Submission via email

31st August 2017

Dear Senator / MP,
The death of Hamed Shamshiripour this month on Manus Island has reinforced our serious concerns about Australia’s Offshore Immigration Detention system. We are writing to inform you of issues which need to be urgently addressed to avoid further foreseeable deaths or serious injury.
Doctors for Refugees is a not-for-profit organisation, advocating for adequate medical care for people seeking asylum. Doctors for Refugees is strictly non-political; we formed under a Labor government in 2013, and have continued our advocacy under subsequent Coalition governments.  Our focus is solely on healthcare.

As doctors, we are duty bound to advocate for optimal human health, and pursue processes which facilitate this. These obligations are stated in Medical Board Code of Conduct. 
(1) We are writing to you, in your capacity as an elected representative in the Australian Parliament, with your responsibilities of proposing and considering legislation that will impact on optimum human health.
We consider it imperative that you are aware of the following information:

1. At least eight people have died in the offshore processing system since 2014:

Hamed Shamshiripour (aged 31), Faysal Ishak Ahmed (aged 27), Kamil Hussain (aged 34), Omid Masoumali (aged 23), Fazal Chegeni, Hamid Khazaei (aged 24), Reza Barati (aged 24) and Rakib Khan (aged 26).

This rate of premature death would never be seen in such a young cohort in Australia.

2. Despite assurances made by the Federal Government, children remain in detention on Nauru.

There have been multiple allegations of sexual assault of children on Nauru
(2) and numerous children have expressed suicidal ideation and/or attempted suicide on Nauru. This is in the context of 243 documented cases of self-harm in the 12 months between July 2014 and June 2015, across all age groups, in the offshore detention system.  These figures come directly from The Department of Immigration and Border Protection's own data. (3)

Families are frequently separated for months under the current system. This practice of separating families exposes children to further emotional harm, depriving them of family support during times of illness and distress. 

3. Medical care on Manus Island and Nauru cannot reach the standard which Australians receive on the Australian mainland.
Unacceptably long flight times to get a medivac from Australia to Nauru, and complex and lengthy bureaucratic requirements for such a transfer, combine to delay emergency care.

It took a medivac 26 hours just to reach Omid Masoumali in Nauru last year, who later died of his injuries.

There are also a myriad of well-documented, systemic deficiencies of infrastructure on Manus Island and Nauru which significantly impede the delivery of appropriate healthcare. To date, Doctors for Refugees has received over 300 formal referrals for concerns about suboptimal care received in the detention system, and new referrals arrive every week. The vast majority of these cases involve gross departures from acceptable Australian standards of clinical management.  

Please contact us if you would like details of these cases.

4. Several levels of non-medical bureaucracy are involved in deciding the medical treatment of people seeking asylum.  This is extremely dangerous and conflicts with long-established Australian standards.

Hamid Khazaei was 24 years old when he died from complications of an infected foot. Doctors for Refugees was granted leave to participate in the Coronial Inquest into his death, which uncovered a number of clinical, systemic and administrative failings. One of the most shocking details the court heard was that it required five separate Departmental officials to approve an urgent transfer request made by several medical personnel.  This requirement is still in place in offshore detention, and would never happen in Australian practice.
Transfers to Papua New Guinea for medical and surgical procedures are subject to approval by the Australian Border Force (ABF) and are limited by available space in Port Moresby hotels.  It is inappropriate for ABF officials and other non-medical personnel to make decisions regarding the urgency of a person’s medical care – yet this is currently the case.

5. Multiple assaults on refugees in the Nauruan and Papua New Guinean communities have occurred, making it impractical to consider resettlement in these countries.

Documented attacks include gang rapes, stabbings, machete attacks and beatings with blunt instruments including rocks. Many individuals have refused to leave the Regional Processing Centres, for fear they will come to harm in the Nauru and PNG community. 

In late 2016, a refugee on Manus Island was struck in the head with a rock, sustaining a depressed skull fracture (seen on X-ray). 
(4) He was a known epileptic and suffered an increased frequency of seizures after his injury, yet it was several days before he was transferred to Port Moresby for a CT scan of his brain to exclude bleeding inside his skull.  This delay could have proved fatal.

The unpredictable policy of settling refugees in these communities has resulted in violent outcomes which Australia has a responsibility to address.

6. The closure of Manus Island Regional Processing Centre (RPC) is scheduled for October 31, 2017. 

The planned closure of the Manus Island RPC, along with the announced withdrawal of medical care, torture and trauma support and security services by October 2017, is exacerbating a highly stressful situation for the refugees who remain on Manus Island. Foxtrot Compound has already shut down with no electricity, running water or drinking water for the men accommodated there.

Ahead of the slated October 31 closure, the Australian Government is pressuring the men to relocate to the East Lorengau facility on the outskirts of the main town on Manus. However, the transit accommodation at East Lorengau is unsafe, lacks basic medical facilities, and will only accommodate a fraction of the men. Many fear for their safety outside the Centre, particularly in the wake of multiple violent incidents and escalating tensions within the local community.

The Australian Government has made no firm plans to ensure the future safety or healthcare of refugees on Manus Island. This is an entirely foreseeable crisis about to happen.

7. The Australian Offshore Detention system has been strongly criticised by the UNHCR, UN Committee Against Torture, Amnesty International and several other International Human Rights Organisations.

The offshore detention regime has also received sustained criticism from numerous Australian community groups and professional bodies, including peak medical and legal organisations, church groups and other religious and community leaders. The PNG High Court has determined the Manus Centre is illegal.

8. The cost of Australia’s offshore detention system has been estimated at over $5 billion AUD since 2012.
In contrast, the construction cost of the Lady Cilento Children's Hospital in Brisbane was $1.5 billion AUD.

When so many Australians are struggling to pay for rising healthcare costs, Offshore Detention is an unconscionable misappropriation of government spending.

Housing people seeking asylum in the Australian community is significantly cheaper than housing them offshore.  From the government audit conducted in 2013, the cost of detaining a single asylum seeker offshore on Manus or Nauru was in excess of $400,000 per year. The cost of asylum seekers living in the Australian community is around $33,000 per year.

9. The overwhelming evidence that this detention process has caused severe and often lifelong harms for people is underscored by the Federal Governments recent settlement of $90 million dollars for claims by the men of Manus Island.

This settlement is in addition to the significant amounts in compensatory payouts made to those subjected to harms in offshore detention over the past four years.

Furthermore, many Australian workers in offshore facilities have been treated for Post-Traumatic Stress Disorder due to their experiences in these workplaces.
(9) We anticipate further claims and costs to the community if this policy remains.

10. The negative impact that offshore processing has had on thousands of lives, the drain on the Australian budget and the degradation of our international human rights record, has been justified as it has 'Stopped the boats'. However, we note that the Navy has been turning back boats in the past four years, demonstrating that the boats have not in fact stopped departing for Australia.

In addition, recent Immigration Ministers have frequently declined to comment on these matters, including the number of boats which have attempted passage to Australia.  As such, it is impossible for the public to assess the validity of the assertion that offshore processing has indeed stopped any boats at all.

We also express our ethical concerns at treating one group of people in a harsh and punitive manner to effect a change in the behaviour of a completely separate group. It is morally and ethically unacceptable to use these individuals as hostages.

For those who are now spending their fourth year in our offshore detention system, it is certain that further deterioration in health and more deaths lie ahead, unless the system is urgently reassessed.

This is an imminent crisis: the solution lies in the hands of Senators and Members of Parliament such as you.

We ask that you raise these issues in Parliament immediately, and we commend those who have done so already.  Offshore detention has been a monumental failure and caused untold harm to thousands of people under the watch of successive governments. It is time for Australia to adopt a humane and responsible approach to people seeking asylum on our shores.
We would like to meet with you in person to discuss these concerns further, at your earliest convenience.

Executive Committee of Doctors for Refugees
Dr Barri Phatarfod
Dr Paddy McLisky
Dr Igal Augarten

Doctors for Refugees
Dr Barri Phatarfod  Ph: 04*********
Dr Paddy McLisky   Ph: 04********* 



1. [Accessed 2017 Aug 16]
2. The Guardian. The Nauru Files. The Guardian Online [Accessed 2017 Aug 16]
3. Koziol, Michael. Self-harm in detention centres at epidemic levels, internal documents show. The Sydney Morning Herald. [Accessed 2017 Aug 16]
4. Gordon, M. Get me off Manus Island: Assaulted Somali refugee and aid worker's plea for medical treatment. The guardian online. [Accessed 2017 Aug 16]
5. Tlozek, E and Anderson, S. PNG's Supreme Court rules detention of asylum seekers on Manus Island is illegal. ABC News Online. [Accessed 2017 Aug 16]
6. McIlroy, Tom. Cost for Australia’s offshore immigration detention near 5 billion.  Canberra Times.
[Accessed 2017 Aug 31]
7. National Commission of Audit, 10.14 Illegal Maritime Arrivals, Appendix volume 2, 2014, Australian Government.
8. Younger, Emma. Commonwealth agrees to pay Manus Island detainees $70m in class action settlement.  ABC News. [Accessed 2017 Aug 16]

9. Hasham, Nicole. Detention centre workers suffering their own trauma in dealing with asylum seekers. The Sydney Morning Herald. [Accessed 2017 Aug 16]


Submission via email

2nd October 2017

Dear Senator/MP,
We sent you an email on the 31st of August 2017, regarding the crisis in the offshore facilities.
Since then the situation has become more critical.
The Chief Medical Officer of DIBP left his post on September 8, 2017 with as yet no replacement.

The IHMS Area Manager has also left his position.
During this time, acute medical incidents have escalated. Last week it took the concerted efforts of advocates in Australia to prevent the imminent death of a young man with a bleeding bowel tumour, which was not being properly treated.

This morning yet another a young refugee was found dead, apparently in the grounds of Manus Island's Lorengau hospital.

These are now the foreseeable consequences of the off shore detention system, as outlined in our letter below.

We have already received a number of positive responses from your colleagues in relation to meeting with us. We are traveling to Canberra on October 16th and 17th to meet with those who have responded and would very much like to meet with you during this time as well.  
If a meeting in Canberra on these dates is not suitable, then please advise us of when is convenient.
Time is critical, as refugees on Manus Island will be having all Australian medical services withdrawn at the end of this month.
We look forward to hearing from you.
Dr Barri Phatarfod  Ph: 04********
Dr Paddy McLisky   Ph: 04********