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

Jo Durham,Claire E Brolan,Maxine Whittaker,Chi-Wai Lui

doi:10.1186/s40985-016-0020-9

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.

Highlights

The power of the executive to cast a man into prison without formulating any charge known to the law, and to deny him the judgment of his peers, is in the highest degree odious and is the foundation of all totalitarian government
International law Having examined the content of Australia’s contemporary offshore immigration detention policy and practices, as well as what is known about asylum seeker health in immigration detention facilities, we will turn to investigate the violation of the right to health, and other human rights, of persons seeking asylum, and the inter-related silencing of Australian health professionals who provide healthcare to these persons
Often unhelpful and misplaced dichotomies are developed in response, especially by politicians: refugee health versus Australian border security; inappropriate funnelling of resources into refugee detainee’s health versus the health and well-being of marginalised Australians in under-resourced settings

Summary

Background

The power of the executive to cast a man into prison without formulating any charge known to the law, and to deny him the judgment of his peers, is in the highest degree odious and is the foundation of all totalitarian government. The Australian Human Rights Commission Report on the health of children in Wickham Point, an onshore detention centre for asylum seekers, found that children who had been held in Nauru were extremely traumatised as a result of the cumulative impact of a traumatic boat trip, movement to different onshore and offshore detention centres, as well as the fear of returning to Nauru [34]. Amnesty International, for instance, found unsafe medical practices in detention centres, including rapid health assessments occurring in inappropriate conditions and basic follow-up health services that are non-compliant with Australian standards [36] This includes inadequate antenatal care, including lack of access to ultrasound for pregnant women, inadequate medical care for children and poor prescribing practices and treatment of chronic conditions such as diabetes, delayed referral to tertiary levels of care, inadequate specialised mental psychiatric services, lack of access to adequate potable water and access to assistive devices for people with physical impairments [36]

Findings

Discussion

Conclusions