So the Rudd Government says “asylum seekers who come here by boat without a visa will never be settled in Australia”, and will instead be assessed in PNG and resettled there if found to be refugees (the agreement with PNG is here).

Much of the subsequent analysis has been from political, human rights and legal perspectives, or looking at the likely impact upon boat numbers and alternative policy options.

But the health implications are enormous and deserve wider debate, according to Croakey contributors quoted below (and also raised in this piece at The Conversation).

At the bottom of the post are some tweets from senior media figures Amanda Wilson and Paul Bongiorno that remind us – how we frame an issue helps determine how we respond to it.

This is clearly an area where policy and political and public debate would benefit from greater attention to health and medical expertise and concerns.

***

Inflicting harm to solve political problems

Professor Mark Harris, Centre for Primary Health Care and Equity,  University of NSW

In my clinical work, I see many refugees seeking asylum who suffer psychological trauma as a result of events in their country of origin and their experiences in transit.

In detention they often experience further trauma as result of interaction with other disturbed detainees and uncertainty about their future.

The latter is a major cause of psychological illness among asylum seekers especially as they are not able to work or participate in further education.

New Guinea is ill equipped to deal with these psychological problems or attempted suicide, especially in remote locations with poor access to work, education and mental health care and uncertainty about where they will eventually be able to settle.

The agreement between Australia and PNG is not a solution to the problems of refugees in the region.

How much of our own values and self respect are we prepared to give up to find a solution to the problems of politicians?

***

Hoping for a better deal

Ann Larson, demographer and public health consultant, Geraldton

Not long before an asylum seeker boat arrived in the Geraldton harbour, where I live, I had started to take more of an interest in asylum seekers.

For a long time I filed asylum seeker issues along with other examples of inexplicable mass hysteria.  Of course Australia had a responsibility to treat humanely and rapidly process anyone who seeks refuge and can prove their status.

I had met enough refuges to know that they were not economic migrants—they had compelling reasons for leaving their country or finding themselves stateless which had nothing to do with wanting to become Australian residents.

Few ‘irregular boat arrivals’ who made it to Australia and those who did were so overwhelmingly genuine refugees that I felt it was a no-brainer: detention is almost by definition had for health and well-being and should be avoided or minimised as part of a humanitarian policy.

But then so many people drowned. And the numbers of arrivals increased beyond any capacity that Australia could muster to deal with either on humane grounds or within domestic political realities.

I hope the PNG policy is a circuit breaker.  I hope it and Indonesia’s new visa rules stop the demand for boat passage from Indonesia.

I hope that PNG has a long list of demands that will benefit local communities for the short time that a processing centre is located there.  I dream that PNG may benefit from the influx of people who want a safe haven.

Much more I hope that in addition to meetings about the PNG solution, there are lots more meetings about how Australia and the rest of the region are going to anticipate and deal with the likely flight from Afghanistan as foreign troops pull out and that refugee policy, including safe passage and processing is part of planning for all responses to disasters and conflict.

I hope that as part of this process Australia significantly increases its refugee quotas and leads by example in fair, rapid and transparent processing and settlement.  I hope.

***

Risking health in PNG

Professor Lesley Barclay, Northern Rivers University Department of Rural Health

The health system is highly problematic and overloaded in PNG – there is no way it can accommodate the needs of an influx of refugees. It will further compromise a population that is already suffering from a problematic institution that cannot meet its own needs.

Related stories for the media to pursue: how health, housing and education in PNG will manage an influx of refugees when it is struggling to look after its own.

***

Substantial investment in PNG health system will be required

Alison Verhoeven, Chief Executive Officer, Australian Healthcare & Hospitals Association

Australia has a humanitarian obligation to ensure that asylum seekers have access to timely, high quality health care, and this obligation should not change regardless of the new policy.

Equally, the Government will have an obligation to ensure that the PNG health system is able to cope with the increased demand for services that can be expected.  This may require substantial investment from Australia so that both asylum seekers and Papua New Guineans have access to quality health services.

Particular health concerns in PNG, for example, related to the increased prevalence of malaria and HIV, should also be formally addressed in health planning to underpin the new asylum seeker policy.
Example of health needs: http://www.publish.csiro.au/paper/PY11065.htm

Related stories for the media: You might consider a story on Australia’s health-related aid initiatives in PNG.

***

Risks to mothers and babies

Medical specialist with experience working in PNG who wishes to remain anonymous

There will be pregnancies which will need to be managed in PNG. It is worth noting that currently PNG has one of the worst maternal mortality rates in the world, 773 (estimated) deaths per 100,000 births. This is 100 times the Australian maternal mortality rate.

Obstetric and midwifery services in the country currently cannot cope with providing adequate care for the women of PNG; who will care for asylum seeker women?

Of course the same arguments would apply to other branches of the PNG health services.

 ***

Humanitarian focus should be on people in refugee camps

Vern Hughes, consumer health advocate

This is the best article I have yet read on this issue, Rudd’s refugee solution: politically brilliant, morally bankrupt.

If you want the focus to be humanitarian well-being of the world’s 43 million refugees in refugee camps, then you would stop what Mirko calls the “strategic travellers” arriving by plane or boat, and redirect all our humanitarian resources to the 43 million in refugee camps.

***

Australia’s obligation to ensure health services in PNG

Professor Helen Keleher, Monash University

Currently, Australia contracts a company called International Health and Medical Services to provide health care to asylum seekers on Christmas Island. Will a similar contract be funded by Australia to provide health care to asylum seekers on PNG?

Currently, IHMS clinical teams include nurses, mental health practitioners, psychologists, interpreters, GPs, visiting psychiatrists and a dental team who take a team based approach to problem solving.

An article in the Medical Observer (http://www.medicalobserver.com.au/news/caring-for-asylum-seekers-a-rewarding-challenge) from one GP describes the work this way:

“On arrival, asylum seekers undergo a health induction assessment as well as public health screening, and initiation of immunisation. Routine chest x-rays are performed to exclude active or latent tuberculosis.

Assessments are also performed to exclude communicable diseases such as hepatitis B.

GPs are well supported through the IHMS area medical director on Christmas Island, as well as several specialists who provide telephone advice and support from Perth.

There is a local hospital staffed by three very capable GPs, and all serious conditions within the centre are transferred to the local hospital, and may include Royal Flying Doctor Service evacuation to Perth. IHMS works in partnership with the detention services provider, Serco, and the Department of Immigration and Citizenship (DIAC).”

So, we must ask if PNG will be supported to provide the same level of health services, screening and follow up treatment that is currently provided for asylum seekers.?

We do know that many asylum seekers have a high level of need for mental health treatment and trauma  counselling which is unlikely to be available at the level required in PNG, given that their health system struggles to provide basic services for their own people, let alone high-needs people seeking asylum.

By refusing to accept asylum seekers and sending them to PNG, Australia still has obligations to ensure that PNG’s primary health systems are strengthened considerably to provide essential health care for asylum seekers trying to reach Australia.

***

An unjust and inhumane policy

Professor Dennis Pashen, adjunct at James Cook and Griffith Universities and ex president of Australian College of Rural and Remote Medicine

The asylum seeker policy may inhibit future refugees and economic migrants which is what both major parties wish.

But there will be a cost, to the Australian public and to the “maritime migrants/refugees”.

PNG and now Nauru are unsatisfactory places to house refugees and have always been so.  They are unsafe, unable to meet their own economic and health demands let alone the demands of such an immigrant population. They are unsafe culturally, socially and economically.

The economic and long term health costs of this policy of housing off shore is such sites is significant.

We will be judged quite fairly I fear, as the perpetrators of an unjust and inhumane policy, leading to a humanitarian disaster. I am ashamed of my government and its opposition.

***

Policy is a threat to mental and physical health

Professor Alan Rosen, psychiatrist

Asylum seeker policy is less about asylum seekers maintaining  residence  in PNG and more about Rudd maintaining residence in the  Lodge.

It is very risky to impose such an absorption problem on such an  already vulnerable society, but Labor’s optics problems are dual:  that they want to look tougher than the coalition AND they must make  it  look really awful enough to be a plausible deterrent.

Trouble is  that asylum seekers in Indonesia either can’t or don’t read the SMH or  the Australian adverts. The other trouble is that in a fight to the  bottom,  the other mob might still be a lot tougher, if that is  possible.

Either way, the mental AND physical health of these adults  & kids will be in question, as will be the capacity of independent  witnesses to access and monitor their mental & physical health at an expert level.

Both governments may continue to conspire to frustrate this, rather than welcoming it in the name of transparent accountability.

***

Shame on us; and raising concerns about HIV risk

Public health researcher Clive Aspin

PNG has 95% of all HIV infections in the Pacific region. Melanesia has 99%.

Migration in its multiple manifestations is a significant risk factor for HIV transmission. Placing vulnerable refugees in a location of extremely high HIV prevalence will dramatically increase their risk of infection.

If HIV infected refugees are placed permanently in PNG they are likely to have poor access to health services in general and HIV health services in particular. This will put strain on PNG’s already stressed health system while adding to the regional burden of HIV.

And then there’s tuberculosis and other diseases. We know that rates of TB are increasing in PNG and that appropriate services are not available. Many TB infected people cross the Torres Strait to receive treatment in Australia.

Health and access to services is intimately connected to human rights and social justice.

It is terrifying to think that the Government is ignoring its obligations under the UN Refugees Convention by sending asylum seekers to a country where they will be denied their rights. It is even more frightening that a large percentage of the Australian population supports this illegal action.

Not only is Australia displaying a monumental lack of compassion, but it is showing the rest of the world that we do not honour our international treaty obligations.

When one considers that the so-called refugee problem is minuscule when compared to that of other countries, it is clear that much needs to be done to inform the community about human rights and the ever present need to ensure that we safeguard those that we do have. I know it’s becoming a cliche but it’s true to say that once we lose a right, it’s almost impossible to get it back.

The refugee issue is an example of the way in which rights can be eroded, with access to health being part of the issue.

This website puts Australia’s so-called asylum seeker problem into perspective.

I am also aware from my experience with refugee rights issues in New Zealand that all governments, no matter what their persuasion will try to hoodwink the public into thinking that they are not breaking international laws, if they think they can get away with it.

Our most effective response is to inform the public and to publicise the illegality internationally. Governments hate being shamed on the international stage but they will do whatever they can domestically in order to ensure their political survival.

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The tweets below are from former SMH editor Amanda Wilson and Paul Bongiorno, National Affairs Editor for Network Ten.


 

 

 

 

 

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