Labor’s promise to resettle some refugees in New Zealand had been a source of hope, now they fear languishing indefinitely

Where does the Coalition's re-election leave refugees on Manus and Nauru?

Asylum seekers and refugees say the mental health of those on Manus Island, in Port Moresby and Nauru has deteriorated dramatically, with many citing the re-election of Australia’s Coalition government as a tipping point.

With no change in government policy expected, what is the situation in Australia’s offshore detention system, and what are the prospects for those still trapped there?

How many people are still on Manus and Nauru?

Since the offshore detention policy was reintroduced by the Gillard government in August 2012, some 4,000 refugees and asylum seekers have been sent to processing centres in Nauru and Papua New Guinea.

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With Australia refusing to settle refugees who arrived by boat after 19 July 2013, they can either resettle in those nations, apply for a limited number of places in the US, or return to the home country they fled.

About 500 people have been resettled in the US under the terms of the deal struck between Australia and the Obama administration, which was forecast to result in up to 1,250 departures. In April the home affairs secretary, Michael Pezzullo, told a parliamentary estimates hearing further departures to the US were “anticipated in coming months”.

About 800 asylum seekers and refugees have returned to their home country, while a few others were resettled in Cambodia.

As of March, there were 359 people in Nauru and between 547 and 561 in Papua New Guinea. The majority of those in PNG are on Manus Island, while about 170 are in Port Moresby for medical treatment.

Is there really a mental health crisis on Manus Island?

Guardian Australia understands there have been 26 cases of attempted suicide or self-harm since Australian election on 18 May, including six since Tuesday.

While similar incidents have occurred regularly throughout the offshore detention period, those on Manus say there is an increased sense of desperation and hopelessness among the island’s refugee population.

What was the impact of the election?

Australia’s offshore detention regime enjoys bipartisan support, but Labor’s promise to accept New Zealand’s offer to resettle 150 asylum seekers and increase the country’s humanitarian intake to 27,000 refugees a year had been a source of some hope for many on Nauru and Manus.

Since the Coalition’s re-election the government has said it plans to repeal medical evacuation laws passed against its opposition in a historic political defeat during the last parliament, and that it will not accept the New Zealand resettlement deal as it now stands.

What are the refugees saying about the mental health crisis?

The government faces an uphill battle to overturn the medevac laws because of opposition from crossbenchers in the Senate, but the Manus refugee Shaminda Kanapathi from Sri Lanka told Guardian Australia the prospect of three more years in limbo meant “all of us have lost our hope”.

“We have been detained for the last six [years] with the current government and we fear that we have to spend another three year indefinitely with no hope,” he said.

“All of us [are] worried that we will be forgotten under this government and just abandoned in [Papua New Guinea] forever. We don’t know what our future is, our life is in limbo.

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“It’s out of control. I’m worried about my future. I completely lost hope of my freedom. I’m worried that I will be detained for another three more years on Manus. I’m helpless.”

The Kurdish Iranian refugee and journalist Behrouz Boochani told Guardian Australia: “I’m struggling to find words to describe this situation. All I can say is that it’s gone out of control. I don’t know what will happen. So scary time.”

What healthcare is available to refugees on Manus Island?

In 2017 the Manus Island detention centre was closed after the PNG supreme court ruled it to be unconstitutional and the detention of asylum seekers illegal.

The centre’s closure prompted a three-week standoff before the men there were forcibly moved into alternative accommodation in the Manus township of Lorengau, with food and security services but a lower level of access to health services.

While International Health and Medical Services had been providing healthcare services to asylum seekers and refugees in Australian-controlled detention centres – including mental health and trauma care – after the closure of the Manus Island detention centre, its services were wound back and its contract was terminated in April 2018.

In May 2018 Amnesty International released a report criticising the termination of IHMS’s mental health services and questioning the healthcare available to refugees and asylum seekers in PNG. It also raised longstanding concerns about the healthcare provided to refugees and asylum seekers in offshore detention.

“Amnesty International’s own findings were consistent with those of UNHCR – that healthcare for refugees has largely been inadequate and declining because of limitations imposed by the Australian government, and that unless some of the most urgent cases are transferred to Australia, they will not be able to receive necessary treatment, with potentially life-threatening results,” Amnesty said.

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Since May 2018 the Australian government has given $21.5m to a healthcare provider called Pacific International hospital to treat asylum seekers on Manus. That’s despite the Queensland coroner laying criticism on PIH’s Port Moresby hospital for its role in the death of Iranian asylum seeker Hamid Kehazaei’s death after he was transferred there in 2014.

The coroner found PIH lacked “necessary clinical skills”, provided “inadequate” care, and was far too slow in treating Kehazaei.

“I conclude that if Mr Kehazaei had been intubated immediately on arrival at the PIH and provided with adequate ventilation support, in addition to intravenous fluids and antibiotics, it is likely that he would have survived,” the coroner found.

The transit centre clinic in Lorengau employs 13 health care professionals including three medical officers, three nurses, one paramedic, an after-hours GP and one after-hours nurse. The five mental health workers include just one psychiatrist.

On Wednesday a Kurdish refugee on Manus, Benham Satah, told Guardian Australia the healthcare on the island was failing to cope with the level of mental health problems.

Satah said the island “doesn’t have any place to keep these mentally sick people” and that the local hospital did not have enough beds to keep those suffering from severe mental illness.

“I have never seen it in this crisis before, never,” he said. “Everyone is mentally unwell and everyone is highly depressed. There really is no way to describe how bad the situation is at the moment.

“Nobody can control the situation. We don’t know what’s going to happen tomorrow.”

• In Australia, the crisis support service Lifeline is 13 11 14. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123. Other international suicide helplines can be found at befrienders.org