The plight of an asylum seeker who died from preventable septicaemia is so moving because it is so blithely routine in a surreal system, writes Chris Rau.

The story of Hamid Kehazaei - who is brain dead in Brisbane's Mater Hospital after a cut to the foot at Manus Island detention centre was left untreated - was both utterly avoidable and utterly inevitable.

The 24-year-old Iranian asylum seeker is the most recent, tragic face of the "collateral damage" in a bipartisan policy which has culminated this past year in fatal riots, medical malfeasance, at least two dead babies, alleged rapes in detention centres, and skyrocketing mental health conditions.

Successive governments have repeatedly cried crocodile tears about people-smuggler-driven deaths at sea while cynically denying asylum seekers who do make it into their care the very basics of human existence which governments can control. All in the name of deterrence.

These responsibilities include a duty of care to those under their jurisdiction, particularly those locked in remote, inhospitable state-sanctioned "facilities" - semantic quibbles about "detention centres" vs "prisons" aside.

Their rights include freedom from hunger, assault, solitary confinement; a basic standard of accommodation and health care; access to reading, writing, and drawing material at the very least; sanitation, clean air and water; and an independent complaints mechanism.

Mr Kehazaei's plight is so moving because it was so blithely routine in a surreal system. It becomes even more shocking when you realise that successive immigration ministers have been wilfully deaf to warnings about woeful standards of detention health care.

One can only assume it's not a lack of ministerial and public service intelligence, information, or even compassion: it is pure realpolitik. The marginal-seat black hole into which political humanity sinks. Or, as former Labor Immigration Minister Mick Young told former Federal Court judge, Ron Merkel, in 1987:

There are no votes in my electorate (Port Adelaide) for keeping blacks in the community.

In January this year, I researched a feature for the GP subscription magazine Australian Doctor, following the December 2013 axing of the Immigration Health Advisory Group (IHAG).

IHAG was first set up in 2006 following Mick Palmer's and Neil Comrie's administrative reviews into then minister Amanda Vanstone's Immigration Department.

Then, as now, governments outsourced their obligations to asylum seekers locked up in mandatory detention to a multi-tiered array of contractors. The primary contractor would run the centres, which were then mainly onshore: Australasian Correctional Management (ACM; a subsidiary of Wakenhut); Global Solutions Limited; G4S; Serco; and now also Transfield.

Then, as now, these umbrella conglomerates subcontracted various chunks of responsibility to other corporations: for instance, International Health and Medical Services (IHMS) took on general health care, subcontracting further chunks off to GP services and to consultant psychiatrists, often on a FIFO basis. There then there was catering; cleaning; transport; tents; construction; tech support; welfare ... a long list.

Now there are the added, complex logistics for remote, hard-to-access tropical islands. Also, the delicacy of negotiating slices of Australian jurisdiction within sovereign countries like PNG (Manus) and Nauru. There, many staffers live on floating hotels, campervans and other hastily-arranged infrastructure.

All up, you get an accounting and accountability shemozzle: literally and figuratively a quagmire.

Even the most battle-hardened Senate Estimates Committees, the most mathematically-agile Financial Review journalists, and the most persistent archive rats have run weeping from their caves while trying to untangle it all.

The latest in the line of intrepid delvers has been the Guardian Australia's Nick Evershed, who ransacked an array of databases to crunch the numbers on August 25, estimating the figure for the contractual rewards of mandatory detention at $10 billion since mid-2007.

The Guardian gives a qualified estimate of 1,770 contracts awarded to 522 entities. And says it costs nearly $860,000 a year to house an asylum seeker offshore.

This can only be a guesstimate, because the Immigration Department shields its finances behind a kaleidoscope of "corporate-in-confidence" walls, just as it shields the stories of individual asylum seekers behind spurious "privacy" barriers.

What is less easy to hide, however, is the growing rebellion of some internal whistleblowers who are leaking documents and who are willing to risk breaching confidentiality clauses in their contracts to speak out about what they have described as substandard, often dangerous detention conditions.

Plus, the porous nature of social media devices - now available, with some ingenuity, even in remote locations - means stories like those of Mr Kehazaei's will no longer stay in previously impervious information bunkers.

Here is what an IHMS whistleblower, GP Dr John Vallentine, told Australian Doctor about Manus Island in April 2013 (he had been flown in from Christmas Island to help establish the clinic on Manus):

There was a sense of unseemly haste about it all but I fell in with the spirit of things. As time passed, however, I found my requests to IHMS for equipment and drugs were receiving no action. Simple things - oxygen, Foley's catheters, yankeur suckers, paediatric antimalarials, parenteral antibiotics, fentanyl, vecuronium, morphine, corneal burrs, portable haemaccues to name but a few - just didn't turn up. IHMS sent boots and uniforms but the important stuff was not arriving. During that time, I was becoming increasingly concerned about our ability to manage children in this remote and quite unforgiving environment. We had no blood transfusion (capabilities), no paediatric-trained staff, no X-ray equipment, no paediatric emergency facilities. And for paediatric emergency cases, a 24-hour air transfer delay was unacceptable.

Since then, children have been removed from Manus, notorious for its waterborne diseases, just like Christmas Island is for its lung-damaging phosphate dust.

During my own research, I heard of mothers near Darwin who were denied access to midwives and later lost their babies; island compounds where three toilets were deemed sufficient for 200-300 detainees (on the days all loos were working and the floors weren't awash in faeces); repeated allegations of rape, both male-on-male and male-on-female; and delays in obtaining even the most basic of medicines like aspirin (which then had to be signed off with elaborate paperwork).

Given this litany of neglect, one has to wonder where IHMS spends its $1 billion (or thereabouts) in taxpayer largesse, while it or its subcontractors can't diagnose the onset of septicaemia.

If Hamid Kehazaei's case could be brought under standard medical negligence litigation in an Australian court, no medical insurer would even dare try to defend the case in court, given the sheer blatancy of medical neglect. It would be quietly settled for a large sum.

Given the implacable electoral hostility in marginal seats against "boat people", another theme is clear: it won't be the politicians of either major party who rediscover some basic humanitarian scruples.

This will only come via the courts, which have doggedly - via a lot of bono legal work - put the false pieties of so many of our politicians to shame. The next High Court case is set down for October 14 and 15.

Chris Rau has worked as a print journalist for 30 years. She has written about asylum seeker issues since 2005 for various outlets. View her full profile here.