Back on Nauru, MSF tried to negotiate with the Nauruan government, but its plan to bring a senior delegation onto the island to try and hash out a way forward was met with no response.



On Wednesday MSF announced its services had officially been terminated, and all international staff had left the island. The departure means only medical staff contracted by the Australian government – those working for International Health and Medical Services (IHMS) – are available to treat refugees and asylum seekers.

At a press conference in Sydney on Thursday, Rufener, McPhun and psychiatrist Beth O’Connor told the Australian government in no uncertain terms that it needed to get refugees and asylum seekers off Nauru now. Many have been detained on the island for more than five years.

"Australia’s policy of indefinite detention should be immediately stopped," McPhun said. "And I absolutely emphasise it should never be looked upon as a model for other governments to replicate."



McPhun declined to speculate on the possible reasons for being handed marching orders, besides saying the notion of simply not being needed anymore was ludicrous.

"It cannot be that 11 months ago we reached an agreement that there was a significant need for mental health services on Nauru, and MSF with its background of over 45 years of working exactly with these kinds of patients was the ideal organisation to fill that gap, and that 11 months later that gap is somehow filled," he said.

Rufener and O'Connor, who was on Nauru for almost the entire 11 months with MSF, told of what they had seen during their time on the island.

Rufener has worked with refugees on the island of Lesbos in Greece and with refugee survivors of sexual violence and torture. The difference on Nauru, she said, is the "utter destruction of people’s sense of hope".



"It’s this hopelessness. It’s this nothing," she said. "Trying to find coping strategies when they've tried everything, and it’s for what? To improve your life to continue to stay here? And not have opportunity? And not being able to live the life you want to live – not a fancy life – but just to have basic human freedoms?"

Rufener said the word she heard most often in her sessions with patients was "destroyed".

"People feeling that their sense of self and any hope that they have about living a meaningful future has been irrevocably destroyed. I heard it in their words and I saw it in their eyes."



The separation of families in offshore detention was an ongoing problem, she said.

"Fathers told us, 'I wasn’t there to support my wife during pregnancy. I wasn’t there in the hospital to support her while she was giving birth. I wasn’t there when my baby took his first breath. I wasn’t there when my child said his first words. I wasn’t there when my child took his first steps'. Every day, these fathers lose the last remnants of hope that they will ever be allowed to meet, to touch and to hold their own children."

O’Connor witnessed a serious decline in health after more than 70 people were rejected from a resettlement deal with the United States in May.

"We saw patients who previously had some life, some spark, come into the clinic and their faces were dull," she said. "There was a real dullness in their eyes. And I never saw that spark return. I never saw the energy or life for these people return, right up until I left."

There were also children on Nauru O’Connor got to know. They'd come up to say hello when they saw her in the settlements or in a shop, but over time she saw them deteriorate into a catatonic state with resignation syndrome.

"They became more depressed and they withdrew socially," she said. "When I went to visit these children at home, they had taken to their bed. They were no longer eating or drinking sufficient amounts to keep themselves alive. Many were no longer able to toilet themselves, they were incontinent of urine and of faeces. And when I tried to talk to them, to these children who would previously talk back to me, they would not respond. They would just stare through me."

She told BuzzFeed News the children with the syndrome would have occasional episodes of acute agitation — another symptom of the rare psychological disorder that has been recorded among refugee children in Sweden.

"A child lying in bed would suddenly become very agitated and difficult to control, and then fall back into this state," she said.