Asylum Seekers Should Have Access To Quality Health Services Under Medicare
In light of recent reports of adverse health outcomes for asylum seekers in Australia, the AMA is once again calling for the Government to offer temporary Medicare cards to asylum seekers.
AMA President, Dr Kerryn Phelps, said today that Australia's immigration system deprives some asylum seekers of basic medical care, particularly emergency care.
"Some essential hospital services are unavailable for asylum seekers unless they pay a large upfront fee," Dr Phelps said.
"About one third of asylum seekers are living in detention; the other two thirds live in the community.
"I think if these people are allowed to stay in Australia pending the results of their applications or appeals, they should be at least granted basic human rights, including quality health care."
Dr Phelps said she would be raising the issue with Immigration Minister, Phillip Ruddock, when she meets with him in Canberra later today.
Some recent cases causing concern for health professionals include:
Shayan Badrie, the six year old son of Iranian asylum seekers who have spent 17 months behind barbed wire, first at Woomera and then at the Villawood Detention Centre. Shayan has been diagnosed with chronic post traumatic stress disorder, which has developed in the context of a physically restraining environment. He was taken to hospital in May when he stopped eating and talking after witnessing a detainee cutting his wrists, and believing that the man was dead. At hospital he was assessed as being acutely traumatised and at risk of dehydration due to poor fluid intake. He was soon eating and drinking adequately again, had fewer nightmares and awoke only once or twice at night. But when Shayan returned to his family in the Detention Centre he again withdrew and his health continues to deteriorate. He returns to hospital to be rehydrated intravenously. The Detention Centre environment has caused this child to withdraw from life, even though it is the only place he can be with his family.
Dr Phelps said many asylum seekers have suffered human rights abuses such as imprisonment without trial, beatings, torture and rape, been exposed to distressing events, and have now had their access to health care compromised.
"Several Australian studies have shown that asylum seekers are highly traumatised people with high risks of depression, anxiety and post traumatic stress disorder," Dr Phelps said.
"The studies say these problems can be worsened by further traumatic experiences here in Australia.
"The very least we can do is ensure their health is looked after.
"Some doctors have been calling for health researchers with legitimate questions to undertake a proper evaluation of health needs, including mental health needs, and the adequacy of health services in detention centres.
"This idea has merit, and I will raise it with the Minister," Dr Phelps said.
8 August 2001
CONTACT: John Flannery (02) 6270 5477 / (0419) 494 761
BACKGROUND NOTES:
The AMA has been receiving briefings from doctors who volunteer their services to assist asylum seekers and from other doctors who provide formal refugee services.
These experts have put forward some recommendations to improve the provision on health services for asylum seekers in Australia.
The AMA supports these recommendations.
These recommendations include:
For asylum seekers in the community:
1. All asylum seekers be given work rights and Medicare coverage until their refugee determination process has been fully completed.
2. In the absence of Medicare access, ASAS funding be expanded to cover all health care costs for pregnant women, families with children, those requiring torture & trauma counselling, and anyone requiring hospital admission.
3. Commonwealth/State agreements on health care provision allow hospitals to provide free care for ineligible asylum seekers on humanitarian grounds.
4. In the absence of Medicare access, asylum seekers be excluded from the requirement to have a Medicare number in order to access PBS priced medication.
5. Persons applying for asylum be referred to a chest clinic early in the application process, to exclude active tuberculosis.
For Asylum Seekers in Detention:
1. Greater use of Bridging Visas on medical/humanitarian grounds to allow children, vulnerable persons and their families to live in the community during the determination process.
2. ACM staff should not be responsible for decisions about who receives medical assistance, or when.
3. Consideration should be given to engaging an appropriate NGO, such as Medecins Sans Frontieres, to provide health services in detention centres nationally.
4. All health staff employed in centres should be trained in cultural and refugee specific health care.
5. There should be increased use of professional interpreters (eg. TIS) for all but the simplest of medical consultations.
6. Detainees should be afforded routine access to confidential consultations with health staff, without the presence of non-health staff in the room.
7. Health Case Management should be the underlying principle for assessments, care and follow up, to promote coordinated care while in detention and on release into the community.
8. There should be contracts with centre management to include accompanied visits for detainees to torture and trauma counselling services.
9. Handcuffs or other restraints should not be used during transport to and from medical or dental appointments.
10. Health staff should be informed as soon as a detainee is due for release, to allow medical follow-up to be arranged.
11 Preventive health programs should be implemented, particularly targeting women and children.
12. Medical record summaries/information accompany detainees when they are released (or deported).
13. Health care should be monitored by an independent medical body to ensure that access to, and quality of, medical care is not compromised by cost factors.
14. Training of all ACM staff should be expanded to ensure adequate knowledge of refugee trauma and torture, cultural awareness, and competency in communication skills and conflict management. Baseline and update training to be conducted by independent, recognised practitioners in these fields.
For Children in detention
In 1999, over 400 children spent some time in a detention centre. In 2000, the figure was over 500 children (Flood report).
The Refugee Council of Australia reported that as of 1 June there were 2,857 adults and 520 children, of whom 39 were unaccompanied minors, in Detention Centres. Detention Centres are inappropriate places for children. However, family units do not want to be separated.
All children under 5 years have full access to Early Childhood services.
2.Structured immunisation programs be put in place.
3.Increased socialisation be allowed beyond the detention centres, through external schooling and other activities.