Chil­dren on Nauru.

The lives of chil­dren de­tained on Nauru are hang­ing in the bal­ance due to trau­matic with­drawal syn­drome, while the gov­ern­ment fights in court to pre­vent them re­ceiv­ing med­i­cal care.

The Saturday Paper - - The Week | Contents - Martin McKen­zie-Mur­ray

In her time as a child pro­tec­tion worker on Nauru, she had grown close to her clients. Es­pe­cially one young girl, thought­ful, sen­si­tive and trau­ma­tised, who might as eas­ily paint pic­tures of flow­ers as of her own im­age, cov­ered in blood. This was com­mon: chil­dren ex­press­ing their sui­ci­dal ideation with crayons.

Save the Chil­dren staff on Nauru worked ros­ters – in­di­vid­u­als did three weeks on, three weeks off – and dur­ing a spell when the care worker with the clos­est re­la­tion­ship to her was back in Aus­tralia, the young girl at­tempted sui­cide by swal­low­ing wash­ing pow­der. She was flown to Aus­tralia, where she sur­vived but suf­fered ex­treme chem­i­cal burns to her throat.

The girl had other car­ers, but the staff mem­ber par­tially blamed her­self. Later, there were night­mares and in­tru­sive mem­o­ries. Be­fore Save the Chil­dren’s con­tract ended on Nauru, be­fore the Aus­tralian gov­ern­ment wrongly ac­cused staff of coach­ing asy­lum seek­ers to self-harm, staff were in a ter­ri­ble bind. “It was a pretty ab­surd sit­u­a­tion,” an­other former child pro­tec­tion worker told me this week. “The risks of harm to chil­dren are en­demic to the en­vi­ron­ment, but you can’t remove them from it. Longer you stay there, the more de­mor­alised you are. You’re the oval face of all this un­met need. Clients would say, ‘You can’t do any­thing for me.’ And they were right. This was the burnout point for me. Your hands are tied be­hind your back. It was all pretty fu­tile.”

In late 2015, days be­fore a chal­lenge to the off­shore de­ten­tion cen­tre’s le­gal­ity in the High Court, the Nauru gov­ern­ment an­nounced that the camps would be opened – mean­ing the asy­lum seek­ers were free to move around the is­land with­out restric­tion. Ad­vo­cates thought the tim­ing sus­pi­cious – the camp could no longer be re­ferred to as de­ten­tion

– but then im­mi­gra­tion min­is­ter Peter Dut­ton said the move was in­evitable and the tim­ing co­in­ci­den­tal. It was to this open­ing of the camps that Dut­ton re­ferred this week in his pub­lic pitch for the prime min­is­ter­ship when he said he had re­moved chil­dren from de­ten­tion.

In re­al­ity, most con­tin­ued to live in the camps that were fre­quently re­ferred to – in staff tes­ti­monies and the gov­ern­ment’s own re­ports – as man­i­festly in­ad­e­quate. Sit­u­ated in the mid­dle of Nauru, upon the moon­scape of a heav­ily mined phos­phate reef, the camps are hot, dirty, un­safe and lack pri­vacy. But more, al­ready trau­ma­tised chil­dren have suf­fered un­cer­tainty and badly ail­ing par­ents. Chil­dren have at­tempted sui­cide and ex­pe­ri­enced psy­chotic episodes, and there are mul­ti­ple al­le­ga­tions of sex­ual abuse.

None of this is new. It has been the sub­ject of mul­ti­ple re­ports. The last, a Sen­ate in­quiry re­port, in ref­er­ence to the leaked “Nauru files” pub­lished by Guardian Aus­tralia, said: “Col­lec­tively, these re­ports paint the pic­ture of a deeply trou­bled asy­lum seeker and refugee pop­u­la­tion, and an un­safe liv­ing en­vi­ron­ment – es­pe­cially for chil­dren.”

Noth­ing has hap­pened. Only days be­fore Can­berra’s lead­er­ship tu­mult, a large group of non-gov­ern­ment or­gan­i­sa­tions – in­clud­ing Ox­fam and World Vi­sion Aus­tralia – sought to re­vive the is­sue, call­ing for the chil­dren’s transfer by Novem­ber 20, Uni­ver­sal Chil­dren’s Day. The fed­eral shadow im­mi­gra­tion min­is­ter, Shayne Neumann, wrote to Peter Dut­ton ask­ing him to ac­cept New Zealand’s of­fer to have the chil­dren and their fam­i­lies re­set­tled there.

It fol­lowed pro­fes­sional claims of a health cri­sis among chil­dren on Nauru, in­clud­ing a stricken 12-year-old boy who had en­tered a near-cata­tonic state de­scribed as “trau­matic with­drawal syn­drome”. The boy had al­most reached three weeks with­out eat­ing – he was sus­tained in­tra­venously – and doc­tors on the is­land said his con­di­tion was crit­i­cal. It was day 19 of his acute with­drawal be­fore the Aus­tralian Bor­der Force per­mit­ted his whole fam­ily to join him in his med­i­cal transfer to Aus­tralia.

Many news re­ports re­ferred to the boy’s “hunger strike”. Pro­fes­sor Louise New­man, a psy­chi­a­trist who has ex­ten­sively con­sulted with chil­dren on Nauru, and whose re­ports have fea­tured in mul­ti­ple court judge­ments, told me this was wrong. The boy was ex­pe­ri­enc­ing trau­matic with­drawal syn­drome, oth­er­wise known as res­ig­na­tion syn­drome. “Hunger strike is not an ap­pro­pri­ate de­scrip­tion,” she said. “Hunger strikes are vo­li­tional. It’s not meant to do any­thing but to take a se­vere ap­proach to achieve an out­come. Chil­dren don’t do this. We need to be clear that the mo­ti­va­tion is un­con­scious, if you like – ‘I can’t deal with this sit­u­a­tion’ – and then de­fen­sive mech­a­nisms come into play, where lit­er­ally they come un­con­scious. That’s when it’s life threat­en­ing.”

Other chil­dren are ex­pe­ri­enc­ing sim­i­lar symp­toms. On Wed­nes­day, a 12-year-old girl set her­self on fire – an act wit­nessed by other chil­dren. Adults in­ter­vened be­fore her in­juries were life threat­en­ing. The girl is be­ing treated on Nauru.

“This is an in­def­i­nite emer­gency, and noth­ing should eclipse the evac­u­a­tion of chil­dren,” refugee lawyer and ad­vo­cate David Manne told me this week. “It’s ur­gent. It’s fun­da­men­tal that the cur­rent po­lit­i­cal cri­sis does not in any way dis­tract from this emer­gency. Chil­dren’s lives re­main at risk, and their fate re­mains in the hands of the gov­ern­ment.”

The Satur­day Pa­per is aware of at least nine cases re­gard­ing the transfer of chil­dren alone where the gov­ern­ment has de­nied med­i­cal trans­fers, choos­ing in­stead to legally con­test in­junc­tions.

In De­cem­ber last year, a young girl on Nauru – iden­ti­fy­ing de­tails have been sup­pressed – at­tempted sui­cide by in­gest­ing her mother’s pre­scrip­tion drugs. She was ad­mit­ted to the lo­cal hospi­tal com­plain­ing of res­pi­ra­tory dis­tress, chest pain and ab­dom­i­nal pain. Af­ter her re­lease, she was seen by a coun­sel­lor em­ployed by In­ter­na­tional Health and Med­i­cal Ser­vices. In part, the coun­sel­lor’s clin­i­cal notes read: “When ex­plor­ing her feel­ings about it she said, ‘the med­i­ca­tion didn’t kill me, I will try some­thing else.’ She stated, ‘I will kill my­self with a knife or jump off the rocks.’ Ex­plored it fur­ther and [she] also dis­closed re­cur­rent sui­ci­dal ideation. She re­ported that she knows how to kill her­self, as she has seen in the movies peo­ple stab­bing them­selves with knives ... Dur­ing con­sul­ta­tion [she] dis­closed that at­tempt­ing sui­cide made her feel good.”

Lawyers and doc­tors ap­pealed to the Aus­tralian gov­ern­ment to have the girl trans­ferred im­me­di­ately to Aus­tralia for proper psy­cho­log­i­cal care. The gov­ern­ment re­fused. Lawyers then filed an in­ter­locu­tory in­junc­tion in the Fed­eral Court of Aus­tralia, where the le­gal test is twofold: one, that there is a se­ri­ous ques­tion to be asked – in this case, of the ur­gency and ap­pro­pri­ate­ness of med­i­cal treat­ment, and the gov­ern­ment’s duty of care; and two, whether the “bal­ance of con­ve­nience” favours the in­junc­tion be­ing granted.

In Fe­bru­ary this year, the in­junc­tion was granted. In part, the judge­ment read: “The in­jury or dam­age the ap­pli­cant may suf­fer if an in­junc­tion is re­fused – death or a fur­ther se­ri­ous de­te­ri­o­ra­tion in her health – car­ries far more weight in the bal­ance than the wasted ex­pen­di­ture the Com­mon­wealth may suf­fer if an in­junc­tion is granted. Fur­ther, given the ap­pli­cant’s ex­treme sui­cide risk, the re­lief sought in the pro­ceed­ing may be­come nu­ga­tory un­less the in­junc­tion is granted.”

“The truth is that the gov­ern­ment has gone to ex­tra­or­di­nary lengths to block chil­dren from be­ing evac­u­ated to Aus­tralia to get the emer­gency care they need,” Manne said. “The courts have been con­sis­tently sat­is­fied that there’s a se­ri­ous ques­tion to be asked of the wel­fare of these chil­dren – and that Nauru or PNG can­not pro­vide ei­ther the proper en­vi­ron­ment or treat­ment for them.

“This is the sharp end and in­evitable con­se­quence of ex­treme deter­rence pol­icy. It be­comes nec­es­sary to treat chil­dren as po­lit­i­cal pawns in this. Their health and lives be­come ex­pend­able. The mind­set is that there can­not be a sin­gle act of com­pas­sion, not a crack of light or pro­vi­sion of care can be pro­vided.”

The Aus­tralian gov­ern­ment’s duty of care of those in off­shore pro­cess­ing has never been defini­tively de­ter­mined by a court – the suc­cess­ful in­junc­tions merely up­hold the fact that there are se­ri­ous questions to be asked about med­i­cal wel­fare and duty of care. Last year, af­ter re­peated ad­journ­ments, the Aus­tralian gov­ern­ment pri­vately set­tled yet more lit­i­ga­tion brought about by off­shore de­ten­tion. Ma­jid Ka­masaee v the Com­mon­wealth of Aus­tralia would have been an enor­mous trial – there were more than 2000 plain­tiffs who ar­gued the gov­ern­ment was neg­li­gent. De­spite the gov­ern­ment’s ob­jec­tions, the trial also would have been broad­cast live, in recog­ni­tion that most plain­tiffs could not watch pro­ceed­ings in per­son. Set­tled at the 11th hour, some lawyers saw a missed op­por­tu­nity for the le­gal ven­ti­la­tion of these is­sues and a de­fin­i­tive rul­ing on the gov­ern­ment’s duty of care.

The ques­tion of duty of care, how­ever, was touched upon in two re­cent coro­nial in­quest re­ports. Last month, Queens­land coro­ner Terry Ryan ruled that the 2014 death of Hamid Khaz­aei – who was de­tained on Manus, and fa­tally suc­cumbed to sep­tic shock af­ter a de­layed med­i­cal transfer to Aus­tralia – was pre­ventable and the re­sult of “sys­temic fail­ure”. He rec­om­mended that doc­tors – and not the Aus­tralian Bor­der Force – have pri­macy over the de­ci­sion to transfer pa­tients, and that all off­shore deaths, not merely those that oc­cur on Aus­tralian soil, be sub­ject to manda­tory in­quest. On the other side of the coun­try, the West Aus­tralian coro­ner re­cently con­cluded an in­quest into the death of Fazel Che­geni Ne­jad, a state­less refugee who com­mit­ted sui­cide af­ter hav­ing es­caped de­ten­tion on Christ­mas Is­land. The forth­com­ing re­port is ex­pected to ex­am­ine questions of neg­li­gence.

This week, Louise New­man wrote an ex­plana­tory piece for The Con­ver­sa­tion on the syn­drome she said was be­ing ex­hib­ited on Nauru. “Res­ig­na­tion syn­drome is a rare psy­chi­atric con­di­tion that presents as a pro­gres­sive so­cial with­drawal and re­luc­tance to en­gage in usual ac­tiv­i­ties such as school and play,” she wrote. “Chil­dren may be­come iso­lated and ap­pear de­pressed and ir­ri­ta­ble ... As the con­di­tion pro­gresses, the child may stop talk­ing and isolate them­selves in bed, and may stop eat­ing and drink­ing. The most se­ri­ous stage of the dis­or­der is when the child en­ters a state of pro­found with­drawal and is un­con­scious or in a co­matose state.”

Sadly, it took a seem­ingly ex­otic syn­drome to in­ter­est the me­dia in the plight of these chil­dren. But the syn­drome is not new, and nei­ther are the con­di­tions on Nauru that have given rise to it. “I’ve seen some me­dia re­ports re­fer to it as ‘Sleeping Beauty dis­ease’, which frankly I find of­fen­sive,” New­man told me. “Mute, in­con­ti­nent chil­dren aren’t Sleeping Beau­ties.

“This is not new. And nor is it iso­lated to asy­lum seek­ers. One of the orig­i­nal terms was ‘per­va­sive re­fusal syn­drome’. These chil­dren were hos­pi­talised. They took to beds. There was a pat­tern of with­drawal and a com­mon fac­tor was var­i­ous trau­ma­tis­ing ex­pe­ri­ences when chil­dren had limited op­tions.

“This is not sur­pris­ing. And the po­lit­i­cal con­text this is oc­cur­ring in is a gov­ern­ment that is re­sis­tant to any ex­pert ad­vice. There is a sys­temic and cul­tural is­sue of vic­tim blam­ing, min­imis­ing of risk, im­pli­ca­tions of chil­dren putting it on. The fact of the mat­ter is that these chil­dren have been medi­vaced over be­cause they’re in a dire sit­u­a­tion. The like­li­hood is that we’ll see more of these cases, yet our pro­fes­sional judge­ments are called into ques­tion.”

Life­line 13 11 44

Two-year-old “Roze”, whose fam­ily has been on Nauru for five years.

MARTIN McKENZIEMURRAY is The Satur­day Pa­per’s chief cor­re­spon­dent.

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