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Lauren Martin   

The first substantial report describing the ‘dire’ mental health situation in Australia’s offshore detention regime emerged in November 2012, just weeks after the first people were transferred offshore. Many more were to come.�� 

Appearing before Senators investigating the proposed repeal of ‘medevac’, the Kaldor Centre’s Madeline Gleeson offered to table seven years’ worth of reports documenting the progressive physical and mental health deterioration among people held on Nauru and Papua New Guinea’s Manus Island, before the medical transfer legislation was enacted on 1 March 2019.��

Outlined below in 28 brief notes, the reports show successive stages of suffering in a system that has claimed at least 12 lives.�� 

1. November 2012:  ‘a climate of anguish’ inside the Nauru regional processing centre (RPC), with at least nine people on hunger strike and noting the first self-harm and suicide attempts.��
2. December 2012: The reports widespread depression on Nauru, as medical staff describe ‘a steady and rapid incidence in mental health diagnoses, self-harm, including hanging attempts, with more than 10 new referrals each day’ and 40 people on hunger strike. UNHCR flags the ‘deleterious impact on the mental and physical health of refugees and asylum-seekers if this is not addressed promptly’.�� 
3. February 2013: From Manus RPC, that harsh detention conditions, uncertainty and delays in processing asylum claims, and the perceptions of unfairness and arbitrariness – by which some people were transferred to Manus while others, often from the same boat, remained in Australia – are leading to hunger strikes and self-harm.�� 
4. July 2013: ‘All asylum-seeker groups [on Manus Island] ,’ UNCHR notes in a report that also cites service providers (the Salvation Army, Save the Children as well as numerous G4S staff) who ‘expressed concerns over the likely deterioration of mental health of asylum-seekers at the facility if certainty and progress was not made in  processing and case resolution’.�� 
5. November 2013: On Manus, UNHCR reports the mental state overall among those held is less acute than in the previous visit but warns that ‘without any clarity or certainty… the are likely to rise. It can reasonably be anticipated that the mental health of asylum-seekers will deteriorate rapidly if those underlying factors are not addressed as a matter of priority.’ 
6. November 2013: ‘Widespread depression’ on Nauru, , urging vigilance because ‘the conditions of mandatory and arbitrary detention within a “return-oriented environment”, delays in RSD [refugee status determination] processing and the absence of clear durable solutions, if left unaddressed, will inevitably have a detrimental impact on the physical and psychosocial health of asylum-seekers, particularly vulnerable individuals.’  
7. December 2013: Conditions on Manus Island were , Amnesty International notes in a lengthy report.��
8. May 2014: Amnesty publishes a are ‘still breaking people’ detained there.��
9. November 2014: ‘Children detained indefinitely on Nauru are suffering from extreme levels of physical, emotional, psychological and developmental distress,’ reports the .��
10. November 2014: The notes ‘serious physical and mental pain and suffering’ on Nauru and Manus created by the combination of harsh conditions, closed detention and uncertainty about the future.��
11. December 2014: The reports evidence of widespread mental health problems on Manus, where there are mounting incidents of serious self-harm and suicide attempts.��
12. March 2015: Former integrity commissioner children as young as 11 are self-harming on Nauru.��
13. August 2015: ‘A high level of physical and mental health problems experienced by the asylum seekers resident’ is reported by the relating to the conditions and circumstances at the Regional Processing Centre in Nauru.��
14. February 2016: ‘Children [detained] at Wickham Point, most of whom had spent several months in Nauru, are amongst the most traumatised children the paediatricians have ever seen,’ the .��
15. May 2016: Madeline Gleeson publishes the award-winning book, ‘’, extensively documenting critical concerns about the physical and mental health of asylum seekers and refugees offshore.��
16. August 2016: ‘Many’ people detained on Nauru ‘have dire mental health problems and ’, Amnesty International and Human Rights Watch note.��
17. October 2016:  ‘Disturbing, detailed accounts of the disintegration of their own or others’ mental health’ are noted in Amnesty International’s ‘Islands of Despair’ report, with Senior Director for Research Anna Neistat reporting after a visit to Nauru, ‘The , discrimination and violent attacks, sexual violence, inadequate medical care and harassment that I heard from mothers, fathers, adults and children as young as six, paint a picture of people driven to absolute despair.’ 
18. 2016 Senate Inquiry: Hears evidence on ’ including that ‘88 per cent of asylum seekers and refugees surveyed on Manus Island were suffering from a depressive or anxiety disorder and/or post-traumatic stress disorder, while 83 per cent on Nauru suffered from posttraumatic stress disorder and/or depression’.��
19. April 2017: ‘Mental health issues are rife [on Nauru], with post-traumatic stress disorder, anxiety and depression being the most common ailments. Many refugees and asylum seekers are on a constant diet of sleeping tablets and antidepressants. Children also show signs of mental distress… Many adolescents are themselves already on antidepressants,’ .��
20. November 2017: A UNHCR to Papua New Guinea reports that ‘if refugees are not able to be knowingly placed on a pathway to a suitable destination, there is the risk of catastrophic mental health outcomes including suicide and further harm’.��
21. January 2018: On Manus, there is ‘a worsening sense of helplessness and hopelessness among asylum-seekers and refugees at all facilities’, .��
22. May 2018: Indrika Ratwatte, UNHCR Director of the Bureau for Asia and the Pacific, tells a briefing in Geneva, ‘The long-term detention – five years plus – in Nauru has taken an immense toll on the people… , in both PNG and Nauru. … The sense of hopelessness and despair was extremely tangible.’ 
23. July 5 2018: that ‘protection staff and medical experts observed a high level of tension and further deterioration in the mental health of refugees and asylum-seekers on Manus Island. Separation from family members and a deep-seated fear of being abandoned in Papua New Guinea by Australia without adequate support has contributed to an acute sense of insecurity and helplessness. It can be anticipated that an ongoing lack of support for vulnerable individuals will lead to serious, adverse outcomes, in the context of high levels of anxiety and depression. These negative consequences are clearly foreseeable and preventable.’ 
24. July 17 2018: ‘In more than one instance, children have also remained in Nauru separated from an adult parent sent to Australia for medical care,’ . ‘This has had a particularly devastating effect on their deteriorating mental health.’ 
25. October 12 2018: ‘In September this year, more refugees and asylum-seekers had to be medically evacuated from Nauru to Australia than in the preceding two years combined,’ amid a ‘collapsing health situation among refugees and asylum-seekers at offshore facilities in Papua New Guinea and Nauru,’ , adding: ‘ even this number is significantly lower than the total with acute health needs, particularly with regard to mental health….One, a suicidal pre-teenage girl… remains on Nauru despite doctors’ advice to the contrary.’ 
26. October 23 2018: Appealing to Australia to take urgent action to evacuate all refugees and asylum-seekers held offshore, that ‘lives are at immediate and critical risk’ and that ‘the desperate situation of refugees and asylum-seekers in Papua New Guinea and Nauru is now such that evacuation of only some individuals would heighten the despair and exacerbate severe mental health risks of those left behind’.��
27. November 2018: The that ‘Australia’s immigration and asylum framework violates fundamental human rights, and… has continued to cause profound harm and distress to thousands of asylum seeker and refugee children and their families’, particularly those offshore, where on Nauru children are self-harming and suffering Post-Traumatic Stress Disorder, depression, anxiety, learning difficulties, bed wetting, nightmares, behavioural regression, memory loss, separation issues, and some suicidal ideation.��
28. December 2018: that ‘the mental health suffering on Nauru is among the worst MSF has ever seen, including in projects providing care for victims of torture’.��

In February 2019, the Home Affairs Legislation Amendment (Miscellaneous Measures) Act 2019, introducing the ‘medevac system’, was passed by both Houses and came into effect on 1 March 2019.��

The Morrison government is seeking to repeal the medevac laws.�� 

Photograph coutesy of: Eoin Blackwell/AAP