The need for a rights-based public health approach to Australian asylum seeker health

Abstract

Public health professionals have a responsibility to protect and promote the right to health amongst populations, especially vulnerable and disenfranchised groups, such as people seeking asylum and whose health care is frequently compromised. As at 31 March 2016, there was a total of 3707 people (including 384 children) in immigration detention facilities or community detention in Australia, with 431 of them detained for more than 2 years. The Public Health Association of Australia and the Australian Medical Association assert that people seeking asylum in Australia have a right to health in the same way as Australian citizens, and they denounce detention of such people in government facilities for prolonged and indeterminate periods of time. The position of these two professional organisations is consistent with the compelling body of evidence demonstrating the negative impact detention has on health. Yet in recent years, both the Labour and Liberal parties—when at the helm of Australia’s Federal Government—have implemented a suite of regressive policies toward individuals seeking asylum. This has involved enforced legal restrictions on dissenting voices of those working with these populations, including health professionals. This paper outlines Australia’s contemporary offshore immigration detention policy and practices. It summarises evidence on asylum seeker health in detention centres and describes the government’s practice of purposeful silencing of health professionals. The authors examine how Australia’s treatment of asylum seekers violates their health rights. Based on these analyses, the authors call for concrete action to translate the overwhelming body of evidence on the deleterious impacts of immigration detention into ethical policy and pragmatic interventions. To this end, they provide four recommendations for action.

“Tough on borders”: how Australia’s immigration detention system fails refugee and asylum seeker health

“…9 However, there has been criticism that their medical care in detention facilities falls under the jurisdiction of Commonwealth immigration law and operates outside the scrutiny of state and territory health policies. 11 Almost 1400 individuals remain in immigration detention in Australia in facilities such as the Villawood Detention Centre as well as alternative places of detention onshore. 8 Ten of these individuals were initially transferred from offshore facilities under the now defunct Medevac legislation in 2019 and remain detained in alternative places of detention.…”

“…[6][7][8]24,25 Historically, whistleblowing in health care has not been welcomed on a systemic level when it comes to immigration detention, as was the case in the now repealed Australian Border Force Act 2015. 8,11,[25][26][27] Discharging refugees and asylum seekers from inpatient hospital settings to detention facilities has presented clinicians with further dilemmas. There have been instances of pressures exerted by the federal government and the Australian Border Force to discharge patients once inpatient care has been completed, despite concerns that adequate safety and continuity of care in detention has not been guaranteed.…”

“…Before 2013, the Immigration Health Advisory Group, consisting of specialists in areas including psychiatry and public health, advised the Department of Immigration and Border Protection to ensure that an appropriate standard of health care was implemented in immigration detention. 11 Following its disbanding in 2013, the independent oversight into the medical care of detainees is lacking. There needs to be renewed calls by more medical professionals, reinforcing the AMA request for an independent panel of experts who regularly review the conditions and medical care delivered by IHMS in immigration detention.…”

“…International Health and Medical Services (IHMS), tasked with the medical care of detainees, has been paid $138.8 million over the past 5 years 9 . However, there has been criticism that their medical care in detention facilities falls under the jurisdiction of Commonwealth immigration law and operates outside the scrutiny of state and territory health policies 11 …”

Damaging the Future: The Health Rights of Children and the Issue of Short-Termism; Issues Facing Australian Bioethicists

“…Australia's treatment of asylum seekers violates their health rights. 6 Should health practitioners-particularly given that they cannot report on what they have witnessed-operate in such centers, or by so doing, are they in fact complicit in a form of torture? 7 A 2016 article argued that health practitioners breach the principle of "do no harm" through inaction and silence, and that it is their duty to bring "the evidence base of right to health (and other inter-related rights) violations to the attention of the Australian public."…”