Crystal Gao, Editorials and Publications Team PMSA
Nauru, located in the South Western Pacific Ocean, is the world’s smallest island nation. Since 2001, it has been the site of Australia’s processing centre for refugees and asylum seekers and as of May 2018, there were 821 recognized refugees living on Nauru, including over 100 children who were brought to or born on the island.
Since its establishment, major concerns have arisen regarding the health and wellbeing of refugees and asylum seekers held at Nauru. This was escalated in 2016, when a series of leaked incident reports exposed cases of sexual assault, mental illness, physical and psychological abuse, self-harm and suicide attempts in the refugee/asylum seeker population; to date, there have been 12 deaths as a result of suicide, medical neglect, or unprovoked violence at the offshore detention centre.
Those living at the detention centre in Nauru face considerable barriers regarding access to healthcare, including access to dental, mental health, and maternity services. This is in part due to the lack of infrastructure to support adequate healthcare practices, as well as the economical cost of seeking medical help given that these refugees/asylum seekers are not eligible for Medicare or any form of financial aid (1).
Access to healthcare is further complicated by the complex political dynamics between Australia and Nauru. Just this year, a number of requests for urgent medical transfers were ‘blocked’ by the authorities on Nauru, with the Australian government reluctant to send in their air ambulances and defy this refusal of permission. Furthermore, in the last financial year alone, the Australian government has spent over $320,000 in legal costs, trying to challenge these requests for urgent medical transfers of refugees/asylum seekers from Nauru and the nearby Manus Island (2,3).
The treatment of refugees and asylum seekers at these detention centres has posed as an ongoing ethical and professional dilemma for doctors in Australia, as they are caught between their professional obligations to the Australian government and their duty of care as doctors to all patients in need, regardless of their background. This is an urgent issue that needs to be prioritised, as in terms of ensuring adequate and timely aid is delivered to those on Nauru Island who are critically ill and need it most, we as a nation are nowhere near there yet (4,5).
1. Paxton GA, Cherian S, Zwi KJ. The Royal Australasian College of Physicians position statement on refugee and asylum seeker health. The Medical Journal of Australia. 2015;203(4):176-177.
2. Davidson H. Australia spent $320,000 fighting requests for urgent medical transfers of asylum seekers 2018.
3. Davidson H. Australia let Nauru block refugee medical transfers to preserve 'relationship'. 2018.
4. Murray SB, Skull SA. Hurdles to health: immigrant and refugee health care in Australia. Australian Health Review. 2005;29(1):25-29.
5. Briskman L, Zion D, Loff B. Challenge and collusion: health professionals and immigration detention in Australia. The International Journal of Human Rights. 2010;14(7):1092-1106.