Volume 199 - Issue 2
Seeking asylum: health and human rights in Australia
Authors: Joshua R Francis, Sarah Cherian and David Forbes
Med J Aust 2013; 199 (2): 99-100. || doi: 10.5694/mja13.10030
Published online: 22 July 2013
Published online: 22 July 2013
Data from a tertiary paediatric refugee health clinic show that instances of post-traumatic stress disorder are on the rise in this population, particularly in children who have been held in detention.
To the Editor: We congratulate Newman for her editorial advocating a humane response to the health needs of asylum seekers in Australia.1 Recently, we have been involved in the care of two such vulnerable children, referred by non-specialist doctors at a remote detention centre and transported to Perth, Western Australia, for emergency management and paediatric subspecialist input. These cases illustrate some of the unique medical and psychological problems affecting this population, and the potential risks associated with inadequate provision of health services.
The first child, a 19-month-old boy, presented with marasmus after a prolonged period of food insecurity and concurrent acute Campylobacter jejuni enteritis. He was treated with oral azithromycin and nutritional supplements. Electrolyte supplementation and multivitamins were administered to obviate complications of refeeding.
The second child, a 2-year-old boy, presented with multiple medical problems including pulmonary tuberculosis, severe impetigo (methicillin-resistant Staphylococcus aureus and Streptococcus pyogenes), extensive tinea capitis with multiple kerions, lymphadenopathy, malnutrition, failure to thrive, and developmental regression secondary to transit trauma. He was treated with nutritional support, trimethoprim–sulfamethoxazole, terbinafine, rifampicin, isoniazid, ethambutol and pyrazinamide.
The families of both children suffered significant psychological trauma during transit to Australian shores, compounded by the uncertainty associated with their detention status. Additionally, both families were initially separated, with the sick children and their mothers transferred to Perth for medical care, and their fathers and siblings remaining in the remote detention centre, before being reunited.
The psychological trauma of detention has resulted in increased rates of post-traumatic stress disorder (PTSD) among the population presenting to our tertiary paediatric refugee health clinic. The prevalence of PTSD features was remarkably low in children seen during 2006–2008 (nightmares in 25/1026 [2.4%]),2 but in a cohort of 200 children presenting in 2011 and 2012, 18 (9.0%) were considered to have PTSD, based on the presence of at least one symptom from each category of re-experiencing, avoidance and hyperarousal.3
Many factors may influence rates of PTSD diagnosis, including shifts in the demographics and associated experiences of the refugee population. Asylum seekers detained in Australia, previously rarely encountered at our clinic, represented 12.5% (25/200) of patients in the 2011–2012 cohort. Children in this cohort who had experienced detention in Australia were significantly more likely to present with features of PTSD than children who were resettled under the humanitarian entrant program (11/25 [44.0%] v 7/175 [4.0%]; P = 0.0001) (our unpublished data).
The true burden of medical and psychological disease among children in detention remains unknown, as access to specialist services is limited to those with acute or life-threatening manifestations. As Newman highlights,1 improved services and ongoing advocacy are required to deal with known problems and to gain a truer picture of the extent of health problems in this group.
Competing interests
No relevant disclosures.
References
- Newman LK. Seeking asylum: health and human rights in Australia [editorial]. Med J Aust 2012; 197: 596-597. 0_CBBFJGAC
- Mutch RC, Cherian S, Nemba K, et al. Tertiary paediatric refugee health clinic in Western Australia: analysis of the first 1026 children. J Paediatr Child Health 2012; 48: 582-587. 0_pgfId-2814762
- Scheeringa MS, Zeanah CH, Cohen JA. PTSD in children and adolescents: toward an empirically based algorithm. Depress Anxiety 2011; 28: 770-782. 0_CBBCGFGI