Children account for the "greatest percentage" of self-harm incidents and suicidal behaviour by asylum seekers in detention, the president of Australia's Human Rights Commission has revealed, citing new statistics showing there were 128 reported self-harm incidents amongst children in detention between January 2013 and March this year.



Professor Gillian Triggs gave the figures, which she called “shockingly high”, at an extraordinary day of public hearings in Melbourne on Tuesday as part of a national inquiry into children in immigration detention.



“Self-harm incidents and thoughts of suicide among children … are dramatically higher than for the parents, or for the other adults in detention, and it is quite clear that the impacts of detention on children are particularly egregious,” Triggs said.



“One of our greatest concerns is that children are being held for significantly greater periods of time than has been the case in the past, and that leads virtually inevitably to greater levels of mental health disturbance,” she said.



Data showed the average length of time a child spent in detention in Australia was 231 days, with 38 children having spent more than a year in detention as of January this year.



Triggs said immigration department officials were “compassionate” and not “bad people”, but that “an element of bureaucratic cruelty” had crept into the way children in detention were being managed.



“There's an element that's created of fear, of scrutiny, of endless checks, many of which appear to be totally unnecessary, in the middle of the night, that appear to have no outcome that's valuable,” she said.



Tuesday’s hearings focused on mental health conditions for the 983 children in detention on the Australian mainland, Christmas Island, and Nauru.



But officials from International Health and Medical Services (IHMS), which is contracted to provide health care for asylum seekers in Australian detention, were unable to say what rate of children in detention were suffering mental health issues.



IHMS’s regional medical director, Mark Parrish, said “the difficulty of pulling data out of our systems" made the figure difficult to ascertain, but that it was “assumed” to be about 30%, the same as that of adults in detention. A study is being conducted to discover the true figure, he said.

Though Triggs said the company’s mental health procedures “were manifestly not having an impact”, Parrish insisted that health services in detention were comparable to those offering in the public health system.



“No system is foolproof and no system is perfect,” Parrish said. “And whenever we have a case of self-harm, we will also report it and look into it and see if there's anything we could have done particularly to prevent it from happening.”



Self assessments by asylum seekers showed that 12% rated themselves to be suffering "severe forms of mental illness" in their first three months in detention, a rate which grew to 41% among those who had spent more than 19 months in detention.



Ray Gadd, who spent six weeks with IHMS as a doctor on Christmas Island, said the issue was one of “hopelessness and helplessness”.



"Children are generally quite resilient and if they have really good parents and hope, they can generally survive most environments. But if you take those things away from children, that's when they suffer,” he said.



Gadd said the standard applied when assessing whether children were fit to be sent to Nauru or Christmas Island was whether the child was “fit to be in a remote area in Australia”, giving Broome as an example.



“Can they be managed in a small peripheral hospital, with the care that can be provided in a small peripheral hospital?” he said.



Triggs gave examples of some of the shortcomings in asylum-seeker health care that the commission had discovered during the course of the inquiry.



Among the most extreme cases was a seven-year-old girl with a lazy eye who broke her glasses on the journey to Christmas Island, and had gone nearly a year without receiving a replacement pair. Virtually blind for that time, she now risked losing her eye and was receiving psychological support.



"We could have done better then," Parrish conceded, saying the girl had been recently given standard chemist's magnifiers and was scheduled to see an ophthalmologist later this year.



Another case, which Triggs called a “typical story”, involved a Syrian father of five who was detained on Christmas Island and suffering from a hernia. He was twice turned away for an operation because the medical facility on the island had run out of power.



The father’s eight-year-old son was considered a "disturbed child", had been prescribed medication and suffered issues with bedwetting. Nonetheless, the whole family was approved by IHMS officials for transferral to Nauru.



Parrish defended a lack of routine tuberculosis screening for children in detention, saying that despite infection rates as high as 55% in some centres, “eminent TB authorities” had said routine screening was a “poor way” of picking up the infection.



He said two children in detention were suffering from “active TB”, with 14 carrying a latent strain of the disease.



A confidential report by five independent clinical experts on health conditions inside the Nauru detention centre, published by Guardian Australia in May, found it was likely that up to 50% of children in the facility were carrying latent tuberculosis.



Staff with the department of immigration and border protection were also among the 16 people who gave evidence at the hearing.



An official with the department, Mark Cormack, said he accepted that extended periods of detention affected asylum seekers' mental health.



"There's a strong evidence base to suggest that the longer a person spends in detention, the higher the incidence of a range of health conditions. I have no challenge to that," Cormack said.



He said overcrowding on Christmas Island in the wake of record boat arrivals last year had begun to ease, and that the number of asylum seekers on the island had "decreased significantly". Schooling from kindergarten to year 12 would also be provided for the first time from July, he added.



Nonetheless, Cormack said, health services on the island suffered due to "a number of unavoidable regional factors". "Christmas Island is a remote part of Australia, and its residents, because they're part of a remote community, have less access or don't have the same timely access [to health care]," he said.



Cormack sparred with the commissioner at points during the hearing, insisting she was using "emotive language" by describing some asylum-seeker accommodation on Christmas Island as "shipping containers". He said shipping containers lacked windows and airconditioning, both of which the "containerised" and "modular accommodation" on the island provided.



He said the fact that schooling had been set up on the island did not mean processing was expected to slow, but accounted for the reality that Christmas Island would continue to be used for some time. "We can't assume that because there's been no boat arrivals in the last six months that that's necessarily going to be the case in the future," he said.



Cormack said efforts had been made to "remedy and improve" some of the "less satisfactory accommodation" on Christmas Island. "We believe that it is an acceptable and safe environment for children, and it will be our aim that it remain that way," he said.



Child health advocates and mental health workers provided the hearing with disturbing evidence of what they had seen working with children in detention.



Professor Louise Newman, a child psychiatrist who specialised in working with detained young people, said many of the children she treated were suffering from post-traumatic stress disorder and were routinely being exposed to suicidal behaviour, including that of their parents. She told the hearing the first word of some young children in detention was "guard".



Newman said that in more than a decade working with children in detention she had seen a number of cases of self-harm in prepubescent children. “[This] is virtually unheard of in the wider community, except in cases of extreme mistreatment,” she said.



Sophie Peer, from the child asylum seeker support group, Chilout, said Australia’s immigration detention system was “child abuse, and nothing short of that”.



“I have met parents so institutionalised and used to being referred to by number that they are distressed by the fact their baby has no ID number,” she said.



“Some may argue that the right to play exists regardless of location and that all children will find a way to play,” Peer said. “Does it count if a five-year-old girl is playing ‘officers’, an emblem drawn on her shoulder in pen as she bosses other children around using ID numbers?”



“Is it play when the ground is sharp coral, when the playground equipment is too hot to use, when the toy room is six metres by 2.4 metres and only open a few hours a day?” she said. “Is it play when your parents are so traumatised they cannot even sit and do a puzzle with you?”



Triggs said on Tuesday a third public hearing would be held next month, and she would use her compulsion powers to require some witnesses to testify.



“There are many people who have been providing mental services or working with children … on Christmas Island or in Nauru detention centre, and for them it's very difficult to give voluntary evidence,” she said.



“Many of them have signed contracts which impose a secrecy or confidentiality provision … and so this is the only basis that they can give evidence. When they're deeply troubled about the time they've spent providing these services, it gives them an opportunity to provide this evidence without being subject to prosecution or losing their job.”