Statement on the health of people seeking asylum

The RACP considers unequivocally that the right to health is a fundamental human right. Health is defined by the World Health Organization as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. The United Nations Committee on Economic, Social and Cultural Rights recognises that health is influenced by many determinants, including food, nutrition, housing, water and sanitation and a healthy environment. The RACP is concerned that Australia is in breach of its obligation to respect health as a human right, as provided for in the relevant international instruments to which Australia is a signatory, by prolonged detention of people seeking asylum. This is especially relevant with respect to the health of those detained in offshore detention facilities and the regional processing centres located on Manus Island in Papua New Guinea (PNG) and Nauru. This is an increasingly urgent issue, with 8521 people, including 1731 children, in Australian immigration detention facilities or alternative places of detention as of 31 May 2013. The RACP is particularly concerned that detention of children seeking asylum is contrary to Australia’s human rights obligations. Australia is a signatory to the United Nations Convention on the Rights of the Child, which notes specifically the rights of children to be protected from discrimination based on their parents’ opinion, that the best interests of the child will be a primary consideration, and that children have rights to health, education, play, and protection from physical and mental violence, injury, abuse, neglect and maltreatment. While the Australian Government has committed to providing health-care services that are ‘broadly comparable with health services available within the Australian community’, the RACP is concerned that this standard is often not met due to environmental factors in regional processing centres located in PNG and Nauru. People seeking asylum who are detained in these facilities are exposed to a number of environmental and infrastructural deficiencies that adversely affect their health, such as: • A lack of adequate health services in remote and offshore detention facilities. • A limited capacity to receive adequate psychiatric care, which is especially important given many people seeking asylum are survivors of torture and/or trauma and that detention is proven to have a detrimental impact on the mental health of detainees. • A lack of engaging and meaningful activity, such as education and employment opportunities. • An increased risk of many communicable diseases, including multi-drug-resistant tuberculosis, typhoid and hepatitis A, in PNG. The increased risk of tuberculosis is particularly problematic for a population group with high levels of latent tuberculosis infection: 27–55% of refugee/asylum seeker background cohorts in Australia have latent tuberculosis infection. Latent infection increases the chance of reactivation and development of active tuberculosis disease, and close living conditions will only amplify this risk. • Malaria is of particular concern, as reports indicate that 94% of the PNG population is at high risk of transmission of malaria. The most common form of malaria in PNG, Plasmodium falciparum, has a high mortality rate. There is therefore a potential risk of death for pregnant women and young babies, for whom preventive treatment is unsafe. Standard environmental avoidance measures such as repellent sprays, treated mosquito nets and staying inside after dusk are challenging in temporary accommodation settings such as tents. • A lack of access to clean drinking water, particularly on Nauru. The health consequences of an inconsistent supply of clean water are especially concerning. • A lack of medical accountability, exacerbated by the absence of performance measures to assess the appropriateness and standard of care being provided. • Limited capacity for health-care professionals to act autonomously and in the best interests of the patient. There is a large body of evidence to suggest that prolonged detention, particularly in isolated locations with poor access to health and social services combined with an uncertainty as to the outcome of asylum seeker claims, has severe and detrimental effects on health outcomes. These long-term effects include damage to social and emotional functioning, especially in those Key Points The Royal Australasian College of Physicians (RACP) believes that: • Health is a basic human right of all people, including those seeking asylum • Conditions in offshore detention facilities and regional processing centres compromise the right to health of asylum seekers • Prolonged detention has severe detrimental effects on health that can be long-term • Detaining children can have profound negative impacts on the health and development of an already highly vulnerable group • Urgent attention is required to the health of people seeking asylum