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Submission to the National

Inquiry into Children in Immigration Detention from

the Department of Health and




The Department's

role in the setting of standards in relation to public and other health


Health and aged care

are shared responsibilities: all levels of government have roles in funding,

administering or providing services.

The Commonwealth

has some statutory obligations to set standards: eg, under the Quarantine

Act 1908 (see below), and the Therapeutic Goods Act 1989 (to

provide a national framework for the regulation of therapeutic goods in

Australia and ensure their quality, safety and efficacy).

In other areas, the

Commonwealth has a policy interest but responsibility for service delivery

rests with the States and Territories, or involves an industry sector

for which the Government sees self-regulation as appropriate. In these

cases, the Commonwealth (through the Department of Health and Ageing)

has a leadership role in facilitating the setting of standards: eg, the

National Standards for Mental Health Services; the Australian Standard

Vaccination Schedule; and the Standards Framework of Accreditation and

Certification for residential care.

The process by

which health undertakings negotiated with Health Services Australia are


The term "Health

Undertaking" has a specific meaning in migration legislation and

policy, to do with post visa issue monitoring of (mainly) tuberculosis

by state health chest clinics. The process does not involve Health Services

Australia (HSA) as it is an arrangement made between the visa issuing

officer, the visa applicant, the Medical Officer of the Commonwealth (appointed

by the Minister for Immigration for immigration purposes) based in the

Health Assessment Service and the state-based chest (or other) clinic


DIMIA can provide

detail on the operation of health undertakings.

What is the role

of the Department in monitoring major communicable diseases?

Under the Quarantine

Act 1908 the Commonwealth Department of Health and Ageing has responsibility

for human quarantine policy in Australia. The policy enables the identification

and surveillance of persons who have been potentially exposed to a quarantinable

disease, the provision of appropriate medical treatment if necessary,

and the application of public health measures to prevent the outbreak

of any of the quarantinable diseases in Australia.

Five human diseases

are subject to quarantine controls: plague, rabies, cholera, yellow fever

and viral haemorrhagic fever. The only vaccination requirement for entry

to Australia is for yellow fever. Any person over one year of age is required

to hold an international yellow fever vaccination certificate if, within

the six days prior to their arrival in Australia, they have stayed overnight

or longer in a declared yellow fever infected country in Africa or South

America. Any such person who does not posses a valid vaccination certificate

on arrival in Australia, is placed under a quarantine surveillance order

by an officer of the Australian Quarantine & Inspection Service. A

surveillance order allows a person to enter Australia on the basis that

they report to a health authority if they develop symptoms of yellow fever

infection within the surveillance period (up to a maximum period of six


The Department is

also a member of, and provides the Secretariat for, the Communicable Diseases

Network Australia. The network:

  • comprises state

    and territory representatives as well as representatives from key laboratory,

    academic and other institutions with expertise in the public health

    management of communicable diseases;

  • develops protocols,

    discusses information in immediate disease threats, etc, and contributes

    data on communicable diseases to the National Notifiable Diseases Surveillance

    System (see further below); and

  • can be convened

    at short notice to handle an acute situation.

Can a copy of

the public health protocol referred to in DIMIA's submission (p.61) be


A copy of the 'Interim

Protocol for public health management at DIMA detention environments'

is attached (Appendix A). This protocol, endorsed by

the Commonwealth Chief Medical Officer, is still operational. Negotiations

on finalising guidelines are continuing with DIMIA.


Are there national

standards of required immunisation, and are these determined by the Department?

National standards

are set out in the Australian Standard Vaccination Schedule, but there

is no legal requirement for immunisation. The Department facilitates the

development of the standards through the Australian Technical Advisory

Group on Immunisation (ATAGI). The Schedule, produced by ATAGI and endorsed

by the National Health and Medical Research Council, outlines all immunisations

recommended by the ATAGI.

Does the Department

or any agency have a role in providing or assessing data about arrivals

who have not had required immunisations in country of origin or residence?

The Department has

a role only in relation to yellow fever (as above), in conjunction with

the Australian Quarantine & Inspection Service.

What are the appropriate

levels of immunisation of adults from countries where diseases such as

polio are common?

The Australian

Immunisation Handbook (7th edition) recommends that all adults have

three doses of diphtheria, tetanus, and polio vaccines and two doses of

measles, mumps and rubella (MMR)vaccine. Some extra vaccinations (such

as those against influenza and pneumococcal disease) are recommended for

older adults and persons with particular medical conditions. The standards

relate to all people: they do not vary according to a person's place of


What is the role

of the States and Territories in immunisation services generally?

The States and Territories

are responsible for the purchase, administration and delivery of vaccines

to the public. Funds for the purchase of vaccines on the Australian Standard

Vaccination Schedule are provided by the Commonwealth.

Is there a national

database of immunisation records?

The Australian Childhood

Immunisation Register (ACIR) is a national database containing information

on the immunisation status of children living in Australia who are under

the age of seven years. Only vaccines given in Australia are recorded

on the ACIR and those given to children in detention may be included.

The ACIR is administered by the Health Insurance Commission.



What is the role

of the Commonwealth, the states and territories, and/or individual medical

providers in notifications?

The States and Territories:

  • are responsible

    for legislation requiring the notification of certain diseases to health

    authorities by medical practitioners and some others (such as pathology

    laboratories and hospitals). Different diseases may be notifiable by

    different mechanisms depending on the jurisdiction and/or the circumstances

    (eg, Detention Centre Service Provider staff are required to make notifications

    in relation to detainees); and

  • analyse and act

    on notifications data for their own jurisdiction, and each fortnight

    forward their data for inclusion in the National Notifiable Diseases

    Surveillance System.

The Commonwealth:

  • maintains the

    national database for the National Notifiable Diseases Surveillance

    System to which covers more than 50 communicable diseases or disease

    groups endorsed by the National Health and Medical Research Council;


  • undertakes national

    analysis for policy purposes, and for publication on the Internet and

    in the Communicable Diseases Intelligence journal.

  • (see


Are there national

standards in relation to the provision of psychiatric care, including

special needs of people who have experienced torture and trauma?

National Standards

for Mental Health Services were endorsed by the Australian Health Ministers

Advisory Council National Mental Health Working Group in 1996.

Standard 7 of the

National Standards addresses issues of cultural awareness and sensitivity,

and a broad recognition that treatment and support should be delivered

in a manner that is sensitive to the unique social and cultural needs

and beliefs of population groups within the community (See

The role of the

Commonwealth in the development and implementation of improved mental

health care for at risk groups in the community (which would include people

who have previously been in immigration detention)

The planning and

delivery of mental health and related services, and the enactment of legislation

pertaining to the treatment of people with a mental illness, are State

and Territory responsibilities.

The Commonwealth's

role is principally to provide leadership and coordination, and to support

national-level activities. However, the Commonwealth has contributed substantial

funds for activities which support the mental health and related care

for at-risk groups; eg:

  • The Program of

    Assistance to the Survivors of Torture and Trauma assists people who

    have experienced traumatising events in their home countries, and supports

    their integration into mainstream medical and mental health services

    ($5.84 million (indexed) over four years from1999-2003. The client group

    for this program includes people granted Permanent Protection and Temporary

    (Humanitarian Concern) Visas.

  • Under the National

    Mental Health Strategy, a national transcultural mental health program

    helps to improve community knowledge and understanding about mental

    health, and the quality and accessibility of mental health services

    available to Australians from diverse cultural and linguistic backgrounds

    (around $2.58 million funding since 1995.

Are there Australian

standards or guidelines on the special needs of children from countries

significantly affected by warfare?

There are no specific

standards or guidelines for the special needs of children in this circumstance.

However, the National

Action Plan for Promotion, Prevention and Early Intervention for Mental

Health 2000 recognises that adverse life events such as experiencing

warfare may impact upon, and increase the risk of, children experiencing

mental health and related problems. It allows for national activities

to enhance community capacity to provide support during adverse life events,

and increase use of evidence-based prevention and early interventions

for high-risk individuals who have experienced adverse life circumstances.


Does the Department

have a role in research, monitoring or provision of information on:

  • Nutritional standards

    for people who are from very disadvantaged backgrounds, and education

    on the provision of appropriate nutrition and food services;

  • Availability of

    national/international measurements of nutritional health to determine

    if particular groups or individuals need supplements etc?

  • Cross-cultural

    nutrition and food information;

  • Special needs

    of babies and pregnant women spending long periods in institutions such

    as immigration detention?

No. The Department

aims to improve the nutrition and healthy eating patterns of Australians

through the development of dietary guidelines that target the general

public, rather than specific population groups such as those in institutions.



Information on

cross-cultural training, and information in community languages on birth


Standards for

post-natal care.

These are State and

Territory responsibilities


Are there any

standards developed that ensure that appropriate privacy is guaranteed

to patients in hospitals, or is this a state matter.

This is largely a

state matter. However, under the Australian Health Care Agreements, each

State and Territory has developed a public hospital charter and these

cover commitments to treating consumers with respect, dignity, privacy

and with consideration for religion and cultural background. The charters

apply only to public hospitals within the State or Territory.


Has the Commonwealth

provided funding, including for research, for any of the above areas?

Health care for children

in detention is provided and paid for by DIMIA.

The Department has

no direct funding role in relation to health services for children in


  • unauthorised

    arrivals who are in immigration detention are not eligible for Medicare;

  • the Department

    has not funded research around any of the matters above in as much as

    they directly relate to children in detention; and

  • nor has DIMIA

    provided the Department with any funding to undertake research or projects

    relating to detainees.

However, the National

Health and Medical Research Council has funded one three year project

to investigate 'The impact of the refugee application process on the psychiatric

status of traumatised asylum seekers'. This project is due to be completed

later in 2002.

Further, people who

arrive illegally but are issued visas in the following categories are

eligible for Medicare under special provisions in legislation:

  • Temporary Protection;
  • Temporary (Humanitarian


  • Offshore Entry;


  • Relocation Secondary


In addition, as the

responses to the questions above show, some funds from the Department

support a range of initiatives and programs that may, indirectly, affect




Interim Protocol for public

health management at DIMA detention environments


This interim protocol

addresses public health issues relevant to detention environments and

is not intended to cover all health management issues. It identifies the

minimum health requirements and vaccination to protect the health of detainees

and the Australian public (see footnote).

This interim protocol

will be in place while awaiting final deliberations of the Committee.

Tuberculosis (TB)

Screening for active

TB should be undertaken in all persons aged 12 years and over, and for

children under 12 who are symptomatic or are family contacts of active

cases. Screening will be by history, physical examination and chest x-ray

(PA film initially).

Chest x-rays should

be taken as soon as possible, and within two weeks of arrival at the detention

centre. Chest x-ray films must be read by a radiologist and the report

sighted by the relevant medical officer before the examination is considered


Pregnant women who

have not had a chest x-ray will be monitored by the medical staff and

have a chest x-ray performed after delivery.

Mantoux (tuberculin)

testing is indicated as a screening test for children under 12 years of

age (see Vaccination). The Mantoux test must be administered by clinical

staff specifically trained in its administration and reading. Interpretation

of the Mantoux result may require the expert advice of the relevant State

based tuberculosis service.

Regardless of screening

results, any person with symptoms suggestive of TB, or who develops symptoms

of TB after initial screening, should be investigated promptly and/or

referred to the relevant State based tuberculosis service.

The detention centre

service provider, contracted medical staff and the HSA should develop

strong links with the State based tuberculosis service to ensure staff

remain up to date on TB issues and to expedite diagnosis and management

of detainees with TB.


HBsAg blood testing

on all pregnant women and/or where there are clinical indications of hepatitis.

HIV antibody testing

HIV testing should

be carried out when there are clinical and/or epidemiological indications

of disease or infection. Pre- and post-test counselling is required for

all persons undergoing HIV testing and/or for the legal guardian in the

case of a symptomatic child.

Confirmed HIV positive

persons should be referred to the State AIDS/STD service for management

and contact tracing upon discharge from detention.


Malaria screening

by thick and thin film should be performed on persons who have come from,

or transited through, a malaria endemic country and who present with a

febrile illness, report fever in the previous week and/or are pregnant.

Other infectious


Routine screening

for other infectious diseases, including gastrointestinal parasites and

typhoid, should not be undertaken unless clinically indicated. Health

care providers should maintain a high level of suspicion of communicable

diseases and investigate accordingly.


The following minimum

schedule is recommended for all children aged 0-15 years unable to provide

a documented history of prior vaccination.


Two doses of MMR

spaced one month apart should be administered to all children aged 12

months to 15 years who are unable to provide documentation of vaccination.

MMR should not be given to an immunocompromised child. To protect the

health of Australians and to minimise the possibility of an outbreak in

the detention centre, MMR should be administered as soon as possible after

arrival in Australia, preferably within the first week.

Polio vaccine

Three doses of oral

polio vaccine (OPV) spaced 2 months apart should be administered to all

children aged 2 months to 15 years who are unable to provide documentation

of vaccination. Inactivated polio vaccine (IPV) should be substituted

for OPV if the person or a member of their family is immunocompromised.


All neonates born

in Australia, and tuberculin negative children up to 5 years of age, should

receive BCG except for those previously vaccinated or for TB contacts

for whom preventive treatment is being considered. BCG should not be given

to an immunocompromised child.

Notification of

State Health Authorities

In the event of a

Notifiable Disease or disease cluster

Where a notifiable

disease is diagnosed in a detainee, the case must be notified to the relevant

State Health Authority in accordance with normal disease notification

protocols. HSA, the detention service provider and contracted medical

staff should be familiar with local notification requirements, including

the procedure for urgent notifications. Maintaining close liaison at all

times with the State Health Authority should be encouraged.

Any unusual increase

in the occurrence of a disease (cluster), even for diseases not usually

notified, must be reported to the relevant State Health Authority as a

matter of urgency and all health staff must cooperate with the disease

control measures required by that Authority. Outbreaks likely to occur

in camps and institutions include measles, hepatitis A, influenza, meningitis,

acute gastrointestinal disease and skin infestations such as scabies.

In the event of discharge

from detention

On discharge, detainees

should be referred to the relevant State Health Authority for follow up

of infectious diseases such as TB, and in order to facilitate access to

public health and clinical services, including completion of vaccination

schedules as above. Pregnant women who were not x-rayed should be referred

to the relevant State Health Authority.

Medical records

To facilitate subsequent

health care arrangements, a copy of the medical discharge summary and

vaccination record should be kept at the detention centre and copies given

to each person (or their legal guardian) on discharge.

Occupational Health

and Safety

As a minimum, all

detention centre staff should be fully vaccinated in accordance with the

Australian Standard Vaccination Schedule. Staff in specific occupational

groups may require additional vaccinations as recommended in the current

edition of the Australian Vaccination Handbook.


This protocol has the endorsement of the Commonwealth Chief Medical Officer

although it will be further developed in consultation with State and Territory

Health Authorities, DIMA, the detention service provider and HSA.


Updated 10 October 2002.