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Doctors should boycott working in Australia’s immigration centres and must continue to speak out on mistreatment of detainees—despite the law

BMJ 2015; 350 doi: (Published 17 June 2015) Cite this as: BMJ 2015;350:h3269
  1. David Isaacs, clinical professor, University of Sydney and Department of Infectious Diseases and Microbiology, Children’s Hospital at Westmead, Locked Bag 4001, Westmead NSW 21245, Australia
  1. david.isaacs{at}

David Isaacs has been to Nauru and seen the suffering among detainees in Australia’s off-shore immigration centre

In 1992 Paul Keating’s Labor government of Australia introduced a controversial policy of mandatory detention of asylum seekers to help cope with rising numbers of Vietnamese, Chinese, and Cambodian refugees. In 2001 John Howard’s Liberal government introduced the “Pacific solution,” which involved excising some islands from the mainland so that they no longer constituted Australian soil and transferred some asylum seekers, who had arrived by boat, to detention centres on the tiny Pacific island of Nauru and later also on Manus Island in Papua New Guinea.1 Some asylum seekers have been sent to detention centres on the mainland. The average time spent in detention before applications for refugee status are processed has lengthened progressively and is now well over a year.2

Detriment to mental health

People seeking asylum in Australia are not told when their applications will be processed, so detention is indefinite—a truly Kafkaesque situation. Strong evidence shows that the harsh conditions under which children and adults are held, particularly on Nauru and Manus, as well as uncertainty about their fate, are highly detrimental to mental health.3 4

The Australian Human Rights Commission’s inquiry examined the …

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