Evacuate all Refugees on Nauru
“It is absolutely disgraceful to say that MSF’s mental health care is no longer required; the mental health situation of the refugees indefinitely held on Nauru is devastating. Over the past 11 months on Nauru, I have seen an alarming number of suicide attempts and incidents of self-harm among the refugee and asylum seeker men, women and children we treat. We were particularly shocked by the many children suffering from traumatic withdrawal syndrome, where their status deteriorated to the extent they were unable to eat, drink, or even walk to the toilet,” Dr Beth O’Connor, MSF psychiatrist.
For the last 11 months, MSF’s psychologists and psychiatrists have been providing critical mental health care to stabilise and manage the symptoms of dozens of patients. Nevertheless, no therapeutic solution can be considered possible for people indefinitely held on Nauru. “Our patients often describe their situation as far worse than prison because in prison you know when you can get out,” continues Dr 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 psychiatric and psychological health care from Nauru will claim lives.”
Although many of the refugees on Nauru have experienced trauma in their countries of origin or during their refugee journey, it is the Australian government’s policy of indefinite offshore detention that has destroyed their resilience and shattered all hope that they will one day lead safe, meaningful lives.
“Separating families and forcibly holding men, women and children on a remote island indefinitely with no hope or protection except in the case of a medical emergency is cruel, inhumane and degrading,” said Paul McPhun, MSF Australia’s Executive Director. “While the Australian government describes offshore detention as a humanitarian policy, our experience proves that there is nothing humanitarian about saving people from sea only to leave them in an open air prison on Nauru. This policy should be stopped immediately and should not be replicated by any government. It’s not MSF’s psychiatrists and psychologists that should be leaving Nauru; it’s the hundreds of asylum seekers and refugees that Australia has trapped on the island for the past five years that should be leaving.”
MSF started providing free psychological and psychiatric services in the Republic of Nauru in November 2017, to refugees, asylum seekers and the Nauruan population. These services were put on hold on 5 October, 2018 when the government of Nauru informed MSF that services were “no longer required” and requested that MSF end activities within 24 hours.
Almost all 900 asylum seekers and refugees on Nauru, including 115 children, have been on the island for more than five years, with no clear process or prospect of permanent resettlement.
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Doctors kicked off Nauru detail 'shattered, destroyed' refugees – video
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 open-air 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”.
(*) Helen Davidson can be reached via @heldavidson or: