A refugee suffering an acute mental health crisis and a broken ankle that requires surgery has been waiting more than a year to be transferred from Australia’s offshore immigration centre on Nauru for medical treatment.

But doctors fear Zamal – a pseudonym – has now become “too sick to transfer” because he may never be well enough to return to Nauru.

Australian Border Force has not made a decision on Zamal’s transfer despite Nauruan authorities twice approving his transfer, and repeated warnings from doctors that he presents a “medical emergency” and cannot be cared for on the island.

“This is a high-risk situation and considered a medical emergency. Risks are of brain damage occurring as a result of ongoing seizures, and also harm or death,” the Australian government’s health contractor International Health and Medical Services has said.

Redacted IHMS document.

Zamal is a refugee from Myanmar, a member of that country’s persecuted Rohingyan minority.

His wife and baby are already living in Australia, having been moved from Nauru.

The Guardian understands discussions are continuing on the island about his treatment and possible transfer.



Reports on Zamal’s condition have been shared with the Guardian and show his condition deteriorating precipitously. He has made repeated attempts to kill himself.



“Mental state continues to deteriorate, low frustration tolerance, continued pain, intermittent compliance with medications. Crying requesting to go home. Risk of harm continues to escalate.

“Due to his current mental state he appears not to understand his current situation.

“We cannot guarantee the safety of Zamal or staff under the current circumstances.”

Sources familiar with Zamal’s case said his transfer to Australia appeared to have been stalled because of a stated policy that refugees transferred to Australia from offshore should be returned to Nauru or Manus once their medical treatment is complete.

There are fears, given the extent of Zamal’s mental and physical injuries, he may never be fit to return.

“He is too sick to transfer. He is the forgotten man of Nauru. Just left behind,” a source told the Guardian.

Redacted IHMS document.

Previously, island sources said, Zamal had been considered a success story of refugee resettlement in Nauru. He was living in the community.

But two years ago, he was attacked (no one has been charged over the incident) as he walked in the street in a violent assault that culminated in rocks being thrown at his head, causing serious injury.

Following the attack, his mental health deteriorated and he attempted suicide by jumping off a roof. He badly broke his ankle and it requires surgery.

The reports said he cannot be cared for in the Nauru immigration centre’s Managed Accommodation Area, where he has been involuntarily committed under Nauruan law and where he remains on “constant line of site observations”.

“There is not enough space, equipment or staff to provide effective medical care in the MAA. Absolutely requires surgery, is not able to weight bear and remains in pain.”

International Health and Medical Services said its “recommendation for tertiary offshore care remains in place”. Sources said IHMS staff were at risk trying to treat Zamal with insufficient staff, space and resources.

“The confined environment of the MAA presents a risk of exacerbation of agitation and irritability and subsequently increases the risk of harm to Zamal and others.

“His persistent confusional state, most likely represents a type of non-convulsive epilepsy. This is a high-risk situation, and considered a medical emergency. Risks are of brain damage occurring as a result of ongoing seizures, and also harm or death as a result of behaviour occurring during or after seizure activity causing confusion.”

The Nauru hospital’s Overseas Medical Referral panel has twice approved Zamal for transfer to Australia for treatment.

The final decision for transfer to Australia rests with the Australian Border Force, which retains ultimate control over the offshore immigration regime.

A spokeswoman for the Australian Border Force said she could not comment on specific case, but told the Guardian: “The department supports and assists the government of Nauru and its service providers in delivery of medical care to transferees and refugees.

“Healthcare in Nauru is the responsibility of the government of Nauru. Decisions about medical transfers of refugees are made on a case by case basis, under the government of Nauru-managed overseas medical referral program.”

An IHMS spokeswoman said it took the health and safety of its staff very seriously.

“When potential risks to staff safety are identified, IHMS implements mitigation strategies,” she said.

The Rohingya are an ethnic and religious minority inside Myanmar. Late last year, a state-sponsored campaign of ethnic cleansing, led by the Myanmarese military, forced more than 600,000 Rohingyans over that country’s border into crowded and squalid refugee camps in Bangladesh, where they remain.

Zamal is one of a number of refugees held on Nauru and Manus Island who have been separated long-term from family members, and face permanent separation. Several fathers held on Nauru have never seen or held their own children.