‘Someone needs to say, enough’: Mental health on Manus Island

The act, and the images that have resulted, are shocking.
 
A 30-year-old Somali man lying on the floor coated in the white chemical powder that extinguished the flames after he set himself alight. The man has been held in indefinite detention for many years, with no foreseeable end in sight.
 
This is one of the most recent – and high-profile – in a long string of almost 70 self-harm incidents and attempted suicides at the former site of the Australian-run detention centre on Manus Island.
 
While the mental health status of the detainees on Manus Island and Nauru have long been of concern within the medical community, such incidents appear to have vastly increased since the re-election of the Coalition government.
 
While Dr Nick Martin, former senior medical officer on Nauru, feels these events are tragic, he is unsurprised.
 
‘These are people who have [been in detention for] six, seven years now,’ he told newsGP. ‘The rhetoric [the Coalition] are coming out with, saying they’d like to repeal the medevac bill just seems very punitive.
 
‘So it may well be called protesting behaviour, but I think these are people who feel they have got no other option to show their despair other than self-harming and attempting suicide.’
 
Dr Ai-Lene Chan, GP and Secretary of the RACGP Refugee Health Specific Interests network, agrees that indefinite detention is putting enormous strain on detainees, and perceives such treatment as inhumane.
 
‘The people on Manus and Nauru have nearly lost all hope,’ she told newsGP. ‘Most of them have been there for nearly seven years, which is an extremely long time.
 
‘We know already that putting them in indefinite detention is going to cause mental health problems, and that the longer that occurs, the more severe the mental health problems and the more difficult it will be to remediate them and for people to recover.’
 
Dr Chan understands it can be difficult for everyday Australians to comprehend the situation faced by detainees, but believes these incidents of self-harm are eloquent expressions of their sense of hopelessness.
 
‘It’s just an incomprehensible situation that none of us, hopefully, will encounter,’ she said.
 
‘I think people see things like self-immolation or cutting or hanging, all these forms of self-harm – it frightens them, because it’s violent, it’s scary, and they make the connections that the individual is a violent, scary person when, in fact, it is often the people who are quiet and who have tried to stoically live through this and have just lost all hope.’
 
Dr Martin regards offshore detention as an attempt by successive Australian governments – Labor as well as Liberal – to keep the issue of asylum seekers and refugees who have arrived by boat at ‘arm’s length’. He believes that it is not just ineffective policy, but morally wrong.
 
‘It’s not a crime to claim asylum,’ he said.
 
‘Australia needs to change the tired old rhetoric about, “We’ve stopped the boats”.
 
‘We need to accept this is not the way to do it, that it doesn’t fulfil Australia’s obligation in international law.
 
‘Offshore detention, and indefinite detention, is a dreadful policy. If you approach claims in a defined period of time, that’s a whole different situation to saying, “You’re stuck there for years and years and years”.’
 
A 30-year-old Somali man who has been held in indefinite detention, after he set himself alight. (Image: Supplied)

Dr Chan agrees that processing of asylum and refugee claims needs to be done more quickly, and also points out the issue is not unique to Australia.
 
‘There are very clear rules for how to manage international law, how to manage people who are seeking asylum,’ she said. ‘We can manage that as a country, regardless of how many people there are.
 
‘And the situation is international. The whole world is dealing with this because of wars, because of political decisions that are made by our governments. We know that these people are leaving, we can see it, we can predict it.
 
‘We need to have processes in place to process them quickly, before they get on a boat or after they get on a boat.’
 
Dr Martin highlights a very pertinent example of how better to handle the processing of asylum seekers and refugees, not too far back in history – the period after the Vietnam War.
 
‘When all the people were leaving Vietnam in 1979, the United Nations convened an international conference in Geneva, resulting in the Orderly Departure Program,’ he said.
 
‘[For] South-East Asian countries that beforehand had refused to let boats arrive, if they granted temporary asylum, Vietnam agreed to promote orderly departures, and Western countries agreed to accelerate resettlement.
 
‘As a result of that, there was a sharp reduction in boat departures in Vietnam, boat arrivals in Australia, and people dying at sea.
 
‘It can be done.’
 
Dr Martin acknowledges, however, that such a solution would require considerable political will.
 
‘If Australia directed even a fraction of the resources it’s throwing at Manus and Nauru right now to work with regional partners like Indonesia and Sri Lanka to say, “We’re going to get people who are thinking about trying to arrive in Australia by boat, we’re going to process them quickly and humanely within Indonesia”, that would be one way of doing it,’ he said.
 
‘But that requires political courage, and it also requires a shift in the current toxic discourse that’s going on right now.’
 
Dr Martin praised the work of doctors who are speaking out about the conditions of refugees and asylum seekers in offshore detention. He feels that if the situation doesn’t change, there will be hard questions for Australia to answer in the future.
 
‘Australia can’t say, “We are the most successful multicultural nation, we have a very generous refugee reassessment program” on one hand, whilst treating people who are overwhelmingly found to be genuine refugees because they are fleeing persecution via boat on the other hand,’ he said.
 
‘Someone needs to say, “Enough, this is not humane, this is not what protecting our waters is supposed to mean”.’

Manus Island offshore detention refugee health refugees and asylum seekers