Dr Kerryn Phelps, AMA President, Radio National, with Dr Norman Swan, Monday 13 August 2001
SWAN: Thanks and welcome to the program. This week on the Health Report a special investigation. Australia has a bipartisan policy of compulsory incommunicado detention for asylum seekers who arrive without permission. There are about 2,500 people presently locked away in detention centres, facilities which have been given over to private enterprise. A growing number of health professionals are deeply concerned at the effect of this detention policy on already traumatised people, many of whom eventually become Australian citizens. They say that detention is creating a spiral of depression, psychotic symptoms and self-mutilation. Not only that, but the standards of care may be less than desirable. The Health Report's Toni Hassan prepared this:
DETAINEE: My country problem, my area fighting, tortured me.
REPORTER: Were you a civilian or were you a soldier in the war?
DETAINEE: I am a teacher.
REPORTER: And you were caught up in the violence?
DETAINEE: Yes.
REPORTER: Meet Jailus Sivem
JAILUS SIVEM: No night time, bad dream, my family, my country sometime too much headache, I can't sleep; I can't eat.
REPORTER: Jailus Sivem, like many people once held in detention, is today an Australian citizen and is being asked to function as a member of the Australian community. Professor McGorrie wonders how Jailus will cope in the long term.
MCGORRIE: What we are doing to, even these people, is actually making their potential contribution to our society once we accept them must less and diminishing it and actually we are creating a burden for ourselves in terms of looking after them.
Well the truth of the matter is that 85 per cent of these people will become Australian citizens or at least be released into the community on temporary protection visas. And I believe that we're taking survivors of some of the most ruthless political regimes and destroying what little resilience they have left. And we're really breaking people and making it extremely difficult for them to make an on-going productive contribution to Australian society. And I suspect that this is going to place a large burden on the health system as people get released from detention and there is already substantial evidence to support that in-service is being provided to some of these people after release.
REPORTER: Are they inundated? What are you finding?
STEELE: Well there's a very high level of service utilisation of the torture and trauma services, by people who are on the temporary protection visas. And because of their on-going level of uncertainty, there's very little again amelioration of their symptoms. And so you're seeing people who are profoundly disabled in their daily living and their ability to gain employment or work productively.
REPORTER: it was these concerns that led the president of the Australian Medical Association, Dr Kerryn Phelps, to meet with the Immigration Minister, Philip Ruddock, on Wednesday.
PHELPS: We have a very productive discussion. The Minister did take on board our concerns regarding the health problems within the detention centres and we are looking forward to further discussions about this as they get more information and see where we can find solutions to the problems.
REPORTER: Are there guidelines in place at the moment as to appropriate medical care for asylum seekers in detention?
PHELPS: The feedback that we have from doctors who are working in this area is that there are inappropriate guidelines and inappropriate treatments available to people who are in detention and in the community. some of the concerns are the poor use of interpreters, particularly for those people in inadequate trauma counselling.
REPORTER: Who does the follow up though? Who is ultimately able to - is there anyone guaranteeing quality of care for people in detention?
PHELPS: No at the moment, the decisions on medical treatment are placed in the hands of Australian Correctional Management which is a private company contracted to run detention centres and they're responsible for meeting the costs of health care for detainees.
REPORTER: Are you happy with the prospect of our detention centres being run by private firms?
PHELPS: I think that that has inherent difficulties and that is one of the areas of concern. Not necessarily the privatised nature but because it naturally needs to make a profit and we're concerned that some of the medical decisions are being made on non-medical grounds.
A number of detainees have been in situations where they have sought medical attention, a decision about whether they get to see a medical person is in the hands of the detention personnel and the security personnel. And then when they do see a medical person, they have the presence of the security people there. So there is a concern about confidentiality.
REPORTER: What do you think are the primary goals of doctors or health care providers generally contracted to work in detention centres? Is there a dilemma over the extent to which they should even work with Immigration officials or the private firm?
PHELPS: Well at the moment they're really obliged to. The issue for the medical people really boils down to the medical needs of the detainees. And they are concerned obviously about the political overtones but really we do have a moral obligation as a community if these people are in Australia and are either being detained or are living in the community awaiting their appeal that at least basic health care needs are provided.
REPORTER: Do doctors have an obligation to play an advocacy role? Not just to treat symptoms of, for example, post-traumatic stress disorder but to change the patient's environment as well?
PHELPS: There's no question that doctors have had a long tradition of being advocates for public health and you can't just look at the outcomes of public health problems without looking at the cause.
REPORTER: Dr Kerryn Phelps of the Australian Medical Association.
The Health Report did contact the general manager of Australasian Correctional Management, the firm that runs Australia's detention centres. He would not give details of medical services provided by his company and referred us to the Department of Immigration and Multicultural Affairs.
This program has focussed on the issue of asylum seekers in detention. However, two-third of all asylum seekers in Australia live in the community and the division between the two groups is often superficial. Under new tighter Federal and State Government rules, some people seeking refugee status living in the community have no work rights, no Medicare and no access to emergency health care. Doctors across Australia have told us of individuals being hit with bills running into thousands of dollars - money they don't have.
All of this however is a story for another time. Patrick McGorrie and other trauma specialists we spoke to for this story believe Australia may be confronted by a legal suit over the way it treats asylum seekers in detention.
Australia is after all signatory to several human rights conventions.
Professor McGorrie says that, in the end, history will judge Australia on the issue and that history will be a harsh critic.
McGORRIE: The level of abuse and trauma that's been visited on people within Australia at the moment in future years is going to become I think to the same sort of situation as the apology for Aboriginal people. Like this is such a marginalised and disempowered group of people that this is happening to. No one is really speaking out adequately for them. And there is such a negative attitude portrayed in relation to them that really I think it's going to come back and really be something we are very ashamed of in the future.
REPORTER: Something that will haunt us?
McGORRIE: I think so.
COMPERE: Professor Patrick McGorrie who is a psychiatrist at the University of Melbourne. And that special investigation was from Toni Hassan. I'm Norman Swan and you've been listening to the Health report here on Radio National.
Ends