asylum seeker health

Dec 17, 2013

Inside the immigration detention facilities in Darwin: breeding grounds for mental illness

The official version of how asylum seekers are treated in immigration detention facilities in Darwin is quite different from the reality, reports a prominent medical specialist,

Melissa Sweet — Health journalist and <a href=Croakey co-ordinator" class="author__portrait">

Melissa Sweet

Health journalist and Croakey co-ordinator

The official version of how asylum seekers are treated in immigration detention facilities in Darwin is quite different from the reality, reports a prominent medical specialist, Professor Caroline de Costa, after a recent visit.

Her first-hand observations about the toll of detention upon the mental health and wellbeing of children and mothers is in line with a study published this week in The Medical Journal of Australia.

She writes:

“It would be good if we could, right now, acknowledge the suffering of the at least 1,153 children imprisoned right now in detention facilities in and outside of Australia who are our direct responsibility… Mandatory detention is no place for children of any age and particularly not for newborn babies or their mothers.”


Caroline de Costa writes:

I am sitting on a hot Darwin Saturday morning in a room with several families and numerous small children. Tea, cakes and tropical fruits are being offered. On my knee is a small boy. He is one today. But nobody is celebrating.

This child is turning one in a detention camp. He has been in detention since he was five months old. Across from me sits his mother, unsmiling, vacant-eyed, clearly suffering from depression.

His father is in Sydney, on a bridging visa, but his wife and son cannot join him. Instead they are kept locked up in the hot, crowded environment of the camp, at considerable expense to the taxpayers of Australia.

I am in Darwin on a private visit but using my many years of experience as a doctor practising obstetrics and women’s health. The visit has been organised by ChilOut, the group which since 2001 has supported and advocated for the rights of all asylum seekers, but particularly those of children.

There are three detention facilities in Darwin in which women and children asylum seekers are located. These are all referred to as APODs, which sounds like a new device from Apple but actually stands for Alternative Places of Detention.

We have had access to all three facilities in a daylong visit organised jointly by the Department of Immigration and Border Protection (DBIP), who have overall responsibility for the facilities, International Health and Medical Services (IHMS), a private organisation which has responsibility for the healthcare of asylum seekers, and Serco, the private multinational organisation responsible for the running and security of the facilities.

During our visit we have been shown right around all three facilities and we have met a large number of employees of all the organisations.  Individually, many these people have appeared professional and caring towards the people they mostly refer to as “detainees”, but some call “clients.” Among other things we are told that names are always used when addressing or referring to asylum seekers, never numbers.

As an obstetrician, my particular concern has been the care offered during pregnancy and labour to asylum seeker women. All pregnant women currently are brought to Darwin from Christmas Island at about 34 weeks of pregnancy. They wait until the birth in the APODs, usually without their husbands and other children who are left on Christmas Island until closer to the birth.

Following birth mother and baby are transferred back to Christmas Island at four weeks postnatally.  Antenatal and postnatal care appears to be very limited on Christmas Island and any woman or baby developing complications needs to be transferred, or retransferred, to Darwin (or Perth).

There appear to have been around 40 births to asylum seeker women in Royal Darwin Hospital (RDH) in the past few months, with up to 60 women expected to give birth there between now and the end of February. Many of these women are high risk, from the point of view of their medical or previous obstetric history, or because of factors affecting the current pregnancy.

No additional staff, either midwives or doctors, have yet been employed in RDH to help provide the often complex care these women need. Nor does it appear that much discussion with RDH staff or the NT Health Department went into the decision to send pregnant asylum seeker women to RDH for care.

There is said to be a fulltime midwife at Wickham Point APOD to provide onsite care to pregnant women but I did not meet this person. There are three IHMS  doctors sharing the overall health care of all asylum seekers but none with obstetric qualifications.

We were told that there is 24/7 access to a nursing triage service, with a doctor on call, for asylum seekers (male and female, adults and children) in all three camps.  We were also told that there are regular playgroups and ‘Mums and Bubs’ sessions held in all three camps for pregnant women and new mothers.

The reality gap

Meeting individual asylum seekers, in the visitors’ rooms of all three facilities, in the two days following our formal visit, we heard stories quite different from the official accounts.

We observed in many parts of the camps that asylum seekers including children and women are routinely listed, dealt with and addressed by the numbers given to them on arrival by boat in Australia, rather than by their names.

This is highly disrespectful and part of a culture that appears dedicated to de-humanising these people. As one pregnant woman said to us: “You can call me illegal, but don’t call my baby illegal!”

Pregnancy care once a woman reaches RDH is excellent, as would be expected. However, none of the women we spoke to had been seen by a midwife in the detention facilities, nor were they aware of the existence of such a person. Playgroups and Mums and Bubs likewise were unknown to them.

All had experience of presenting to the clinic with health concerns for themselves or their children and not being seen at all. Postnatal care and assistance with breastfeeding were minimal at best.

I spoke to two women who had recently lost their babies in Darwin; both stated that prior to their babies’ deaths they had presented to the clinic with complaints (decreased fetal movements, baby stopping breathing) that would be taken seriously in a general medical context anywhere else in Australia. Both had been turned away from the clinic over several days.

While I have no way of corroborating their stories, and it is impossible to say that the stillbirth and the early infant death which later resulted might have been prevented by earlier intervention, their stories are sufficiently consistent and alarming to warrant immediate efforts to improve current care arrangements for asylum seeker women.

There is an urgent need for improved antenatal care on Christmas Island, and for more designated midwives and doctors with obstetric qualifications to be employed in Darwin.

Earlier this year I was asked to provide some information to the International Health Advisory Group regarding the basic needs for the provision of antenatal care on Christmas Island. Protocols were drawn up consistent with the kind of care provided within the Australian community; with the abandonment of the IHAG group earlier this week, I would be concerned that these recommendations may not be implemented.

Following the IHAG sacking there was a government statement to the effect that the group’s contribution had not been useful. I would disagree – the health of mothers and babies is absolutely integral to all other healthcare, in all populations.

It also makes good sense, from the financial point of view as well as that of asylum seekers’ mental health, that families are kept together before and after birth. We saw plenty of accommodation suitable for families in all three Darwin APODs, and DIBP and Serco staff agreed that the Darwin APODs at present are far from full.

The purpose of good antenatal and pregnancy care is to produce babies and mothers who are as healthy as possible. And as happy.

Whether or not these babies ultimately become Australian citizens or residents, Australia has responsibility for them right now.

One Darwin doctor who works closely with asylum seekers said to me that “there are the mental health problems that people have before they arrive (in detention). Then there are the problems they develop as a result of being in detention, and these are much greater.”

One of these problems is postnatal depression, and my impression is that PND is rife among women in Darwin who have recently given birth. This was certainly the case on Nauru, where I was involved in providing care for asylum seeker women in 2003 in the Top Side Camp on the island.

My experience at that time of Nauru, and my extensive experience of practising medicine in Papua-New Guinea, mean that I can unequivocally state that neither Manus nor Nauru are suitable places for the detention of very young babies and their families.

These environments are hot, crowded and lacking in the most basic facilities (eg adequate bathing facilities for babies). The ease with which infections of many kinds can spread in such environments is potentially lethal for young children; in addition there are the risks of tropical diseases such as malaria.

However, the greatest and most pervasive risk is to the mental health of children and their families. The fact of ongoing uncertain detention is bad enough; adding to it with an extremely isolated hot and crowded environment with few diversions within the detention facility and none outside is demonstrably contributing to very high levels of psychiatric presentations among asylum seekers, well documented by many of my colleagues in recent weeks.

My own observations of recent mothers I met in Darwin is of a high level of postnatal depression that is continuing on well past the postnatal period; the mother of the child mentioned above is but one example.

In recent years we have seen the acknowledgment of the Stolen Generations, the inquiries and the Apology. We have seen the acknowledgment of the suffering of children institutionalised and abused, the inquiries and the apologies.

It would be good if we could, right now, acknowledge the suffering of the at least 1,153 children imprisoned right now in detention facilities in and outside of Australia who are our direct responsibility. And solve this problem right now, rather than needing further inquiries and apologies down the track.

Mandatory detention is no place for children of any age and particularly not for newborn babies or their mothers.

• Caroline de Costa is Professor of Obstetrics and Gynaecology and Director of the Clinical School at James Cook University School of Medicine, Cairns Campus in North Queensland.



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20 thoughts on “Inside the immigration detention facilities in Darwin: breeding grounds for mental illness

  1. Samantha Choveaux

    The current asylum seeker policy has serious consequences for the health and wellbeing of people seeking protection in Australia. Why is it that we are more concerned with “stopping the boats” than the implications these policies have on the vulnerable human beings our Federal Government label as “illegal maritime arrivals”?

    It is important to take notice of the changing language and the impact that this has on our perception of refugees and asylum seekers. Under the previous Labor Government asylum seeker policy was the responsibility of a Minister for Immigration and Citizenship. Now in the Coalition government it is being handled by a Minister for Immigration and Border Protection. The use of language such as “border protection”, “illegal maritime arrivals”, “illegal boat arrivals”, “queue jumpers”, “economic migrants” all have the potential for people to take a less sympathetic view towards some of the worlds most vulnerable people. Furthermore, the use of negative rhetoric against asylum seekers who enter Australia by boat is not assisting us to be a cohesive and diverse nation, rather it is assisting the population to be ok with the policies the Coalition Government is implementing.

  2. M P Casey

    I usually watch Question Time in Parliament. When Morrison was in Opposition it horrified me to see his face screw up with hate when he spoke about refugees. Post election he’s in his dream job and I bet he can’t wait to get to the office each day.

    Also, perhaps someone could explain why an Army General is in command of a Naval Operations Unit he has no qualifications nor experience to command?

  3. David Hand

    What I believe is that detention is only part of the solution.

    Your other point about Australia being culpable for the deaths at sea of boat people who drown in Indonesia’s search and rescue zone displays all the moral certainty of a religious fundamentalist who thinks everybody apart from his sect is going to hell.

    You allege that-
    a) Indonesia does not have the capability to patrol its search and rescue zone.
    b) Australia is deliberately allowing boats to sink.
    c) Desperate boat people have no alternative but to come to Australia.

    None of these allegations are supported by any facts.

    Here’s a fact for you. Australia succeeded in stopping the boats from 2001 until the ALP government dismantled the policy in a bleeding heart lefty mutual wank.

    Here’s another fact for you. The million or so Syrian refugees fleeing into Turkey have no right to permanent settlement there. They will be expected to return home once the civil war ends. The Australian government would like to do the same using temporary protection visas. Such visas are opposed at every stage by the bleeding heart left.

    TPVs would place these 1500 or so children into the community quite quickly.

    While boats remain a visa free way of permanently resettling in Australia with a 95% success rate, the boats will keep coming and the potential number of people is in the millions.

  4. graybul

    It seems to me David, now we have reached common ground ie “Detention doesn’t work” . . we could move forward to the second part of your construct. That being, “Stop the Boats”.
    Indonesia has explained it does not have a capacity to carry out sea rescues beyond 1 – 5 miles from land. Implication being Australia, under the law of the sea, must assume responsibility on the basis of ‘enhanced capability’. Yet Australian Search and Rescue has delayed response to distress calls, resulting in many deaths. Would you agree, boats cannot be stopped whilst desperate people, in their minds, have no alternative other than to attempt to seek asylum in another country?

  5. jass

    The treatment of asylum seekers in detention centres has horrifying effects. One need not use the precise words ‘mental and physical abuse’ but that is what it is.

    If the best you can do is lay claims against my ‘moral superiority’ to defend the indefensible argument, then there is no argument. Just mud-slinging.

    People who hold your views are in the minority, David, as are people who hold mine. The large number are misinformed. That is where my energies go to – changing public opinion by providing information, such as that provided in Caroline’s article.

  6. David Hand

    “Mental and physical abuse” is a term used by refugee activists such as yourself. It’s the usual morally superior rhetoric so beloved of the inner urban elites that makes balanced dialogue difficult.

    I note that Caroline de Costa did not use it. And she was there.

    Detention is a measure both governments have used as part of a suite of measures to discourage asylum seekers to come to Australia by boat.

  7. graybul

    If as you now concede David, that “Detention is clearly not working and it can’t work on its own” . . . What then is your rationale for Govt(s) continuing to inflict mental and physical abuse upon children and pregnant women?
    Surprise, surprise . . . I also do not reside in “deep inner suburbs” of capital cities, in fact my electorate is rock solid blue ribbon, but am hoping open, balanced dialogue may address that!

  8. David Hand

    It’s a generalisation, Jass. The deep inner suburbs of Sydney and Melbourne are where large concentrations of Green voters and sympathisers live. Suburban single mums are quite entitled hold views of moral superiority as well.

    Detention is clearly not working and it can’t work on its own. A number of measures need to be implemented together to stop the boats and we are up against a determined, flexible and organised people smuggling industry who think nothing of killing one in twenty of their customers.

  9. jass

    Answer the question David: if the policy of mandatory detention is working, why are boats still arriving

    How horribly presumptive of you to slot me into a neat political framework! Laughable. I don’t live in inner city, I am a single mum who works full-time, and I have radical political views. Shock, horror!

  10. David Hand

    I apologise for being so unclear as you think I’m obfuscating. I was actually using the Socratic method to ask a question that might cause Jass to reconsider his/her position.

    So I’ll just have to spell it out.

    The ALP government changed its mind on boat people because the vast majority of voters do not want the boats to come. Having dismantled an effective policy that was working, along with teary-eyed statements of being so proud and worthy, the flood of boat people coming to Australia and entering unlawfully without a valid visa meant electoral annihilation at the general election. So they changed their minds.

    I’ll spell something else out as well. The moral superiority of inner-urban left elites, who think their point of view is the only valid one, and that antipathy to boat people by middle Australia is some sort of moral failure is truly nauseating.

    To be labelled “R*cist” by Jass is offensive and just so typical of the Green Left occupiers of the moral high ground.

  11. graybul

    Jass, Your last paragraph sums up David’s strategy . . his sole objective is to employ obfuscation with intent to redirect focus. Frankly, I don’t care a toss which political party deserves the greater or lesser acrimony. I do care, that we as a Nation are losing our way with the consequence, innocent people, refugees, have become a ‘whipping stick’. Destroying the mental and physical health of innocents to make a political point debases all of us. Our responsibility must be to call it what it is . .

  12. David Hand

    Hey Jass,
    “Cruel and gruesome concentration camps” is a nice turn of phrase. “Apologist for a racist policy” is another.

    You must have such a clear view sitting up there next to Jesus on the moral high ground.

    Here’s a question for you. Why is it only the Greens, with their 8% support in the community that opposes detention and supports the ongoing trade in desperate people out of Indonesia? Why did the ALP government change its mind?

  13. jass

    Right, David, presumably you have evidence to support your hypothesis? Because, really, there have been some 167 new arrivals this week alone. How is detaining people in cruel and gruesome concentration camps do anything but break international law, break the asylum-seekers’ will to live, and break every known moral and ethical code humanity prides itself in?

    Your argument is one of those where the’means justify the end’. You simply fail to address the inhumane treatment of asylum seekers described in this article because you are just a veiled apologist for a racist policy.

  14. David Hand

    There is nothing “disingenuous” about women and children in detention helping stop boat people arrivals. I can’t think of another possible reason for having women and children in detention.

    Detention was started by the Keating government in the mid 90’s in an effort to stem the rising number of people entering Australia by boat without a valid visa.

    The fear that governments of both sides have is that eliminating detention will act as a pull factor for people using the refugee convention to enter Australia without a visa.

    So we can either let the 1153 children out of detention and back fill them in the next 12 months with another 1100-odd children, less those who drown on the way, of course or we can stop the trade.

    Maintaining the detention system helps stop the trade.

  15. graybul

    David, is it not somewhat disingenuous to employ the words “helping stop” when referring to children and pregnant women being systematically brutalized by Australian Immigration Authorities working directly under orders of a Federal Minister and Armed Forces General?

  16. graybul

    Once again we are alerted to the brutal incarceration of persons claiming refuge from war, dispossession and political persecution. Do not give up Melissa!
    Professor De Costa highlights the circumstance of children and pregnant women . . services that do not exist; direct threat to health and life, and the so effective corrosive nature of denying the very legitimacy of existence by reducing one’s identity to a number. This Nation, you and I, in company with the Foreign, Immigration and Prime Minister(s) . . cannot plead ignorance, nor indemnity for our silence. Nor will we escape the repudiation and judgement of our fellow world citizens, down the track!

  17. David Hand

    Thank you for another powerful message about why it is so important to stop people getting on leaky boats and risking that dangerous journey to Australia.

    You may think about the 1153 children in detention but you say nothing of the children who were put on these boats by their parents and never made it – part of the 1000 plus people who drowned at sea.

    The detention system is helping stop yet more small children enter this desperate and dangerous trade. It’s a diabolical problem that governments of both sides of politics are grappling with and the decline of boat numbers gives us hope for the future.

  18. Marshall Thornton

    Babies dying, children suffering. Australia will go down in history as a cruel country. Previous history – convicts, genocide of the indigenous, White Australia policy. We continue on. Shame, Shame, the latest shame going to Abbot & Morrison.

  19. MJPC

    Detention centres are Australia’s gulags; revolution now!

  20. Andybob

    Thankyou Melissa and Professor de Costa for ensuring that we know what is being done in our name. Our leaders, on both sides of politics, prefer to maintain an adverse environment for detainees in order to discourage others. We need better leaders.

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