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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Australia Continues Policy of Mandatory Detention
- Annette A. McKail (8 February 2006)
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mandatory detention of asylum seekers in Australia
- Gaille Abud (8 February 2006)
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Response
- Mina S Fazel, Derrick Silove (8 February 2006)
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Unmet Medical Needs in Detention
- Frank W Arnold, Miriam Beeks MRCP DCH, Jonathan Fluxman MRCGP, Cornelius Katona FRCPsych, Felicity deZuluetta FRCPsych (2 March 2006)
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False and misleading report
- Madeleine Byrne (26 August 2006)
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Annette A. McKail, Research & Policy Worker Refugee Council of Australia
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Please be alerted to an error in the article "Detention of Refugees". Unfortunately Australia has not reversed its policy of mandatory detention. The authors may have confused the changes last year which included the affirmation in legislation that children will only be kept in immigration detention as a measure of last resort. Australian's policy of mandatory detention still continues. Competing interests: None declared |
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Gaille Abud, registered nurse Lonsdale house Aged Care Facility, Melbourne Australia 3070
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Thanks for the article on the mental health problems identified in Australian immigration detention centres. The poor mental health state of detainees has indeed been confirmed in both onshore and offshore centres (Nauru and Christmas Island). However unfortunately the mandatory detention policy has not changed and is in fact supported by the opposition, who introduced it. Recent revelations have only resulted in more temporary visas being granted, and the promise of better conditions within the centres. The improved conditions do not appear to have eventuated. Competing interests: None declared |
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Mina S Fazel, Lecturer in Child and Adolescent Psychiatry University Department of Psychiatry, Oxford OX3 7JX, Derrick Silove
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The comments from Annette McKail and Gaille Abud remind us that it would be premature to say that there is no longer a problem in Australia for detained asylum seekers. The main thrust of our editorial was (1) to draw attention to the evidence of mental health harm caused by detention using the experience from Australia and (2) to indicate that the Prime Minister of Australia, after defending detention vehemently for a long time, admitted publicly in 2005 that the policy was a failure, in effect giving substance to the longstanding concerns raised by mental health professionals and others. This is the message of relevance to the UK. For reference, the editorial was written soon after the following press release from the Australian government: http://www.pm.gov.au/News/media_releases/media_Release1427.html. There have been many recent announced changes in Australia and so the flow through effects of these amendments is by no means clear. Although technically, mandatory detention has not been abolished, several provisions have been introduced that potentially lessen its impact substantially, particularly in the areas of concern to mental health professionals. These include the release of all or almost all of the long- term detained children and families into the community (as far as can be ascertained), although some are in "community detention" which is a regime not as harsh as past detention but still of concern. The overall numbers of persons in detention actively applying for asylum in Australia has dropped considerably. This is most likely because of a reduction in numbers of asylum seekers entering Australia, but also to some extent because of new practices, including the wider capacity to offer alternatives to detention and the impetus to complete temporary protection arrangements more expeditiously. There is now a technical limit on the time of detention (2 years) after which the ombudsman can intervene, assess the case and make recommendations for alternatives, eg community visas, although recommendations are not binding. We should note that there was an error in the editorial: mandatory detention was introduced in Australia in the early 1990s. Also, "this year" really refers to 2005. Mina Fazel and Derrick Silove Competing interests: None declared |
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Frank W Arnold, Clinical Researcher 14 College Road, Reading RG6 1QB, Miriam Beeks MRCP DCH, Jonathan Fluxman MRCGP, Cornelius Katona FRCPsych, Felicity deZuluetta FRCPsych
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In the past six months, we have examined 56 “failed” asylum seekers in four UK detention centres or shortly after their release. Our findings agree exactly with those previously reported by Medecins sans Frontieres (1) and in the British Medical Journal editorial by Fazel and Silove (2): “….detainees, particularly those held for long periods, suffer from profound hopelessness, despair, and suicidal urges…. In many of these patients, both medical and psychiatric needs were frequently not adequately addressed. Such neglect violates the European convention on human rights and other agreed international obligations with respect to medical care. Depression and suicide: At least 33 of our patients fulfilled ICD10 criteria for Post-Traumatic Stress Disorder or depression. Many had either harmed themselves or made determined attempts at suicide. Official guidance that people with serious health problems including mental illness, should not normally be detained, was not followed in these patients. Torture: The Home Office Operating Enforcement Manual states that “where there is independent evidence that they have been tortured” people should normally be “considered suitable for detention in only very exceptional circumstances” (3). More than 20 of the detainees in our sample gave a history of torture and had physical signs “consistent with” or “typical of” torture, by the definitions of the Istanbul Protocol on the Reporting of Torture (4). In no case were our patients aware of any effort by the Home Office to investigate this, even when it had been appropriately reported to them via established channels by detention centre clinicians. HIV: Three of four women who had been receiving anti-retrovirals in the community before detention had an unplanned disruption of their treatment in detention because of problems in arranging appropriate and timely secondary care. Malaria: After some months of UK residence, refugees who come from areas where malaria is prevalent lose their relative immunity to the parasite. Despite this, children and pregnant women with removal directions to high risk malarious areas in the past year have not been offered prophylaxis or bed nets. Our patients include six who developed laboratory confirmed falciparum malaria following return to sub-Saharan Africa. Hunger strikers: Eleven of our patients were first seen during or shortly after being on hunger strike. Six were in imminent danger of organ failure. According to the medical notes, four had not been examined by a doctor for extended periods. We are unaware of any policy for detention centre staff dealing with the well documented dangers of recommencing food intake after prolonged starvation (5). Tuberculosis: Three of our patients have been identified as having tuberculosis. One was subjected to delayed diagnosis and suffered side effects of treatment which were not adequately explained to him. Another, who probably has multi-drug resistance, had treatment disrupted after his detention for more than one month. He was also unable to keep hospital appointments for specialist management of his TB and three other medical conditions. Conclusions: Unmet health needs are a major problem among immigration detainees. Moreover detention itself is frequently damaging to the health of detainees, sometimes profoundly so. Responsibility for health care of detainees should be transferred to the Department of Health. A responsible, independent public body should conduct and publish regular comprehensive investigations of medical care of detainees. Detention of torture survivors, children and those with physical or mental ill health is unjustifiable, contrary to the Home Office’s own policy, and should cease. References: 1) Cutler S. Fit to be detained? Bail for Immigration Detainees. London 2005. http://www.biduk.org/pdf/Fit%20to%20be%20detained/FittobedetainedReport.pdf 2) Fazel M, Silove D. Detention of refugees. British Medical Journal 2006; 332: 251. 3) Home Office Operations Enforcement Manual. http://www.ind.homeoffice.gov.uk/ind/en/home/laws___policy/policy_instructions/oem.html 4) The Manual on Effective Investigation and Documentation of Torture and other Cruel, Inhuman or Degrading Treatment or Punishment http://www.phrusa.org/research/istanbul_protocol/ist_prot.pdf 5) Peel Hunger strikes. British Medical Journal 1997; 315: 829 (All references accessed February 22, 2006.) Competing interests: The authors are part of the Medical Justice Network, an organization of ex-detainees, their supporters, doctors, and lawyers. Our purpose is to improve healthcare for refugees who are or have been in detention. We continue to collect and analyse data about the health of asylum detainees. MJ welcomes assistance from other clinicians in this work. Website: www.medicaljustice.org.uk |
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Madeleine Byrne, Journalist Melbourne, Australia
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The authors of the editorial continue to defend their work as largely accurate, but this is not the case. They write that the Australian Prime Minister John Howard "admitted that the detention policy had failed, and the government subsequently changed the law". This is false. When Peter McGauran, former Citizenship and Multicultural Affairs minister, tabled a Bill in June 2005 that would release families with children into community detention; introduce time limits on claim assessment; increase the Minister’s power to grant visas and allow the Ombudsman to make recommendations to Parliament on those detained for more than two years, he stressed that the policy framework had not changed. On offer was mandatory detention with a "softer edge". He added that “the government remains committed to the existing policy of mandatory detention.” Included in this was the excision of Australian territories from the migration zone "the maintenance of offshore processing and in the unlikely event of it being needed in the future – the policy of turning boats around". Moreover, the claim that detained asylum seekers can now "challenge their confinement" is also incorrect. There is no facility under Australian law for detainees to challenge detention, either within Australia or offshore. Mandatory detention has not been abolished, but increased so that future asylum seekers arriving by boat will be now be detained in other Pacific states. As someone writing on UK policy in this area I am concerned about the increase of places reserved for asylum seekers within detention facilities. For this reason it is crucial that international researchers focus on the complexity of the Australian experience without falling into bouts of wishful thinking. Mandatory detention is still firmly in place in Australia and as long as it and the indefinite detention of asylum seekers in Australia or offshore continues, mental illness will continue to be a scourge. Furthermore, for many of those previously detained in the centres often for periods of three to four years the challenge today is gaining access to adequate psychiatric care now that they are in the community. To ensure the credibility of your journal, I ask that you correct this editorial so that it is accurate and stops misinforming your readers. Competing interests: None declared |
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