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DOCTORS have provided a vital “voice outside of politics” in calling out the treatment of asylum seekers and refugees under Australia’s mandatory immigration detention policy, says a key whistle-blower.
Victorian GP Dr Nick Martin – a former senior medical on Nauru who was awarded the 2019 Blueprint for Free Speech prize for speaking out about the lack of medical treatment for asylum seekers – said it was important that advocacy be viewed as a by-product of what doctors do.
“Regardless of your politics, Australia has a duty of care to [asylum seekers and refugees] and doctors have a duty of care to their patients. I think it is incumbent on every doctor who is involved in the care of these patients – either reviewing their files, looking after them in offshore detention or when they come to the mainland – to speak up about their treatment or lack of treatment, as is frequently the case. If we don’t speak up for our patients, then who will?
“It’s not political; it’s a simple humanitarian issue. And it’s a difficult voice to ignore.”
Dr Martin was commenting on a Perspective published in the MJA, that outlined the lessons learnt in the health community’s response to Australia’s mandatory immigration detention regime. The authors , Dr Ryan Essex from the University of Greenwich, and Professor David Isaacs of the University of Sydney, wrote that clinicians have lobbied, marched and protested against these policies – from Dr Sara Townend’s open petition that attracted 6000 signatories, to acts of civil disobedience when clinicians spoke out about asylum seekers’ medical care in defiance of the Australian Border Force Act 2015. The Act was amended in 2016 so health professionals no longer had to comply with its secrecy and disclosure provisions.
The authors said lessons to be taken from these actions included the importance of undertaking research and working with the legal profession and the media, as well as engaging in civil disobedience and activism, where necessary.
“There is substantial scholarship in this area which highlights the effectiveness of non-violent direct action; we should not shy away from it given the circumstances,” they wrote.
The article’s publication precedes the expected release this week of a Senate Inquiry report into a Bill to repeal the so-called Medevac Bill, which enabled doctors to assess asylum seekers for possible transfer to mainland Australia for medical and psychiatric care (the Migration Amendment [Repairing Medical Transfers] Bill 2019).
Dr Martin said there was one more lesson for doctors in their advocacy efforts, and that was to “stick to the facts”.
“If doctors just stick to the facts, they speak for themselves,” he said.
Leading Australian barrister and human rights advocate Mr Julian Burnside AO QC agreed that doctors played a critical role in drawing attention to Australia’s treatment of asylum seekers and refugees.
“The medical profession is much more highly regarded than the legal profession. If doctors speak out, people really listen,” Mr Burnside told InSight+. “It is absolutely shameful that our government is so dishonest about what they are doing, hiding the facts, making it very difficult for people to know what’s going on and covering it all over with this nonsense about “illegals” and “queue jumpers” – all of which is false – to make the public a little bit more ready to accept what would otherwise be totally unacceptable.
“But doctors are exposing that, and good on them.”
Mr Burnside supported the MJA authors’ call for doctors to continue to work with the legal profession and the media to call out these [injustices], but he described the lack of mainstream media attention to these issues as “alarming”.
“Even the [United Nations High Commissioner for Human Rights (UNHCR)] getting on our back doesn’t seem to worry anyone because it doesn’t get published in the mainstream press,” he said. Mr Burnside praised SBS and The Guardian Australia for their coverage of UNHCR Michelle Bachelet’s call for Australia to roll back its asylum and migration policies.
During a speech in Sydney on 8 October, Ms Bachelet called on Federal Members of Parliament not to repeal the Medevac laws, which she described as an “example of the practical improvements that can be made to … mitigate the harmful effects of detention”.
Professor Paul Komesaroff, Professor of Medicine at Monash University and Director of the Centre for Ethics in Society and Medicine, said Australia’s mandatory immigration detention regime was of such crucial significance for our culture that all citizens, not just health care professionals, should exercise the pressure necessary to ensure that the rights of asylum seekers and refugees were adequately respected.
“It’s important that … the international laws, to which Australia has signed up, be complied with and that we discharge our ethical responsibilities as health care professionals,” he said. “Looking after people and respecting their rights is core business for us; it’s right at the centre of everything that we do, so, in a sense, we don’t have a choice.”
Professor Komesaroff, who is also President and Chair of the Adult Medicine Division of the Royal Australasian College of Physicians, wrote earlier in 2019 of the College’s opposition to the proposed repeal of the Medevac legislation. He also called on physicians to volunteer to assess as many asylum seekers as possible before the possible repeal of the legislation.
He told InSight+: “The Medevac legislation was a significant step forward and I think that there are very few people in the health community who do not agree that this legislation was sorely needed and that it works quite efficiently and well.”
Professor Komesaroff said he was not aware of a single instance where the legislation had operated inappropriately.
“If it’s doing good and no harm, there wouldn’t seem to be any valid justification for repealing that legislation. Many people, including myself, would be concerned about the repeal of that legislation and feel that it’s likely to increase the risks to the people that we have been seeking to protect.”
In its submission to the Senate Inquiry, the Australian Medical Association (AMA) has also reaffirmed its support for the Medevac legislation. The AMA said the Immigration Health Advisory Group – which assesses asylum seekers and refugees for medical transfer – was working well, but called for the Group to be properly resourced, including remuneration for members.
Dr Martin said that regardless of whether the Medevac law was repealed or not, it had been “very gratifying” to see doctors rallying to try and assess these patients.
“I am sure it is an embarrassment [for the federal government] when you look at the numbers of people [in immigration detention] who are seen to have a mental illness,” he said. “There is evidence that this system of offshore processing and indefinite detention is hurting people.”
The ethical conflicts faced by doctors whose clinical decisions were overridden by government policy will be further explored in a new documentary, Against Our Oath. The film, which features interviews with Professor Isaacs and Dr Martin, will be screening around Australia from 19 October.
Naive?
Or disingenuous?
As the medical profession, we should advocate for healthcare for all people under the remit of the Australian government. These people are clearly neglected. The report from Manus investigating the death of a detainee of sepsis made it very clear that there was inadequate access to higher level care required, which is very unlike the remote communities I have worked in where a phone call to RFDS will get help – nil bureaucrats involved, nil delays. What really needs to happen is that this issue needs to become less political and more about healthcare – bring in some transparency around the healthcare needs and have panels healthcare professionals deciding treatment and location of treatment. How they got here, whether they should be here, what there motivations are for leaving their homeland – that’s not a deciding factor in whether they deserve quality healthcare, because every person does.
I see there are reports in The Australian from 21st and 22nd October that most people brought to Australia under the Medevac legislation have not needed hospitalisation, some have refused to have pathology tests or x-rays and a small number are considered potentially violent on the basis of their records. It has also proved impossible to return any of them to Manus or Nauru under this legislation. I rest my case. The AMA and specialist colleges are complicit in creating this back door for illegal migration into Australia; the leaders of these organisations should be ashamed of their misguided actions in supporting this legislation.
I am surprised by the gullibility of my professionals, as it is clear that there is adequate medical care in the camps, and in the local hospitals. This is better than the care available to many in remote communities and small towns in Australia! The doctors crying out for the care of the illegal entrants seem to be those working in the best hospitals in the country or major centres of population! And one of the other problems is getting experienced Australian doctors to go and work at the camps, thus requiring employing doctors on contract from our friendly countries. And these are doctors just out of teaching hospitals, and therefore their views are limited by their experience. I have only heard of one or two experienced doctors who have volunteered to work in the camps for very short periods, and they are from the best hospitals in the land!! So it is not surprising that their views are coloured by their backgrounds.
Doctors supporting the legislation be maintained are only helping the people smugglers to continue and prosper in their business! As well as helping some drown on the way! Is that a decision of good professionals?
In reply to comments #4 and #5, I have no problem with provision of appropriate medical care, but it should be provided offshore. I would personally volunteer to contribute to hospital care provided on Manus and Nauru for both the citizens of those places and the alleged refugees there. BUT medical treatment must not become a back door for people to enter and remain in Australia illegally, which is what the Medevac legislation has created.
I would also ask why, if these people are not economic refugees, they have passed through other countries where they are not at risk of imprisonment, torture or execution on their way to Australia, and why many have conveniently destroyed their identification documents?
…and if it actually were about the medical care, it might be supported, much as these economic migrants have connived to put themselves in our way to make themselves our responsibility.
But that is not what this is about.
This is yet another skirmish in the broader socio-cultural war by anti-border, anti-nation-state, we-are-the-world, ‘anywhere’ first world apologists to undermine the autonomy of a government to determine who comes to a country and the circumstances under which they come.
Crocodile tears over the health woes of yet-to-be-determined-as-refugees are mere ammunition for the battle.
The first three commentators are forgetting why the laws are introduced. When you have a system set up where people with, say, poorly controlled diabetes, lung cancer, kidney stones being referred for investigation and treatment by the doctors on island, and the department of home affairs ignores that medical advice, people suffer. That’s the reality of what happened for years. Medevac was designed to stop bureaucrats overriding medical decisions.
I have read the comments of Marcus, Graeme and Greg. It is not the case of refusing to accept the results of the ballot box. The election was not run on the issue of asylum detainees and even if it were we still have the right to contest issues we think are important. The issue of what is happening in east Africa, Syria, or elsewhere is not relevant as Australia in not in control of these camps. Finally I dont think there is any evidence that the majority of detainees on Manus and Naru are economic migrants. There is no transparancy on this matter, nor how many refugees are having their status actively assessed in a timely manner. They are just being left there to rot.
I completely agree with Marcus and Graham. Blind Freddy can see that the Medevac laws are being exploited to provide a back-door entry into Australia to enable economic refugees to access our generous legal aid and welfare systems. This creates another “pull factor” for the people smugglers to promote and will lead to more drownings at sea if the law is not repealed. Those many genuine refugees following due process and waiting their turn in overseas refugee camps, usually for years, should be given priority over those paying people smugglers to come illegally. I am disgusted with the RACP’s advocacy on this issue; unfortunately I need to retain my membership for the purpose of CPD. I hope that the members of the RACP executive are prepared to accept some responsibility when boats start sinking again.
I agree completely with Marcus.
Those who come by boat via Indonesia, have the money to fly over more suitable countries, destroy all paperwork to make life difficult for our authorities, know which lawyer to ring and where Centrelink can be assessed quickly. On arrival, they insist their customs and culture must be acknowledged and that we should consider changing our ways to accommodate them. There seems little indication they they are passionate about adopting Australia or even trying to look like an Australian.
Doctors I have spoken to, who have worked on Christmas Island have serious concerns about the attitude shown by most of these economic refugees, a more accurate description than “asylum seekers “.It is hard to believe that some sections of our profession have become so gullible as to not see the true picture.
Doctors should of course advocate for their patients: one would not expect anything less.
With this issue one is, however, always struck by 3 confounding variables:
1. Doctors seem to be very selective in who they advocate for: those queuing in wretched refugee camps in e.g. East Africa are vastly worse off than those in any Australian-supervised camps (the latter of whom will displace the former in our annual intake quota: yes, that is queue-jumping Julian), but I guess it’s a case of out-of-sight-out-of-mind
2. The secondary gain of virtue-signalling one’s compassion as motivation
3. The advocacy just happens to undermine the policies of a democratically elected federal government, one which is detested by those who do not count themselves among the Quiet Australian majority.
Yet another refusal to accept the results of the ballot box, a la Brexit, Trump etc?