Days after a coroner found “systemic failures” caused the death of Hamid Kehazaei on Manus Island, doctors say healthcare on the island is the worst it has been. Guardian Australia has learned of at least two critical cases being left untreated: one man faces permanent blindness and another has been five days with a suspected fractured femur, given only Panadol and a bandage.

Doctors say more refugees under Australia’s care will die if healthcare is not reformed.

Iraqi refugee Mohammed Hamza Hussein, who lost sight in one eye when he was beaten with a post during the 2014 attack on the Manus detention centre is now going blind in his other eye.

Ophthalmologists have said he requires urgent intervention – including treatments not available on Manus Island – in order to save his sight.

“I’m the father of four girls,” 46-year-old Hussein, a former Iraqi policeman, told Guardian Australia through an interpreter, “but I’ve been locked up here for five years ... I want to be able to see my family again.”

Last week, Hussein attempted suicide, and survived only after friends intervened. Serious concerns remain for his deteriorating mental health.



Ophthalmologists say Mohammed Hamza Hussein requires urgent intervention to save his sight. Photograph: Nikala Sim/Supplied

In a separate case, Somalian refugee Abdikaldeawe Abdisalam has been living with a a suspected broken femur for five days following an accident playing football. He has not been x-rayed and given only Panadol and a bandage as treatment.

In both cases, doctors have implored the government to allow the men to urgently be treated in Australian healthcare facilities.

‘I beg you, please help me’

On the night of February 17, 2014, the Manus Island detention centre was invaded by guards and rioters from outside, who attacked those held inside. Reza Barati was murdered by at least two guards, and Hussein was beaten into unconsciousness with a wooden post, causing massive injuries to his face.

Hussein has not been able to see with his right eye since.

Four years on, Hussein, who is also diabetic, is now losing sight in his left eye. His vision has been reduced to only just being able to count fingers held up to that eye.

The most recent doctor’s report, written this month and shared with Guardian Australia, stated:

“Poor visual prognosis in the right eye. The eye is blind and there is no treatment. He needs counselling for this.

“Vision in the left is getting worse. It is most probably diabetic maculopathy. He needs urgent OCT (Optical coherence tomography – an imaging test) and an anti-VEGF injection (used to treat retinal and macular conditions).”

Neither of those tests is available on Manus Island.

Hussein has told friends on Manus and advocates in Australia he fears going blind.

“I beg the Australian prime minister and immigration minister: I have lost one of my eyes, and now I am losing another eye and I’m going to be blind. I plead to whomever … to help me. I don’t want to be blind. I beg you, please help me.”

Ophthalmologist Dr Hessom Razavi treated Hussein twice on Manus, in 2015 and 2016. He said his deteriorating physical health caused him immense mental anguish.

The injury to Hussein’s right eye was a severe trauma, Razavi told Guardian Australia. The impact on his eye was “like being in a car crash” and the loss of sight irreversible.

“When I saw him he was absolutely distraught, and very fearful about his other eye. Every time I saw Mohammed, he was in tears every time: a grown man, slumped over crying.”

Razavi said when a patient loses sight in one eye, they become “VIP patients”, requiring additional check-ups to ensure the remaining eye maintains good vision.

“But in the system over there, that follow-up just doesn’t happen. And the technology that you would use to do those checks just doesn’t exist.

“Mohammed doesn’t have regular access to an appropriate level of care. A person in the worst situation in Australia would have better access to care.”

Razavi said there were “good people, working hard” on Manus to assist Hussein, but the offshore system was deeply flawed and dangerous. He said Australia held a clear moral obligation to provide Hussein with the care he needed.

Razavi has said he is willing to treat Hussein if he can come to Australia.

‘It could threaten his life’

Somalian refugee Abdisalam, who has been on Manus for five years, is at risk of losing his leg or dying from compartment syndrome, doctors say, if his suspected broken femur continues to be left untreated.

Abdikaldeawe Abdisalam is at risk of losing his leg or dying from compartment syndrome, doctors say.

There is currently no working x-ray machine on Manus Island to determine whether he has broken his femur, and how badly.

Since the withdrawal of IHMS from Manus, healthcare for refugees and asylum seekers in the Australian-run camps is provided by a clinic run by the Pacific International hospital (PIH).

The PIH clinic was closed when Abdisalam injured himself on Friday. On Saturday, he went to the Lorengau hospital, where he waited several hours before being told to return Monday for an x-ray.

On Monday, when Abdisalam returned to the hospital, he was told the x-ray machine was broken. He went back to the PIH clinic at the refugee centre but was told by the doctor he could not be treated unless he had an x-ray. When he told the doctor “I will stay here until you solve the problem”, the doctor called security and had him ejected.

In a formal complaint to camp manager JDA Wokman, Abdisalam begged for painkillers.

“I cannot sleep day or night because of that horrible pain that none of you can ever imagine. The pain kills me every minute ... all I see is just pain. The leg is broken, and the fracture in the bone is not yet medically dealt with. Please, I need desperately emergency medical assistance.”

The precise details of the Pacific International hospital’s contract with the Australian government are not known. However, the latest government contract to the PIH – for “comprehensive health services” but for just 42 days – was more than $4.8 million, or more than $110,000 a day.

Dr David Berger, a specialist in remote and emergency medicine and an executive committee member with Doctors for Refugees, said if Abdisalam has fractured his femur, he is at risk of pulmonary emobulus or fat embolus “both potentially – and likely – life-threatening conditions”. He is also at risk of compartment syndrome, which can cut off blood supply to the limb.

“It’s extremely urgent, he’s got a condition that threatens his leg, and if it’s untreated, it could threaten his life. It’s that serious,” Berger said.

“This is Kehazaei 2.0,” Berger said. “This is a case where somebody with an urgent condition does not have their case escalated. And we have seen, delays in treatment are threatening to life.”

‘Scandalous’ medical neglect

Berger said in the wake of Queensland coroner Terry Ryan’s findings this week on the 2014 death of Hamid Kehazaei, the continued medical neglect of people to whom Australia owed a legal duty of care was “scandalous”.

Ryan was scathing of the healthcare provided to those held in offshore processing. He said “multiple errors” – including not having basic antibiotics to treat common tropical infections – and “systemic failures” such as doctors’ orders being ignored or overruled by non-medically trained bureaucrats – in Kehazaei’s care caused his death.

Ryan said Australia was responsible for Kehazaei’s “preventable” death, and recommended healthcare be improved to a standard comparable with Australia, or people moved off the offshore islands.

Berger said there had been a significant reduction in the quality of healthcare on Manus Island since the departure of IHMS last year.

“PIH has taken over primary healthcare, but does not do as good a job and we have no mechanism to raise concerns with them. The Lorengau hospital is in an appalling state, often without even a functioning ECG machine or x-ray machine, as now.

“It is safe to say there is no functioning healthcare in any form that an Australian would recognise and no way to escalate concerns in any manner, let alone a timely manner. These cases are not isolated ones.”

A Manusian man died in Lorengau hospital last week after presenting with chest pains. He died after several hours without seeing a doctor, island sources told Guardian Australia.

Berger has written directly to the Department of Home Affairs chief medical officer, Dr Parbodh Gogna, on the Hussein and Abdisalam cases but has not received a reply.

“We have sent multiple emails about healthcare issues since he started this month. We have yet to hear back from him about any of them.”

Guardian Australia has made multiple requests for interviews with Dr Gogna, but these have been declined.

The department does not comment on individual medical cases.

A spokeswoman told Guardian Australia the department “is reviewing the findings of the Queensland coroner in relation to the death of Hamid Kehazaei in 2014”.