Urgent call from GPs for healthcare standards boost on Manus and Nauru

Refugees and asylum seekers on Manus Island and Nauru are a uniquely vulnerable cohort, having experienced prolonged detention and facing limited (if any) permanent settlement opportunities. Healthcare workers at both offshore sites report high rates of severe mental illness.
 
In the wake of the inquest into the preventable and tragic death of Iranian asylum seeker Hamid Kehazaei, the immediate need is for specialised psychiatric services, inclusive primary health and access to emergency and critical care, in conjunction with clear procedures for medical evacuation.
 
Unfortunately, the closure of the Manus Island Regional Processing Centre (MIRPC) in 2017 saw the withdrawal of nearly all Australian health and support services.
 
UNHCR reported that remaining health services for asylum seekers on Manus Island are rudimentary, have restricted hours and minimal access to diagnostic tools or medicines. There are limited mental health services, no outreach, or after-hours capacity and no interpreters. Specialist medical and allied health services are no longer available.
 
Pacific International Hospital in Port Moresby now oversees healthcare for the men who remain in Lorengau transit centres, while the Republic of Nauru hospital has assumed care for individuals and families on Nauru. While information on the quality of these health services is scarce, it is assumed that asylum seekers receive equivalent treatment to the local community, that is, below the standard of care available in Australia and presumably not tailored to the specific health needs of refugee groups.
 
As RACGP President Bastian Seidel has said, improving standards of health services in PNG and Nauru, commensurate to that found in Australia, could offer mutual benefits to the local communities and asylum seekers. However, it is expensive and takes time. It also needs the collaborative will of Australian, PNG and Nauruan governments. In the first instance, the Australian Government needs to move away from the deterrent policy to one that is transparent and open to scrutiny by independent advisors.
 
What view should Australian GPs and other health professionals take on the Manus Island issue?
GPs have a vital role in advocating for asylum seekers. There were more than 65 million displaced people worldwide in 2017. This is a global crisis.

Under the current policy, the asylum seekers on Manus Island, Nauru and many living in the community in Australia (most of those who arrived after 13 August 2012) will never settle permanently in Australia, or reunite with their families. The stress of this has caused unnecessary deaths, particularly in offshore detention centres.
 
Australia has a duty of care to the asylum seekers it transported to and detained on Nauru and PNG. We cannot abdicate our obligations because they are out of sight.
 
Ultimately, Australia needs to change its migration policy and prioritise securing resettlement options in countries (if not within Australia) with established capacity to provide the health, education and social support asylum seekers deserve.
 
In lieu of this, we support the recommendations made by Coroner Terry Ryan for independent oversight and clinical audits of health services in Nauru and PNG to urgently align them with Australian standards.
 
GPs may choose to advocate for asylum seekers by educating the wider Australian community, or by approaching the Federal Government individually, with the RACGP, and/or through humanitarian groups to help prevent further adverse outcomes and deaths.

“asylum “manus “nauru” “refugee health” island” seeker”