Medical evidence steps up campaign to end Nauru

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A message that our government doesn't seem to understand (Screenshot via YouTube)

While the Morrison Government continues to ignore pleas from doctors to remove detainees from Nauru, the campaign to put a stop to the cruelty has received a boost from the celebrity community, writes Dr Binoy Kampark.

THE CAMPAIGN TO REMOVE asylum seekers and refugees from the tropical prison of Nauru has received a few shots to the weary arm of late. One came from a collective of 700 arts industry professionals featuring such luminaries as Asher Keddie, Sam Neill, Simon Baker and Jackie Weaver

On Monday, both Prime Minister Scott Morrison and opposition leader Bill Shorten were presented with a letter signed by the collective stressing the importance of putting ‘aside parties and politics’. It had taken five years of indefinite detention, now, ‘we must bring these human beings to safety and ensure they receive the medical treatment they need.’  

The authors behind the letter do not mince words, lacing them with the carceral language of doom befitting any suitable prison literature.

‘For five long years these refugees have been detained and made an example of. Fathers, mothers, toddlers and newborn babies — living behind bars and imprisoned by the sea with no freedom in sight.’ 

The list of casualties in this ghoulish experiment of population control is noted: twelve deaths, with more in the offing.

The intervention of dramatists and those in the field of arts is admirable, but few can come close to the harrowing impact had by a doctor’s informed impression. No other non-government organisation – and this includes the good investigative efforts of Amnesty International and the Refugee Council of Australia – has had the same emotive cache and heart-wrenching appeal than Médecins Sans Frontières. Politicians, unlike doctors, are unguided by the Hippocratic Oath, an ancient bond that ties the protector of health to a healing duty. 

Having supplied psychiatric assistance to the detainees and finding the policy of keeping them on the island desperately and cruelly wanting, the government of Nauru expelled members of MSF. Had the organisation been more politically amenable to illusion, their invitation might not have been revoked in October this year. 

The refugees and asylum seekers, insisted the Nauru authorities, were being held in splendid conditions that were the envy of the global camp industry. Even refugees and locals were living ‘side by side as part of a homogenous multicultural community’. MSF found, to the contrary, chronically under-resourced facilities, notably from the perspective of mental health staffing and training. A cultural stigma – one borne from a poor understanding of the darkly labyrinthine corridors of mental health – made a fair contribution to this problem as well.

The response from Australia’s Prime Minister, Scott Morrison, was typically bureaucratic, a spreadsheet morality if ever there was one. In place of a quibbling MSF, International Health and Medical Services, Australia’s long contracted behemoth in this field, would be courted. If one group of doctors shows disaffection, get in those who do not.

In an October interview with Sky News, Morrison said:

“We don’t go around making a big song and dance about it, we just get on and help people and provide the care that is necessary.” 

A truly Pentecostal sentiment.

Expulsion from the island was never going to act as a means of censorship. As it promised, MSF’s working report on the state of mental health for those left to their despairing state on Nauru was released on 3 December. The opening observations introducing the report promise the horrendous and cruel, an examination of mental ruin perpetrated by authorities over the course of five years.

‘Close to one-third of MSF’s refugee and asylum seeker patients had attempted suicide, while 12 patients were diagnosed with the rare psychiatric condition of “resignation syndrome”.’

Less spoken about in broader media circles is the debilitative effects on Nauruan nationals (some 22 per cent of the 285 patients examined by MSF) who ‘also had high levels of severe mental illness’ with almost half those in MSF’s care needing ‘treatment for psychosis’.

Comments by various psychiatrists buttress the mental torment that afflicts those held on the island.

In a recent article, MSF psychiatrist Dr Beth O’Connor said:

“Patients spoke about the injustice of their situation. Most people have been recognised as refugees, yet while they have been told there are processes to resettlement, the criteria are unclear.” 

O’Connor seems to be articulating a near-Kafkaesque vision of cruelty, one of fickle and arbitrary procedures.

“People try to learn the ‘rules’ of the system, but the rules keep changing. They realise it is impossible to help themselves.”

Dr Patricia Schmid, another MSF colleague in psychiatry, elaborated on the beastly nature of timelessness: to be detained without a clear timetable and to be held without a specific marker for release and resettlement.

“The issue of ‘indefiniteness’ – that there is no timeframe for the detention process – has a strong impact on my patients’ mental health. They tell me that even prisoners have a sentence — they know when they will be released, they can plan their lives.”

How, then, to measure such inexorable decline and ruination? MSF practitioners, for the purposes of reviewing the patients in their care, used the Global Assessment of Functioning (GAF) scale, measuring the extent a patient’s symptoms affect everyday life, with one being the lowest measure of functioning and 100 being the highest. “Scores above 70 are considered healthy.”  A GAF score of 35 revealed “the high rates of untreated psychosis among this group”.

Hopelessness provides the rich breeding ground for self-harming despair. That desperate sense, one leading to thoughts and acts of suicide, “is linked to the fear that they be kept on Nauru indefinitely, with no time limit or hope of escape”. For MSF, only one logical and humane course was open — to reiterate ‘the call to immediately evacuate all refugees and asylum seekers from Nauru to a place where they can rebuild their mental health and to end the policy of detention”.

In terms of tangible political impact, independent MP Dr Kerryn Phelps has taken the reins in parliament, putting together a private member’s bill for the lower house to remove all children and their families from Nauru. Usual problems persist in bringing the matter forth for debate, despite Phelps’s claim that there was no “reasonable argument against this”: vacillation from Labor, ever keen to look strong on border protection yet hypocritically compassionate and the scepticism of the LNP coalition still gripped by its “turn back the boats” mentality. Those who might have crossed the floor have gone cold. Australia remains complicit in remaining the indirect gaoler and direct sponsor of its own Pacific gulag.

Dr Binoy Kampmark was a Commonwealth Scholar at Selwyn College, Cambridge. He lectures at RMIT University, Melbourne. Email: bkampmark@gmail.com

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