Médecins Sans Fron­tières calls for im­me­di­ate evac­u­a­tion of all refugees on Nauru

The Guardian Australia - - News - He­len David­son

Médecins Sans Fron­tières has called for the im­me­di­ate evac­u­a­tion of all asy­lum seek­ers and refugees from Nauru and the end of Aus­tralia’s off­shore de­ten­tion pol­icy for good.

In a rare and force­ful state­ment, the in­ter­na­tional non-gov­ern­men­tal or­gan­i­sa­tion said there was “noth­ing hu­man­i­tar­ian about sav­ing peo­ple from sea only to leave them in an ope­nair prison.”

“This pol­icy should be stopped im­me­di­ately and should not be repli­cated by any gov­ern­ment,” said MSF Aus­tralia’s di­rec­tor, Paul McPhun.

At a press con­fer­ence on Thurs­day McPhun and two mem­bers of the former Nauru team also de­scribed hos­tile treat­ment from the Nau­ruan gov­ern­ment de­spite be­ing in­vited to work there.

MSF was forced by Nauru’s gov­ern­ment to leave this is­land this week, af­ter al­most a year of pro­vid­ing psy­cho­log­i­cal and psy­chi­atric ser­vices to refugees, asy­lum seek­ers, and lo­cal Nau­ru­ans.

Their visas were can­celled on the way out “to make it clear there was no in­ten­tion of invit­ing us back,” said McPhun.

Upon re­turn­ing to Aus­tralia, the apo­lit­i­cal med­i­cal charity con­demned the de­ci­sion, as well as the Aus­tralian gov­ern­ment’s poli­cies.

“While many asy­lum seek­ers and refugees on Nauru ex­pe­ri­enced trauma in their coun­tries of ori­gin or dur­ing their jour­ney, it is the Aus­tralian gov­ern­ment’s pol­icy of in­def­i­nite off­shore de­ten­tion that has de­stroyed their re­silience, shat­tered all hope, and ul­ti­mately im­pacted their men­tal health,” McPhun said.

“Sep­a­rat­ing fam­i­lies, hold­ing men, women and chil­dren on a re­mote is­land in­def­i­nitely with no hope of pro­tec­tion, ex­cept in the case of a med­i­cal emer­gency, is cruel and in­hu­mane.”

He said it should never be looked as a model for other gov­ern­ments to emu­late.

Dr Chris­tine Rufener said there was a “sig­nif­i­cant dif­fer­ence” in the pa­tients she treated on Nauru com­pared to those she had treated with MSF in Les­bos, Greece, and in a clinic for sur­vivors of sex­ual vi­o­lence, tor­ture and trauma, was “the ut­ter de­struc­tion of peo­ple’s sense of hope”.

“The word I heard most of­ten in my ther­apy ses­sions with pa­tients was ‘de­stroyed’.”

“Any hope they have of liv­ing a mean­ing­ful fu­ture has been ir­re­vo­ca­bly de­stroyed. I heard it in their words and I saw it in their eyes.”

Rufener said one of the most dis­tress­ing out­comes of what she de­scribed as “in­def­i­nite trap­ping” of peo­ple on Nauru was the sep­a­ra­tion of fam­ily mem­bers, in­clud­ing par­ents and chil­dren, hus­bands and wives.

“MSF is also deeply con­cerned about the men­tal health of the Nau­ruan pop­u­la­tion it­self,” McPhun added.

While they saw an im­prove­ment among the Nau­ruan peo­ple in the past year – many who had not been treated for months be­fore they ar­rived – they feared a de­cline in men­tal health and an in­crease in abuse and ne­glect. There were a sig­nif­i­cant num­ber with chronic psy­chotic dis­or­ders, in­clud­ing schizophre­nia and bipo­lar, who had not re­ceived treat­ment.

The most com­mon con­di­tions treated among the refugees and asy­lum seek­ers were de­pres­sion, anx­i­ety, and post trau­matic stress dis­or­der, with sig­nif­i­cant lev­els of self harm, sui­ci­dal ideation, and sui­cide at­tempts, in­clud­ing chil­dren as young as nine.

At least 78 pa­tients had con­sid­ered or at­tempted sui­cide or self harm. An­other 100 were on MSF’s wait­list.

Dur­ing MSF’s time there more than 70 peo­ple re­ceived neg­a­tive re­sponses from the US re­set­tle­ment pro­gram, prompt­ing de­te­ri­o­ra­tion into men­tal ill­ness worse than when MSF ar­rived, the staff said.

“Our pa­tients of­ten de­scribe their sit­u­a­tion as far worse than prison be­cause in prison you know when you can get out,” said an MSF psy­chi­a­trist, Dr Beth O’Con­nor.

“Whilst in my pro­fes­sional opin­ion there is no ther­a­peu­tic so­lu­tion for these pa­tients as long as they are trapped on the is­land, I fear the with­drawal of MSF’s … health­care will claim lives.”

Nauru told MSF it was no longer needed be­cause the gov­ern­ment con­cur­rently pro­vided the same ser­vices – a claim the MSF staff de­nied on Thurs­day.

“The Nauru hos­pi­tal has no psy­chol­o­gists or ther­a­pist on staff,” said Rufener.

“There is one men­tal health nurse who sup­ports Nau­ruan pa­tients only and who will con­tinue to do her best. The hos­pi­tal employs one full time psy­chi­a­trist and that per­son does not even speak English. She has no trans­la­tor to com­mu­ni­cate with pa­tients.”

Rufener also con­firmed pa­tients had told them po­lice had taken refugees to jail in­stead of hos­pi­tal af­ter sui­cide at­tempts, and that oth­ers had been turned away from the hos­pi­tal af­ter seek­ing help.

McPhun said it had not been an easy re­la­tion­ship with the Nau­ruan gov­ern­ment and there had been many ob­sta­cles re­lat­ing to in­for­ma­tion shar­ing, ac­cess to pa­tients in their homes, as well as “lo­gis­tics”.

“It’s an en­vi­ron­ment where we were the only in­de­pen­dent or­gan­i­sa­tion … so there was a sig­nif­i­cant di­vide,” he said. “I think we felt quite iso­lated for many rea­sons.”

O’Con­nor said the in­ter­fer­ence would af­fect clin­i­cal work, and de­scribed one in­ci­dent when she was do­ing a psy­chi­atric as­sess­ment of a child at the hos­pi­tal who had at­tempted sui­cide, be­cause there was no avail­able qual­i­fied doc­tor.

“Dur­ing this con­sul­ta­tion with this fam­ily I was in­ter­rupted by a gov­ern­ment of­fi­cial and told to leave,” she said.

“Ob­vi­ously I have an obli­ga­tion to pa­tients, and ended up hav­ing to try and sneak the de­tails of our clinic to this fam­ily so they could later come and see us for as­sis­tance.”

McPhun said their re­moval was “very very un­usual” even within the com­plex and of­ten hos­tile en­vi­ron­ments they work in around the world.

He would not spec­u­late on the rea­sons for Nauru’s de­ci­sion, but said: “it can­not be that 11 months ago that we reached an agree­ment that there was a sig­nif­i­cant need for our ser­vices on Nauru… and 11 months later that gap is

some­how filled.”

McPhun also de­scribed com­ments by home af­fairs min­is­ter Peter Dut­ton on Tues­day, that MSF was not con­tracted to treat refugees, as “quite clearly ill-in­formed”.

• In Aus­tralia, the cri­sis sup­port ser­vice Life­line is on 13 11 14. In the UK Sa­mar­i­tans can be con­tacted on 116 123. In the US, the Na­tional Sui­cide Pre­ven­tion Life­line is 1-800-273-8255. Other in­ter­na­tional sui­cide helplines can be found at www.be­frien­ders.org

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