Two asylum-seekers look at the ocean in front of the community based camp for families with children on the island of Nauru, October 2014. © UNHCR/Vlad Sokhin

UNHCR, the UN Refugee Agency, is urging immediate action by the Government of Australia to address a collapsing health situation among refugees and asylum-seekers at off-shore facilities in Papua New Guinea and Nauru. Australia remains responsible under International Law for those who have sought its protection. In the context of deteriorating health and reduced medical care, Australia must now act to prevent further tragedy to those forcibly transferred under its so-called “offshore processing” policy. UNHCR renews its call for refugees and asylum-seekers to be moved immediately to Australia, where they can receive adequate support and care.

In September this year, more refugees and asylum-seekers had to be medically evacuated from Nauru to Australia than in the preceding two years combined. This reflects both the longstanding poor healthcare situation under “offshore processing” and a recent worsening of conditions, rather than any moderating of stance. A number of these re-transfers have taken place in the context of court orders or legal actions more broadly. With approximately 1,420 people still held in Papua New Guinea and Nauru, some 500 have now been returned to Australia on medical grounds – this is more than a quarter of the population.

UNHCR’s monitoring suggests that even this number is significantly lower than the total with acute health needs, particularly with regard to mental health. One of the various cases brought to UNHCR’s attention in September was a suicidal pre-teenage girl. She remains on Nauru despite doctors’ advice to the contrary. Medical details seen by UNHCR record how she doused herself in petrol before attempting to set herself alight and pulling chunks of hair from her head.

In Papua New Guinea, there have been no re-transfers to Australia this year. This is despite a clear and urgent imperative for medical evacuation. Several instances of self-harm or attempted suicide have taken place in Papua New Guinea in the past month. A number of people suffering both acute physical and mental health needs, including some who UNHCR brought to the attention of the Australian Government in 2017, remain untreated.

Among 12 deaths that have occurred to date under the so-called “offshore processing” approach, half of which have been confirmed or suspected suicides, are various refugees and asylum-seekers who should have been transferred to Australia.

A young Iranian man, who had spent most of his adult life under “offshore processing,” wrote as early as 2014 to the Australian-contracted medical service provider in Nauru, expressing suicidal thoughts and asking to see a doctor. In letters now publicly released in accordance with the family’s wishes, his mother repeatedly begged for the medical care he needed. Tragically, he took his own life in June this year.

Since 2016, UNHCR has consistently and repeatedly warned of the severe, negative health impacts of "offshore processing" which are as acute as they are predictable. These concerns have been echoed by other independent bodies including the Australian Medical Association. UNHCR has repeatedly stressed the need for immediate long-term solutions outside of Papua New Guinea and Nauru. These should include comprehensive medical outreach and torture- and trauma counselling. The Australian authorities have a clear duty of care for the welfare of people transferred to these places. These critical responsibilities nevertheless remain unfulfilled.

UNHCR does not agree with the Government of Australia’s assertion that such cases are solely “matters for Papua New Guinea and Nauru,” with Australia having simultaneously designed, financed and managed the system in which these two developing and under-resourced countries participate.

Since 2013, Australia has reduced the budget available for care of "offshore" refugees and asylum-seekers by approximately half. This despite the fact that throughout the same period the population has fallen by only 7 per cent and medical needs continue to grow.

While some 1,250 refugees are expected to be relocated to the United States of America under a bilateral arrangement with the Government of Australia, there is still no solution on the table for a number of men, women and children who can no longer wait.

UNHCR has repeatedly urged that Australia should accept New Zealand’s welcome and ongoing offer to take refugees from both Papua New Guinea and Nauru. In the absence of any other alternatives, UNHCR appeals for all refugees and asylum-seekers to be immediately brought from Papua New Guinea and Nauru to Australia, to avert further serious harm and loss of life.

BACKGROUND

Approximately 3,000 refugees and asylum-seekers have been forcibly transferred by Australia to so-called “offshore processing” facilities in Papua New Guinea and Nauru since the introduction of the current policy in 2013. Of these, some 800 remain in Nauru and 650 in Papua New Guinea.

Refugees and asylum-seekers were initially held in closed detention, before the transition of the Nauru Regional Processing Centre (in 2015) and Manus Island Regional Processing Centre (in 2016) to more open facilities. In April 2016, the Supreme Court of Papua New Guinea found that the detention arrangements on Manus Island violated the right to liberty under Papua New Guinea’s Constitution.

Circumstances and conditions for refugees under Australia’s “offshore processing” policy have had severely negative impacts on health, and particularly significantly mental health. During 2016, UNHCR medical experts found cumulative rates of depression, anxiety and PTSD among refugees forcibly transferred to Papua New Guinea and Nauru to be the highest recorded in the medical literature to date at over 80% in both locations[1]. The wellbeing of refugees has been noted by various medical experts to have further deteriorated since that time.

The Government of Australia currently contracts International Health and Medical Services (IHMS) to provide limited healthcare services to refugees and asylum-seekers in Nauru, and Pacific International Hospital in Papua New Guinea. The respective local healthcare systems, on which most refugees are forced to rely after hours, are under-resourced and understaffed in both countries. Torture and trauma counselling services were discontinued on Manus Island following the withdrawal of the Government of Australia in October 2017. In Nauru, torture and trauma support is available only to those who experienced trauma prior to their arrival in Australia. MSF International ceased providing medical services to Nauruans and refugees alike on 6 October 2018, in accordance with an order received from the Government of Nauru. They have called for the immediate medical evacuation of all refugees and asylum-seekers from Nauru, noting at least 78 instances of attempted suicide, suicidal thoughts and self-harm among their patients in Nauru in the past 11 months.

The Government of Australia stated in May 2018 that 494 people had been returned for medical reasons from Papua New Guinea and Nauru to Australia as of 30 June 2017[2]. Those brought back to Australia for medical treatment do not escape the ongoing negative impacts of “offshore processing”. Some have been formally detained in onshore detention centres in Australia following their medical transfer, which is particularly damaging in cases of poor mental health. The current policy offers them no long-term solution in Australia, and leaves them vulnerable to being sent back to Nauru or Papua New Guinea in future. They live with the persistent threat of being returned to the place where they were detained for years, and where adequate support services and long-term solutions are lacking. UNHCR has strongly urged the Government of Australia to not return anyone to Papua New Guinea or Nauru.

Under a bilateral arrangement between Australia and the United States of America, announced in November 2016, 1,250 refugees are expected to be relocated from Nauru and Papua New Guinea to the United States. As of October 2018, a similar number of men, women and children remain with no appropriate solutions in sight.

For more information on this topic, please contact:

In Canberra, Catherine Stubberfield, [email protected] , +61 424 545 569

, +61 424 545 569 In Geneva, Andrej Mahecic, [email protected] , +41 79 642 97 09

[1] See: UN High Commissioner for Refugees (UNHCR), Submission by the Office of the United Nations High Commissioner for Refugees on the Inquiry into the Serious Allegations of Abuse, Self-harm and Neglect of Asylum-seekers in Relation to the Nauru Regional Processing Centre, and any like Allegations in Relation to the Manus Regional Processing Centre Referred to the Senate Legal and Constitutional Affairs Committee, 12 November 2016, available at: http://www.refworld.org/docid/591597934.html.

[2] See Question on notice no. 142, Portfolio question number: AE18/147, 2017-18 Additional Estimates, Legal and Constitutional Affairs Committee, Home Affairs Portfolio, available here.