Refugee children on Nauru are facing an unprecedented health crisis and are at a real risk of death, three whistleblowers have warned.

One healthcare worker recently employed on Nauru told 7.30 some of the children are using Google to research ways to die.

Leaked documents compiled by immigration workers and obtained by 7.30 reveal a shocking spate of recent self-harm incidents.

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One incident report from June 2018 says a 14-year-old refugee child "had poured petrol over herself and had a lighter".

A further report from June shows a 10-year-old refugee "attempted to self-harm by ingesting some sharp metal objects".

The metal objects were consistent with fencing wire, the report said.

"Am I concerned that children could die in Nauru, that some of these refugee children could die? I'm absolutely concerned about that. I'm reasonably surprised that no-one has," said Dr Vernon Reynolds, a former child psychiatrist on the island employed by the Australian Government's contractor, International Health and Medical Services (IHMS).

"I certainly hope that nothing fatal happens. I am deeply concerned that we will see that."

'We're neglecting these kids'

Dr Vernon Reynolds worked on Nauru for almost two years. ( ABC News )

Dr Reynolds is one of the longest serving mental health staff on Nauru. He was deployed continuously by IHMS from August 2016 to April 2018.

He said the children are exhibiting signs of severe trauma.

"What we see is these young people and adults basically withdraw from life and generally take to their bed and their whole functioning deteriorates," Dr Reynolds said.

"They stop eating much, they stop drinking much, they stop looking after their day-to-day self cares.

"They stop interacting with people, they stop talking, they stop doing anything they might have done for interest and enjoyment and they really just exist in their bed."

He said he also recommended that children with developmental disabilities should be brought to Australia for specialist care.

"My reports became probably stronger and stronger in their wording, talking about how we're failing these kids, how we're neglecting these kids," he said.

"How we have a duty of care to treat these kids appropriately, and how by not doing these things we are increasing the harm and the long-term disability."

He was scheduled to return to Nauru in April 2018, but he said IHMS told him the day before his deployment that Australian officials had asked that he not return, because of his increasingly strident clinical recommendations.

"Twenty-four hours before I was due to hop on the plane I was told, 'I'm sorry, you're not going, the Australian Border Force has declined your ability to go back'," he said.

"I was told by my employer [IHMS] that some of my statements were too personalised ... they weren't clinical enough, and that I was potentially putting the organisation, or potentially the Government, at risk by stating we were neglecting the care of these children."

A spokeswoman for Australia's Department of Home Affairs said in a statement; "Any transferee at risk of actual or threatened self-harm receives immediate and appropriate medical care and support.

"Health care for all persons, including transferees and refugees, in Nauru is the responsibility of the Government of Nauru."

'The children have given up hope'

Fiona Owens says working on Nauru was "an impossible job". ( ABC News: Alex McDonald )

Dr Reynolds is not alone in his concerns. Social worker Fiona Owens was employed by IHMS as the child mental health team leader from May to July 2018, and alleges she witnessed alarming rates of self-harm among children.

"The only thing a lot of the children are thinking about is how to die. They Google it on the internet," Ms Owens said.

"The extreme possibilities are death of children, death of adults, continual death of adults and children."

Ms Owens has worked in difficult places all around the world. But she said working on Nauru became an impossible job.

"I've never worked anywhere where it's been an impossible job before," she said.

She said Australia's agreement with the United States to resettle refugees on Nauru was initially welcomed by refugees when it was announced in October 2016. But as of May 2018, close to 250 people on Nauru had been resettled, with 939 asylum seekers and refugees remaining on the island. Of these, 137 are children. Refugees live in the community on Nauru and are not held in the Regional Processing Centre.

"Unfortunately for a lot of Iranian and Somali families, they haven't been able to go to America," she said.

Donald Trump's administration suspended the US refugee program in January 2017, and has taken a strict approach to vetting entrants from countries such as Iran, Iraq, Syria and Sudan.

"For those families there's an extreme lack of hope for their future and a hope for their children," Ms Owens said.

"The children have given up hope because the parents have, so the whole families implode with the knowledge that their only hope was to go to America and that's now been dashed."

'An awful situation'

Registered nurse Jacinta O'Leary worked on Nauru. ( ABC News: Alex McDonald )

The Australian Government said the healthcare of refugees on Nauru is a matter for the Government of Nauru.

Transfers to countries overseas for refugees who are too unwell to be treated on Nauru are managed by the Nauruan Government's Overseas Medical Referral (OMR) system.

The process created particular difficulties for pregnant refugees seeking terminations, according to another health worker, because abortions are illegal on Nauru.

Jacinta O'Leary was a nurse and midwife on Nauru from June to September 2017, and saw firsthand how it affected some women.

"Women who were being denied transfer to Australia to have a termination, they were faced with the prospect of continuing with an unwanted pregnancy, which significantly increased their mental health burden," she said.

Ms O'Leary is the first former staff member on Nauru to speak out about what transpired with these pregnant women. She cared for three women who were seeking terminations.

Previously, refugees seeking terminations were brought to Australia at the discretion of Australian officials. But according to a November 2017 government briefing, Australia's Department of Home Affairs agreed that terminations should be considered part of the OMR process in July 2017 "in recognition of the sovereignty of Nauru and its responsibilities for the care and welfare of refugees".

The policy lasted for about three months, but Ms O'Leary said it had a dramatic toll on the three women she cared for.

"They were self-harming, they had plans for suicide, for home abortion. It was an awful situation," she said.

Australian lawyers launched a Federal Court case to have the women brought to Australia. The Government agreed to bring them to the mainland because the proceedings went to a hearing.

The November 2017 government briefing states that in October 2017 the Australian High Commission on Nauru was told the Government of Nauru had agreed to remove terminations from the OMR process, which means Australian officials again decide if they need to be moved off the island.

A spokeswoman from Australia's Department of Home Affairs said in a statement; "Australia provides significant support to the Government of Nauru to provide welfare and health services, including mental health care, education and to support law and order.



"A range of care, welfare and support arrangements are in place to provide for the needs of refugee children and young people. Service providers are contracted to provide age-appropriate health, education, recreational, and cultural services."

A spokeswoman from the Government of Nauru said; "The Nauru Government will not be answering questions at this time."

A spokeswoman for IHMS said; "IHMS is not at liberty to discuss these issues."

Concerns about how OMR works

Refugee children on Nauru. ( Supplied: World Vision )

Documents obtained by 7.30 under Freedom of Information laws reveal that Australia has a substantial role in the OMR process.

The briefing document shows the Australian Government is responsible for funding the process for refugees and arranging treating specialists.

Once Nauru's OMR group signs off on a transfer, a powerful Australian Government committee, known as the Transitory Person's Committee, then considers clinical recommendations for transfer to Australia.

A request is then made to the Nauruan secretary of multicultural affairs to approve the movement of a patient.

The process is seen as cumbersome, and former detention staff have previously raised concerns with 7.30 about how it works.

In a recent Federal Court decision, Justice Bernard Murphy wrote that he agreed a suicidal refugee child should be brought to Australia.

"I do not consider that the OMR process is adequate or likely to be sufficiently swift to adequately protect against the risk of suicide," he wrote.

For more on this story, watch 7.30 tonight on ABC or iview.