vector issue 14 part a

vector magazine amsa global health committee page 1

The Australian Medical Association recently updated its Position Statement on the Health Care of Asylum Seekers and Refugees.

The President of the AMA, Dr Steve Hambleton, spoke from Canberra with Andrew Lees, the Editor-in-Chief of Vector, on the direction of these amendments and the organisations thinking on refugee healthcare more generally.

The issue of refugee and asylum seeker arrivals has been a political issue in Australia for many years, as future medical practitioners why should students care about this issue?

It is a very important issue that we recognize already that students are very engaged with. We know that most of the people who are seeking asylum end up becoming Australian citizens, and we know the longer they stay in mandatory detention the worse their medical health gets, there is poor access to physical and mental health, and that impacts upon the Australian Health System ultimately. The Australian government has internal rules that target a three month detention time, a maximum three month detention time, but we have got people who have been in there for over fifteen months, and we’ve got kids that were born in detention, we’ve got unaccompanied minors in detention, and as I say, a lot of these people end up being Australian citizens, and so those health impacts are really felt by everyone.

You mentioned in your speech at the AMA Parliamentary Dinner in August 2011, which was about many things other than detention as well, but you also suggested that you considered mandatory detention to be “inherently harmful”, and that is the standard position of the AMA, and you have just mentioned some of the reasons why. What is it about mandatory detention that is inherently harmful, and what has the response been to those comments?

The fact that people are already damaged, in terms of inherent harm, they’re already damaged. They have actually left their country of origin, they have actually struggled to get here, the thing about inherent harm are the uncertainties about what is going to happen to them, and the length of time people are there as part of that uncertainty, in that it seems to be forever. The other thing is that they’re exposed to other damaged individuals, you have got children exposed to that as well, you’ve got self-harm happening, you’ve got attempted suicide, a lot of stuff that we’re not hearing about that’s happening that we’re not getting access to.

Q&A with the AMA President


Given that the AMA is calling for a reconsideration of that approach on health grounds, what do you think the preferred approach would be from the AMAs perspective?

Look, I think we’ve got to talk about the health aspects. A lot of this stuff is in remote locations where there just isn’t access to medical care, so the remoteness is the first issue. If they weren’t so remote we would be able to get people in and out much better, we would be able to get better access to general practice services, better access to health assessments, better access to psychiatric support, so part of the problem I suppose from the previous answer is the remoteness, and we’ve got to recognize that this is a damaging environment and therefore we have got to actually provide people with access to proper medical care, that’s the point we are making the loudest. Politicians have got to decide the bigger issues, but we have to focus on health because that’s our role.

The AMA recently updated its position statement on the Healthcare of Asylum Seekers and Refugees. How long has the AMA been following this issue in public health terms, and what recommendations and observations have you made?

We have been looking at this for a number of years. Initially in 2004 and then 2006, and certainly before that we have been looking at issues about hunger strikers as far back as 1992, so I guess the AMA has been in this space for some time and the current numbers of asylum seekers really does focus the mind and that’s why the AMA chose to update this. In fact, they had finished the update before my commentary at the press club. I think the prolonged detention is really the issue that we have been talking about. It should be for the shortest practical time, and it is the indeterminate amounts of time that is so damaging.

There has been a lot of commentary around how the impact occurs for children. What do you think it is about the impact upon children specifically that is most concerning?

The children really are at great risk. They often witness psychological distress in adults so that the accompanied children see their parents being very distressed, they often see violence and self-harm. For the ones that are unaccompanied obviously the separation from their immediate family, but also separation from their extended family. There are opportunities and risks of sexual violence, particularly for unaccompanied children, and we don’t think unaccompanied children should be in detention in the first place. Now, some times the government will say they are not in detention they are in a different place, but it is still detention, it is just not the same place. An unaccompanied child, clearly they have got to come in, but a month is more than fair to give an opportunity for either identification of an adult relative, and if you can’t do that, then community centred care should be available. There is going to be ethnic groups that can actually look at providing a culturally appropriate support structure for these people, and we have really got to be compassionate about this.

What has been the response from members of the AMA themselves to the approach of the AMA to this issue recently?

Look, we have had very heartening levels of comment and support from AMA members, particularly from our psychiatrists and paediatricians. This is the one topic I would say where we have had more non-members congratulate the AMA for taking a stand than any other topic. Even more importantly, some of those people have said “give me the name of my local AMA I am going to join on the basis of what you are doing, I thought you were focused in other areas but I am really heartened to see the AMA is looking at some of these issues.” I must say, I was vice president for two years and I’ve been president for, how long is it, it feels like years now, and out of all that exposure at the executive level this is the topic that has given us more outside support than any other.


Putting aside the question of mandatory detention, there is a much larger group of refugees who are already members of the Australian community and they use the health system on a regular basis. What are some of the barriers faced by those people that the AMA has identified and what recommendations have you made to address some of those issues?

Well, obviously the health status of refugees coming from other cultures and other environments is that they are to exposed different levels of infectious disease and the rates of malaria are significant, the rates of TB and that sort of long term chronic infectious disease. But, they’ve also often got mental health problems, often post-traumatic stress disorder, depression, and all the other medical and physical illness that you can imagine are spread through asylum seekers as well. But in particular, the ones I have mentioned are quite high. Now, the AMA was instrumental through the Medicare Benefits Consultative Committee (NBCC) in getting up a health assessment for asylum seekers and refugees, which is a Medicare rebate to spend extra time and get a comprehensive review of what their health status is. The other thing is that the immunization rates in our refugees who do settle in the country are very different to the local population, and we certainly go to great lengths to try and take a history about the immunization rates and bringing the children up to speed, and even the adults. Things as simple as tetanus and diphtheria, and whooping cough vaccines, are often absent in people who have come to this country in these circumstances.

There are many areas within the health system that I am sure you can identify where there is need. Which needs do you think are the ones of greatest impact upon those refugees who are already within the community?

We haven’t even spoken about the language barriers, the cultural barriers, and they’re real as well. If you said which one of the medical problems is the greatest, I think the mental health issues. It is easy to see the risk of TB, it is easy to see the risk of malaria, they’re fixable, they are hard, but they’re fixable. It is the mental health issues that are subliminal, that are a bit in the background, that are not easy to talk about, and that are subject to the cultural difficulties of communicating. These people are hurting in many cases and it is hard to get to that point, and get the confidence of people to actually be able to talk to you.

VECTOR would like to thank Dr. Hambleton for his time. The current version of the AMA Position Statement on the Healthcare of Asylum Seekers and Refugees can be found here:

http://ama.com.au/asylum-seekers


The United Nations’ 1951 Convention Relating to the Status of Refugees (the 1951 Convention) is the principal international treaty that establishes a framework for protection for refugees and asylum seekers. A critical insight of the 1951 Convention is the expectation that asylum seekers may need to contravene immigration laws of potential host states in their search for asylum and that they should not be punished on account of their illegal entry or presence.

Australia is signatory to the 1951 Convention and has made a valuable contribution to the protection of refugees. However, continued mandatory detention for all asylum seekers arriving by boat stands in contrast to the obligation described above. Asylum seekers that arrive by air, usually on a travel or some other visa, are allowed to remain in the community while their claim for refugee status is evaluated. For those asylum seekers that may have no choice but to undertake the dangerous boat

crossing from Indonesia and other nearby islands, what should be the end of a journey in search of freedom is instead prolonged, usually for 6-18 months, [1] in one of Australia’s immigration detention facilities. Mandatory detention of asylum seekers is an entrenched component of immigration policy. This commitment to mandatory detention persists despite continued criticism by national and international organisations that mandatory detention violates the rights of asylum seekers established under the Universal Declaration of Human Rights and the 1951 Convention. Added to these criticisms is mounting evidence of the detrimental impacts of prolonged detention on detainee health, mental health in particular. [2] Furthermore, the cost of current detention and interception programs will exceed $800 million in the 2011/2012 financial year. This amounts to about $90,000 for every asylum seeker who comes to Australia. [3]

“Everyone has the right to seek and to enjoy in other countries asylum from persecution”-Article 14 (1), Universal Declaration of Human Rights

Mandatory Detention in Australia: problems and alternatives

Iain Law (Flinders University) and Prashanti Manchikanti (Monash University)


The persistent criticism and human and financial costs of detention demand careful evaluation of the reasons for its continued inclusion. A variety of justifications resonate throughout the debate. These include the health and safety of Australian citizens and detention as a deterrent to asylum seekers and people smugglers.

A principal justification for mandatory detention is concern for the health and safety of Australian citizens. This is a reasonable concern but only legitimizes detention of sufficient length to undergo health and security checks, but not the lengthy duration of application processing currently employed in Australia.

Justification for prolonged detention focuses on its function as a deterrent: a) to ‘protect’ asylum seekers from undertaking the dangerous boat crossing to Australia that has tragically cost many asylum seekers their lives; b) to prevent Australia from being ‘overrun’ with refugees; or c) as a way to disrupt people smugglers operating in the region.

Take the first two justifications for mandatory detention as a deterrent to asylum seekers. Proponents often cite trends in boat arrivals following the introduction by the Howard government of the “Pacific Solution”, which included mandatory detention. In the year following its introduction the number of boat arrivals did decline rapidly and fell to close to zero. However, not only did this drop in boat arrivals coincides with a major decrease in refugee numbers globally, but mandatory detention was only one component of the Pacific Solution and therefore the effectiveness of mandatory detention is impossible to isolate and evaluate. [3]

Furthermore, interviews with asylum seekers reveal that they are usually unaware of the detention policy in a potential destination country; they tend to expect a period of detention as an inevitable part of the journey and therefore

not avoid it; and rarely communicate with their origin country to discourage others from seeking asylum based on their treatment in detention. [3] This emphasizes the significance of the hostile and intolerant conditions experience by refugees in their country of origin over the challenges they must overcome in the search for safety and freedom.

Although it may be reasonable to deter people from undertaking a journey that could cost them their life, the lack of evidence that mandatory detention is an effective deterrent suggest it is poor protection for future asylum seekers.The second justification suffers from another flawed assumption that immigration of refugees seeking asylum in Australia is excessive.

In comparison to other countries, Australia receives and accepts very few applications for asylum. Refugees only comprise 1.04% of annual immigration to Australia. In a worldwide comparison conducted in 2010 Australia ranked 69th in terms of refugees hosted relative to population size, 70th in terms of refugees hosted relative to national wealth (GDP per capita), and 51st in terms of applications for asylum relative to population size. [4]


To put these rankings into perspective, in 2009, top ranking industrialized nations, including Denmark, Sweden, Norway, Finland, and Iceland, which have a combined population approximate to Australia, received and processed 51,120 asylum claims. Australia received and processed 6,500. [3]

Finally, mandatory detention is justified as a deterrent to people smugglers. However, if mandatory detention does not discourage refugees from seeking asylum in Australia, it is unlikely that it will have any affect on demand for boats. It is poor policy analysis to expect that punishing vulnerable asylum seekers will affect the operation of people smugglers.

The evidence for mandatory detention is not sufficient to justify the inclusion of mandatory detention at least not in its current form. A recent report by the Centre for Policy Development (CPD) outlines a collection of policy reforms that would increase the effectiveness of Australian immigration policy and minimize the harms caused by detention. [3]

The backbone of the CPD recommendations is implementation of risk-based detention across the entire detention system. It recommends detention sufficient to conduct mandatory health, identity, and security checks to protect the health and safety of Australian citizens. After clearance is granted asylum seekers would be allowed to live in the community while waiting for their application to be processed. Asylum seekers in this community based detention are free to move about the community, but remain administratively in detention. This is an attractive option considering that the necessary policies

and systems already exist. Risk-based detention already exists for asylum seekers that arrive by plane on a valid visa. Also, following pressure to remove minors from detention centers, more and more children and vulnerable families are being released into community detention following their health checks and community screens. All that is needed is for these programs to be scaled up to be applied to all boat arrivals. Other important recommendations of the report include scaling up of the annual refugee intake in an effort to bring Australia’s contribution in line with similar countries and engaging with regional governments to better control people smuggling.

Immigration policy remains a politically contentious issue. The way forward demands a careful evaluation of the evidence for mandatory detention, consideration of the substantial social and financial costs, and thorough consideration of alternatives. Crucially, policy must be rights based with the intention of treating asylum seekers with the dignity, respect, and compassion they deserve.

“...policy must be rights based with the

intention of treating asylum seekers with

the dignity, respect and compassion they

deserve”

1. Department of Immigration and Citizenship. Immigration Detention Statistics Summary: 30 September 2011. Canberra: Commonwealth of Australia; 2011.2. Green, J.P. and Eager K., The health of people in Australian immigration detention centres. Medical Journal of Australia, 2010, 192(2): p. 65-70.3. Menadue, J., Keski-Nummi, A., Gauthier, K. A New Approach. Breaking the Stalemate on Refugees and Asylum Seekers. Sydney: Center for Policy Development; 2011.4. Asylum Seeker Resource Centre. Australia vs the World. Melbourne: Asylum Seeker Resource Centre; 2011 [cited December 2011]. Available from: www.asrc.org.au/media/documents/how-we-compare-internationally_.pdf


The Heart of Darkness: A Snapshot of Displacement in AfricaThe drought, hunger and insecurity in the Horn of Africa has caused the displacement of more than 900,000 Somalis who sought refuge and asylum in neighbouring countries.

Somali refugees assemble for relocation (UNHCR/B. Bannon/2011)

New refugees from Somalia wait outside the Dagahaley reception centre, Dadaab, Kenya


A mother cools her child with water as they wait in the heat outside the reception centre in Dagahely refugee camp, Kenya (UNHCR/B. Bannon/2011)

Health screening clinic in Dagahley refugee camp, Kenya. (UNHCR/B. Bannon/2011)

With no family, a 70 year old Somali refugee who is blind relies on an elderly friend to care for her. (UNHCR/B. Bannon/2011)

Children and elderly members of the community most often feel the impact of such humanitarian crises.


From droughts to floods, the United Nations stepped in to assist those displaced by the severe flooding that hit parts of southern Pakistan in 2011.

Women and children crowd into trucks destined for the relief camp in Sanghar district of Pakistan’s Sindh province (UNHRC/S. Phelps)

The family of these two sisters opted to stay in their flood-damaged home to tend to the livestock. (UNHRC/S.Phelps)


Kakuma Refugee settlement is located in the northwest region of Kenya and is populated by around 84, 000 refugees. Refugees who have been displaced by conflict seek the shelter, food, water and health services provided in this camp.

As more and more refugees arrive resources are stretched thin. The number of children who attend the school outweigh the number of available teachers meaning that classrooms are always overcrowded.(UNHCR 2011)

Tens of thousands of Somalis seek refuge in their capital Mogadishu after fleeing drought and famine. For the first time in 5 years, UNHCR were able to airlift in supplies to help aid with this humanitarian crisis. The UNHCR estimates that there are currently around half a million internally displaced people in the city.

Children at the Al Adala settlement await the supplies of the airlifted aid.(UNHCR / S. Modola)

Entire families were forced to leave their homes due to the drought and settle in the Al Adala settlement. This Somali family tells how they had to leave their home because there was nothing left.(UNHCR / S. Modola)


Tell us a bit about yourself and how you ended up working in Refugee Health?

I graduated from Sydney University, did some hospital work on graduation and then worked as a GP locum. After that I went overseas to do some travel – ended up working overseas in Pakistan where I worked with Afghan refugees and taught Afghan medics. Subsequently, I worked in Hong Kong with Medicins Sans Frontiers.

What made you decide to work in Pakistan?

I guess I had the advice from a number of people to work overseas. I was also interested in travel, so I thought combining travel and work was ideal. I didn’t really plan to work with refugees- I feel almost as if the job picked me. I spoke English, so was recruited by MSF to work with Vietnamese refugees- they had refugee camps there in the early 90s. After that, I continued to work with MSF, coordinating health services in a number of refugee camps in Hong Kong. Eventually, I returned to Australia and did a Masters of Public Health (MIPH) at Sydney University – and have continued to work in public health and refugee health in Sydney since that time.

What do you enjoy the most about being in refugee health?

I like it because it’s based in social justice and largely preventive health. I find public health and prevention at the community level in a way, more useful than one-on-one healthcare. Refugee health entails mostly working with population groups rather than individuals. Of course, there are also clinical encounters. In addition, the variety in refugee health appeals to me too as it crosses over different disciplines – ranging from oral health to paediatrics, psychiatry and infectious disease, etc.

How is it different from caring for patients in mainstream medical services?

At NSW Refugee Health, the sorts of clinics we run are different because they are assessment clinics, different to hospital medicine and general practice. Doctors are funded so that they are able to spend longer time in consultations and have interpreters for as long as they like. It makes the interaction with refugee patients easier. Our nurses also have an advocacy role where they make sure patients receive the treatment they are entitled to from other services.

Dr. Mitchell Smith, director of NSW Refugee Health Services, has been at the helm of this organisation since its inception, plays an influential role in refugee health and policy and has published widely on the subject. He was also my supervisor during my public health term at NSW Refugee Health, so for this issue of Vector, I had a chat with him about his personal journey and views regarding refugee health in the past, present and future.

Words with Mitchell Smith

Yushan Ting

The NSW Refugee Service was founded in April 1999 as part of the NSW Department of Health’s strategy for Refugee Health and runs free clinics for refugees and asylum seekers. The service also plays an important role in health education and health professional training through administration of programs such as the Fairfield Refugee Nutrition Project and the Refugee Health in General Practice project.


You set up the NSW Refugee Health Service in the 90s. Did you meet with any significant difficulties then? What was refugee health like then, and how does it differ from now?

Well, part of my job in public health was as a doctor in refugee screening. At the time the new service was funded and I got the job as director. The main difficulties were that we were starting from scratch and had to gain credibility as we were the first such service in Australia. We also had a limited budget. There weren’t that many people interested in refugee health then, not like how it is now, and in the early years it was difficult to recruit doctors. There is a lot more interest now in refugee health, with services all over the country that are similar to NSW Refugee Health, and I now have a network of colleagues in every state and territory in Australia.

Has that made it a lot easier?

A lot more support and sharing of information and discussion – it’s now a very significant issue and international interest means that I now also have contacts in Canada and the US. There are more policies and guidelines to improve refugee health and to help doctors work with refugees. Now the needs of refugees in terms of health care have become more widely recognized. This is in contrast to how 25 years ago refugee health used to be limited to mental health. The first services set up were formal counselling services whereas now there is recognition of a whole host of refugee health needs.

What do you see as the most important issues in refugee health in your practice area (Sydney, greater Australia as a whole, even internationally) today? What are the main barriers to progress and how may we overcome them for better care delivery?

The most important issues are equitable access to health services and health knowledge. Many refugees don’t have good health literacy – which is really people’s knowledge and understanding of health and what makes you healthy. In the context of Hepatitis B or influenza, if people don’t understand what a virus is – then it makes it harder for them to care for themselves and doctors to treat them. If people don’t believe that tap water is healthy and always drink bottled water it makes them miss out on chloride. If you are not able to address those beliefs, people will have continued reduced health knowledge.

The other issue I mentioned was limited healthcare access. This is compounded by health knowledge and language barriers which mean that people can’t get access to health care- one of the important issues we aim to address in our health service.

There are also a number of barriers to progress. I would say one of the large barriers is a lack of flexibility in the health system in Australia. The health system caters to English speaking individuals who are knowledgeable about the health system and fit into it. Additionally, lack of interpreters can be a barrier to access, for example, the refusal of GPs and other healthcare professionals to use interpreters. Some of these are big system issues that are very difficult to change, but hopefully better education of medical students and nurses, hospital administrators, and GP registrars can increase ongoing education, and cultural awareness can help to overcome some of these barriers.


The area of refugee health is often complicated by political agendas and external regulations, for example the recent ‘Malaysian solution’ instituted by the Gillard government. As a healthcare practitioner, what kind of role do you think doctors should play in this crossfire where the idea of better healthcare for refugees may conflict with political motives?

Doctors can be very good advocates, because medicine is a respected profession. And particularly in terms of policies that are bad for health, then I think doctors should have a role in speaking up. So that’s one aspect of it. And there are organisations that doctors can be a part of, such as the medical association for the prevention of war. Groups like that make statements about asylum seeker issues, as does the AMA, or the public health association of Australia.

So you don’t think that doctors’ say are sometimes limited in these issues?Sometimes it can be limited, for example myself as a State Government employee, I can’t speak out. But there are others that can do so, such as some working in universities. But even if you can’t speak out, you can make a difference through participating in the discussion some of the groups above have to influence policy. I actually sit on a subgroup of the detention health advisory group, so through that I can have a voice in the matter through a formal channel.

Many medical students and junior doctors are very interested in playing a part to better refugee health in Australia or overseas. Do you have any suggestions as to how we can help contribute in a way that would make a difference?I have made a list for all of you that are interested in this area.

1. Be informed2. Join relevant groups e.g. MABW, Amnesty International, MSF 3. Advocate for patients, in other words take an interest in cross cultural healthcare and challenge your teachers, specialists, registrars if they don’t use interpreters when needed, or if they don’t show sensitivity to those of refugee backgrounds4. Volunteer for organisations that help refugees and asylum seekers5. Do clinical placements with refugee health services6. Experience in Aboriginal health and experience with cross cultural health is especially useful if you want to work overseas7. Do additional study e.g. have a public health masters, or MIPH and then there’s also relevant training courses at James Cook University in Queensland

For those that have limited contact with refugee patients, if we are faced with a refugee patient in our everyday practice, what should be the issues running through our minds?1. Communication – ask the patient if he/she needs an interpreter2. Be aware of the context – how long have they been in the country? Is their presentation related to their context as a refugee or asylum seeker, or is it unrelated? This is important especially if you think there are psychosomatic elements to the presentation. 3. This should go without saying, and should be applied to all patients, but show respect and sensitivity.4. Be aware that some people have been mistreated or even tortured overseas, so be wary of that before you start connecting up to a whole lot of machines – check with the patient that it’s alright.


What is it that you value in life? Is it your friends, family, occupation, possessions?

But, do you value freedom of speech, the vote, freedom of movement, the right to protest, access to Centrelink? Do you even think about it, or is this taken for granted?

Having lived in a beautiful peaceful country such as our own, where democracy reigns and politics can be discussed freely publically and among friends, it is often difficult to understand life in a country without these privileges.

Imagine being born during war time in Sri Lanka – a new Tamil citizen of the minority ethnic group. Your farming family treads on soil between the Sinhalese government forces and the rebel Tamil Tigers (LTTE). The government exterminates the minority whilst the LTTE fights for independence utilising suicide bombers, guerrilla warfare and violence. For your family, the civilians in the crossfire, you hope for food and water, for the sun to rise each morning, for the war to end, and for your family to be safe. There is limited access to education and as the national language is now Sinhala, it is difficult for you to continue. However, you are Tamil and the LTTE believe your family must join them or you are treated as the enemy and shot. You have heard that the LTTE is taking all young boys to build their army, as one of your friends was taken only after his mother and sisters were raped and his entire family shot in front of him, due to their resistance to his recruitment.

You are most probably recruited, or if you are lucky, you escape. But, either way, throughout the early and developmental years of your life you are to experience violence, death, destruction, starvation and overwhelming fear which will remain etched in your mind even once the war has ended.

This is a common story for Sri Lankan asylum seekers currently in Immigration Detention Centres. They have arrived by boat or by plane, usually after a period of time spent in Malaysia or Indonesia before they risk travelling to Australia instead of joining ten million displaced people worldwide currently in United Nations refugee camps awaiting visas. On arrival in Australia, most Sri Lankan asylum seekers do not have to wait long before being granted refugee status; however some still wait beyond two years as the Australian Security Intelligence Organisation (ASIO) processes their claims. Currently, ASIO deems those who are Tamil asylum seekers to be ‘potential terrorists’ as there is a high likelihood they were recruited to fight with the LTTE, and therefore despite having refugee status, they remain in detention without a defined end date.

When Australian soldiers returned home from the Vietnam War after being conscripted, some against their will, there were extremely high numbers wtih post traumatic stress disorder. [1] Eventually, the Australian public recognised the atrocities experienced by the soldiers and support was provided, particularly from a mental health viewpoint. This support is ongoing in the Australian Defence Force, even among those volunteering and training in defence. [2] In the case of the Sri Lankan men, it is people who have been recruited also against their will, the only difference being that they are fleeing their country and not returning post war. Rather than terrorism, it is perhaps the basic instinct of survival which was required in extenuating circumstances.

People are arriving in Australia not only from Sri Lanka, but from Myanmar, Iran, Iraq and Afghanistan, among many other nationalities (Figure 1), all sharing similar stories of war, famine, minority extermination, and loss of basic human rights. They arrive with dreams and aspirations of a new life in Australia, full of promise, only to remain in detention facilities or on restrictive community visas.

The Role of Primary Prevention in Asylum Seeker Health

Genna Verbeek

“...do you value freedom of speech, the vote, freedom of movement, the right to protest, access to Centrelink? Do you even think about it, or is this taken for granted?”


If you arrived by boat or plane in a new country of boundless plains and a reputation for hospitality and multiculturalism, ready to leave the horrors of your earlier years behind you, why should you be forced to languish in detention facilities under lock and key? Why, after all you have experienced, do you wait for years in the community always with a fear of being sent home? Whilst you wait for months or years for news, what can you do? What can you think about?

It is no wonder that mental health issues surface. Without a sense of purpose or a sense of belonging, with memories of horrendous experiences, and for some combined with a fear of being sent back to certain execution or torture, any person would be at extreme risk of mental health problems. This is where the medical system becomes involved from a secondary and tertiary prevention viewpoint, due to depression, post traumatic stress disorder, self harm, voluntary starvation and suicide attempts (Figure 2).

Figure 2: Statistics, Asylum seekers and detentionAccessed from Asylum Seekers Resource Centre - http://www.asrc.org.au/media/documents/statistics___.pdf

What became of the people first applying for asylum, so hopeful for a life in a new and safe country? It is the detention facilities and the lack of answers which causes the deterioration.

As medical practitioners, we learn that primary prevention is the most useful strategy for our patients in disease prevention. In an article published in The Age in October 2011, Sister Brigid Arthur (teacher and asylum seeker advocate) and Professor Louise Newman (psychiatrist and psychologist) agree that “mandatory detention has contributed in a direct way to a generation of asylum seekers in our country who are suffering from mental disorder” [3].

Therefore, in order to prevent long term health impacts in our asylum seeker population, support and appropriate services (such as the Asylum Seeker Resource Centre, Melbourne) are required, but particularly with reference to expediting claims and minimising time spent in mandatory detention.

References:1. O’Toole BL, Catts SV, Outram S, Pierse KR, Cockburn J. The physical and mental health of Australia Vietnam veterans 3 decades after the war and its relation to military service, combat, and post traumatic stress disorder. Am J Epidemiol. Aug 2009. 170(3):318-30.).2. Mental Health Program, Australian Defence Force. Accessed at [http://www.defence.gov.au/health/DMH/i-dmh.htm]3. Gordon, M. In Harm’s Way. The Age Newspaper, Oct 29, 2011. Accessed at [http://www.theage.com.au/national/in-harms-way-20111028-1moif.html]

Figure 1: Nationalities of people currently in immigration detention facilitiesAccessed from Immigration Detention Statistics Summary - http://www.immi.gov.au/managing-australias-borders/detention/_pdf/immigration-detention-statistics-20111031.pdf

The Role of Primary Prevention in Asylum Seeker Health


Australian General Practice Training

Looking for a rewarding career in general practice?

For information on training opportunities visit www.agpt.com.au or talk to the GPSN Ambassador

at your university today!

vector issue 14 part a

Documents

medical health

health impacts

health assessments

mental health

health grounds

health aspects

mandatory detention

australian health system