Doctors have diagnosed a refugee held on Nauru as being at “high and imminent risk of … heart attack or sudden death”, but the Australian Border Force has refused to move her to a hospital that can treat her, because she won’t leave her young son alone on the island.

On five separate occasions since September 2016, and with increasing urgency, doctors have requested that Fatemeh, an Iranian refugee, be moved off Nauru for heart checks that cannot be performed on the island.

She has refused to leave her son – a minor – unaccompanied on the island, so the border force is not allowing her to leave the island for healthcare, even as her condition showed a precipitous deterioration.

“She is at extremely high and imminent risk of having a catastrophic cardiac event such as heart attack, or sudden death due to arrhythmias, given her risk factor profile and the fact that she has failed medical management,” said the latest doctor’s report provided to the border force, written on 20 January by Dr Maria Fiatarone Singh, a professor at the Sydney Medical School.

Officials on Nauru have confirmed that the border force has received at least five requests “for medical movement” from doctors for Fatemeh – in September 2016 (twice), November 2016 and January 2017 (twice).

Her health status over the past almost four years since her detention began has been noted to have deteriorated significantly Dr Maria Fiatarone Singh

In May 2017, the border force was again warned that her condition required advanced testing that was not available on Nauru.

Fatemeh, 55, fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son, then aged 13. She and her son have been held on Nauru since August 2013. They have been recognised as refugees, but still live in a tent inside the regional processing centre.

The Guardian, which first reported Fatemeh’s case last month, has chosen not to publish her surname, or the name of her son, for privacy and safety reasons.

Dr Nick Martin, a former senior medical officer on Nauru, treated Fatemeh on the island and repeatedly warned Australian immigration authorities that she needed care of a higher level than could be provided there.

“For the Australian Border Force to use her son as a way of denying treatment is breathtakingly cynical,” he told the Guardian.



Singh’s report, commissioned by the Asylum Seeker Resource Centre, presents a damning situation of Fatemeh’s health and conditions on the island.

“[Fatemeh’s] health status over the past almost four years since her detention began has been noted to have deteriorated significantly. It has been marked by innumerable visits to the medical clinic and IHMS for evaluation and treatment of chest pain,” it says.

“The frequency of these episodes has increased markedly over the past two years and have sometimes persisted for hours, unrelieved by medications.

“Her psychological distress has also increased markedly over time, in concert with the distress and poor condition of her son who has become depressed, withdrawn, hostile and has twice displayed suicidal gestures.”

Singh’s report says Fatemeh displayed no history of mental illness before seeking asylum and being placed in detention.

Her psychological distress has also increased markedly over time, in concert with the distress and poor condition of her son Extract from doctor's report

“It is clear from the extensive mental health evaluations that she has had that the psychological pain and distress she feels revolves specifically around the wellbeing and safety of her son … and the despair over the conditions they find themselves in.

“She has nightmares of being killed on a regular basis, as well as fears for the safety and future life of her son.

“Her son has never lived apart from his mother and she has legitimate reason to feel that without her to protect him, he may suffer at the hands of others on Nauru or may self-harm if he is left by himself.”

A spokesman for the home affairs department told the Guardian the department would not comment on individual cases.

“Healthcare in Nauru is the responsibility of the government of Nauru,” he said.

“Decisions about medical transfers are made on a case by case basis according to clinical need, in consultation with the contracted health services provider and the government of Nauru.”

But in mid-September, a letter to Fatemeh from the Australian Border Force – part of the home affairs ministry – confirmed it had approved her treatment overseas, but she would not be allowed to take her son with her.

“The ABF can confirm you have been approved to receive medical care in Port Moresby. In line with current policy and as previously explained, your son will need to remain in Nauru while you are temporarily transferred to Port Moresby,” it said.

“You will need to nominate a temporary care person for your son and then arrangements can be arranged for your temporary transfer to Port Moresby.”

Fatemeh said she had been judged to have “refused treatment” because she would not leave Nauru without her son.

“I wrote a complaint and ask them to put poison in our food and kill us,” she told the Guardian. “I can’t cope with slow death any more. They put us on suicide watch.”

Fatemeh said her health had continued to deteriorate.

“How can I control my anxiety when my son hasn’t gone to school in three years? I live in a small, dark tent like a solitary cell – you can’t even breathe it it. Whenever the Red Cross comes here, my tent is an example to depict the dire tent situation.”

Fatemeh said she had become “familiar with cruelty” fleeing her homeland, “but Nauru made the concept of justice meaningless to me”.

“I have not been able to bring the safety and tranquillity I sought for my son and my life. I feel worthless, defenceless. My only dream is for my son to go to school, and for us to be free.”