Sam was a Baluan man of Manus province, living on Manus Island. He was thin and muscular with a warm smile and acute observations. I had known him for over a year. Like most Manusians he had a deep love for Manus, its islands, waters, and its people. Sam was a man who objected to the way Australia treated refugees; he often expressed his solidarity with the refugees. He had special insight about the history of Manus, and if you ever had the opportunity to listen to him he would share his knowledge for hours about music, nature and culture.

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A strong friendship developed between us and to be in his presence was always a pleasant experience. For this reason, when I wanted to make the film Chauka, Please Tell Us the Time, I sought his help. Sam had a significant role in the making of this film and we discussed for hours the history and culture of Manus. During the filming Sam criticised Australia from a Manusian perspective for its colonial politics and treatment of refugees. He also stood up for the dignity of his people.



One day I made plans to see Sam at his place but when I arrived, I only saw his niece who was smoking outside. She said: “Sam had heart pains a few days ago and died.” It was one of the most painful moments during my time on Manus Island. This feeling was the same as the pain I felt every time a refugee died on this island of medical neglect. His niece explained: “Sam could have been saved. The GP said that had he encountered this pain anywhere else other than Manus he could have been treated with ease.” The problem was that he was extremely poor and it was not easy for him to travel to Port Moresby. Sam’s tragic death made me contemplate. I still think of his wonderful laugh and kindness, I think about his life, I think about his untimely death … these things will always remain with me.

Today, the hospital on Manus Island looks more like a ruin about to crumble

Over and over again, incidents such as this one have occurred through the years we have been imprisoned here. The people on Manus have died even though hundreds of millions of dollars have been paid to companies who are assigned to run the prison camp. According to the agreement between PNG and Australia the main road of Manus must be repaired, a police station must be built and the hospital on the island must be adequately equipped. But after years the hospital has fallen into disrepair. A few months ago the roof of the primary school was destroyed by a storm and the school requested assistance from the community. But no one had the capacity to help rebuild the school. For months the children had to attend their lessons within a hazardous zone and under the rain. The condition of the hospital is getting worse by the day.

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Dr Nilanthi Kanapathipillai from Central Gippsland Health in Victoria recently inspected the island’s medical facilities. She told me, “The clinic is totally ill-equipped to deal with medical and surgical emergencies such as an acute myocardial infarction or diabetic ketoacidosis or severe sepsis warranting intravenous antibiotics. Emergency acute surgical procedures such as appendectomy cannot be reliably performed here. Radiology facilities are inadequate with no CT scanner. Sterility is questionable and hence local procedures such as simple lancing of abscesses are unable to be performed without risking further sepsis.”



She went on to say, “There are enormous delays to accessing appropriate medical care [for refugees] through this bizarre triage system involving application to the nurse first. Basic asthma medication and oral hypoglycaemics or even blood glucose strips to access glycaemic control is totally unavailable. I was shocked to see a 28-year-old with persistent untreated hypoglycaemia for weeks, no basic education of patients with chronic illness such as diabetes; orthopedic injuries were startling … left unreduced and untreated for years; ophthalmology reviews should be easily accessible but I have seen to date significant deterioration in at least two men who have been waiting for an ophthalmology review for at least three years. There is a specialist ophthalmologist on the island, and has been for years! “ Kanapathipillai continues listing the conditions she observed, repeating, “I am still shocked.”



Pacific International hospital (PIH) in Port Moresby is the hospital that has been contracted to provide medical services to refugees on Manus Island. As Kanapathipillai noted: “PIH is a huge tertiary referral centre with all the facilities available.” Yet, she continues: “Late transfers and unequal access to the same gold standard medical and surgical care towards refugees even whilst in PIH was palpably noticeable even from an outside perspective.”

In January the Australian federal government refused an order from the Senate to release documents on the health, construction and security services for refugees on Manus Island. The home affairs minister, Peter Dutton, refused the request, telling the Senate: “I believe the disclosure of the requested material would, or could reasonably be expected to, cause damage to international relations: specifically, Australia’s relations with Papua New Guinea.”



We know very little about the payments, obligations and terms of contracts signed by the Australian government with companies such as Paladin, JDA Wokman, Toll Group, NKW and International Health and Medical Services (IHMS), all involved in the offshore immigration regime. In January, the Guardian pointed out that the security firm Paladin Solutions was being paid $72m for providing security on Manus Island for four months with the contract extended an extra month even though a local security firm had kicked the Paladin workers off the island.



What is most interesting here is that Australia has signed a contract with PIH for them to provide medical services to refugees, yet their clinic is made up of just a few small rooms. They seem to do little but give sick refugees some paracetamol, afterward referring patients to the general hospital, which is unequipped and decrepit. But as the condition of the PIH clinic is even worse than the general hospital, the refugees are forced to go to the hospital. The contracts are probably worth hundreds of millions of dollars and are given to companies working on Manus Island. Where does all this money go? A fraction of it could have been spent and equipped the island’s hospital or built a school for the children of Manus Island.

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What seems clear is that the Australian government does not care about what happens to the local people. Sam used to speak of how the lack of Australia’s investment in schools and health was a part of the colonial project: “If many of us get education, have a good hospital, then we will become bigger. Australia wants to control us.” Today, the hospital on Manus Island looks more like a ruin about to crumble. At the hospital the local workers are extremely kind and show empathy with the refugees. However, hierarchies of power make it impossible for Manusians or anyone else to provide adequate care. No matter how many deaths have occurred on Manus, Sam’s death feels the most tragic to me. He did not receive the support he needed and lost his life from something so simple. The hospital is a wreck of a place where companies make hundreds of millions every year. This place embodies the essence of discrimination.

• Behrouz Boochani is a journalist and an Iranian refugee held on Manus Island. Translated by Omid Tofighian, American University in Cairo/University of Sydney. Edited by Janet Galbraith.

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