Asylum seeker boy on Nauru pleads for medical help for his mother

A 12-year-old asylum seeker held on Nauru has publicly pleaded for his severely depressed mother to be moved to Australia, for the urgent medical treatment doctors have been recommending for more than a year.

“I feel helpless because there is no one to help us. There is no one to see how we are suffering. My mother is very sick and my brother is totally depressed,” Ali says in a series of videos filmed in the tent he shares with his mother.

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Ali’s pleas – and his own depressive symptoms – raise further concerns about mental health issues among refugee and asylum seeker children held on Nauru, which sources on the island say have reached epidemic proportions and a new criticality.

The case of the Iranian asylum seeker Fazileh M, who has been suffering gynaecological issues causing incontinence for more than three years, is the latest in a string of medical transfers that have been urgently requested by doctors on the island but delayed or refused by the Australian Border Force (ABF). Doctors have been recommending her transfer off Nauru for medical treatment since February 2017. Guardian Australia has chosen not to report her surname out of concern she could be identified in her home country.

For months, medical transfers have been a source of acute tension within the Australian-run offshore processing regime on Nauru: doctors’ recommendations for dozens of refugees and asylum seekers have been overruled by government bureaucrats on Nauru and in Canberra.

Three preteen children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court actions were launched in Australia to have them moved. Fazileh’s son Ali has made several self-harm attempts, including repeatedly banging his head into a wall.

Fazileh has been suffering severe gynaecological issues for more than three years. They have caused her severe and worsening urinary incontinence. She has been forced to wear a nappy for months.

Her condition is “causing significant personal distress and having an adverse effect on her quality of life”, a doctor’s report seen by Guardian Australia says. Fazileh is a single mother of two sons, both also held on Nauru. She has two siblings living in Australia.

She has also suffered acute depression in offshore processing and has made repeated suicide attempts. One medical file reports her “distressed, screaming, uncontrollable behaviour, and banging head against wall where Wilson’s staff has had to restrain for the safety of self and others”. She repeatedly told staff “I want to die, I want to die, I want to die”.

An incident report from Nauru reveals she wrote during an adult education class: “I don’t happy. I don’t like Nauru. I don’t like living. I like to die.”

“The trajectory of the course of her depression is least favourable,” a psychiatrist wrote, “I do note her concerns for her sons and the guilt issues she’s grappling with at the moment.” Fazileh has been cautioned in writing for being “rude” to IHMS staff and for shouting.

Fazileh has previously been transferred for treatment, to Australia in 2015 and Port Moresby in 2016, but in both cases the required therapy was either not followed up on or not approved by the ABF, according to her medical records.

As long ago as 2016, doctors warned that her detention on Nauru was causing her depression, and that treatment on the island could not help her.

“A large proportion of her distress comes from the situation she finds herself in and … it is essentially reactive to her experience in Nauru.”

In “hysterical” tears, during an appointment with a psychiatrist, she said she “just wanted to die and get away from ‘this life’”.

“She stated she just wanted to walk down the street with her children and be the same as everyone else.”

With Fazileh’s conditions unresolved and worsening, doctors again recommended her for medical transfer to “Australia or third country with equivalent medical standards” on 14 February 2017, stating she should be moved within one month.

Fourteen months on, with one planned transfer cancelled, there is no immediate plan to move her.

In correspondence, the ABF has offered to assist Fazileh in returning to Iran, even as her claim for refugee status is currently being contested in the Nauru court system.

Her youngest son, who turned 12 this week, said from the mould-infested tent he shares with his mother that his ongoing indefinite detention had harmed his family.

“From the age of seven, when I came here, I have been stuck. I had so many dreams but they have all blown away. I wanted to become an important person but instead I became nothing – even worse than nothing.

“This dream remained in my heart to stick my favorite football pictures on the wall. I even don’t have a wall to stick them. When I stick them to the tent they become wet and fall down. They become colourless after the rain.”

The ABF approved Fazileh’s transfer to Taiwan for treatment on 13 March. However, the day before she was due to fly out – with her youngest son – her transfer was cancelled “due to a decision by Taiwanese doctors who prioritised treatment according to their busy schedule”.

A subsequent transfer has not yet been arranged. Guardian Australia has sent detailed questions to Australia’s Home Affairs Department about her treatment.

The ABF flies some offshore refugees suffering acute medical conditions to Taiwan, even though it is further away and more expensive than bringing someone to Australia, because refugees taken there cannot access Australia’s courts, where refugees often win injunctions preventing their return to Nauru.

Spokeswoman for the UNHCR regional representation in Canberra, Catherine Stubberfield, said the refugee agency’s longstanding position was that offshore processing was entirely inappropriate, particularly for children.

“The harm caused by over four years in harsh and punitive conditions has taken an enormous toll, confirmed by experts ranging from psychiatrists and paediatricians to the government’s own chief medical officer. Further mental health deterioration is both predictable and wholly preventable.”

Stubberfield told Guardian Australia all children and families should be prioritised for solutions outside of Nauru without delay.