Department of Immigration and Citizenship in 2010 found high rates of self-harm in detained unauthorised persons compared with illegal foreign fishers and visa overstayers.5 Similarly, asylum seekers detained in remote facilities have been found to have trauma-related disorders associated with their experiences in detention.4 The harsh environment of detention and the uncertainty of outcome contribute to mental deterioration. The implications for long-term adaptation and recovery for released asylum seekers are significant, and psychiatrists, mental health professionals and community refugee health services are now in the position of supporting individuals who have experienced both premigration trauma and the trauma of immigration detention. There continue to be concerns about the impact of detention on vulnerable groups, such as torture and trauma survivors and those with mental disorders, and the inherent difficulty of providing support and treatment within this environment.6

The asylum seeker issue has become one of the most contested social issues of the past half century. Australia is essentially a nation built on immigration, and we see ourselves as progressive in terms of a human rights agenda. But there is an underside to this, with the historical treatment of Indigenous peoples being the prime example, and now the failure to acknowledge human rights issues in asylum seeker policy.7 Current bipartisan support of offshore processing serves only to relocate relatively few asylum seekers in the interests of deterrence. This is a high-risk strategy in several ways. The most concerning of these is the potential for long-term detention in remote locations to lead to mental breakdown, as witnessed a decade ago in the first version of the “Pacific Solution”.8 Although we are seeing increasing community detention for asylum seekers, bringing us into line with most host nations, this also creates a corresponding need for community services.

Many clinicians are troubled by becoming observers of mental deterioration, or contemplating the harm caused by long-term detention in offshore settings such as Nauru. The clinical role necessarily involves advocacy for the rights of detainees to care, treatment and protection in the face of a system focused on detention, behavioural management and deterrence. The overwhelming challenge for clinicians is to provide evidence-based expert advice and treatment, within an ethical framework, in a political context where it is all too easy to overlook human rights concerns. The Australian Medical Association and several colleges continue to offer independent expert advice and support the establishment of a formal advisory body.

The medical profession must continue to advocate for the right to health and services for all peoples, and it has a key role in advocating for a humane response to asylum seekers in Australia and the region, with greater emphasis on protective frameworks. In situations where government policy is potentially damaging to people or violates human rights, we have a responsibility to raise objections. It is difficult to highlight these issues in the face of an overwhelming motivation to find a “solution” to the “asylum seeker problem”. The level of political and social discussion about the broader issues is limited and added to by an artificial sense of crisis. Despite these difficulties, we should question the use of offshore processing as a solution and support mainland community-based processing of asylum claims and the end of prolonged detention. Building community mental health services for traumatised asylum seekers continues to be an area of need in the immediate and longer term.

The health of asylum seekers and refugees deserves this attention.