Asylum seekers and refugees awaiting surgeries, abortions and other treatment prevented from having overseas transfers by Nauru hospital committee

This article is more than 3 years old

This article is more than 3 years old

Nearly 50 refugees and asylum seekers held on Nauru – including at least three women seeking to terminate a pregnancy – are being refused, or not considered for, overseas medical treatment, in defiance of doctors’ recommendations.

Three pregnant refugee women on Nauru have asked to terminate their pregnancies, for cultural, familial and health reasons. Doctors’ requests for them to be transferred overseas for the procedure have been rejected. Terminations are illegal on Nauru, a devoutly Christian country.

And Australian immigration department staff have confirmed to the Guardian that nearly 50 refugees and asylum seekers are on a waiting list for approval for medical transfer for a variety of conditions including musculoskeletal injuries and surgeries that cannot be performed on the island.

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Since July this year, Australia’s Department of Immigration and Border Protection has mandated that all medical transfers must be approved by the Nauru hospital overseas medical referral committee. Previously, urgent or sensitive medical transfers were directly arranged between the Australian Border Force and the Australian government’s health contractor, International Health and Medical Services.

Staff on the island say the changed procedure is a political effort to obstruct medical transfers. The OMR committee meets irregularly, keeps little paperwork, repeatedly defers decisions and often cancels meetings.

But island sources say, as well, the OMR committee has been placed in an invidious position in the case of terminations, essentially being asked to sign off a procedure overseas that is illegal in Nauru.

The three pregnant women have been recommended by doctors for transfer overseas for terminations this month but have been refused by the hospital OMR committee.

In at least one case, a psychiatrist has recommended a woman’s “mental health was being significantly impacted upon by her current situation and that if the termination of pregnancy does not proceed it will very likely pose a significant risk to her physical and mental health, both from an individual, familial and community perspective”.

Politically, there is resistance from the Australian government to refugees and asylum seekers being brought to Australia for tertiary care.

Refugees and asylum seekers brought to Australia for medical treatment often exercise their rights before the courts, and seek injunctions preventing them from being returned. These are regularly granted by Australian courts.

Since 2015 it has been Australian government policy that asylum seekers and refugees deliver babies on Nauru because of their “propensity” – in the government’s words – to exercise those legal rights.

A staff member on Nauru told the Guardian there was no reason – beyond political obstruction – to give the Nauru hospital OMR committee final authority over the transfer of asylum seekers and refugees to other countries for treatment.

“In the past, some women who went to Australia for terminations sought injunctions and are now living in community detention in Australia. Some others declined the termination once they reached Australia, secured an injunction and have since given birth to their child. Not all women did this, some returned to Nauru after their termination.

“The Australian Border Force needed another step in the process, to prevent women from travelling to Australia. Now that requests for terminations must be submitted to the OMR committee, it is guaranteed that approval will not be given. Women are being denied the right to end their pregnancy.”

The staff member said medical professionals on the island held deep concerns for the wellbeing of the pregnant women, and for anyone else who sought a termination in the future.

“These women already have significant mental health problems. Giving birth and raising a child in Nauru would only increase their mental health burden. I am concerned that these women will self-harm, attempt suicide, or attempt a home abortion.

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“One of the women is now 15 weeks pregnant. For this woman, there is only five weeks left in which to end her pregnancy. This current policy … denies women the right to end their pregnancy. If things do not change, these women will unwillingly become mothers, if they do not kill themselves first.”

The staff member said the instruction to involve the Nauru hospital OMR committee in referral decisions was politically motivated.

“Terminations should be managed between IHMS and ABF. There is no reason to include the OMR committee and the Republic of Nauru hospital, other than to enforce Australia’s current policy that anyone who arrives by boat will not be settled in Australia.”

Nauru – a country of 10,000 people – has limited medical facilities and only one small hospital, recently upgraded with $12m of Australian aid money. Nauruan women facing complex deliveries are regularly flown to Australia, Fiji or Singapore to give birth.

Dr Paddy McLisky from Doctors for Refugees said the Australian immigration department had deliberately created a cumbersome, complex, and bureaucratic process for medical transfers, that appeared as though it was designed to fail.

“The epitome of this is referring termination of pregnancy to the OMR committee, when that procedure is illegal in Nauru. The committee is being put in an impossible position.

“It was completely forseeable that this process would create a frightening and potentially dangerous situation for women seeking termination of pregnancy.”



McLisky said the patients’ best interests were not being considered in sending termination referrals to the OMR, where they were almost certain to be rejected.



“Going through a termination of pregnancy is one of the most difficult situations of a woman’s life. It’s an incredibly difficult decision to make, and to have this referred off to a committee to decide, to have it discussed and evaluated by bureaucrats, security and travel staff, when it is something many people would prefer to keep quiet, is just inhumane.

“This is yet another example of medical care which is clearly not ‘broadly comparable’ with health services available in the Australian community, where abortion in early pregnancy is widely permitted.”

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The Guardian put a series of questions regarding medical transfers to the Australian Department of Immigration and Border Protection’s media unit. A spokesman in response said: “these are matters for authorities in Nauru”.

Repeated calls to the Nauru government and Nauru hospital were not returned.

The Australian immigration department has consistently maintained that refugees held offshore enjoy access to healthcare “broadly comparable” to that in the Australian community.

Australia’s handling of pregnancies among the refugee and asylum seeker community on Nauru has often been controversial.

Earlier this year, a Kuwaiti refugee facing a complex birth was flown from Nauru to Australia late in her pregnancy after intense lobbying from doctors arguing that she faced a potential life-threatening delivery on Nauru. Five obstetricians in Australia, including the president of the Australian Medical Association, Dr Michael Gannon, reviewed her case and said she should be immediately moved to a hospital with appropriate neonatal facilities.

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 on the island one month prematurely.

And 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. The woman ultimately gave birth on Nauru.

The government’s policy around babies born to refugee women has 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” to the country, despite having never been on a boat nor having left Australia.

• In Australia, the crisis support service Lifeline is on 13 11 14. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. Hotlines in other countries can be found here