THIS week has been a wild ride.

At the start of it, I was simply a GP on the northern beaches of Sydney, with lovely patients, work that I enjoy, which includes palliative care, and party preparations for my 6-year-old.

I had just read an article by Ben Doherty of The Guardian newspaper, which described a man dying, isolated and without proper medical care on Nauru.

I was stunned. I got on the internet and tried to find out more information. It was frustrating because there didn’t seem to be any. I tried ringing the Australian Border Force and advocacy groups, and spoke to a relative of mine who works in the media. Everyone was very kind, but no one seemed to know much. I was an outsider.

I didn’t know how to proceed. I’m a media novice. I care deeply about the people immediately around me, but I had never felt so compelled to raise my voice for someone I didn’t know. And without much information. A colleague rightly pointed out to me that I shouldn’t act on media hype.

I took their advice. I set out to research the situation. I went back to basics and confirmed what the United Nations says about refugees, and their right to care. I reread about Australia’s position in the international community, and that back in 1945, we were a proud founding member state for the UN’s Universal Declaration of Human Rights. I read about what Australia’s obligations are under international conventions. I reread what the World Health Organization says constitutes excellent palliative care. I read our Department of Health’s policies about access to palliative care in culturally and linguistically diverse groups of our population.

And I searched for reports about medical care specific to Nauru. A friend sent me a report released on 14 June 2018 by the Public Interest Advocacy Centre which is titled In poor health: health care in Australian immigration detention. Even the title speaks volumes.

In the media, I found a litany of reports and calls to arms by doctors advocating for individual refugees who had very severe and undertreated medical and psychiatric conditions, but were being forced back to offshore detention by the Australian Border Force. Dr Nick Martin was a senior medical officer on Nauru and has documented (here and here) what he described as the “horror” of the refugees’ situation there. He spoke up too much, and so was not allowed back.

I’m a risk averse, middle class, comfortable white doctor. I wasn’t about to stick my neck out without a good reason for a patient I didn’t know. Back in university, when I was studying teaching, I must have been headstrong, because I was awarded “Most likely to campaign for the cane toad” at our graduating dinner.

When I went into medicine as a post-graduate student, I went silent. I’d come from the humanities tribe, and the science students (all lovely) were very different to what I knew. As part of the first class of post-graduate entry students, we were immediately immersed in the hospitals. While my tutors were mostly kind, I was terrified by the rapid-fire questions on ward rounds. I might as well have been learning medicine in Japan. A kind uncle sent me a nursing dictionary to try and decipher all the terminology.

It took me a long time to feel confident. I was always shocked when I received positive feedback from a supervisor or colleague. Even though I had an interest in emergency medicine and surgery, I ended up dropping out and working as a locum. Eventually, I needed a provider number to keep going, so I figured the best way was to do general practice.

After a couple of years, things really started firing. I discovered that I loved my patients, and I loved the intellectual rigour attached to undifferentiated medicine on the frontline. And I relished going in to bat for my patients to get them the best care. The doctors that I’ve met along the way, within and out of my GP tribe, have mostly been fantastic. We work, as a profession, incredibly hard to make other’s lives better by trying to deliver excellent health care.

When I read the article in The Guardian, I could recognise many aspects of patients I knew. The recognition helped give me the courage to write a letter and show it to some colleagues. Most of them wanted to sign too. At the start, I was cutting and pasting everyone’s names into a Word document. A couple of days in, it was getting overwhelming, so my husband kindly put the letter on a webpage. I’m humbled by each and every name on that letter. This week is a week that I want to shout from the rooftops how much I respect our medical fraternity.

I don’t know what will happen for Ali or the other refugees on Nauru. The more I read, the more I’m appalled. If it were up to me, I would ask for a full parliamentary inquiry into what seems to be systemic, state-sanctioned neglect.

But for now, I want to share something precious that I’ve learned this week.

As doctors, our voices count. We straddle the worlds of cutting edge research and connecting it with our own patients’ lives. We seek to deliver excellent care. We regularly advocate for our own patients. What I’ve learned this week makes me think that isn’t enough. I feel that we need to stretch our wings and look to the bigger battlefields. Those who don’t have a voice need us to do this.

Sara Townend is a GP on Sydney’s north side. Her petition to Peter Dutton can be found at Doctors Make Change.


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All asylum seekers and refugees needing medical care should be brought to Australia immediately
  • Strongly agree (52%, 136 Votes)
  • Strongly disagree (28%, 74 Votes)
  • Disagree (9%, 23 Votes)
  • Agree (6%, 16 Votes)
  • Neutral (5%, 13 Votes)

Total Voters: 262

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29 thoughts on “An open letter to my medical colleagues about refugees

  1. Anonymous says:

    Please leave the politics alone. We are doctors and we try to provide care to the best of our ability and knowledge. country shopping for a better life is definitely not a crime but neither is the refusal of accepting these people.

  2. Anthony Cleeton says:

    Refugees. the very mention – sight, or sounding of the word conjures many things to many people. From, say, the tidal wave of those persecuted by psychopathic, dogmatic, dictatorships; and illegal economic migrants wanting to short-circuit the entry into another, if better – land; and the 9-11 styled terrorist seeking to wield jihadi upon the rest of us whether or not the perpetrator knows why; to the opportunist seeking free medical treatment from a foreign government. I aplaude Sara’s vision and sympathise with her rationale. But, the question I have for Sara is this: Suppose you were granted access to the sheer volume of detainees shuffled into the various holding facilities in the vicinity of Australian shores and that funding for medical intervention of the kind you’re wanting was provisionally provided. How do you decide to whom gets what treatment (outside of normalised triage criterion)? Where do you draw the line in the sand between the genuinely malnourished (and possibly injured) and diseased refugee and that of the repeat offender seeking assistance for a procedure he or she cannot receive elsewhere?

    I agree with [Minister] Dutton. We cannot fix everyone. We don’t have the infinite resources to deal with international crises such as these. And neither should we. There’s a wealth of disgruntled patients currently in rural Australia, as residents by birth, who do not have access to adequate medical assistance. I would encourage you and those of your following to return onshore and head inland. You may be pleasantly surprised that your talents will be infinitely rewarded here at home.

  3. saul geffen says:

    Dr Berger, as the child of Jewish immigrants who applied through correct channels, did not transit third countries, did not pay cash bribes, did not destroy ID, could you explain to me how my points on selective compassion are irrelevant?

    Your claims that Sri Lankan, Tamils or Pakistanis or Iranians or Afghans who used to arrive here on boats is analogous to the treatment suffered by our relatives by the Nazis is not only false but frankly revolting.

  4. Marcus says:

    All strength to Peter Dutton’s hand.
    Well done Peter.

  5. Anonymous says:

    Wow look at all the signatures on the petition. well done

  6. Greg the Physician says:

    Richard Middleton’s first post (#10) is, at best, misleading. First, he implies that people who did not post under their full name may not be real persons. I have seen similar posts to Anonymous #1, with a full name attached, in other online forums, such as the electronic readers’ comments in The Australian newspaper. I choose to use an on-line nom-de-plume because of the vicious tactics of the far left in this country to make ad hominem attacks on social media and the twittersphere to try to achieve character assassination and shut down rational debate.

    Middleton’s accusation of racism against the supporters of Anonymous #1 is unfounded. For the record, I have happily mentored and supervised physician trainees for many years from highly diverse backgrounds, including various religions (yes, including Muslims) and ethnic groups (including ones from India, Pakistan, Sri Lanka, Myanmar and the West Indies, as well as the UK, Ireland and Belgium). The partner of one of my sons is a wonderful young woman from Malaysia of ethnic Indian background. I deeply resent any claim of racism against me.

    Middleton appears to want to expand the debate to immigration in general, let me say that my only requirements for immigrants would be a desire to integrate into Australian society (without turning their backs on their own culture and heritage) and to become productive members of society without long-term reliance on welfare. Statistics prove that most immigrants who do not speak English are unemployed and receiving welfare for at least five years after arrival In Australia. So a practical English language test and a willingness to adapt to Australian society should be the key selection criteria. None of this is racist.

    Middleton uses emotive language rather than rational debate. For example, he refers to John Howard as “hateful,” presumably because of Howard’s stance over the Tampa. Howard is a man whom I and many other Australians greatly admire, the Menzies of his generation. I and other posters have not made derogatory comments against politicians who support open access to Australia for refugees, such as di Natale from the Greens. I might vehemently disagree with their opinions, but I still respect them as human beings prepared to speak out in support of their beliefs.

    I am particularly offended by Middleton’s comment regarding Australian veterans of the two world wars (although I accept in the interests of free speech that it is Middleton’s right to give offense). My father died last year at 93 years of age. He saw combat in the RAAF during WW2 and had three cousins who also served in the RAAF in WW2; none of them survived. He was extremely disappointed that the Rudd and Gillard governments allowed the people smugglers to ply their evil trade, resulting in many unnecessary deaths at sea, and felt that these governments had betrayed those who had made the supreme sacrifice for their country. If Middleton doubts that this is a commonly held attitude among veterans, I suggest that he discuss the issue with returned servicemen in RSL clubs, or on ANZAC Day,

    In conclusion, I respect the opinions and actions of all the posters on this thread and do not doubt their good intentions. However, as someone once wrote, the road to hell is paved with good intentions. I urge all interested persons to read about what is happening in Europe as a result of the huge number of economic refugees accepted there. Only a few days ago, President Macron of France (once a senior minister in a former socialist government) announced that France now contains 1500 “sensitive zones” (covering 10% of the French population) where it is unsafe for people to go, because civil law (as opposed to Sharia law) can no longer be enforced there by the authorities. No one would have predicted this outcome for France a few years ago and it could well be Australia’s future if our border protection is relaxed.

    I have always voted on health issues at federal elections, but the only issues which will determine my vote at the next election will be immigration, border protection and refugee policies. Although not a member of any political party, I also intend to donate to the election campaign of Peter Dutton to help counter the GetUp campaign against him (and I do not even live in his electorate).

  7. Lauren Honcope says:

    I don’t think that the efforts of one medical practitioner to diminish the suffering of one person dying and on an island under the control of Australia – and the efforts of all the medical practitioners who signed her petition and all the people, like me, who are not medical practitioner but who signed another petition – should be put into some false competition with the work of other medical practitioners (‘Anonymous’) who have decided to exercise their medical professional ethics and skills in a different way. I cannot understand how, when seeing the selfless professional efforts of a medical colleague, which have contributed significantly to the well being of an ill man, the sensible response is a brag about how many years the writer (‘Anonymous’) has spent working for refugees in lots of countries around the world, followed by what reads, to me, as a patronising ‘tut-tut’.
    Every effort to diminish suffering matters, surely? Isn’t that what the Hippocratic Oath is about? Isn’t one of the differences between a professional and another type of worker a commitment to mutual support in furtherance of the greater good which the profession serves? Is that now considered ‘left wing’ (whatever that is)?
    Thank you to Dr Townend and to all those here who have written in support of her.

  8. David Berger says:

    I believe the first post by ‘Anonymous’ is fake. The claims repeat verbatim extensively discredited Australian government propaganda and I believe that without verification of identity and credentials this post, and potentially others in this thread, must be considered part of a deliberate, even government-sponsored, disinformation campaign. Paranoid? I think the experience of the last several years has taught us to be a little more discerning with respect to this medium. As an executive committee member of Doctors for Refugees in Australia I have direct experience of dealing with many cases on Nauru and Manus Islands. The picture ‘Anonymous’ paints of the demographics and lifestyles of the people incarcerated on Manus and Nauru is completely at odds with the reality, as the overwhelming weight of documentary evidence proves. And anyone with the dedication to have spent twenty years working with refugees as a physician in the implausibly long list of countries this poster purports to have worked in could not talk about the people I know personally who are being maltreated there in the callous, dismissive and factually incorrect manner of this poster. Plenty of people who have worked in the refugee sphere who have gone on to have experience of the environment being managed by Australia on Manus and Nauru have condemned it as appalling. Here is one such, a trauma psychologist of decades of experience, and someone who does not hide behind anonymity:

    Dr Nick Martin, a former Royal Navy doctor with extensive experience in war zones around the world, who has also posted on this thread, is another. He is quoted as saying:

    “The people I saw in Nauru, and the state they were in after being locked up there for three or four years, to me was in a way more traumatic than anything I’d seen in Afghanistan,”

    My colleagues and I in Doctors for Refugees are dealing, at this very moment, with numerous heart-breaking cases of human suffering on Nauru and Manus, cases of people physically and mentally broken by the conditions and indefinite nature of their incarceration. What is happening on Nauru and Manus Islands amounts to the torture, by the Australian government, of men, women and children who have committed no crime. This is not exaggeration. Both Amnesty and the UN have termed the conditions of Australian immigration detention on Nauru and Manus to be torture and I confirm this to you from my personal experience as an Australian-registered doctor and under my own name.

    I shall not go on to refute the fatuous points made by other posters about ‘Queue-jumping’ and the other lies of the Dutton administration they repeat. There is more than enough evidence freely available for me not to concern myself with them and anyway some other respondents here have already done that most effectively. I will make one more point about the ‘whataboutism’ tactic which a number of the other posts here employ. You know ‘whataboutism’, it looks like this:

    ‘What about all the other poor people in the third world? Why are these deserving of more compassion?’

    ‘What about you? You haven’t sold your house and gone to live in a ditch and given all your money to refugees, so you have no right to talk about this subject.’

    ‘Whataboutism’ is an effective diversionary propaganda tactic, today of the right, but originating in the Soviet Union. It is designed to deflect substantive argument by asserting hypocrisy in the other party. This avoids having to actually challenge any assertions and is entirely irrelevant to the subject at hand. I will not stoop to answer the ‘whataboutism’ claims.

    Finally, in 2016 I wrote an article comparing the actions of the Australian government to those of Nazi Germany, drawing on my own experience as the child of Jewish refugees. It has received over 37,000 Facebook shares. I stand by every word:

    Dr David Berger
    Doctors for Refugees

  9. Karen Price says:

    Reply to Peter:

    Thanks, Peter, a good question we must ask ourselves. I care, but my capacity to care is exceeded by the suffering and so I do what I can when I can and where I can. Which acknowledges that sometimes I cant -whereas another may be able to do more in any given situation. Interdependence.

    No, I haven’t sold all my possessions and dressed in sack-cloth but that is surely not the point of this argument or of compassion.

    None of that changes my response or my belief that I did what I could in the 15 feet around me. Yes, I feel for the world but I cannot dwell on it for the overwhelm so try to focus on the small nudges I can give and which are given freely or not at all. I rescue spiders out of the shower too, but I haven’t stopped eating red meat for the planet. Its a messy conflicted and difficult thing to be human and I allow myself all the hypocrisy of that state. Sometimes the best I can do is a poor or null attempt. My motivations are not to seek your approval or anyone else’s but to live as I feel happy and able to live.

    Maybe for whatever reason, this mans situation or suffering does not move you. Well, you live as you feel happy to live with Peter. I hope you are ok. The situation of massive displacement of people around the world is a vexed and wicked problem.
    I hope one man suffers less now.

    Why him and why now is not a question anyone can answer well, which is I think the question you are trying to ask of me.

    As regards alleviating the suffering of refugees coming to our shores I believe there is the international law covering that. And heeding the lessons of the past- almost certainly I believe the standard you walk past is the standard you accept.

    Our capacity to care is probably at least in part related to how we are feeling ourselves and our own situations as per the Maslow hierarchy of needs so I do truly hope you are ok. Because to not care about the suffering of others would be a very worrying place to be for a physician in my humble opinion. We know that burnout and compassion fatigue is rife within the Medical Profession. Politically and ethically, at least in this country, you have the freedom to act, as you will, whichever way you might feel, which is a different question.

  10. Peter (Melbourne GP) says:


    Let me posit the argument to you this way. If you really care about those who are suffering, what about the billions across this world who live in poverty? You see, it is very easy to argue on a forum that we should alleviate suffering of refugees coming to our shores. But let me ask you a question.

    If you were to stop eating out, buying quality clothing, technology, entertainment and forgo driving a car, you could raise at least $10,000 a year to devote to the impoverished in third world countries. And if you sold your home and lived in a dingy unit, you might make another half a million or so for the same. But why don’t we, as a society do this?

    I’m just asking the questions. Because it is easy to say we care, and it is easy to argue ‘compassion,’ but do we just care to be on the right side of an argument, or do we really care?

  11. Karen Price says:

    I am a physician. I try to deal in facts but I am aware of all my biases and aware that I have some unknown to me. I don’t know enough about the status of refugees offshore or onshore. Reasons for this are many- I am very busy which is limited attention, and not indifference to suffering. I am also unable to get good information out of these areas because there is a media ban on information. I would like to know that there is a recognised due process around the status but this seems opaque and that worries me. To not have transparency is a concern to me about the behaviour of the governing bodies both here and offshore.

    What I understood in this narrative was that a dying human being was suffering. I know that humanity suffers in general. I frequently do my bit to advocate for better public housing and shine a light on the many faces of human violence of which poverty is one facet, as much as I can. None of this changes the one apparent fact that a human being of no particular threat was suffering and we had the means as a compassionate nation to alleviate that with the cultural and spiritual dignity that as I understood it was not available in the alternative of Taiwan.
    Sure it doesn’t rescue the homeless, the abused children, the battered wives- and all the inequity of the world. But one man.

    I signed the petition because I’m a physician. Not an ethicist. Not a politician. Not a party political manoeuvre. I’m not military or security trained. Just a Doctor.

    The world does bother me and this was one very small thing I could do. The eternal ethical trolley problems of the world and determining the right action and choosing who to let die who to let live are beyond me. In this case, I hoped that collectively with many others we helped one man.

    I hope he is provided with a compassionate palliative process. Thank you, Sara and thanks to everyone for the opinions.

  12. Cate Swannell says:

    Yes Richard, there is. Everyone is entitled to their opinion here, as long as they express it politely and back themselves up with evidence and an ability to avoid going ad hominem

  13. Richard Middleton says:

    Peter (GP)
    How do I know.
    Obviously I can only go from descriptions of who these people are and what they have been through.
    That is impressive enough. Could you do it?

    Is there actually active moderation on this board??

  14. saul geffen says:

    Richard Middleton. I’m neither anonymous nor do I accept that the refugees are from countries “largely destroyed by Western Military adventures”.

    No do I, a Jew, accept your assertion that my views are based on racism.

    Nick and Richard perhaps you should check your facts.

    2 of three largest ethnic groups held in offshore detentiion where / are Sri Lankan Tamils (who could have turned left when leaving Sri Lanka to go 300km to the Indian state of Tamil) or Pakistanis (who have a functioning democracy, medical system that produces fine doctors and the economy to support nuclear weapons). Instead they chose to transit several countries, destroyed their documents and attempted to circumvent our generous existing refugee intake.

    Almost all the refugees in question transited Indonesia. They are almost all more wealthy and worldly than the poor Indonesian fisherman they bribe with US dollars to transport them from somewhere they were no longer being persucueted.

    A final fact that politically motivated doctors seem hard to accept is indisputably clear. The current policies (advocated by both major political parties) work. The boats have stopped.

    I have a question for the outraged souls in comfort in leafy suburbs of Australia. Why do those inside the wire on Manus (ie thie detained irregular boat arrivals) deserve your / our sympathy, support, medical care and money more than the Melanesian residents of Manus outside the wire?

  15. Max Kamien says:

    Bravo to Richard Middleton.
    1. There is no queue for most of the asylum seekers. Where does a Rohingya in fear of his life and that of his family find an Australian Embassy. Those I interviewed did not know anything about Australia except that it was safe.
    2. Indeterminate incarceration (9 years now) is classified as torture by the UN.
    3. Sure, they get fed food and anti-depressants.
    4. Australia’s treatment of asylum seekers has sullied our once good reputation as the land of the Fair Go.
    5. I was an adventure ship’s doctor in the Arctic. The majority of passengers were Germans. They objected to having a doctor from a cruel and conscienceless country.
    6. Half the people locked up in Australian detention centres are ‘Australians’ waiting to be deported. They have served short prison sentences and would normally try to resume their lives with their families in Australia. But their migrant parents never took out Australian citizenship. Their children never knew they were not Australian citizens. More innocent that some of our former members of parliament. So back to Croatia etc a land they do not know with a language they do not speak and to hell with their Australian born family they must leave behind.
    7. And this is all about stirring up xenophobia to get votes. Each Party tries to out do the other in stirring up the masses and thinking up new cruelties.
    8. Yes we have homeless people. The plight of millions around the world is pitiful. Aboriginal health lags behind the the rest of non-incarcerated Australians. I too have spent much of my medical life working in these situations. The world needs to find a way to stop the wars that generate much of these overseas problems. Our human natures and self interested politicians are a constant barrier. It is a tall order to expect such change. We do have smaller challenges in our detention facilities and with refugees stuck in Indonesia. These could be solved with a bit of compassionate leadership, as was shown by PM Malcolm Fraser to the Vietnamese boat people. And, just look at the contribution they have made to Australian life.

  16. Maureen Helen, PhD says:

    Oh, dear, Dr Townsend.

    I am an eighty-year-old retired nurse. I am even more ashamed now to be an Australian than I was before I read the comments from your colleagues who hide behind their anonymity. Where is Australia heading when it locks people up, offers spurious ‘alternatives’ like the ability to return to the countries they came from.

    Whatever happened to compassion in Australia, in government and in the medical profession?

  17. David MacFarlane says:

    Much as it is sickening to read the self-serving politicians appeal to the lowest common denominator being repeated verbatim by members of the caring professions, the Poll numbers show, and the signatures on the petition attest, the opinion of the contributor who worked in over 40 countries in 20 years, and his/her supporters are in a thankfully small minority. It is pointless addressing their arguments – they have it all worked out.

    I want to applaud you Sara for doing something. We cant all visit 40 countries in 20 years and save the world but we can all do something. The problem is too few of us do anything.

  18. Nick Martin says:

    It’s interesting how two different people can come to completely different conclusions- and I say this as having worked on Nauru, and also seen many refugees around the world in a variety of conflict zones.

    (i) Relatively affluent (international air & boat travel is a dead give-away)

    Bullshit. I saw penniless Rohynga whose family had all pulled together about $500 for their ill fated boat journey.

    (ii) Predominately young, fit males, well dressed and brandishing cell phones

    For Nauru that is simply not true. I dealt with families, single unaccompanied females, pensioners, teenagers as well as young men. Their clothes were donated.

    (iii) Often abusive & demanding, “what are your medical qualifications?”

    Not to me. Compared to a typical Aussie GP practice they were respectful and thankful for any help they could get.

    (iv) Destruction of identity papers

    Often they had no papers, being stateless or having had them confiscated.

    (v) Lawyer-savvy, recruiting the likes of Burnside to rage on their behalf

    If you’d been locked up for five years. I reckon you’d try and get help from anyone too.

    (vi) Capacity to manipulate their supporters through internet, spokespersons and a sympathetic leftist press.

    I don’t know if reporting facts can be described as manipulation. Remember that no journalists are allowed on Nauru.

    The conditions in which they are living are also unique:
    (i) Three square meals a day (culturally appropriate)

    Not true. People living in portacabins outside the main camps have to fend for themselves. Last time I asked, a lettuce cost $8 on Nauru.

    (ii) Relatively comfortable accommodation, roof over their heads, bedding and laundry facilities, bathing facilities and flush-toilets

    Again, not true. May still live in leaky mouldy tents, watched over by guards who frequently molest them. Of not, they are in Portacabin accommodation where they are frequently burgled by locals.

    (iii) On-site medical and counselling services

    Yes, that is true. To try and keep them from killing themselves and being an embarrassment to Mr Dutton.

    (iv) Free access to internet and international phone calls

    That comes from charitable donations raised by advocates.

    (v) Sporting and recreational facilities

    Yes, that is true. Lucky them; they can play soccer for two hours a week.

    (vi) Cash incentives to return to their country of origin.

    85% are refugees. That means they cannot return home. They have fled because of a well founded fear of persecution.

    I would suggest that you get your facts right and leave your vitriol behind. And perhaps not comment anonymously.

  19. Peter (Melbourne GP) says:

    “Furthermore, these are just he sort of people we could do with here. Intelligent, educated, skilled land driven.”

    How do you know?

  20. Richard Middleton says:

    I question who “anonymous” and all his/her supporters are.
    I question the implication that they are somehow not worthy of refugee status (something to do with having various resources that have got them this far) but are more justifiably labelled as “illegal non people” and therefore can be locked up by our law abiding and caring government and left to swelter and smoulder and molder in a tropical hell hole. The prison process itself has been shown to be unremittingly cruel and dangerous even as it enriches private interests.

    I would remind anonymous that (and I remain open to be corrected here) that the deliberately glacial security assessments done on the people so incarcerated has shown that the great majority qualify as genuine refugees. Furthermore, these are just he sort of people we could do with here. Intelligent, educated, skilled land driven.
    I wonder if their main crime is being dark skinned or (*gasp*) Muslims?

    Their main real mistake, NOT a crime, at least not on the books at the moment, is to have come by an “unauthorised boat”, like oh, pretty much every other non Aboriginal race here at some time or other. They represent of course less than 1% of all other refugees coming here annually.

    Their other mistake was to give the hateful Mr Howard a point of focus, around which to gather his Xenophobic Opportunistic White Male Politician Club, which he did with consummate skill and breathtaking dishonesty (children overboard), to his eternal shame. The nascent police state that we now live in can trace much of its origins back to allowing similar such simplistic sophistry and obvious lies a place in the national debate.

    I reject all the imagined benefits that anonymous and his/her anonymous supporters have suggested as a compensation for spending the rest of their lives in such conditions, for daring to try and find a better life, away from their own countries and societies that have been, it is conveniently forgotten here, largely destroyed by Western military adventures, in which Australia has assisted.

    I reject the term “open borders” smear when Australia is surrounded by miles of sea and simply do not believe that real diplomatic skills could not have developed a much more humane, beneficent and certainly cheaper policy to settle this tiny number of refugees in this extremely wealthy and capable land, and control the subsequent entry of genuine refugees. I also doubt that settling these people would encourage others to follow, IF such a proper policy were in place.
    I have little doubt those left (and there are still children incarcerated, by the way, despite Dutton’s claims) are political pawns. Bogey People, The Evil to Dread that comes by Sea, to keep the feat factor on 11.

    I don’t believe diggers fought & died in WW1 & WW2 for our once generous nation to be corrupted by the vile and venal for their own ends.

  21. Anonymous says:

    I endorse the pragmatic experienced commentary from the doc who has treated refugees worldwide. Just think of the next generation ( your kids) who’ll have to fix up the shambles created by the soft hearts & heads of the comfortable middle-class advocating an open-border policy. Have a talk to your working class patients, steadily losing jobs from closing factories, to see what they feel about their suburbs being infiltrated by foreign religions & languages; Not happy. I don’t believe diggers fought & died in WW1 & WW2 for our generous immigration system to be abused.

  22. Anonymous says:

    The inpatient palliative care service where I work will rarely accept any inpatient unless his/her life expectancy is less than 2 weeks. Those who survive longer are often pressured to move to residential aged care, even if they are not elderly.

    This, shamefully, is in a major Australian city, due to lack of resources.

  23. Greg the Physician says:

    I completely agree with the earlier readers’ comments and thank the first (anonymous) commentator in particular. I fail to see why palliative care could not have been provided on Nauru to the person in question. All those detained on Nauru and Manus have the options of returning to their countries of origin or accepting re-settlement in a third country, such as Cambodia or PNG. My sympathies are with the legal refugees patiently awaiting their turn for years in refugee camps, not the queue-jumpers trying to access Australia’s generous welfare system. I am really annoyed that some office-bearers in the AMA and RACP take it on themselves to make official comments on these issues without polling their members’ views first. I also think that Peter Dutton and the members of our Border Force are doing a terrific job in safe-guarding our country.

  24. Peter (Melbourne GP) says:

    Two things are usual with such left wing advocates, be they medical or political (and MJA Insight seems to be publishing them exclusively at present, try a different viewpoint at least 20% of the time?)

    1. Their reasons for their advocated policies are always emotional. (e.g. I read of a refugee dying, I heard that transgender children commit suicide, etc etc.).

    2. The policies they advocate, they themselves would not accept if taken to their full and logical conclusions.

    So to expand on point 2 in this case:
    Immediately every refugee will claim some sort of illness (severe anxiety, depression, on and on), and they will be accepted into Australia immediately and with no questions.
    Then people smugglers will have more pull to attract more ‘refugees’ to take a boat ride.
    Then more people smugglers will come to the country.

    It sounds really mean to say this, but in countries where intake of refugees has been massively increased, there HAS BEEN an outcry among the white, privileged upper class, like you Sarah Townend, who begin to fear for their lives when a particular religion over-runs their country and street gangs fill the cities.

    The final step is they vote in a populist government to ‘stop the boats’ and run a hate campaign. And they all vote for them.

    For further examples see: United States, Italy, Austria, Hungary, almost France, and many more in the years to come.

    Progressives will never learn that emotion is not a valid reason for anything…

  25. Anonymous says:

    The commentary from a colleague with substantial Refugee experience is refreshingly forthright and deserves far greater exposure.

  26. Anonymous says:

    I agree with the two previous responses. People who come by boat jump the queue and abuse the system. They are entitled to apply for asylum in the normal way, like so many refugees. We cannot afford to encourage this flouting of the rules.

  27. saul geffen says:

    Dear Dr, very commendable actions and sentiments.

    However why are your actions and feelings limited to those who have travelled from third countries to arrive in Nauru/ Australia?

    I’m currently in Indonesia. There is no palliative care service on the large Island I’m staying on. There are for the vast majority of the population no obstetric care, no psychiatric medication, no paediatricians.

    The villagers I meet are as deserving. It is our closest neighbour. Would you advocate for them if they hopped in a boat and motored south for a few days?

  28. Anonymous says:

    Dr Townend, your undoubted sympathy is understandable, but the policy you advocate would, if implemented, send a message to the people smugglers to resume the mass transfer of undocumented migrants to Australia as happened between 2007 and 2013-some 250,000. that way. Is that what you want? A very practical way to help would be to volunteer to work with an aid organisation in the middle east

  29. Anonymous says:

    I do not see the commitment of our ‘refugee advocates’ as noble or selfless.

    I question the outrage expressed by them because the group they are so aggressively supporting are a relatively privileged and unique group while they ignore the plight of those who suffer greatly.
    The cohort on Manus and Nauru are not at all representative of the millions of miserable, dispossessed and stateless souls, without a voice, who scatter the globe.

    I have worked for over 20 years as a physician with refugees, asylum seekers and internally displaced persons (IDP’s), in the following countries:
    Angola, Bangladesh, Bosnia, Cambodia, Croatia, Cuba (Guantanamo Bay), East Timor, Ghana, Hong Kong, Indonesia, Ivory Coast, Jordan, Kenya, Macau, Malaysia, Moldova, Mozambique, Myanmar, Nauru, New Guinea (Manus Island), Philippines (Bataan & Palawan), Russia, Rwanda, Saudi Arabia, Singapore, South Africa, Somalia, Senegal, Sudan, Switzerland, Tanzania, Thailand, Turkey, Ukraine, U.S.A., Vietnam, Zaire and Zimbabwe.
    This involved a multitude of miserable, unheard-of and un-cared-for locations far from the journalists and camera’s eye where hundreds of thousands of sad and sorry souls lived in unimaginably horrid situations of depravation and hopelessness.
    As a consequence, I cannot empathize with those who rage against the assumed injustice to which our our offshore asylum seekers and refugees are subjected.

    Having also worked on Nauru, Manus & Christmas Island it was immediately apparent that those folk have little in common with those I have worked with in the rest of the world.
    The qualities that set them are immediately apart and stark, and include:
    (i) Relatively affluent (international air & boat travel is a dead give-away)
    (ii) Predominately young, fit males, well dressed and brandishing cell phones
    (iii) Often abusive & demanding, “what are your medical qualifications?”
    (iv) Destruction of identity papers
    (v) Lawyer-savvy, recruiting the likes of Burnside to rage on their behalf
    (vi) Capacity to manipulate their supporters through internet, spokespersons and a sympathetic leftist press.
    The conditions in which they are living are also unique:
    (i) Three square meals a day (culturally appropriate)
    (ii) Relatively comfortable accommodation, roof over their heads, bedding and laundry facilities, bathing facilities and flush-toilets
    (iii) On-site medical and counselling services
    (iv) Free access to internet and international phone calls
    (v) Sporting and recreational facilities
    (vi) Cash incentives to return to their country of origin.

    As an aside, Australia has well over 100,000 homeless persons, a significant number are sleeping on the streets (certainly many more than our refugee cohort). The conditions under which they are living are immeasurably worse than those on Nauru, Manus or Christmas Island, yet there is nary a whisper on their behalf by the those so enraged by the treatment of our visitors from overseas. Helping an unwashed social reject sleeping on the street would certainly be a selfless act but it would not promote a group embrace while singing ‘kumbaya’, press coverage or a spot on ABC’s Q&A panel.
    And for those who might be interested in helping refugees, asylum seekers or IDP’s who could really use some support, they could easily find a way to demonstrate their concern and compassion but again, without the glamour and self-gratification of raging on the streets of Melbourne with the those so pained by the ‘concentration camp conditions’ on Manus and Nauru.
    Medical colleagues with global refugee experience whom I have shared the workload in Manus and Nauru with have mockingly described the conditions as “refugees for beginners”. The conditions are indeed exceptional and unlike the real world.

    Selective compassion is the easy route and not nearly as challenging as the real deal!

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