Doctors have pleaded for a heavily pregnant refugee on Nauru facing a complex and possibly life-threatening birth to be moved to an Australian hospital.

The 37-year-old Kuwaiti is more than 35 weeks’ pregnant, her baby is in breech and she has a large fibroid or benign tumour on the wall of her uterus. She has previously had a miscarriage on Nauru.

But the Australian government has said that she must deliver her baby on Nauru, saying there are “comprehensive” medical services on the island.

The woman, whom the Guardian has chosen not to name, has been prescribed the antidepressant drug citalopram, a pregnancy class C medication that, Australian guidelines state, has “caused or may be suspected of causing, harmful effects on the human foetus”.

According to the drug’s manufacturer, possible effects on the newborn include persistent pulmonary hypertension, respiratory distress, cyanosis, apnoea, seizures, temperature instability, feeding difficulty, vomiting and hypoglycemia among others.

The Guardian has confirmed the woman remains on Nauru, despite medical transfer flights leaving the island this week.



A spokeswoman for the Department of Immigration and Border Protection declined to comment on the refugee’s specific circumstance but told the Guardian: “Australia provides comprehensive medical support services to the regional processing centre in Nauru and to the Nauruan government health facilities.

“The department does not comment on individuals’ medical situations.”

The department’s chief medical officer, Dr John Brayley, was made aware of the woman’s impending complex delivery a month ago.



In subsequent correspondence sent last week, the president of Doctors for Refugees, Dr Barri Phatarfod, told Brayley: “We have discussed this case with Australian obstetric specialists who all agree that she should definitely come to Australia for the delivery, cautioning that elective breech vaginal deliveries have recently had some quite adverse outcomes in Australia and that any external cephalic version (manually turning a breech baby) attempt should only be done by experienced obstetricians in the presence of an operating theatre and team ready to proceed to immediate caesarean section and with appropriate neonatal expertise and facilities on hand.

“We urge you as the chief medical officer of the Department of Immigration and Border Protection and in your profession as a doctor to comply with the RANZCOG [Royal Australian and New Zealand College of Obstetricians and Gynaecologists] standards and take urgent steps to ensure this woman is brought to Australia immediately and receive the care she needs.”

The risks to her life, and to her baby’s life, are very significant Barri Phatarfod, Doctors for Refugees

Phatarfod told the Guardian that the woman faced a “very complex delivery”.



“The risks to her life, and to her baby’s life, are very significant,” she said. “In pregnancy, and in the delivery of babies, when things go wrong, they can go dreadfully wrong. But she can be given the best possible care very simply by being brought to Australia. Fly her to Brisbane and allow her to deliver at the Mater [hospital in Sydney] or the RBH [in Brisbane].”

Several babies have been born to refugee women in offshore immigration detention.

Until 2015, it was government practice that refugee and asylum seeker women in offshore detention be flown to Australia to give birth, because of access to superior tertiary hospital care.

Nauruan women facing complex births are still routinely flown to Australia for delivery and follow-up treatment. However, since 2015, it has been Australian government policy that asylum seekers and refugees deliver babies on Nauru because of their “propensity” to exercise their legal rights in Australia’s courts and seek an injunction against their removal from Australia.

Briefing notes provided to Brayley as the incoming chief medical officer revealed under FoI state: “Please note the propensity of those transferred to Australia to join legal action which prevents their subsequent return to PNG or Nauru.”

The notes counsel that additional medical equipment and specialist visits were being provided in offshore detention, because “it is preferred that only those cases where the life of the refugee/transferee is in danger … are considered for transfer”.

The policy has led to extraordinary circumstances on the island for pregnant refugee women.



In 2015, a government health contractor advertised on LinkedIn for a neonatologist to fly the very next day to Nauru to oversee a complex birth. The ad even invited doctors to nominate their salary for a week’s work. Doctors told the government the mother should be flown, with the baby in utero, to a tertiary hospital.

Last year, a Somali refugee and her newborn infant were medically evacuated from Nauru in a critical condition and placed on life support in a Brisbane hospital after she gave birth by caesarean one month prematurely.

In Australia, when the government sought to return the infant known as Baby Asha to Nauru, protesters surrounded the Lady Cilento hospital to stop her being removed. Doctors refused to discharge the baby from hospital, stating the Nauru detention centre was not a safe environment for her. Baby Asha was ultimately discharged to live in the community in Australia.

The government’s policies around babies born to refugee women have also led to an unusual legal sophistry.



Babies born in Australia to women moved from offshore detention are regarded by the department as “illegal maritime arrivals”, despite having never been on a boat nor having left Australia.