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Why care about the health and well-being of asylum seekers?

Protesters in Brisbane at a rally against the Australian government’s asylum seekers policy on April 12, 2014. AAP/Andrew Stevenson

A report on the refugee detention centre in Nauru by five independent clinical experts posted online by The Guardian on Friday paints a bleak picture of life on the island, particularly for children. But why should we care about how these people are being treated?

The report describes the now-familiar wretched conditions of refugee detention. Tents that leak in the rain and become unbearably hot and humid by 10am. Burning white rocks underfoot, little natural shade, dust everywhere, only electric fans for cooling in most areas of the camp.

Mosquitoes that prevent sleep and may carry diseases. Overwhelming boredom. And the hopelessness, helplessness, frustration and despair that accompany radical uncertainty about the future.

The authors detail the effects of this environment on the physical and mental health of asylum seekers. And, not unexpectedly, they recommend changes to the detention centre. This implies, of course, that current conditions should change; that the damage we are doing to these adults and children is unacceptable.

But the Australian government disagrees. It claims current policy is justified because it prevents asylum seekers from dying at sea. Let’s assume for a moment that this is truly the purpose of offshore mandatory detention. The goal – preventing deaths – is worthy, but what means are justified to reach it?

Making life unbearable

This is where the report is vital. It describes what Australia is doing to asylum seekers right now, at least on Nauru. We can’t reproduce all the details here, but let’s recount just a few.

The experts found the standard of health care in the camp, especially for children, was substantially lower than in Australia. Vaccinations were incomplete, and an arcane translation system meant delays of ten to 15 days to see a health worker.

Learning was limited – children received less schooling than Australian or Nauruan children and had few opportunities for play. They were at higher-than-average risk for infectious diseases, mental health issues and developmental problems because of their circumstances, but were not adequately screened to identify these problems.

All pregnant women were depressed; most were severely depressed. Over the previous 14 months, seven adults harmed themselves each month, including by hanging and cutting; two people had been evacuated for psychiatric conditions every month.

Basic public health measures - preventing overcrowding, managing medical and toilet waste, having safe clean water - were precarious.

Many services were lacking or limited, including specialist child care, paediatrics and dental services. Other service providers lacked relevant expertise, particularly in mental health. The report’s authors concluded that if a small child became severely ill, she might die before being transferred off the island.

The stories are especially memorable. One child needed teeth pulled out. That required three appointments because there were no painkillers available, and

the previous two visits had been curtailed because… the child could not tolerate the procedure.

A single visit was made by local women in 2013 to make grass skirts and flower garlands. The garlands could not be made, because detained women were “just grabbing the flowers and smelling them”.

People were allowed just ten minutes a week to call their families. This, distressingly, was often used just trying to make a connection and they would then have to wait another week.

Failing on two fronts

As a signatory to the UN Refugee Convention and other treaties, Australia has international legal responsibilities toward refugees. Many, including the United Nations and the Australian Human Rights Commission, have argued we’re probably failing to meet these responsibilities.

But human rights, including our right to seek asylum, are not just international legal conventions, they also have special moral significance. They’re all equally important; none is optional. And they’re held to exist even when governments ignore them.

They set a minimum standard below which a decent government should not fall. And they’re universal; they apply equally to everyone. This universality reflects the important truth that all humans share vulnerabilities and needs.

The universality of human rights encourages us to identify with people who might, on the surface, seem very different to us.

Now try to identify with the individuals described above. Imagine watching your child having teeth extracted without anaesthetic for the third time. Imagine having not seen a flower for so long that you can’t put it down, can’t stop smelling it. Imagine trying for the sixth week in a row to call the people you love most, only to have the line fail.

This is what rights require of us – that we face the terrible truth that asylum seekers are just like us.

The report also raises serious concerns about justice for Nauruans. Australia administered and mined Nauru for decades. It’s arguable that Australia has a special responsibility towards Nauru because of this history.

The detention centre is a significant drain on the island’s limited resources. It has increased the population (10,000) by 17%, and would increase it by 50% if fully occupied.

Nauru’s limited health services are strained by overflow from the detention centre, but the only renovated ward of the hospital is reserved for people in detention. No locals allowed. And local people can’t obtain food as good as that in the centre.

People in detention are rarely allowed into the community, the community doesn’t know what’s going on inside, and Nauruans have been offended by ongoing negative reporting about themselves and their home.

In our name

Australians are being asked to make a trade-off: the possibility of preventing deaths at sea against a litany of actual harms and wrongs. Aggravating existing injustices in Nauru, as well as restricting asylum seekers’ liberty, making them seriously physically and mentally ill, preventing their childrens’ education and development, and imposing an opaque system for processing refugee claims, causing extreme uncertainty about the future.

Even if we were prepared to accept this bald trade-off, there is a further, important, ethical question. Are there alternatives? The evidence suggests there are.

Our exorbitant detention budget could be spent on other measures that would be more consistent with our obligations not just as international citizens but as human beings.

As a detained person said to the authors:

If you change the environment [of the centre] we will be healthy…It is the environment that is making us sick.

It seems possible that this, in fact, is the real goal of the current system. To break asylum seekers, to make them mentally and physically ill as a warning to others. If this is true, it’s a responsibility we all share.

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