The Australian government had a problem.

From July 2013, it had banned refugees and asylum seekers who came to Australia by boat from ever settling in the country. Instead, the thousands of men, women and children who attempted the journey across from Indonesia were sent to live in detention centres on small islands in the Pacific.

But soon, the medical limitations of Nauru and Manus Island in Papua New Guinea became clear. Ill health was rife among detainees, and the local hospitals could not cater for patients with complex illnesses or who needed acute psychiatric care.

Simpler problems eluded treatment too. Ahmed (a pseudonym to protect his privacy), a 49-year-old refugee who has been held on Nauru for six years, told BuzzFeed News he endured a painful cavity in his tooth for seven months in 2018.

Medical staff on Nauru told him their dental equipment was broken. Untreated, the cavity ballooned into an infection on Ahmed’s face. At one point, he said, his gum was so puffy that he sterilised a needle himself and pierced it to clean the pus out.

Australia’s world-class public healthcare system is largely affordable and accessible to residents. Bringing sick people like Ahmed onshore would have been an obvious solution — but another hardline policy dictated only refugees in the throes of a “life-threatening medical emergency” could come to Australia for treatment.

So for more than a year, Australia’s immigration department fished around to find somewhere else with sophisticated healthcare to take the problem off their hands. After extensive planning and negotiation, an agreement was secretly signed with Taiwan in September 2017. Its existence was only confirmed eight months later.



Now, BuzzFeed News has obtained a copy of the agreement between the two countries, and details of the intense efforts leading to its execution.

The Department of Home Affairs has repeatedly refused freedom of information (FOI) requests for the text of the agreement, citing potential harm to Australia’s international relations. But using a copy of the deal filed in domestic court proceedings, plus other documents released under FOI, BuzzFeed News has been able to piece together the backstory for the first time.

The details lay bare the extraordinary and expensive lengths Australia has gone to in order to keep sick detainees away from its shores.

Ahmed flew to Taiwan to get a filling for his infected cavity in January 2019. He travelled in a batch of four and waited there under guard for four months, until the others in the group had finished their treatment, before they were sent back to Nauru. Australia footed the bill.

“They only take you to Australia when you actually have a near-death experience,” Ahmed said. “They have to see you die, practically, and everyone knows this.”