Dr Barri Phatarfod, a Sydney GP and president of Doctors 4 Refugees, described the policy as “dangerous”, arguing that the threshold for transfer needed to be lower.



"If you’re only looking at people who have a life-threatening condition, it invariably means that some people will not survive," she told BuzzFeed News.



In Australia "the benchmark for transferring someone to hospital for appendicitis is not if you’re convinced they have appendicitis, but if there’s a possibility they have appendicitis," said Dr Phatarfod.



"Many of the cases that go to hospital don’t have it, but it’s better than them rupturing an appendix at home or in a shopping centre where you could have a potentially fatal outcome," she explained.



In 2014 24-year-old Hamid Khazaei died after contracting an infection in his leg on Manus Island. He presented with flu-like symptoms and was transferred to a Port Moresby hospital three days later, where he had a series of cardiac arrests. The next day he was transferred to Brisbane, but died a week later.



A coroner later found that if he had access to Australian-level health care Khazaei would not have died.



Khazaei's condition "deteriorated very rapidly", said Dr Phatarfod, and the evacuation came too late. "You can’t have somebody who needs to be in a critical state [before being transferred]. That needs to be revised."



Dr Phatarfod pointed to the difficulty in arranging a medical evacuation for a critically ill patient. She said even in a best case scenario, where a medivac plane is ready and a pilot is available, it would be a 12-hour trip to get the plane from Australia to Nauru and back again. "A lot can happen in 12 hours," she said.



Dr Phatarfod told of a woman who was raped on Nauru and has experienced vaginal bleeding for the past two years.



"Is she going to die tomorrow morning? Maybe not. But that absolutely needs to be investigated," she said.



Dr Paul J. Stevenson OAM is a consultant psychologist and traumatologist who has spent time on both Manus Island and Nauru. He described the health care available on both islands as "third-world" and "under-facilitated".



He said that in his experience, even when patients were critical, transfers were delayed or refused. However, he said, "it was relatively easy to send home sick security guards and Australians" on commercial flights.



The policy document outlines five "health service delivery principles", which prioritise providing health care on the islands.

