A detailed report released by Médecins Sans Frontières (MSF) documents the severe levels of mental health degradation among refugees on the small island nation of Nauru, which hosts one of Australia’s offshore asylum-seeker prison camps.
MSF provided mental healthcare on Nauru for 11 months, from November 2017 to October 2018, before being given just 24 hours’ notice to pack up and leave, despite hundreds of patients requiring ongoing care.
The report stated that the data collected “shows that the mental health suffering on Nauru is among the worst MSF has ever seen, including in projects providing care for victims of torture.”
Throughout their 11 months on Nauru, MSF staff faced hostility and obstruction from Nauru government officials, despite a memorandum of understanding signed between MSF and the health minister.
MSF staff were forced to leave hospitals in the middle of treating patients, not always allowed into asylum-seekers’ accommodation, and banned from the prison facilities themselves. They also experienced long visa delays and other organisations were directed not to refer refugees to MSF for mental health services.
Despite these obstructions, the MSF report is a damning indictment of Australia’s bipartisan border protection regime, in which all asylum seekers who attempt to reach Australia by boat are either turned away by naval vessels or indefinitely detained.
MSF provided care for 285 patients, of which 73 percent were asylum seekers or refugees, and 22 percent were Nauruan nationals. The remaining 5 percent were foreign workers or had unknown status. The patients ranged from under 1 to 74 years of age, with 19 percent of patients under the age of 18.
The mental health conditions of the patients were assessed via the Global Assessment of Functioning (GAF) scale, which measures the impact the patient’s mental health has on their daily life. With 1 the most serious rating and 100 the best, scores below 70 are considered unhealthy.
For the Nauruan patients their GAF score was 35, reflecting high rates of untreated psychosis on the island, as Nauru has no acute mental health treatment services. For asylum seekers and refugees, their median score was 40.
Among the asylum seekers, 60 percent (124 patients) had suicidal thoughts, and 30 percent (63 patients) had attempted suicide. “Children as young as 9 were found to have suicidal thoughts, committed acts of self-harm or attempted suicide,” the report stated.
Nearly two-thirds, 62 percent, of the refugee and asylum seeker patients were diagnosed with moderate to severe depression. Among them, 25 percent had anxiety disorder, 18 percent suffered post-traumatic stress disorder and 6 percent, or 12 patients, were diagnosed with resignation syndrome. This is a rare condition, produced by forms of extreme depression, which can lead a victim into a catatonic state.
The report quoted psychiatrist Professor Louise Newman’s description of the condition: “This comatose state appears to be a state of ‘hibernation’ in response to an intolerable reality. They are unresponsive, even to pain. They appear floppy, without normal reflexes, and require total care, including feeding and intravenous fluids, as otherwise they risk kidney failure and death from complications caused by immobility, malnutrition and dehydration. This is a life-threatening condition needing high-level medical care.”
Australia’s anti-refugee “border protection” regime maintains a “deterrence” policy, which involves creating conditions so harsh that no asylum seekers will attempt to reach Australia. In practice, this means the psychological and physical torturing of families.
One cruel practice is the family separation policy, started in late 2016, in which detainees requiring urgent medical evacuation to Australia are transferred alone or with a single family member. MSF’s data shows that those subjected to this inhuman policy are 40 percent more likely to have suicidal thoughts and/or have attempted suicide.
“One of the most distressing outcomes of this policy of indefinite trapping of refugees on Nauru is that of family separation,” Dr Christine Rufener reported. “Our mental health team has worked with multiple fathers who have been separated from their wives and children for months or for years. Fathers told us: ‘I wasn’t there to support my wife during her pregnancy or childbirth; I wasn’t there when my baby took his first breath’.”
MSF concluded that the “alarming level of mental health distress is related to Australia’s offshore processing policy.” Indefinite detention itself was a major contributing factor—65 percent of asylum seeker patients told MSF they felt they had no control over the events in their lives. These patients had a significantly higher chance of being suicidal or being diagnosed with major psychiatric conditions.
Dr Beth O’Connor, an MSF psychiatrist, said: “Patients spoke about the injustice of their situation. Most people have been recognised as refugees, yet while they have been told there are processes to resettlement, the criteria are unclear. People try to learn the ‘rules’ of the system, but the rules keep changing. They realise it is impossible to help themselves.”
MSF reported that 55 percent of the Nauruan nationals it treated showed signs of recovery once their psychosis was addressed and they were placed on appropriate medication. By contrast, only 11 percent of asylum seeker and refugee patients improved, 69 percent deteriorated, and 20 percent remained stable.
The report stated: “This suggests that while MSF could stabilise some these patients, without a change to their living conditions and asylum situation, significant clinical progress was unlikely.”
Farhad, a man imprisoned on Nauru, told MSF: “If I was in my home country, the government wants to kill me straight away. I tried to come to Australia and the government kills me a little by little, step by step. They tormented me a lot over five years on Nauru because I have no future in my life.”
The criminal and inhumane treatment of refugees and asylum seekers is the direct responsibility of not just the current Liberal-National Coalition government. The previous Labor government, which was kept in office by the Greens, reopened the Nauru camp, and another on Papua New Guinea’s Manus Island, in 2012.