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MANY years ago I undertook a study of the general population in the US, trying to determine if trauma in childhood affected adult health.
The results shocked and horrified me, and I didn’t want to believe them. So when I was back in Sydney, I followed up on this research.
We discovered that about one in five people in a representative Australian sample reported a history of being sexually abused in childhood, just like I had observed in the US; women had been much more often affected than men. And those who reported such trauma were significantly more likely to have psychological issues as adults.
That trauma in early life can and, in many cases, will lead to irreparable harm even years later is now an established fact.
It is no wonder that most Australians have been outraged by the accumulating revelations to the Royal Commission into Institutional Responses to Child Sexual Abuse of abuse inflicted by various clergy. How could good people have turned a blind eye or worse? How could the churches, and arguably society in general, have allowed the abuse to go on for so long? And how can this be prevented in the future?
Shining a very public light into such abuse will, I believe, drive positive cultural change.
What about the damning revelations in the Northern Territory on incarceration of children and the abuse they appear to have endured in gaol, as revealed by the recent Four Corners program, which led the Prime Minister to initiate a Royal Commission?
It was the images that were shocking and drove the furore – words weren’t enough, as much of what was seen was already known to many.
Australians were horrified to see Indigenous children as young as 10 years old allegedly being abused, this time by the prison system.
How could we lock up children and not anticipate damaging them? How could we condone placing children who misbehave in solitary confinement, or tear gassing children, or tying them up for hours in contraptions that look like they originated in the Middle Ages?
This type of institutional abuse, if confirmed, is clearly unacceptable to the PM and to most Australians, and we as a nation are taking steps to publicly deal with the problem, as we should.
But another group of innocent children are at high risk and we as a society have supported and promoted their institutionalisation, with no end in sight. Yet, current public interest in the plight of these innocent children seems to remain limited. We don’t see a film of their suffering; we are not allowed to. And there is bipartisan support for continuing the current policy settings.
I’m talking of course about asylum seeker children in detention on Nauru.
At a time when we are celebrating Australian values at the Olympics, because of our actions, a group of asylum seeker children is suffering. This is based on more than 2000 recently leaked incident reports on Nauru, over half of which involving children.
The evidence suggests endemic child abuse, including 59 reports of assaults on children, 30 reports of self-harm attempts and 159 reports of threatened self-harm by distressed children. There were also seven reports of child sexual assault.
We, according to the available data, let children cower in fear or despair with no end in sight. And many argue that this is right and proper; we hear that these people came here illegally, we fear terrorism, we do not want any more boat people arriving on our shores, and we are told this is Nauru’s problem not ours.
What has the medical profession said about the situation?
Australian doctors are highly educated and highly trained; they know (or can find) the evidence that locking up asylum seeker children will damage them. They recognise, as does the Australian Government, that the harms cannot be properly mitigated no matter how good the facilities.
A number of doctors have spoken out about the problem of the asylum seekers’ health. Arguably, the Government has done more than discourage doctors from speaking out; Section 42 of the Australian Border Force Act 2015 puts doctors and other health professionals who have worked in asylum detention at risk of incarceration for up to 2 years if they publicly speak out and loss of their registration if convicted – a career-ending step.
Are secrecy provisions such as these to become a permanent part of Australian values along with a fair go for all and freedom of speech and religion? The Australian Medical Association, the Royal Australasian College of Physicians (RACP) and others have voiced very strong concerns about this, but these criticisms have been batted away by politicians.
So we have, I would argue, set up an uncontrolled human experiment. Our hypothesis: if we lock up asylum seekers indefinitely we will prevent more harm than we cause.
But we do not, as a nation, intend to systematically measure the outcomes or, if we can help it, publicly release relevant information. We have not excluded children. We have not sought ethical approval from anyone to do so.
It is a very expensive experiment and we have no idea when or if it will end. There is no rescue therapy or independent oversight committee. And doctors are expected to work in this setting providing what care they can with the threat that if they release information they can be prosecuted, limiting the risk to those responsible.
Yes, we are told, far fewer people are now drowning trying to get here. But in part could this be because we are turning boats back more effectively? Worryingly, we haven’t been told.
I would argue that the reason why many accept the current asylum seeker solution is because of accepted cultural norms – they judge that the benefit to our society of locking up strangers to this land who come out of turn outweighs the harm being done, even if innocents are hurt.
That’s the kind of faulty thinking that I would suggest was applied in the cloisters of churches, too, when abuse was uncovered all those years ago – covering up the abuse seemed justified because of the great hurt an alternative action would have caused.
Or the kind of faulty thinking when human experiments were carried out without ethical approval in the past so many might benefit from the suffering of a few.
All now unacceptable. Or is it?
Should we, a highly educated profession which knows the overwhelming evidence that detention is causing harm, speak out even more loudly and forcefully and insist on change? I would argue yes.
Laws that unnecessarily limit free speech, like the Australian Border Force Act 2015, and secrecy provisions that protect governments, not their citizens, should be removed from the statute books.
I would go further; we should lobby for constitutional amendments that better protect all our rights.
I welcome the interest that the Royal Commission into Institutional Responses to Child Sexual Abuse has expressed in the case of the Nauru children, but they deserve more.
They deserve the full attention of a Royal Commission, or equivalent process, of their own. A public, accountable investigation dedicated to finding, and resolving, all the problems which surround our offshore detention policy and asylum seeker situation, so all Australians can judge if the current policy settings are fair and reasonable.
I entered medicine to heal and to stand up for the rights of patients, who must come first, particularly the most vulnerable. If we help to shine a light on injustice, if we refuse to ever compromise the principles we swore to uphold as medical practitioners, if we educate effectively and show united leadership, I believe we can make a difference to the lives of vulnerable children who deserve better, both on and off shore.
Laureate Professor Nick Talley is editor-in-chief of the Medical Journal of Australia, former president of the RACP and an internationally renowned gastroenterologist. Note: the viewpoints expressed in this article are solely the personal views of the author.
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Glenn- your post does not surprise me at all. I have no doubts that the condition on Nauru could be improved- but please let’s not believe every bit of propaganda that’s coming from people who would want us to replicate the current European experience.
Nick Tally’s piece oozes righteousness- the easy, unthinking righteousness of those who know exactly what’s right and wrong. The righteousness of those who react to thousands of drownings in the Mediterranean by making it easier for people smugglers to run their business.
The righteousness of those who have put all of Central and Western Europe on a fast track to chaos and mayhem.
I worked in Immigration Detention (on the mainland) in 2012-3, so I have some personal knowledge of the ethos and the practical circumstances in Immigration Detention. My experience was profoundly different from what is now claimed in the Nauru files, and in this article.
I examined the 11 ‘Nauru files’ reports for 2015 cited as ‘critical’ (to the extent the original documents are available – two original documents are not available). Those 11 documents in no way confirmed the allegation that was made of ‘routine dysfunction and cruelty’. I do not have the time to go through the entire gamut of 2000 documents, and (indeed) the authors have made review more difficult and time-consuming than they needed to. It would have been much better to have simply presented the significant and relevant reports, rather than hide them among the inconsequential and trivial – which were most of the 11 reports I read.
It was my observation, even in the circumstance of ‘on-shore detention’ – while detainees had a reasonable expectation of discharge into the Australian community – that fabrication of circumstance was common. Abruptly the names and even the birthdates of detainees would be changed by them. It posed us problems of sequentially matching identities with path and imaging reports, similar problems posed to the pathology and imaging providers. Ultimately it was decided, that for clinical purposes, the original name and date of birth provided at arrival in Christmas Island would be continued throughout the duration of detention, and changes would be listed as aliases.
Persons with a credible reason for claiming asylum do not need to change their names and dates of birth, partway through detention. Many of these ‘refugees’ were economic migrants, spending their (or other people’s) money to ‘jump the queue’ – for an immediate better life, and immediate access to Medicare benefits. (One middle aged man arrived, with terminal Hep B cirrhosis, hoping for a liver transplant. He was not placed in the queue. That was not our decision.) And ultimate Australian citizenship. That is what the ‘people smugglers’ sold.
So can allegations made by detainees on Nauru and Manus Island be ‘ipsi facto’ considered genuine and credible? Must we act before the claims of abuse made are competently assessed?
I note the listing of numbers of events of child abuse here on Australian soil, the removal of Aboriginal children from their mothers, and the sexual abuse of children by clerics, being examples. There are contemporary ongoing problems, such as the custodial management of delinquent Aboriginal adolescents in the Northern Territory – and elsewhere. Nicholas Talley has identified a gamut of past and present inadequate and inappropriate management. He has not identified what – in practical terms – should be done to rectify all these problems. What must be done, what are the necessary human resources (who and where are they) and what will it cost? Is our first concern ‘non-Australian citizen’ children living with their parents on Manus Island and Nauru? If so – why?
The living circumstances on Nauru and Manus Island are far better than those in the refugee camps scattered over the Middle East and (now – even) Europe.
As I began work in Immigration Detention in 2012 the ‘fare’ for passage on an overloaded boat was $20,000 per person. You can calculate what profit the people smugglers made on 50 passengers. (The cost of the boat and crew was trivial.) As I left, the fare had reduced to $5,000, but more than 4 times as many were arriving each week. the Christmas Island facility was overwhelmed, and ‘initial medical assessments’ (10 minutes per asylum seeker) were about to be made at the Scherger base Detention Centre on Cape York. It was with enormous difficulty the flow of asylum seekers was stopped. It was credibly estimated to me (by a senior Immigration officer) that the profit of the people smugglers in the 6 years from 2007 to 2013 was between one half and one billion Australian dollars. The cost of picking them up from the ocean, landing, processing them (initial application for asylum and two levels of appeal – all paid for by you and I, housing, feeding and instructing them) was about 14 billion Australian dollars.
Can we afford to allow the flow to restart? I predict the first boats to arrive would be laden with women and children. I expect the flow would rapidly increase to at least 1000 persons a week, and rapidly overwhelm any capacity for orderly intake. The people smugglers would never allow us to stop the boats again. It would be the European experience with a vengeance. (There is much too much money to be made.)
The Germans have now estimated the cost of the refugee intake to the German economy in the next 4 years to be 100 billion Euro.
Thank you for your article. As a concerned medical practitioner, I am taking up your call to arms, and have drafted an Open Letter to the immigration minister from Australian doctors calling for a more humane approach to refugees. I am encouraging as many doctors as possible to sign, in the hope of demonstrating, to politicians and the public at large, our resolve to bring about a change in policy. You can access the letter here – https://goo.gl/forms/Lz8Aq3cT6QLdMSXX2 Please sign and share widely.
I am certain Professor Nick Talley is correct in his assessment of the effects Nauru situation on children’s health. I make the point that their parents brought them, knowing that they would be breaking our law.
I mention the case of a recent tragic death in Brisbane of a “refugee” from Manus. After his death, an apparently caring family surfaced, mourning, in the Middle East and claimed the body. So what was he fleeing? I have thought we in Oz had a responsibility to Iraq, having “willingly” waded in with GWB to topple the dominant sect of a sectarian conflict after his father had shown better judgement.
The Syrian conflict appears to be failed multiculturalism, after the subjected cultures challenged the dominance of the ruling tribes.
We need a border policy. Currently, we have a tough one. There are many millions in this over-populated world who would like to live here. We think we have a successful multi-culturalism, or is this because one culture has superior power? If our stance is softened and people flood in, will such things as royal commissions (for eg) remain an option? I feel sorry for the children in question, but am not in favour of sacrificing many to save a few.
Thank you Nick Tolley for a direct and pertinent comment founded in experience and appropriate concern. A government hiding its coercive abuse of children under a cloak of secrecy requires vigorous exposure and the repeal of its disastrous policies. We are told these children must be exported to some other county, never Australia. Some another authority, therefore, will be left with the life-long support of these individuals damaged more by our abuse of them than by other traumas that forced their parents to take them on dangerous passage towards Australia. They are Australia’s responsibility, and Australian medical opinion must continue to argue for their immediate release from detention and that Australia will ensuring their effective future care in Australia.