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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 effect of immigration detention on children.4 Its report, The Forgotten Children, compared its findings with the relevant articles of the United Nations’ Convention on the Rights of the Child.3 4 It found that mandatory and prolonged immigration detention of children was harmful to them, contravened Australia’s international obligations, and violated international law.3 4 The 2015 report by Philip Moss5 showed that children and adults held in immigration detention on Nauru were frequently subjected to sexual or physical abuse. And in March 2015 the UN special rapporteur on torture found that various aspects of Australia’s policies on how people seeking asylum are treated violated the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.6

Tony Abbott’s current government boasts that it has prevented deaths at sea by “turning back the boats,” even though this contravenes the UN’s 1951 Refugee Convention, to which Australia is a signatory.1 Government policy is clothed in secrecy, although a few support workers7 and healthcare professionals3 4 8 have defied contracts that restrict publicity and have disclosed the sheer horror of conditions on Nauru. Information about arrivals and turning back boats is withheld from the public. Journalists who want to visit Nauru have to pay A$8000 (£4000; €5530; $6220) for a visa, seemingly to deter publicity. Extreme right wing European political parties praise Australia for its tough immigration policies.

In December 2014 I and a paediatric nurse, Alanna Maycock, were contracted by International Health and Medical Services, a private health organisation funded by the Australian government, to spend five days on Nauru seeing children in consultation. Our contract forbade any critical comments to mainstream or social media.8 We agonised about the morality of going but decided that we should go to treat children in need and assess living conditions. We were utterly appalled by the spartan living conditions on Nauru and by the treatment meted out to detainees.

Everyone, including medical staff, referred to asylum seekers by their boat numbers, not their names. Toilet and shower facilities were 30-120 m from the rows of tents where they lived in stifling humidity, leaving women and children in fear of predators if they needed to go to the toilet at night. Many had enuresis, and menstruating women suffered. Most children had stress related behaviour problems. We saw a 6 year old girl who had tried to strangle herself with a fence tie and a defiant 15 year old boy who sewed his lips together in silent protest. The only hope we could offer these people was to promise to publicise their plight when we returned to Australia. On our return we talked to the mainstream media and published our findings in a paediatrics journal.8

Now the Australian government has sought to block this avenue of protest. The Border Force Act 2015, passed with bipartisan support, says that, from July 2015, contracted workers including doctors, nurses, and other healthcare professionals can face a prison sentence of as long as two years for revealing the truth about what happens to asylum seekers in detention.9 This, to my knowledge, is the first time in Australian history that doctors have faced imprisonment for telling the truth about serious harms being inflicted on their patients. While the United States is introducing a law to protect whistleblowers and hence freedom of speech10—as we would expect from democratic governments—Australia is legislating to punish whistleblowers.

What can doctors do?

Australian and foreign doctors should boycott working in detention centres. Health professionals face an ethical dilemma: to try to help desperately needy people in detention; or to say that doing so condones iniquity and to boycott it. Medical staff in Russian psychiatric institutions and those in Iraq’s Abu Ghraib prison have been condemned for not refusing to work there. Although a boycott may not be successful—as some Australian doctors will defy it and International Health and Medical Services will simply use more foreign staff—a boycott is the only ethical option available.

I believe that healthcare staff should continue to consider publicising abuses of patients that they witness, as our professional ethics demand; but each person will have to weigh up the personal cost of possibly going to prison for two years. Colleagues worldwide should protest against repressive legislation that aims to silence doctors from telling the truth about conditions that harm their patients, and which is a serious blow to the democratic process. Doctors and nurses must be able to advocate for their disadvantaged patients without fear of reprisal.


Cite this as: BMJ 2015;350:h3269


  • Personal view 10.1136/bmj.h3269
  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: I was paid for working on Nauru but donated all earnings to the Health Assessment for Refugee Kids (HARK) clinic at the Children’s Hospital at Westmead.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.


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