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Submission to the National

Inquiry into Children in Immigration Detention from

the Melbourne International

Health and Justice Group



About the Melbourne

International Health and Justice Group

(The MIHJG is a coalition

of people from various institutions not the institutions themselves)

Department of

Justice and Youth Studies at the Royal Melbourne Institute of Technology

The Department

of Justice and Youth Studies (JYS) is part of the Faculty of Education,

Language and Community Services (FELCS) at RMIT University. JYS offers

undergraduate courses in Criminal Justice Administration and Youth Affairs,

as well as Masters by Research and PhD programs. The two undergraduate

courses offered are designed to educate professionals and others whose

work is directed to enabling groups and individuals to improve their ability

to control their own lives within the framework of community aims and

goals. JYS and FELCS staff are actively involved in research and teaching

that addresses issues of globalisation and localisation, cultural diversity

and the development of strategies for inclusive community services and

social development.

Associate Professor

Scott Phillips has extensive experience in social policy development.

His research interests cover multiculturalism, policies and strategies

for responding to the needs of people from diverse linguistic and cultural

backgrounds, multicultural drugs education and the role of organised sport

in promoting social development among culturally diverse youth. He teaches

in the fields of ethnography and public policy.

The Centre for

International Health, Macfarlane Burnet Institute for Medical Research

and Public Health

The Centre for International Health (CIH) at the Macfarlane Burnet Institute

for Medical Research and Public Health (Burnet Institute) leads the Institute's

collaboration with other Australian, overseas government, and international

agencies to promote the health of populations in less developed countries.

The CIH provides technical support, program management, assistance with

public health policy development, and training related to communicable

disease prevention and control in the broader context of community-based

primary health care and refugee health care.

CIH staff have been

actively involved in emergency preparedness and response programs and

work closely with the Office of the United Nations High Commissioner for

Refugees, the World Health Organization, the International Committee of

the Red Cross and many non-governmental organisations to develop technical

guidelines and conduct training courses. Members of staff are involved

in training Australian and International personnel for work in refugee

and emergency settings.

The Centre for

Culture Ethnicity and Health

Established in 1993 by the Victorian government when an agreement

was established between the then Department of Health and Community Services

(DHS) and the North Richmond Community Health Centre (NRCHC) to establish

a Centre for Ethnic Health, the Centre for Culture Ethnicity and Health

(CEH) was to play a major strategic role as a provider of information,

research, and education and training with an emphasis upon the promotion

of organisational cultural change in mainstream health and welfare agencies.CEH

is seen as a principal resource and clearing house in the area of health

and cultural and linguistic diversity, to the primary health care sector

in Victoria.

Department of

Public Health Nutrition, School of Health Sciences, Faculty of Health

and Behavioural Sciences, Deakin University

The School of Health Sciences is committed to excellence in teaching,

research and service. Its major focus is on enhancing understanding of

the behavioural, biological and social determinants of health and human

performance. This fundamental knowledge underpins the development, implementation

and evaluation of innovative strategies designed to enhance health and

human performance, and informs our teaching programs.

Strategic focus of major research programs includes nutrition and physical

activity in population health and social and cultural determinants of

population health. The School and the University support staff including

Dr Cate Burns using research and expertise to inform discussion in the

National Inquiry into Children in Immigration Detention. Dr Cate Burns

has particular expertise in social nutrition and nutrition of vulnerable

groups.

Introduction

The concerns of the Melbourne International Health and Justice

Group

The members of the

Group are concerned with the health of all asylum seekers in detention

but of special concern for this submission is the health of children in

detention.

Children are fragile,

dependent and developing; if the support system is weak, they are among

the very first to suffer. Children must always be seen in the context

of their families and community. Although age-specific requirements for

the nutrition and health for example, of refugee children should be addressed

as part of food and medical programs for the general refugee population,

specific activities have to be undertaken for children. Above all it must

be remembered that children are not small adults. Their needs are quite

specific and immediate.

The submission appeals

to all stakeholders concerned, notably the Australian government and service

providers to provide a forum to address the issue of asylum seekers. Alternative

methods that accord with the Convention on the Rights of the Child and

other International and Australian standards and based on sound ethical

and moral principles could be debated.

The circumstances

with respect to children in detention centres, the diversity of their

backgrounds and the number and status of children may vary from one centre

to another. We will not focus on particular details, however. Rather,

we are addressing our concerns in terms of an evidence-based picture of

the detention experience of asylum seekers in Australia. While there may

be no single common feature of experience across all the detention centres,

there are, in our view, resemblances between the centres as to the sorts

of experiences and issues that asylum seekers face as a consequence of

being detainees in those centres. Our submission is based on addressing

the impact of these characteristic features of the migration detention

experience.

Our concerns extend

to the several hundred asylum seekers detained on Manus Island of Papua

New Guinea and in Nauru. It is reported that around one third of the people

on Manus Island are children under 17 years of age and around 50 small

children are included. [1]

The Melbourne Group

for International Health and Justice is particularly concerned by the

Government's policy whereby asylum seekers are 'farmed out' to other countries

as part of the so-called 'Pacific solution' rather than providing refuge

according to international obligations for people seeking refuge in Australia.

Although these people are not criminals they are detained in secure inaccessible

camps. It is not possible to monitor the conditions of their incarceration.

However there are clearly human rights violations involved:

  • This 'solution'

    places asylum seekers in the position of being stateless and, therefore,

    having no rights of redress should they seek to have a decision made

    in Australia reviewed.

A policy designed

to place people in precisely this situation of being stateless flies in

the face of giving people (especially desperate asylum seekers) a genuine

fair go.

Equally, the 'Pacific

solution' is no solution at the policy level. In fact, it has the potential

to do Australia actual harm. We have been perceived by our Pacific neighbours

to be bullying small island states into accepting refugees on our behalf.

As reported on Foreign Correspondent (ABC, 17 April 2002) there are suggestions

by some of our Pacific neighbours that Australia's foreign policy in this

area is being prosecuted in terms of payments and development assistance

inducements. These are being perceived and portrayed by some Pacific countries

(as the ABC program revealed) as bribes.

There is also the

realisation in Australia that the amount of taxpayers' money spent by

the Government to deliver refugee determination services at great expense

in offshore locations, far exceeds the amount required for providing services

to people onshore in Australia.

  • It does not make

    any sound policy sense to allocate a substantial amount of scarce budget

    resources to shipping asylum seekers offshore to centres built, owned

    and operated offshore by the Australian Government only to then assess

    many asylum seekers as legitimate refugees who must either be shipped

    back to Australia or be offered a payment to resettle in an alternative

    country.

The secrecy surrounding

these centres means that information concerning provision of services

and conditions is not available. However, there are several principles

involved. Standards of care for refugees are set by UNHCR and other international

bodies Equal Australian standards could be expected. Both Papua New Guinea

and Nauru are developing countries that struggle to provide services to

their own people. We believe it is immoral to expect these countries to

extend their scarce resources, or even use resources supplied by outsiders,

to care for people who are Australia's responsibility. Alternatively,

standards of care may not be met. We are aware that malaria is endemic

in the Manus Island area. The question arises as to whether, in line with

refugee health protocols, pregnant women and children under five years

are provided with appropriate malaria chemoprophylaxis. [2]

[3]

Without transparency

and accountability, these issues cannot be monitored.

The Group's principles

The Group endorses

the underlying principles of the UNHCR's Guidelines that children who

are seeking asylum should not be detained and the Preamble of the UN Convention

on the Rights of the Child that covers the need for a healthy, supportive

family environment as a prerequisite for a healthy child. Implicit in

the principles is that release of children from detention or non-detention

of children must not result in their separation from their families or

guardians.

The Group expects

that, as a signatory to the UN Convention on the Rights of the Child,

the Australian government will use this document as a major reference

point in the care of all children who are asylum seekers and will move

swiftly towards the release of children and their families into the community.

Article 37 of the Convention requires that the detention of minors shall

be used only as a measure of last resort and for the shortest appropriate

period of time and Article 22 requires that States take appropriate measures

to ensure that minors who are seeking refugee status or who are recognised

refugees, whether accompanied or not, receive appropriate protection and

assistance.

Call for leadership

The group calls

upon the Australian government (and all political parties) to show bipartisan

leadership in basing our treatment of refugees on sound ethical principles

associated with the Universal Declaration of Human Rights as well as the

fundamental values associated with neighbouring, peace and justice. It

is time for leadership to be shown in establishing that the inhumane treatment

of refugee children (and their parents/guardians) is unacceptable to the

community standards of the Australian people.

Executive summary

As an introduction,

we provide a brief overview of the global situation and population movement,

international standards concerning the rights of refugees and asylum seekers

including standards for the care of refugee children in detention and

Australian standards for health care of children in detention.

Then the submission addresses the issues of refugee children in detention

in Australia in four sections:

1. Mandatory detention

of asylum seekers in Australia: its impact on children and the need

for alternative approaches

2. The impact of detention on the health of refugee children

3. Exploration of cross-cultural issues and barriers to delivering culturally

competent services in detention centres

4. Nutritional issues associated with mandatory detention of refugee

children.

The evidence-based

picture of the detention experience for asylum seekers in Australia presented

in this submission suggests there is an urgent need for Australia to re-consider

its approach to receiving asylum seekers and processing their claims to

refugee status.

Keeping people in

de-humanising lock-ups, where adults, young people and children experience

violence, vilification and abuse, can only worsen their mental health

outcomes as well as those of our society in general when traumatised asylum

seekers are eventually released into the community.

The Melbourne Group

for International Health and Justice is also concerned by the Government's

policy whereby asylum seekers are 'farmed out' to other countries as part

of the so-called 'Pacific solution' rather than providing refuge according

to international obligations for people in distress who have sought refuge

in Australia.

As a society, we

threaten to do ourselves collective psychological harm if we continue

turning a blind eye to the incarceration and mistreatment of desperate

people who, by whatever means available to them, have sought refuge in

our midst.

The Australian Government

should consider how an alternative to mandatory detention could be designed

and implemented so that we can balance legitimate concerns about national

security with humanitarian obligations to assist desperate people seeking

refuge from persecution for themselves and their families.

This submission recommends

that the Australian government give immediate priority to examining the

cost effectiveness of a community-based approach to the reception, detention,

determination, integration and resettlement of refugees as described in

Section 1. More broadly, the submission calls upon all political parties

to commit to leading the community in a bipartisan process of rethinking

and redesigning our policy approach to asylum seekers and refugees.

Specifically, the following recommendations are made:

Health Issues

Accommodation in

the community is recommended. However, until a policy of release of detainees

is in place there must be compliance with basic standards of health care

for families and children in detention.

It has been shown

that community involvement does not seem to be a priority in detention

centres. However, refugee community participation could enhance the delivery

of the following programs that should be present as a minimum:

  • Family health

    services with emphasis on women and children's health services and the

    appointment of women health professionals and involvement of health

    workers from the refugee community

  • Access to appropriate

    curative care for common problems

  • Health promotion

    services with emphasis on women and children's health services

  • Immunisations
  • Appropriate hygiene

    and sanitation facilities

  • Health education

    for families with attention to the needs of adolescents for information

    about Sexually Transmitted Infections. Special attention should be paid

    to all health services needed by adolescent girlsExclusive

    appointment of independent appropriately trained staff or provision

    for relevant training, including cross cultural training, before commencement

    of duties.

Cultural Issues

  • Restore cultural

    normalcy. Children should not be accommodated in detention centres.

    With their families, they should be housed in the community.

The social and

mental well-being of all refugees, but particularly of refugee children,

can be most effectively assured by the quick re-establishment of normal

community life. [4]

  • Ensure cultural

    competency of staff and officials through accreditation procedures and

    ongoing cross cultural training.

  • Ensure quality

    assurance mechanisms and ongoing training of staff on how to work with

    interpreters as part of the accreditation procedures for organisations

    working with asylum seekers.

  • Employ accredited

    interpreters exclusively.

  • Involve members

    of the asylum seekers community in programs and education for children,

    including religious programs. The presence of these sorts of programs

    can be very beneficial for the physical and mental health and development

    of children.

  • Ensure the presence

    of mechanisms to prevent officials or members of other groups reacting

    in a negative manner to the cultural or religious beliefs and practices

    of detainees, particularly children.

  • Cultural considerations

    must be taken into account with respect to food type, preparation and

    serving, particularly considering the traditional roles of family members

    in relation to the child's food. It is therefore vital that children

    in immigration detention are provided with food that is culturally and

    religiously appropriate and that it is possible for the child's family

    members to prepare and serve the food in accordance with the family's

    cultural practices, including appropriate times of day.

Issues associated

with nutrition

Children and their

families should be accommodated in the community where they can make their

own decisions about food purchases and preparation.

While children remain in custody:

  • There should

    be consultation with parents to ensure food is culturally appropriate.

  • They require

    adequate quantity and quality of food and frequency of food intake.

  • Food provided

    must be culturally and socially acceptable, palatable and digestible

    and served at appropriate times.

  • The community

    must be involved in decisions about the type of food that would be acceptable

    and in the preparation of food.

  • Nutrition monitoring

    and surveillance systems must be established and mechanisms put in place

    for ongoing management of nutrition-related problems including deficiency

    diseases among children, especially girls, or among pregnant or lactating

    women.

  • Breast-feeding

    must be promoted and supported and where breast feeding is not possible

    adequate professional support must be available to promote appropriate

    feeding practices.

  • The use of infant

    feeding bottles should be discouraged.

  • The use of milk

    products must be monitored according to UNHCR (or appropriate) policy.

  • Weaning foods

    for babies between 6 and 12 months must be available together with age-appropriate,

    culturally appropriate food for toddlers.

Appointed staff

need expertise in nutrition including the cultural aspects of food and

nutrition monitoring.

Methodology used in this submission

In preparation for

this submission we interviewed staff, service providers, observers and

ex-detainees. In addition we consulted

  • International

    documents concerned with the rights of children and with the health

    care of children

  • International

    standards for the care of refugees and asylum seekers, particularly

    children

  • Australian standards

    relevant to the care of children in custodial facilities

  • International

    and Australian literature concerned with refugees and asylum seekers

  • Reports and publications

    prepared by concerned individuals and agencies

  • Relevant media

    accounts

In certain cases

individuals are not identified in the text due to the need to protect

their identity.

Abbreviations

ABC Australian Broadcasting

Corporation

ACM Australasian Correctional Management

AMA Australian Medical Association

CIH Centre for International Health (Burnet Institute)

CRC Convention on the Rights of the Child

DIMIA Department of Immigration, Multicultural and Indigenous Affairs

HIV Human immunodeficiency virus

ICCPR International Covenant on Civil and Political Rights

MCH Mother and Child Health

MJA Medical Journal of Australia

NEDA National Ethnic Disability Alliance

STI Sexually transmitted infection

UNHCR United Nations High Commission for Refugees

UNICEF United Nations Childrens Fund

The Global situation and population movement

Large-scale movements

of refugees and other forced migrants have become a defining characteristic

of the contemporary world. The global refugee problem has confronted the

world with a range of practical and ethical dilemmas. Countries close

to areas of conflict are faced with caring for millions of refugees while

countries further afield, such as Australia, are not beyond the reach

of a small number of people each year, desperate for refuge. Refugees

and other displaced persons will continue to seek refuge, even in places

such as Australia, which are very remote from their own countries.

Refugees are defined

as people who have crossed international borders fleeing war or persecution

for reason of race, religion, nationality, or membership in particular

social and political groups. They are protected by several international

conventions. In the International conventions, the term 'refugee' includes

a person in need of international protection, regardless of the legality

or illegality of her or his status in the country of refuge and whether

or not refugee status has been recognized formally. This term includes

asylum-seekers whose claims to refugee status have not been definitively

evaluated and other persons of concern to the High Commissioner's office.

[5]

The vulnerability

of asylum seekers

Displaced people

are often suffering the devastating effects of exhaustion, bereavement,

separation from loved ones, family and community, ill-health or injury,

poor shelter and water supplies and inadequate food availability. Whenever

people are uprooted, for whatever reason, they are placed at an increased

risk of physical and emotional ill health. The public health consequences

of population displacement have been extensively documented (Toole and

Waldman . [6] Trauma prior to and during their exodus

is an important determinant of the health status of refugees on arrival

in a country of asylum. Harassment, physical violence and grief will in

many cases have added to the trauma of flight.

All of the above

elements combine to reduce the physical and emotional reserves of the

affected population. Inappropriate care on arrival at their destination

can only exacerbate the problems. With the removal of control of all aspects

of their daily life, increased manifestations of depression and even of

destructive behaviour including sexual violence are not uncommon.

All issues that impact

on the health of families in detention will clearly impact on the health

of the children. Children are at grave risk of suffering permanent psychological

injury.

We know so much

more about the brain, and how it influences future mental health problems

and now we couldn't do any worse if we want to guarantee poor mental

health outcomes.

Dr Shanti Raman,

Paediatrician, 2002 [7]

Dr Michael Dudley,

chairman of Suicide Prevention Australia and head of the faculty of Child

and Adolescent Psychiatry at the Royal Australian College of Psychiatry,

the profession's peak professional organisation visited Woomera in January

2002 and said that conditions at Woomera for the children were akin to

those in a concentration camp and he described long term impact on children's

health such as withdrawal and bedwetting that could be expected. [8]

International

standards concerning the rights of refugees and asylum seekers

UNHCR's Guidelines

on applicable Criteria and Standards relating to the Detention of Asylum-Seekers

state in the Introduction that

The detention

of asylum-seekers is in the view of UNHCR inherently undesirable. This

is even more so in the case of vulnerable groups such as single women,

children, unaccompanied minors and those with special medical or psychological

needs. Freedom from arbitrary detention is a fundamental human right,

and the use of detention is, in many instances, contrary to the norms

and principles of international law. Article 37 of the Convention on

Human Rights explains that detention must be 'used only as a measure

of last resort and for the shortest appropriate period of time'.

UNHCR, 1999; This

document relates also to the UN 1951 Convention and the 1967 Protocol

relating to the Status of Refugees. Geneva, Switzerland.

UNHCR's Guidelines

on applicable Criteria and Standards relating to the Detention of Asylum-Seekers,

February 1999 in Section 3 of the introduction explain that provision

for protection of refugees applies not only to recognised refugees but

also to asylum-seekers pending determination of their status, as recognition

of refugee status does not make an individual a refugee but declares him

to be one.

UNHCR's Guideline 3 explains that, in conformity with Executive Committee

Conclusion No. 44 (XXXVII) 1986, the detention of asylum-seekers may only

be resorted to, if necessary:

(i) to verify

identity. This relates to cases where identity may be undetermined or

in dispute.

(ii) to determine the elements on which the claim for refugee status

or asylum is based.

This statement

means that the asylum-seeker may be detained exclusively for the purposes

of a preliminary interview to identify the basis of the asylum claim.

This would involve obtaining essential facts from the asylum-seeker

as to why asylum is being sought and would not extend to a determination

of the merits or otherwise of the claim. This exception to the general

principle cannot be used to justify detention for the entire status

determination procedure, or for an unlimited period of time.

The guidelines relating

to the detention of asylum-seekers further state that

Detention of

asylum-seekers which is applied for purposes other than those listed

above, for example, as part of a policy to deter future asylum-seekers,

or to dissuade those who have commenced their claims from pursuing them,

is contrary to the norms of refugee law.

The Executive Committee

Conclusion No. 44 (1986) discusses the limited circumstances when asylum

seekers can be detained, and sets out basic standards for their care.

Standards for

the Care of Refugee Children in Detention

International standards

that are particularly relevant to the protection of children are 'Refugee

Children: Guidelines for protection and care' ( UNHCR 1994) and the Convention

on the Rights of the Child.

These documents cover

issues of

  • Alternatives

    to detention

  • Guidelines on

    Protection and Care including all aspects of health care including the

    training of staff.

  • Unaccompanied

    minors

Refugee children:

Guidelines on protection and care UNHCR 1994 provides a sound basis from

which to examine the care of refugee children in detention in Australia.

These guidelines are based on the relevant Articles of the UN Convention

on the Rights of the Child and do not conflict with the standards expected

in mainstream Australia nor with the relevant aspects of standards for

health care of children in the juvenile justice systems in Australia.

Of particular interest also, are the United Nations Rules for the Protection

of Juveniles Deprived of their Liberty, 1990.

Australian Standards

Australian standards for health care of children in detention

In Australia, there

are standards for management of health care of children in custody. The

application of these standards is limited in that they are intended for

juveniles who are being punished for breaking Australian laws.

Children seeking

asylum are not in the category of 'being punished' and have rights beyond

those of children in juvenile justice custody. However the standards for

Juvenile Custodial Facilities determine that health care must at least

equal the health care provided for children in mainstream Australian communities.

The New South Wales

document, Standards for Juvenile Custodial Facilities [9]

states that the underlying principle for care of children in custody is

adherence to the United Nations Rules for Protection of Juveniles Deprived

of their Liberty, 1990.

The State Government

of Victoria, Department of Human Services' 'Framework for the Delivery

of Juvenile Justice Health Services, September 2001', also states as a

principle for the delivery of health services that quality of health care

must be at least equivalent to mainstream services and also at a minimum

meet national and relevant international standards of service provision

to juvenile justice clients.

ABC radio reported

[10] that the South Australian government was not satisfied

that standards applied at Woomera met the South Australian standards.

The South Australian authorities were informed that these standards did

not apply as Woomera was a Commonwealth Government installation.

The provision of

services to asylum seekers in detention in Australia is contracted to

specialist companies but the Terms of Reference provided by DIMIA indicate

that there must be compliance with certain standards which are set out

in the Schedule: Immigration Detention Standards. This document covers

all aspects of detention functions and includes reference to factors that

impact on health and care of children in particular.

A stated underlying

principle is that Immigration detention is required by the Migration Act

and is administrative detention, not a prison or correctional sentence.

Nevertheless the detention centres in Australia all exhibit characteristics

of secure prisons including surrounds of high wire fences topped with

razor wire.

Section 1.

Mandatory detention of asylum seekers in Australia: its impact on children

and the need for alternative approaches

Associate Professor Scott Phillips

RMIT University, Melbourne, Australia

Introduction

There is a growing

body of evidence of psychological disturbances among refugees held in

long term detention in Australia. And the mental health implications affect

children as well as adults.

  • Medical researchers

    Sultan and O'Sullivan [11] have reported that the

    psychological reaction patterns of detainees whose claims are unsuccessful

    'are characterised by stages of increasing depression, punctuated by

    periods of protest, as feelings of injustice overwhelm them.' They

    observe that 'these reactions have a marked secondary impact on their

    children in detention.'

  • Steel and Silove

    [12] also have noted that research studies in Australia

    and elsewhere suggest that detained asylum seekers (including children)

    may have experienced greater levels of previous trauma than other refugees,

    and this could contribute to their mental health problems, in that detention

    provides a re-traumatising environment.

This section of the

submission does three things. First, it provides an evidence-based

picture of the experience of being in mandatory detention as an asylum

seeker in Australia. There are by now considerable and alarming eye-witness

accounts and first-hand reports that show how the current Australian mandatory

detention regime for asylum seekers systematically diminishes and abrogates

the human rights of asylum-seeking children and adults (particularly parents)

held in detention. The detention system does this by subjecting adults

and children to physical and psychological abuse. In doing so, the detention

system for asylum seekers contributes to worsening the mental health of

Australian society as a whole when traumatised detainees are eventually

released into the general community.

Second, the

evidence base will be used to argue the urgent need for the Australian

Government to reconsider and alter its current arrangements for receiving

asylum seekers and assessing their claims to refugee status. In this context,

the submission will outline alternative approaches that would better meet

our legitimate national security and public health concerns as well as

our long-established humanitarian undertakings and obligations to assist

asylum seekers in a compassionate, considerate and caring way.

Third and

finally, the submission calls upon the Australian Government (and all

the political parties) to show bipartisan leadership in basing our treatment

of asylum seekers on sound ethical principles associated with the Universal

Declaration of Human Rights as well as the fundamental values associated

with neighbouring, peace and justice. It is time for leadership to be

shown in establishing that the inhumane treatment of asylum-seeking children

(and their parents/guardians) is unacceptable to the community standards

of Australian people.

1. The detention

experience of asylum seekers

In preparing this submission, I have worked with colleagues in the

community health sector, universities and public health research institutes.

On the basis of our interviews with detainees, detention centre workers

and former detainees now living in the community, cross-checked with written

reports by health workers, detainees and detention centre visitors, we

have been able to assemble a very clear picture of the asylum seeker's

experience of detention here in Australia.

Although there is

some variability of conditions across the different detention centres

run by Australasian Correctional Management (ACM), there are nevertheless

several recurring characteristic features of the detention experience

in these centres. The experience of mandatory detention is proving to

be particularly damaging not only for adults but also for the children

and adolescents whose lives are bound up with the mandatory detention

system. The characteristic features of the detention experience of asylum

seekers may be highlighted as follows:

A. Intimidating

physical environment:

Detainees find themselves faced with an essentially intimidating

prison-like environment.

  • Centres typically

    are surrounded by several layers of high fencing. These fences are topped

    with razor wire.

  • Security checkpoints

    control the access and egress of visitors to the centres.

  • There are multiple

    daily musters involving adults and children.

  • There are also

    nightly head counts, which may occur any time between 2 am and 5.30

    am.

  • A public address

    system operates almost constantly from 7 am to 9 pm. [13]

B. Intimidating

human environment:

Detainees are subject to a range of intimidatory behaviours and procedures.

  • When being transported

    to and from medical and legal appointments, detainees are routinely

    handcuffed.

  • They may have

    sedatives prescribed by doctors to facilitate their containment and

    removal rather than for any genuine medical reason.

  • They may be rendered

    isolated and unable to communicate their needs, because of a lack of

    readily available interpreter services.

  • They may be confined

    in their rooms during crises, such as hunger strikes or breakouts. Confinement

    can include the subjection of parents and young children to solitary

    confinement (in one case a father and his baby were placed in solitary

    confinement for a period of 13 days ).[14]

  • They may be denied

    access to telephones, faxes, postal services and visitors.

  • They may experience

    a sense of uncertainty regarding the rules that govern daily life, as

    these can be changed arbitrarily, at the discretion of each detention

    officer. As Sultan and O'Sullivan report:

Some detainees

have suffered intimidation and reprisals after acts of advocacy, protest

or revolt. Authorities have instituted room searches, confinement in

solitary cells, restrictions in receiving visitors, and obstacles to

accessing legal representation or medical care. During a hunger strike

in July 2000, all electrical power and water supplies to the cell block

where the hunger strikers were residing were cut off, affecting uninvolved

women and children. [15]

C. Sense of boredom

and aimlessness:

Due to a general insufficiency of activities, recreational resources

and educational activities, detainees are subjected to long periods of

unstructured time. The dearth of adequate childcare facilities, coupled

with the cramped conditions families usually live in, means that children

have insufficient opportunities for play as well as education. These conditions

give rise to feelings of boredom, aimlessness and apathy especially when

people have been detained for extended periods of time. [16]

D. Nutritional

inadequacy:

There are common reports of detainees being served standardised institutional

food that is culturally inappropriate. This is no small matter, as some

people are unable to eat culturally inappropriate food, which means that

their nutritional needs are not being met properly. Details concerning

issues associated with nutrition are provided in Section 4.

E. Cultural identity

diminished:

Detainees regularly experience a sense of their cultural identity being

diminished. They are subjected to culturally inappropriate service delivery,

staff behaviour and communication. Experiences of discrimination and lack

of respect shown to them by detention officers and other officials give

rise to feelings of stigmatised identity. Issues associated with culture

are dealt with in detail in Section 3.

F. Exposure to

violent incidents:

The Human Rights and Equal Opportunity Commission, in its 1998 report

on the conditions of detained unauthorised arrivals, noted evidence of

violence between detainees - especially within families - as well as between

detainees and custodial officers. [17]

G. Mental health

deterioration:

Medical health professionals have noted a pattern of mental health

deterioration, with each successive depressive stage closely associated

with each stage in the refugee determination process. Four stages are

identifiable: (1) a non symptomatic stage; (2) a primary depressive stage;

(3) a secondary depressive stage; and (4) a tertiary depressive stage.

These have been well characterised elsewhere, so I will only summarise

the observations of others here. [18]

The non-symptomatic

stage is associated with the early months of detention - prior to the

primary refugee determination decision. While the detainee is shocked

and disoriented they are sustained by a sense of hope that their detention

will be short-lived once their claim of refugee status is upheld.

The primary depressive

stage occurs after a detainee receives a negative decision and realises

that they face the prospect of forced repatriation or continued detention

in Australia for an indefinite period while they apply for a review of

the negative decision. Depressed detainees commonly enter a primary revolt

stage which manifests itself variously: some become protestors (engaging

in hunger strikes); others become advocates (seeking to raise public awareness

of the realities experienced by detainees); and some become aggressors

(becoming involved in confrontations, riots and violent incidents with

guards and other detainees).

The secondary depressive

stage is consequent upon the rejection of the asylum seeker's application

by the Refugee Review Tribunal. The depressive reaction at this stage

becomes more severe and debilitating. These detainees now virtually cease

communicating their concerns to others and become largely withdrawn. Some

may become passive resisters and attempt escape.

The tertiary depressive

stage is predominantly characterised by hopelessness, passive acceptance

of their fate and a pervasive fear of being targeted or punished by the

managing authorities. Paranoid tendencies lead detainees to become untrusting

of people. Detainees in this stage of depression spend long periods of

time alone, and develop psychotic symptoms such as delusions and auditory

hallucinations. In the most extreme cases people engage in repeated acts

of self harm resulting in a need to be hospitalised.

H. Disrupted sense

of security and psychological stability among children:

There is evidence in our media on an almost daily basis of young

children and adolescents held in refugee detention centres being exposed

to highly stressful instances of violence and abuse. The long-term effects

of this can only be imagined at this stage. What is clear is that they

have experienced disruptions in their developmental pathway due to breaks

in their schooling, possible loss of a parent or both parents (through

death or separation) and the trauma associated with their initial decision

to flee their country of origin. [19]

The primary effect

on children of the detention environment, exposure to hunger strikes,

demonstrations, episodes of self-harm and attempted suicide, and forcible

removal procedures, is that a child's sense of security and stability

is disrupted. [20] A secondary impact is mediated via

the child's parents, whose ability to be nurturing and protective parents

is diminished as they progress through the successive stages of depression

associated with the asylum seeker's detention experience. Depressed parents

are at risk of becoming neglectful or abusive of their dependent children

as the course of their own detention progresses.

Psychological disturbances

experienced by children are wide and varied. These include separation

anxiety, sleep disturbances, nightmares, bed wetting and impaired cognitive

development. Sultan and O'Sullivan report that 'at the most severe end

of the spectrum, a number of children have displayed profound symptoms

of psychological distress, including mutism, stereotypic behaviours, and

refusal to eat or drink'. Children of parents who reach the tertiary depressive

stage appear to be particularly vulnerable of developing a range of psychological

disorders. [21]

Visit any migration

detention centre in Australia and a similar texture of experiences will

emerge. The detainees I have visited and spoken with, for instance, have

made the following points:

  • They are not

    criminals - but are treated like criminals in prison.

  • On being admitted

    to the centre they suddenly realise they are being treated as 'illegal

    immigrants' instead of 'refugees' who justifiably fear persecution.

  • People do not

    know what is happening inside the detention centres. The detainees I

    visited do not have access to grass and trees. Children play on plastic

    play frames inside the centre. A fare of boiled rice, meat (undercooked

    with blood still showing) and coagulated vegetables is provided, with

    no reference to people's cultural requirements - for instance, for halal

    food or for unleavened bread. People's rooms are cramped and unhealthy.

  • Some have been

    held in isolation cells for extended periods - 45 days in one case,

    six months in another.

  • Detainees are

    traumatised by what they allege is brutal treatment by staff. The people

    I visited were reeling from the harsh treatment of a detainee who had

    protested vigorously after some staff threatened him with deportation.

    I was told that the detainee had spent two days in an isolation cell

    and was now faced with being deported before he could complete his asylum

    application. On expressing his frustration physically (his English being

    quite poor) he was (allegedly) severely manhandled. One detainee said

    he himself could not sleep after this incident. I also heard of a woman,

    a young mother of three children, who fainted in her room upon hearing

    the screams of the detainee as he was (allegedly) bashed by the centre

    staff.

    If accounts such as these are true (and we need some way to verify them

    independently) we have grounds for serious concern about the wellbeing

    and human rights of asylum seekers in detention centres.

2. Alternative

approaches

The above picture

of the detention experience for asylum seekers in Australia suggests there

is an urgent need for Australia to re-consider its approach to receiving

asylum seekers into our midst and processing their claims to refugee status.

The current environment is evidently humiliating, terrifying and abusive,

and this is having a profoundly negative impact on the development of

children and adolescents caught up in this system through no fault of

their own.

The psychological

impact of detention

The nature of the impact can best be gleaned from the accounts of

parents or children themselves. The following statements come from affidavits

by detainees.

The mother of a boy who was held in a solitary confinement cell without

access to a toilet recounts how her son described the experience to her.

(Names have been anglicised to protect the family.)

My son, Andrew,

later described to me his experience in detention. He said in words

to the effect of: 'I needed to go to the toilet and called the guards.

After a few minutes four guards came rushing down the corridor. They

broke into my cell wearing CERT [Centre Emergency Response Team} gear

and armed with blocking cushions. They pushed me back and held me against

the wall. One guard held my legs, the other held my hands behind my

back. A third guard used his arm to encircle my neck and hold me tightly.

I thought I would choke. The fourth guard swore at me. When I answered

back, the officer punched me in the face.' [22]

It is understandable

that parents held in detention are concerned about the effect the experience

has on their children. One detainee, released after 17 months into the

Perth community on a Temporary Protection Visa and separated from his

family who remain in the Port Hedland detention centre, speaks for all

asylum-seeking parents when he says:

Since being

in detention Charlotte, now 16 years old, and Jessie, now 12, have changed

completely. While I was in Port Hedland with them they became more and

more anxious and distressed. They began to lose interest in eating food

and had difficulty sleeping. The whole family is living in a room that

is 2.8 by 2.5 metres. [23]

I do not propose

to list case after case here. These are well documented by now, and can

be readily reviewed by inspecting published cases posted on the Children

Out of Detention (Chilout) website.

My point is simply

this: that many of the children and young people in detention (as at December

2001, some 582 - 53 being unaccompanied minors) are being exposed to violence,

degradation and abuse. They are seeing instances of self harm and attempted

suicide. And they are being confined in ways that abrogate their human

rights. They are living in conditions at the detention centres that violate

the United Nations Convention on the Rights of the Child (CRC).

Jaqueline Everitt,

an advocate for asylum seekers who is reading for a Masters in international

law, has put the matter cogently, when she states:

Is there any

other country prepared to lock up endlessly, children who have not been

charged with any crime? These children, who have already suffered in

their own country, who have made a frightening and perilous journey

to get to Australia and are possibly already among the most traumatised

of the world's children, have their trauma compounded by being taken

to a forbidding place and locked behind the razor wire, their rights

neatly incised.

They are out

of sight of the Australian people. If we don't see them, we don't know

they're human. They can't be real.

It's an irony

that Australian law provides for mandatory reporting of suspected child

abuse by professionals - and mandatory locking up of child asylum seekers.

We call both these practices government policy. One protects, the other

destroys. [24]

Statements such as

those by Everitt, and more recently a wave of statements of concern by

a broad range of citizens, suggest the need to rethink the current approach

to receiving and processing asylum seekers who come to our shores seeking

protection from persecution and abuse.

The call for alternatives

Professor Alice Tay,

President of the Human Rights and Equal Opportunity Commission, as early

as December 2000, called upon the Australian Government to develop a fresh

approach to the issue of asylum seekers, including considering a community

release program. In a press article at the end of 2000, Professor Tay

noted:

There are alternatives.

They have been used elsewhere and Australia should explore the options

and implement alternatives as a matter of priority. [25]

Most recently the

Head of Amnesty International, when visiting this country in early March,

called upon the Australian Government to consider alternatives to its

approach. Calls such as these reinforce the view that the time for exploring

and implementing more humane alternatives is now.

But just what are these alternatives?

This submission will

outline some of the main alternatives proposed by the UNHCR and then point

to two particularly noteworthy alternatives: one developed by the Swedish

government after addressing similar issues to those which we are currently

facing, the other proposed by our own Human Rights and Equal Opportunity

Commission (HREOC).

The UNHCR Revised

Guideline on Applicable Criteria and Standards relating to the Detention

of Asylum Seekers (February 1999) address the issue of alternatives to

detention. The fourth guideline specifies that alternatives to the detention

of an asylum seeker pending a determination of their status should be

considered. Choices about appropriate alternatives would need to be based

on assessment of each individual's particular circumstances and the prevailing

local conditions. The fourth guideline spells out the main alternatives

to detention that could be considered by governments. These are reproduced

here (in italics):

(i) Monitoring

Requirements.

Reporting Requirements:

Whether an asylum-seeker stays out of detention may be conditional

on compliance with periodic reporting requirements during the status determination

procedures. Release could be on the asylum-seeker's own recognisance,

and/or that of a family member, NGO or community group who would be expected

to ensure the asylum-seeker reports to the authorities periodically, complies

with status determination procedures, and appears at hearings and official

appointments.

Residency Requirements:

Asylum-seekers would not be detained on condition they reside at

a specific address or within a particular administrative region until

their status has been determined. Asylum-seekers would have to obtain

prior approval to change their address or move out of the administrative

region. However this would not be unreasonably withheld where the main

purpose of the relocation was to facilitate family reunification or closeness

to relatives.

(ii) Provision of a Guarantor/ Surety

Asylum seekers would be required to provide a guarantor who would

be responsible for ensuring their attendance at official appointments

and hearings, failure of which a penalty most likely the forfeiture of

a sum of money, levied against the guarantor.

(iii) Release on Bail

This alternative allows for asylum-seekers already in detention to

apply for release on bail, subject to the provision of recognisance and

surety. For this to be genuinely available to asylum-seekers they must

be informed of its availability and the amount set must not be so high

as to be prohibitive.

(iv) Open Centres

Asylum-seekers may be released on condition that they reside at specific

collective accommodation centres where they would be allowed permission

to leave and return during stipulated times.

These alternatives are not exhaustive. They identify options which provide

State authorities with a degree of control over the whereabouts of asylum-seekers

while allowing asylum-seekers basic freedom of movement. [26]

Discussion of

the alternatives

Elements of these UNHCR guideline approaches have been developed

elsewhere. The Australian Government should consider how an alternative

to mandatory detention could be designed and implemented so that we can

balance legitimate concerns about national security with humanitarian

obligations to assist desperate people seeking refuge from persecution

for themselves and their families.

The Swedish Government's

experience in this regard is instructive. A paper by Grant Mitchell, the

Coordinator of the Asylum Seeker Project, Hotham Mission, Melbourne, has

drawn attention to the lessons that Australia could learn from Sweden

in this area of public policy. [27] As Mitchell notes:

Sweden has been

successful in building a functioning reception process that allows for

a just and humane treatment of asylum seekers while they await a decision,

addresses national security concerns and effectively removes failed

refugee-claimants. Sweden has also been successful in quickly integrating

resettled refugees into society.

Mitchell explains

how most asylum seekers in Sweden live freely in the wider community.

Once a person has

been cleared by immigration and has indicated that they wish to seek asylum,

she or he is taken initially to the Carlslund Refugee Reception Centre,

close to the main international airport in Stockholm. At this central

reception centre they are signed in and have a Caseworker allocated to

them. [28]

The Caseworker's

role is to explain the refugee determination process and the rights and

entitlements that asylum seekers have while they await a decision on their

refugee status. In addition, caseworkers ensure that each client's asylum

application is processed correctly and that interpreters and legal representation

are made available where necessary.

The Carlslund Refugee

Reception Centre encompasses a refugee medical centre, accommodation,

a group home for unaccompanied minors, the Carlslund Detention Centre,

and for the Migration Board (which is the government body responsible

for the reception and processing of asylum seekers in Sweden). After spending

at least 2 weeks in the Carlslund Reception Centre, to complete the initial

application and to undertake health or support need assessments, an asylum

seeker is moved to one of Sweden's regional refugee centres while they

await a decision. Where an applicant has family or close friends in Sweden

they can choose to live with them. This occurs in more than half of all

cases.

In the majority of

cases, an asylum seeker's application will take more than four months

to determine. In such cases, the applicant is entitled to work. Free housing

is made available to asylum seekers, but they must provide for themselves

if they have enough money. For a fee of around A$10, emergency medical

and dental procedures and prescriptions are provided. Asylum seeker children

receive the same medical coverage as Swedish children. [29]

Mitchell's paper

reveals the Swedish system as providing a supportive and engaging physical

and human environment. Regional refugee centres comprise groups of flats

and apartments in small communities close to a central office reception,

which includes childcare and recreation facilities. Asylum seekers are

required to visit the reception office at least monthly for their allowance,

news on their application and need and risk assessment.

Caseworkers assigned

to each asylum seeker by the Migration Board make these assessments and,

where appropriate, refer clients for medical care, counselling and other

services. Caseworkers are also must provide 'motivational counselling',

to prepare the asylum seeker for all possible immigration outcomes and

to assess the risk of their absconding should they receive a negative

decision. Asylum seekers in urban areas work in a similar way with a caseworker,

whom they are required to visit at the local Migration Board office. All

asylum seekers awaiting a decision are encouraged to participate in some

form of organized activity such as English or Swedish lessons if they

are not working.

The Swedish system

has not always been like this. Mitchell notes that prior to comprehensive

changes being introduced in 1997, the Swedish approach was similar to

the detention regime which operates in Australia, and the Swedish Government

faced many of the issues that currently face Australia. He writes:

Many of these

problems, including riots, mass hunger strikes and worker safety have

been addressed due to comprehensive changes by the Swedish government

following an inquiry in 1997. The changes included:

  • The removal

    of private contractors and the police from the detention centres

  • Dividing

    detention into 3 categories: initial health, security and identity

    checks; investigation; realising return for individuals at high risk

    of absconding

  • Implementing

    a caseworker system aimed at need and risk assessment, the informing

    of rights and preparing detainees for all possible immigration outcomes

  • Increasing

    transparency in management and operation, with centres to be run more

    like closed institutions than prisons

  • Ensuring

    all staff are trained to work with asylum seekers and show appropriate

    cultural and gender sensitivity and respect to all detainees

  • Increasing

    access for NGOs, clergy, researchers, counsellors and the media

  • Allowing

    for freedom of information, such as access to internet, NGOs and the

    option to speak to the media

  • Allowing

    for regular meetings between staff and detainees on the running of

    the centres and ensuring detainees are aware of complaint mechanisms

  • Ensuring

    legal counsel and the right to appeal is available

  • Ensuring

    no children are held in detention for extended periods and removing

    families as soon as possible.

Mitchell concludes

that Sweden's integrated approach to detention and reception has been

helped by the caseworker system - especially by preparing clients for

either return or settlement. Furthermore, the system of release into the

community after initial checks has resulted in a significant reduction

in public outcry, not only in relation to the use of tax payer's money

but also as regards the previous system of detention. The reduced use

of detention, when coupled with the caseworker system, has not led to

large numbers of asylum seekers absconding.

Finally, detention

is not completely excluded from the Swedish system. Asylum seekers living

in the community who are assessed as likely to abscond prior to receiving

a final decision are placed in detention for removal. But these instances

are rare, because the caseworker system has encouraged failed refugee

claimants to comply and return after a final decision has been made. Mitchell

notes that this compliance has been achieved by:

  • Providing 'motivational

    counselling', including coping with a decision and preparation to return;

  • providing three

    options to asylum seekers: voluntary repatriation; escort by caseworkers;

    or escort by police; and

  • providing incentives

    for those who choose to voluntarily repatriate, including allowing time

    to find a third country of resettlement, paying for return flights,

    including domestic travel and allowing for some funds for resettlement.

    [30]

Australia and asylum

seekers alike could benefit from introducing a system along the lines

adopted in Sweden. Indeed, a similar sort of approach has already been

suggested by the Human Rights and Equal Opportunity Commission (HREOC)

in its 1998 report Those who've come across the seas: Detention of unauthorised

arrivals. The alternative option proposed by HREOC has been outlined by

the President of HREOC, Professor Alice Tay, as follows:

This option

proposes community release while claims are finalised. People who present

a real threat to national security or public order would not be released.

Individual assessments would be made on the risk of absconding. Most

could and should be released on their own promise to report as needed

to deal with their claims. [31]

In its bare outlines,

this system would not be too dissimilar from the Swedish model, suitably

adapted to Australian circumstances. It would allow us to move back towards

a moderate, compassionate and humane approach to the issue of receiving,

processing and settling asylum seekers. And it would help us to take a

more humane and constructive approach to removing and re-settling unsuccessful

applicants.

What is required

now is to see the issue in terms other than nationalistic xenophobia.

It is possible to preserve Australia's legitimate self interest while

nonetheless upholding universal human rights consistent with our international

obligations. And this will require clear and ethical leadership.

3. Time for a

new sort of leadership on the refugee issue

Alice Tay has rightly

called for a fresh approach to be taken to the way our national community

deals with asylum seekers. As she observes:

Some time in

the past decade we lost our compassion towards asylum-seekers and became

insular and hard-hearted. Australia's refugee policy is moving from

a humanitarian one to a punitive one: from a relatively liberal assessment

of individual circumstances against our international obligations to

preventing entry and punishing those who slip through the net. [32]

Regrettably, the

two main political parties in Australia have adopted this more or less

punitive approach. And this has been done largely because political leaders

have been concerned to calibrate their policy stances in accord with what

they perceive as community opinion on the issue of refugees. The xenophobia

associated with Hansonism and the One Nation Party has had a lot to do

with the way that the two major parties have effectively demonised refugees

and portrayed them as a threat to Australia's national security.

But this is an issue

that requires leadership on sound ethical principles appropriate to ensuring

not only Australia's future but its role in developing a just and sustainable

global society. Leadership of this kind is not possible if the focus is

only upon alignment of policies with popular opinion so as to secure national

electoral ascendancy.

As Alice Tay reminds

us:

Sadly, the mandatory

detention of asylum-seekers and others who arrive without visas is popular

with a community more concerned about continuing to enjoy reasonable

prosperity than sharing a little of it with the needy. It is also worth

mentioning that the two main political parties are more or less in agreement

on how to deal with the errant and desperate few who enter the country

without authorisation. In balancing national security interests and

individual human rights, the pendulum has swung too far in the direction

of border protection and national security. There are times when one

must turn away from the will of the people and swim against that tide;

times when the humanitarian obligation should be paramount. Now is the

time to rethink Australia's policy of mandatory detention. [33]

Alice Tay is not

alone in calling for such a rethink and leadership against the grain of

popular sentiment.

Malcolm Fraser (the

former Liberal Prime Minister) recently has formed a broad alliance of

citizens from across the political spectrum who are concerned to pressure

the current Government to develop a more humane approach taken to the

way Australia receives and processes asylum seekers.

Greg Barns, a former

Howard Government adviser and now the endorsed Liberal Party candidate

for the 2002 Tasmanian state election, also has called upon the Government

to reconsider its approach to this issue. He observed in a recent press

article that 'the problem with the current policy by the Howard Government

towards asylum seekers is that it actually devalues the humanity of asylum

seekers through its characterisation of them as offenders against humanity'.

[34] He notes the British Conservative Party's Home

Affairs spokesperson, Humfrey Malins, who recently observed that mandatory

detention of asylum seekers is unjustifiable because these 'people

have not committed any offence. They are not criminals'. [35]

Justice Marcus Einfeld

has been vocal also in calling upon the Government and the community to

take a fresh and humane approach to addressing the needs of asylum seekers.

Faith community leaders are also joining the chorus. The list could be

extended. The point to draw from these expressions of concern is surely

this: A policy of mandatory detention of asylum seekers is inhumane and

unjustifiable. It flies in the face of compassion and logic. It is out

of keeping with the golden rule of treating others as we would want to

be treated that underlies commonsense morality.

Any policy that involves

locking up the children of asylum seekers is doubly indefensible. Not

only does it defy logic, ie their parents have not committed an offence

by seeking asylum from persecution, so neither they nor their children

should be locked up in the first place. It also contravenes the UNHCR's

Guidelines and the UN Convention on the Rights of the Child (CRC). For

example, Articles 2, 3, 9 22 and 27 of the UN CRC make it clear that detention

of children is not in the best interests of the child and is inherently

discriminatory. Article 2 specifically requires States to protect children

from discrimination or punishment on the basis of the status, activities,

expressed opinions or beliefs of a child's parents, legal guardians or

family members. As a signatory to these UN instruments, Australia urgently

needs to rethink its approach.

The time has come

for us to look at how we can best align our national security and economic

concerns with our international commitments to promote human rights and

build a just and sustainable world order. For, in the context of globalisation,

it is simply not possible to secure the one without the other.

This submission recommends

that the Australian government give immediate priority to examining the

cost-effectiveness of a community-based approach to the reception, detention,

determination, integration and resettlement of refugees. More broadly,

the submission calls upon all political parties to commit to leading the

community in a bipartisan process of rethinking and redesigning our policy

approach to refugees.

We are in a particular

moment of our history where there seems to be a growing sensibility among

our people that the way we deal with refugees could be done not only differently

but better. The former senior public servant, John Menadue, has reminded

us of this:

In the end,

the government must abandon its xenophobia and punishment of the vulnerable

and traumatised. It must abandon mandatory imprisonment. It doesn't

work. Australia has a self interest as well as a humanitarian responsibility

in this. Refugees have made, and continue to make, an outstanding contribution

to his country. They are risk takers, highly motivated and prepared

to leave everything for the sake of a new start for themselves and their

children in a new country. We need more of that spirit in Australia.

[36]

We could, indeed,

do with more of that spirit. But what is required to grow that spirit

in Australia is a fresh commitment to principles of justice and fair treatment.

We need to commit

openly, as a national community, to welcoming and assisting any adults

and children who seek safe harbour and new beginnings on our shores.

We need to put in

place policies and procedures that protect vulnerable global citizens,

especially children, from abuse and trauma when they venture amongst us,

against all odds, in search of freedom, hope and justice.

We need to show wisdom

and leadership on this issue. And these have to be built on a clear recognition

that securing our future development will not be based on exclusionary

concerns with protecting national borders from desperate people doing

desperate things in desperate circumstances.

We must recognise

that our future development and stability can only be assured if it is

grounded on an ethic of inter-existence and productive diversity. By welcoming

risk takers, and offering them a chance to contribute to the development

of Australia and the world, we are most likely to build a humane, tolerant,

diverse and capable national community. And in doing that we will contribute

to securing not only our own national stability but also to a truly just

and peaceful world.

Conclusion

We have, by now,

heard reports from former workers in detention centres of the brutal conditions

inside them. We have, by now, read accounts and seen television footage

of people driven to extremes of personal action to try to have their conditions

improved or to escape them. As a result, Australians increasingly are

forming a shared view that the operations of these detention centres are

not transparent and are out of line with community standards.

There is enough evidence

in the public domain to suggest that the Government should move beyond

its detention regime for asylum seekers and towards a community-based

reception regime.

Keeping people in

de-humanising lock-ups, where adults, young people and children experience

violence, vilification and abuse, can only worsen their mental health

outcomes as well as those of our society in general when traumatised asylum

seekers are eventually released into the community.

Ultimately this is

a question of upholding people's human rights.

All people, especially

those fleeing from persecution, should be treated with dignity and compassion.

It is their right.

As a society, we

threaten to do ourselves some collective psychological harm, if we continue

turning a blind eye to the incarceration and mistreatment of desperate

people who, by whatever means available to them, have sought refuge in

our midst.

Australia's detention centres have become silent places where people from

different backgrounds, but with the same sentiments, fears and hopes as

all human beings, are being systematically denied some of their most basic

freedoms.

  • They are unable

    to exercise their right to freedom of speech.

  • They are denied

    their right to freedom of association.

  • Children in detention

    are denied their right to free public education.

  • But, perhaps most

    alarming with respect to mental health, they are denied their right

    to freedom from fear.

These freedoms, these

liberties, are part of the universal notion of what it is to be human.

At the moment, we live in a state that is taking liberties - liberties

that are intrinsic to all people, as human beings, as citizens of the

world. We are all being diminished as a result.

It is, by now, incumbent on all of us to speak up and speak out about

ensuring the rights of all people, whatever their background, whatever

their circumstances, to a just and dignified life.

For it is through

creating the conditions in which all people can exercise their fundamental

human rights that we can best promote the mental, physical and social

health of all people in Australia as well as the wider world, now and

into the future.

Section

2.

The impact of detention on the health of refugee children

The Centre for International Health (CIH), Macfarlane Burnet Institute

for Medical Research and Public Health Beverley Snell and Michael Toole

This section provides

observations on the lives of children and their families in Australian

detention centres and offers informed assessment of likely long term impacts

on health. In addition, the authors suggest more appropriate responses.

Definition of

health

In line with the WHO definition of health, the group sees health

as not merely the absence of disease but as a state of complete physical

and emotional wellbeing.

Family and living

environment

The child,

for the full and harmonious development of his or her personality, should

grow up in a family environment, in an atmosphere of happiness, love

and understanding. [37]

The following questions

arise:

  • Are families living

    together?

  • Do they have sufficient

    privacy?

  • What is being

    done to enable refugee families to live in dignity and provide care

    and protection for their children?

  • How do the general

    living arrangements and social organization of the refugee population

    affect the protection and care of children?

  • What are the

    normal activities in the community to assist children who have difficulties?

Observations

There is evidence

that in Australian detention centres families are housed in cramped conditions

with very little privacy. In many cases families are housed in units of

multiple groups separated only by a curtain. There are few facilities

for family activities. Adults have no control over their daily lives or

that of their children.

Families may be separated

from each other because they did not all arrive together. It is reported

that people are housed in different sections of detention centres according

to the stage of the processing of their claims. Frustration is increased

by the fact that detainees are unaware of the progress of their appeals

for refugee status and they are rarely able to communicate with relatives

and friends. In many cases, families remaining in the country from which

they fled do not know whether the detainees are alive or dead or conversely,

the detainees don't know whether their family members are alive or dead.

Impact

In these conditions both parents and children suffer. Parents become

frustrated, tired and impatient and have difficulty in being good parents.

Children are exposed to the psychological distress and despair of parents

living in confined conditions with little control over their lives, and

unaware of their legal status as refugees. Children cry, fight, or become

very withdrawn. Parental distress and anxiety can seriously disrupt the

normal emotional development of their children and can contribute to both

psychological and physical illness. Examples of the psychological impact

of these conditions are also discussed in Section 1.

Recreation

The relationship between nutrition and physical activity is integral

to a child's development. Nutrition is dealt with in detail in Section

4.

Article 6(2), Convention

on the Rights of the Child explains

States Parties shall enure to the maximum extent possible the survival

and development of the child.

Article 31(1), Convention on the Rights of the Child declares

State Parties recognise the right of the child to rest and leisure, to

engage in play and recreational activities appropriate to the age of the

child and to participate freely in cultural life and the arts.

Observations

Of concern are reports from detention centres that children have

very restricted facilities for play, for example a small internal section

in the men's area at Maribyrnong, external areas of bare earth in the

blazing sun with no appropriate facilities at Woomera where more than

100 children are held.

The following reports

from the sources cited in this submission [38] illustrate

conditions in Australian detention centres

  • There is little

    room for children to crawl or run around and play.

  • They need to

    be let out into the open where it is extremely hot (about 50 degrees)

    or very cold

  • Children do

    have a few toys to play with but very often they are not interested

    in playing because they are so confined.

An ex-detainee explained

that there was no organised child care in Woomera when she was there.

She volunteered to run daily child care activities but there were no facilities

provided.

  • I looked after

    13 children in childcare

  • I would entertain

    them with videos of cartoons

  • There were

    about 3 cycles and the kids were constantly fighting over them

  • There was only

    one swing for about 50 children and constant fights over who would play

    on the swing

Rest, leisure, play

and recreation are vital for the healthy development of the child. In

order to ensure the appropriate development of children in immigration

detention and provide them with the highest attainable standard of health,

they must be provided with opportunities, spaces, equipment and education

that encourage and facilitate physical activity and sport. [39]

Interaction with

the physical environment is stated to be an innate and necessary propensity

in all people, including children. [40] The quality

of play experience for children will be related to the environment in

which it takes place.

Australia's obligations

under the Convention extend beyond merely treating illness to ensuring

the development of the child to the maximum possible extent, [41]

and preventing, treating and rehabilitating disabilities. [42]

The UNHCR Guidelines

for the care and protection of children state that

Refugee camps, settlements or reception centres should have play areas

from the outset. The play areas must be free from hazards and must fit

in with the rest of the community.

The United Nations

rules for the Protection of Juveniles deprived of their Liberty require

that

The design and physical environment should be in keeping ….. with

the need for privacy, sensory stimuli, opportunities for association with

peers and participation in sports, physical exercise and leisure time

activities

Impact

Normal development milestones like crawling, walking, talking may

be delayed because of lack of space and the opportunity to move and the

atmosphere of despair and frustration that inhibits normal interaction.

According to Dr Shanti Raman, Paediatrician : [43]

Young babies and

toddlers seem not to be reaching key milestones in their development.

  • Their social

    and communication skills are behind.

  • They're not

    talking, not engaging.

  • There's a definite

    lack of curiosity, what we call a dull effect, a lethargy.

Physical manifestations

of frustration in children include bed-wetting and mutism. [44]

The psychological impact of these conditions is discussed in detail in

Section 1 of this submission.

Pliskin [45]

describes social and cultural problems of Iranians brought on by revolution,

war, immigration, and changes in family status as being expressed as narahati

- depression, nervousness, sadness and anger that are usually masked or

expressed nonverbally through sulking or not eating. Children exposed

to this sort of family behaviour commonly respond with disturbed behaviour

but also by exhibiting symptoms of somatised illness. The illness can

be manifest physically as well as mentally with for example, headaches,

tiredness, abdominal pain and gastric disturbances. It is important that

clinicians trained to understand these problems are employed. But more

important is the support of the family to remain a nurturing unit. Montgomery

and Foldspang [46] are among authors who stress the

prime importance of the family environment in maintaining the health of

children.

Community support

Isolation between families in different sections of detention centres

can prevent access to the support mechanisms that may be available within

communities and have a very negative effect on psychological and emotional

wellbeing. The UNHCR guidelines stress the importance of involving members

of the refugee community in community activities to support families.

The question arises - are there persons among the refugee community who

could provide regular activities for refugee children such as non-formal

education, play and recreation? The communities reflect most facets of

a common community, there are teachers, lawyers, health workers, etc.

So skills within the community could be beneficially employed in many

areas.

Health workers who

know and can help their communities should be integrated into the health

delivery system (recommended by UN guidelines). Community teachers, child

care workers and other leaders are also important. It is doubtful whether

these approaches are encouraged.

Environmental

Safety

Safety in both the living environment and the built environment are

crucial to the maintenance of family wellbeing and security. There is

little specific evidence about safety standards in detention centres.

We recommend that HREOC examine facilities and ensure that there is compliance

with national occupational health and safety standards.

The Australasian

Standards for Juvenile Custodial Facilities specifies that centres as

a whole must comply with occupational health and safety standards and

provide a safe living environment. These Australasian standards use the

United Nations rules for the Protection of Juveniles as their reference

point.

The United Nations rules for the Protection of Juveniles deprived of their

Liberty state

… [they]

have the right to facilities and services that meet the requirements

of health and dignity

…. the design and structure of detention facilities should be such

as to minimise the risk of fire and ensure safe evacuation from the

premises. There should be an effective alarm system in the case of fire,

as well as formal and drilled procedures to ensure the safety of juveniles.

Concerning the built environment, the Australasian standards specify

that standards are in line with the United Nations rules for the Protection

of Juveniles deprived of their Liberty in that

Services meet

the requirements for health and human dignity

Of further concern

to us are reports of access to toilet facilities. In some cases the toilet

block can be up to 500 m away. Because of the distance from the toilet

block and the environment, children have been known to wait until they

are incontinent. [47] Female ex-detainees have reported

their unease about passing men 'who hang around' the toilet block and

mothers will not allow their children to go to the toilet blocks alone.

Visitors and ex-detainees have described the toilets in Woomera detention

centre as being 'filthy and splattered with blood'. [48]

[49] [50] This situation does not

comply with the UN Rules specifying that

Sanitary installations

should be so located and of a sufficient standard to enable every juvenile

to comply with their physical needs in privacy and in a clean and decent

manner

Health services

The UN Committee on Economic, Social and Cultural Rights has identified

six core obligations on the right to health under Article 12, which include:

  • access to health

    facilities

  • nutritionally

    adequate and safe food

  • basic shelter,

    sanitation and safe drinking water

  • essential drugs

  • equitable distribution

    of all health facilities

  • a public health

    strategy and plan of action

Initial assessment

In line with the recommendations of the Royal College of Paediatricians

and Child Health [51] we believe it is important that

children among families seeking asylum are initially assessed by a clinician

with expertise about children. Any problems identified will need to be

addressed according to best practice in Australia. Growth assessment is

routine procedure for Australian children.

Observation

It has been reported that initial assessments are carried out by

a Registered Nurse not by paediatricians nor clinicians with specialised

knowledge of children. They focus on conditions of 'public health importance

only'. [52] There is no evidence that health professionals

who conduct the initial assessments have any training in the conditions

that may be unfamiliar in Australia but which may be present among newcomers

nor is there any evidence that they have any cross-cultural training.

The preparation of a health file for each child as a basis for ongoing

health care, is not an outcome of the initial assessment. The UNHCR Guidelines

specify the need for personal records, including health records, for each

child.

Impact

If a comprehensive health assessment is not undertaken, conditions

affecting eyes, ears, skin, teeth, gums, etc as well as growth and development

may not be detected. There may also be conditions uncommon in Australia

and unfamiliar to Australian clinicians that should be noted. Examples

might be nutritional deficiencies and conditions associated with parasites.

We consider that there should be awareness of previous common problems

of the populations represented by people detained in the centres. An initial

assessment also provides a benchmark against which to measure any health

developments and to guide subsequent health responses.

Without a personal

health file, it would be difficult for health professionals to care adequately

for each child and provide appropriate follow-up.

Appropriate curative

services including dental services

It is crucial that children have the benefit of an effective primary

health care program including a health monitoring program. In order to

deliver effective primary health care a comprehensive initial assessment,

on which to base ongoing care, is needed for each individual. Personal

records for each child will enable ongoing health assessments and monitoring

of children's psychological and physical development. The file (record)

should follow the child through the detention centre and into the community

when the child is released. We are pleased to note that immunisation against

vaccine-preventable diseases is undertaken in all detention centres and

records are maintained appropriately and provided to the child or carers

on release.

The UNHCR Guidelines

state, not only that it is necessary to ensure that children have the

benefit of an effective primary health care program, but that health services

should be implemented with the full participation of the community.

According to our

informants, services provided are solely curative and provided by staff

without cross cultural training and without special training in the management

of disorders that are common in the home countries of detainees. Monitoring

of children's psychological or physical development is not an integral

part of the health services.

Problems have arisen

regarding durable solutions when refugees have been inappropriately diagnosed

by mental health professionals without adequate experience regarding the

situational stress reactions or sufficient cross-cultural skills and understanding.

Specialised services

are needed. Special difficulties such as trauma from witnessing or being

a victim of torture, sexual assault or other forms of violence, require

the involvement of a qualified mental health professional trained to work

with children. Such a professional should preferably be of the same ethnic

background as the refugees or at least have good cross-cultural skills.

Her/his role could be either to provide treatment directly or to guide

and support members of the family or community to do so.

Removal from the

family unit should be avoided. Unless it is necessary to prevent abuse

or neglect, a child should not be separated from her/his family and community

for treatment. Even if it is not possible to get the specialised help

the child needs, all positive action to normalise the life of the child

is good.

Commonly reported

symptoms of displaced children have been somatic complaints, social withdrawal,

attention problems, anxiety, and depression. Zivcic [53]

assessed the health of Croatian adolescents who had been displaced by

war and found displaced children manifested more negative emotions (especially

sadness and fear) than did their local peers, based on self-report as

well as parents' and teachers' reports. Sikic [54] showed

that hyperactivity, anxiety and psychosomatic disturbances to be rare

in non-displaced children; more frequent in refugee, and most expressed

in displaced children.

Access to health

services

The processes involved in consulting health professionals have been

described by ex-detainees, staff and observers. Detainees have to satisfy

guards of their needs in order to consult health professionals. Informants

have also referred to the processes should a detainee require treatment

outside a centre or admission to hospital. Detainees may be handcuffed

or otherwise restrained and accompanied by one or more guards. Small children

may be accompanied by a parent but a guard is also present. This procedure

raises questions of confidentiality as well as maintenance of dignity.

Access is multidimensional

concept and includes consideration of the number and type of services,

staffing, cultural appropriateness and communication skills of staff.

Issues associated with culture and communication are addressed in Section

3.

The Australian Medical

Association (AMA) has asserted that within and beyond detention centres,

detainees are often deprived of basic medical care, particularly emergency

care. The AMA has argued that the government should provide temporary

access to Australia's universal subsidised system of health care. This

provision would be in line with Australian standards for custodial care

of children that recommend care at least equal to care in the mainstream

community. [55] [56] [57]

This provision would

also ensure access to essential drugs in line with the UN Committee on

Economic, Social and Cultural Rights core obligations and also in line

with the Rules for the Protection of Juveniles Deprived of their Liberty,

United Nations 1990:

Every juvenile

shall receive adequate medical care, both preventive and remedial, including

dental, ophthalmological and mental health care, as well as pharmaceutical

products and special diets as medically indicated

It has been reported

that without access to Australia's universal subsidised system of health

care, detainees have been denied access to the most appropriate medication

because of cost. [58]

Other incidents have

also been reported that highlight the need for access to appropriate care.

At Villawood, for example, where despite formal recommendations by medical

practitioners in February for a patient to receive specialist care, and

repeated informal requests by independent doctors nothing occurred until

finally this patient became moribund. She was a first time mother and

her child was considered at risk from her condition. At that time a lawyer

organised an emergency independent assessment and reported that it had

been difficult to achieve given DIMIA and ACM bureaucracy. This action

resulted in an emergency admission to hospital. A second similar case

occurred a week later. Pressure had been exerted by ACM to resist specialist

interventions on the basis of budgetary considerations. [59]

We would recommend

that any health staff employed should be independent of ACM to avoid conflict

of interest.

Dental care is not

routinely available in detention centres and it has been reported that

conservative procedures are not available and that dental pain is treated

with paracetamol - a mild analgesic. However, extractions are performed.

Public health

practitioners must be concerned to learn that the dentist's main activity

is tooth extraction and that the main health 'treatment' was advice

to 'drink more water' [60]

Women's' Health

services

The UNHCR guidelines stress the importance of the appointment of

women health professionals. There is no evidence of attention to family

health services, appointment of female health professionals or specialised

women's services.

We asked informants

whether refugee women have access to primary health care services which

provide for the monitoring of the health of pregnant and lactating women.

According to our informants regular antenatal care is provided by nurses

in detention centres. However, while it is reported that the contractors

prefer midwives, they do not ask for nor provide cross cultural training

for their employees.

The procedures associated

with delivery vary between detention centres. It has been reported that

the practice of sending women alone for delivery to a hospital far from

the detention centre has resulted in women waiting as long as possible

and sometimes being involved in an obstetric emergency without appropriate

medical support.

According to our

informants there is no routine MCH support for women. Formulae for infant

feeding are not available so by default, breast-feeding is 'promoted'

without support. Use of milk products is not monitored and cow's milk

is reported to be used inappropriately for infants less than 12 months

old. There are reports of formulae being provided to mothers of infants

by friends in the community.

According to our

informants there is no nutritional status surveillance of infants and

young children, see Section 4.

Adolescents:

The UNHCR guidelines raise the questions:

  • Are the health

    services meeting the health needs of children and adolescents?

  • Are additional

    female health professionals/or community health care workers required?

Although adolescents

may have adult bodies and perform many adult roles, generally speaking

they have not fully developed the emotional maturity and judgment, nor

achieved the social status, of adults that come with life experience.

In refugee situations, adolescents do need the 'special care and assistance'

given them by the CRC: they are still developing their identities and

learning essential skills. When the refugee situation takes away the

structure they need, it can be more difficult for them to adjust than

for adults. Their physical maturity but lack of full adult capabilities

and status also make them possible targets of exploitation, such as

in sexual abuse.

Refugee Children:

Guidelines on protection and care 1994

It has been reported

that there are no special services available for adolescent boys or girls.

Culturally appropriate

and sensitive services are needed to provide accessible services to both

boys and girls and adolescent boys and girls have specific health and

emotional needs that will need to be addressed. Special cultural issues

associated with young females are discussed in Section 3.

Afghan women have

come from a culture where they were denied access to health care if there

was no female health professional available. It is important that female

health professionals are available in Australian facilities because these

young women may seek health care from a female professional before a male.

There are also structural

conditions that have a negative impact on the reproductive health of adolescent

girls in particular, eg lack of privacy about person health and no cross-cultural

staff training. A young female ex-detainee described how women have to

complete a form including the date and personal details when they need

sanitary towels. They are supplied with ten pads and face possible questioning

by a staff member, who is not always a woman, if more are needed. [61]

Suggested activities

Group activities should emphasize peer leadership. Sports, group

discussions and community projects are examples. They can support adolescents

in making the transition to adulthood by discussions on issues such as

sexuality and adjusting to the host country culture.

Health education

for families, including the risks and means of preventing diseases with

public health importance; including sexually transmitted infections (STI)/HIV

infections can be included. Particular attention should be focussed on

the need of adolescents for such information and special attention should

be paid to services needed by adolescent girls.

Separated children

The following are the key concepts addressed by the United Nations

High Commission for Refugees in relation to separated children who are

seeking protection as refugees that we feel are relevant to this enquiry.

  • The identification,

    care and protection of separated children are high priorities.

  • All work with

    separated children should be in keeping with the provisions of the UN

    Convention on the Rights of the Child and other international, regional

    and national instruments.

  • Care arrangements

    for separated children should, wherever possible, be based on family

    and community responsibilities for children. Institutional forms of

    care should be avoided wherever possible but the risks involved in foster

    programs also have to be acknowledged.

  • The importance

    of careful and coordinated planning amongst those agencies involved

    in developing programs on behalf of separated children cannot be underestimated.

    This includes ensuring that any activities do not in themselves lead,

    be it inadvertently, to further separations.

  • It must not be

    assumed that a child arriving without family is unaccompanied.

The following questions

arise

  • Are there children

    who are alone?

  • Are the special

    needs of unaccompanied children in confinement being addressed?

  • Sometimes grandparents

    send children to seek asylum because their parents have been killed

  • There was a young

    girl who was alone and had a small sibling to care for

  • The father had

    arrived earlier. When his wife and children arrived they were accommodated

    in a separate part of the centre because their applications were at

    a different stage

The above cases were

described by ex-detainees and visitors to centres.

A reported incident

[62] involved children being separated from their mother

who was mentally unwell. They were housed outside the centre. The mother

remained inside and her condition deteriorated until she was also released.

When she was reunited with her children in the community her condition

improved.

Another case at Villawood

[63] involved the removal under guard of a young woman

suffering post-natal depression, from her 10 month old child who remained

at the centre.

We believe such interventions

would be more likely to exacerbate problems. They also contravene Key

Concept 6 of the UNCHR guidelines on the care of separated children that

activities undertaken by agencies should not lead to further separation.

Two issues arise:

If children are separated by authorities from parents, for whatever reason,

it is crucial that they are accommodated with a family of their own culture

and preferably known to them. Easy access to the detained parent is extremely

important. However, the second issue - of detention - is the real problem.

The whole family would be much better accommodated in the community. Again

the inappropriateness of detention per se is highlighted.

Levenson and Sharma

describe the standards adopted by the Royal College of Paediatricians

and Child Health as a basis for the care of unaccompanied children seeking

asylum.[64] Those standards are in line with the key

concepts of the United Nations High Commission for Refugees relating to

the care of unaccompanied children.

Children with

disabilities

  • Have disabled

    children been registered and assessed?

  • What is their

    gender and age?

  • What are the nature

    and extent of their disabilities?

  • What are the cultural

    attitudes towards different disabilities?

  • Are families of

    disabled children provided with help to cope with the specific needs

    of the child ?

The answers to the

above questions will guide the care of disabled children in detention.Further

questions arise. It is doubtful whether these questions could be answered

in the affirmative.

  • Are steps being

    taken to allow each disabled child to reach their potential?

  • Are there community-based,

    family-focused rehabilitation services?

  • Are children with

    disabilities integrated into the usual services and life of the community,

    such as schooling?

  • What additional

    measures are required to ensure the rehabilitation and well-being of

    refugee children with disabilities?

It is reported that

as of February 1, 378 children were residing in detention centres and

of these 16 children (or 4.2%) were disabled (Port Hedland and Woomera).

[65]

Types of disability

include: cerebral palsy, hearing impairment, vision impairment, acute

dwarfism, trauma, Perthe's disease (atrophy of the femur), cardiac, asthmatic

and genetic disabilities.

According to the

National Ethnic Disability Alliance (NEDA), the Department has 'reassured'

it that all necessary steps are taken to ensure that the needs of these

children are met. However, NEDA is 'totally opposed to any child with

a disability being detained in detention centres', especially as detained

children are likely to come from a non-English speaking backgrounds. NEDA

says such detention is a violation of children's human rights and the

organisation is making a submission to HREOC's National Inquiry into Children

in Immigration Detention. [66]

Issues related

to nutritional status

A comprehensive initial assessment by appropriately qualified staff

would identify problems associated with nutrition and procedures could

be put in place for ongoing management.

Section 4 covers

issues associated with nutrition in detail

Staff and training

The UNHCR Guidelines for the care of children is one of many documents

that stress the importance of employing health staff with specific cross-cultural

training as well as specific training for working with refugee populations.

If trained staff is not available, training must be provided by the institution.

The guidelines specify the need for appropriate preventive, public health

and curative services. They also stress the importance of appointing women

health professionals.

According to our

informants, staff members are not appointed on the basis of their training

for working with refugee populations, nor is there emphasis on recruiting

female personnel. Services provided are solely curative and provided by

staff without cross-cultural training and without special training for

work in a system that requires management and referral according to relevant

protocols. The section of this submission on Culture and the health of

children in detention provides details about cross-cultural issues. Staff

could also benefit from familiarity with disorders that are common in

the home countries of detainees and from special training concerning those

disorders. As explained in the introduction to the submission, the CIH

staff have worked closely with the Office of the United Nations High Commissioner

for Refugees, the World Health Organization, the International Committee

of the Red Cross and many non-governmental organisations to develop technical

guidelines and conduct training courses for health professionals working

with refugees.

It would appear that

in Australian detention centres, there are no treatment guidelines or

protocols to cover the responsibilities of different levels of staff.

Nurses and other middle level health providers are forced to rely on their

own individual judgments. Most recruited staff members are trained to

work in Australian settings. Although they are committed to their strict

Codes of Conduct, many ex staff have reported the difficulties associated

with maintaining their own ethical standards in an environment where the

highest priority was securing the asylum seekers. It has

been reported [67] that nurses are recruited primarily

for suitability in a correctional environment.

An ex-detainee

described a range of situations where nurses would not allow patients

to see a doctor when the patients felt the problem needed a doctor's

attention. [68] Staff and ex-detainees have

indicated that paracetamol (a mild analgesic) is prescribed for 'everything'

A doctor working

at Woomera was concerned that nursing staff were forced out of their

depth to supervise procedures that would normally require expert supervision

[69]

In reference to the

prescription of paracetamol by nurses, nurses are not allowed to prescribe

prescription only (S4) drugs so they are legally limited in what they

may prescribe and it is clear that this response will not always be appropriate.

The use of appropriate transparent treatment guidelines for different

levels of staff would overcome problems associated with determining different

levels of responsibilities. They would also provide patients with clear

expectations of the responsibilities of different levels of health staff.

There are many examples of treatment guidelines and training for health

workers in refugee settings that could be used as models. The World Health

Organisation, for example, provides a range of models. [70]

[71]

Evidence of health

promotion activity has not been documented although in Woomera, warnings

about skin cancer from excessive sun exposure are reported. There has

been little shade available and only minimal sunscreen distributed.

There is no evidence

of training for staff for detection of outbreaks of problems of public

health importance. In the Australian detention context these problems

might include respiratory tract infections because people are forced to

live indoors in cramped conditions, nutritional disorders because of inappropriate

diet or they may include outbreaks of problems that are common in the

country of origin but uncommon and unfamiliar in Australia.

Recommendations

Asylum seekers should not be detained. Children particularly, should

not be detained but their release from detention must not involve separation

from their families. Until a policy of release is in place there must

be compliance with basic standards of care for families and children in

detention.

It has been shown

that community involvement does not seem to be a priority in detention

centres. However, refugee community participation could enhance the delivery

of the following programs that should be present as a minimum:

  • Family health

    services with emphasis on women and children's health services and the

    appointment of women health professionals and involvement of health

    workers from the refugee community

  • Access to appropriate

    curative care for common problems

  • Health promotion

    services with emphasis on women and children's health services

  • Immunisations
  • Appropriate hygiene

    and sanitation facilities

  • Health education

    for families with attention to the needs of adolescents for information

    about STIs. Special attention should be paid to all health services

    needed by adolescent girls

  • Exclusive appointment

    of independent appropriately trained staff or provision for relevant

    training, including cross cultural training, before commencement of

    duties.

Section

3.

Exploration of cross-cultural issues and barriers to delivering culturally

competent services in detention centres

Centre for Culture

Ethnicity and Health

Andre Renzaho, Centre for Culture Ethnicity and Health; Demos Krouskos,

North Richmond Community Health Centre

Introduction

This section of the submission will address cross-cultural issues

related to service delivery in detention centres and how these issues

impact upon the health and welfare of children in particular. In exploring

these cultural issues, we use the Convention on the Rights of the Child

and other international documents to elucidate some specific key issues,

supported by accounts from former detainees.

Cross-cultural

issues in detention centres

The Centre for Culture Ethnicity and Health (CEH) is concerned with

the health and welfare of asylum seekers but of particular interest for

this submission are cross-cultural issues related to children in detention

centres.

The UNHCR, in its

guidelines on applicable criteria and standards for the detention of asylum

seekers, refers to detention as:

a mechanism which

seeks to address the particular concerns of States related to illegal

entry requires the exercise of great caution in its use to ensure that

it does not serve to undermine the fundamental principles upon which

the regime of international protection is based

Guideline 3. states further that

[detention]

should not be used as a punitive or disciplinary measure for illegal

entry or presence in the country, and should be avoided for failure

to comply with administrative requirements or breach of reception centre,

refugee camp, or other institutional restrictions.

The Convention

on the Rights of the Child state

The importance

of the traditional and cultural values of each people for the protection

and harmonious development of the child' must be taken into account

Preamble, Convention on the Rights of the Child

Every child

who belongs to an 'ethnic, religious or linguistic' minority or indigenous

group has the right, in community with other members of his or her group,

to enjoy his or her culture, to profess and practice his or her own

religion, or use his or her own language (Article 30).

In those States

in which ethnic, religious or linguistic minorities … exist, a

child belonging to such a minority … shall not be denied the right,

in community with other members of his or her group, to enjoy his or

her own culture, to profess and practice his or her own religion, or

to use his or her own language.

Article 30, Convention on the Rights of the Child.

Children in detention

have a history of exposure to war, organised violence and human rights

violation and flight. They have often been exposed to their parents' traumatic

experiences before arrival in Australia. During incarceration in detention

centres they are further exposed to the psychological distress and despair

of parents who are not only living outside their culture, but have little

control over their lives and are kept unaware of their legal status as

refugees. Children are exposed to parents who no longer behave according

to their cultural norms. Parental distress and anxiety can seriously disrupt

the normal emotional development of their children and can contribute

to growing alienation between child and parent. Under normal circumstances,

parents provide the primary role model for their children, contributing

significantly to the development of their identities and to their acquisition

of skills and values. In a detention situation children often lose their

role models.

Every society has

a unique body of accumulated knowledge, which is reflected in its social

and religious beliefs, and ways of interpreting and explaining the world

around them. By learning the values and traditions of their culture, children

learn how to fit into their family, community and the larger society.

Service providers cannot meet the needs of children in detention centres

with a 'one fits all' approach.

Living conditions

and the integrity of the family

The best way to help refugee children is to help their families,

and one of the best ways to help families is to help the community. …

Most often, programmes are designed to help the family assist and protect

their children and to assist the community in supporting the family and

thereby protecting the child. [72]

The child, for the

full and harmonious development of his or her personality, should grow

up in a family environment, in an atmosphere of happiness, love and understanding.

Preamble, Convention

on the Rights of the Child

In detention centres, families are accommodated in an environment

that is very different from the cultural environment with which their

children are familiar. The family members cannot perform their routine

tasks such as planning and undertaking their daily activities. They cannot

even be involved in decision making about the food they will eat. Even

when both parents are present, their potential for continuing to provide

role models for their children is likely to be hampered by the loss of

their normal livelihood and pattern of living.

The continuity of

experience required for normal childhood development may be further undermined

for refugee children when they come into contact with different cultures.

In detention centres, the language, religion and customs of other groups

in the centres, as well as that of officials and other workers may be

quite different from those of the refugee community. In such cross-cultural

situations, in particular in the context of detention, children 'lose'

their cultural identity more quickly than adults.

Family relationships

and dynamics

  • Are children

    living with their respective families as a whole?

  • Do detention

    centres offer an environment that enable parents to provide culturally

    appropriate care for their children?

  • What is the impact

    of general living arrangements and social organisation of detention

    centres on the care of children?

The preamble of the

Convention on the Rights of the Children recognises that

the child, for

the full and harmonious development of his or her personality, should

grow up in a family environment, in an atmosphere of happiness, love

and understanding

Factors such as seeing

their parents involved in hunger strikes, exposure to verbal harassment,

exchanges between adult detainees and ACM staff, the remoteness of certain

detention centres and extremes of weather create an environment in sharp

contrast with an atmosphere of happiness, love and understanding.

The emotional and

mental distress associated with the above conditions interfere with children's

physical, intellectual, psychological, cultural and social development.

It is illustrated by one of the pleading notes from children. [73]

It is clear that

detention centres violate Article 39 of the Convention on the Rights

of the Child which specifies that:

States Parties shall take all appropriate measures to promote physical

and psychological recovery and social reintegration of a child victim

of any form of neglect, exploitation, or abuse; torture or any other

form of cruel, inhuman or degrading treatment or punishment; or armed

conflicts. Such recovery and reintegration shall take place in an environment

which fosters the health, self-respect and dignity of the child.

Such an environment

also violates Articles 18.2 of the Convention on the Rights of the Child

which stipulates

For the purpose of guaranteeing and promoting the rights set forth in

the present Convention, States Parties shall render appropriate assistance

to parents and legal guardians in the performance of their child-rearing

responsibilities and shall ensure the development of institutions, facilities

and services for the care of children.

Dehumanisation

The culture of detention centres can have a dehumanising effect on

both the detainees and staff. Many ex staff have reported the difficulties

associated with maintaining their own ethical standards in an environment

where the highest priority was securing the asylum seekers and there are

reports of other staff who, isolated from the influence of their own standards,

fit in more with the culture of detention. The wide use of numbers rather

than names for detainees is just one of many factors that contribute to

dehumanisation of individuals.

Children's right

to a name is connected with their identity and must be respected always,

including through registration and record-keeping in Australia. A teacher

at Port Hedland told how children replied with their numbers when she

asked their names. [74] The practice of using numbers

rather than names when referring to or addressing detainees has been reported

widely. The issue was followed up with the Minister, Mr Ruddock, on April

10.[75] He stated that use of the number in place of

a name contravened his instructions to service providers.

Article 8 of the

CRC:

1. States Parties

undertake to respect the right of the child to preserve his or her identity,

including nationality, name and family relations as recognized by law

without unlawful interference.

2. Where a child is illegally deprived of some or all of the elements

of his or her identity, States Parties shall provide appropriate assistance

and protection, with a view to re-establishing speedily his or her identity.

Preservation of

religion

Children must be able to profess and practise their religion. They

must also be able to use their own language. Both these rights must be

able to be exercised not only in the child's immediate family circle,

but also in conjunction with members of the child's community. [76]

Religion includes

theistic and non-theistic beliefs. It is important that the child is able

to renew religious and ritual practices which may have been disrupted

during refugee or migrant movement. These practices are important physical

manifestations of the child's culture and assist in preserving the identity

of the child. The UNHCR stresses the benefit to community mental health

of festivals and rites of passage:

Religious festivals

and rites of passage such as birth, transition into adulthood, marriage

and death are extremely important in unifying a community and in conferring

identity on its individual members. The importance of such activities

to community mental health should not be underestimated. For example,

the provision of extra food for communal meals, or other material assistance

for funerals (burial cloths, coffins, firewood, etc.) can give vital

emotional support and sustain culture through a crisis. [77]

There is evidence

that some religious practitioners have visited detention centres but they

have been mainly Christian. Although their visits have been appreciated,

we do not believe this response to be the most appropriate. [78]

In order to

practice their religion [79] along with other

members of their group, a child should have access to 'books and other

items of religious observance and instruction and a diet in keeping

with his or her religion' They should be allowed to attend regular religious

services. Parents' responsibilities in ensuring their children receive

appropriate teaching and practice should be specifically recognised.

There may be qualified religious representatives among the detainees

who should be encouraged to support their communities.

Preservation of

language

Language is an important element of a child's identity and any loss

of the child's first language may have long-term consequences for the

child. [80] Child asylum seekers must be able to retain

and, where necessary, become literate in their mother tongue, in addition

to learning the local language. While children's rights to use their own

language under the Convention may not necessarily include being taught

entirely in that language, it may require that part of their education

be in their first language, particularly for young children. [81]

Although the communities

in detention centres reflect most facets of a common community - there

are teachers, lawyers, health workers, etc. skills within the community

are rarely beneficially employed. The UN guidelines recommend that community

members who know and can help their communities be integrated into the

health delivery system. Others who can contribute are teachers including

language teachers, child care workers and community leaders. In addition,

children's participation in planning and developing their own activities

is crucial.

Nutritional considerations

The relationship between health, culture and food is discussed in

detail in Section 4. Serious micronutrient deficiencies in child asylum

seekers may be the result of the child not having access to a balanced

diet of culturally acceptable food. This situation may be the result of

inability of family members to contribute to food preparation, or not

being able to fulfil cultural or religious practices surrounding food

preparation and consumption or inappropriate or unpalatable food provided

institutionally.

The environment in

which the child is detained must meet some cultural requirements to allow

the child to participate and to promote growth and development. Be it

playgrounds, family relationships or family commensality, they must be

as familiar as possible to the child's cultural environment. In detention

centres, design of menus, playground facilities, and the family environment

may not necessarily meet certain cultural norms of children from specific

ethnic backgrounds.

Children's participation

in and equity of access to services in detention centres

The participation of children capable of forming their own views

in decision-making is a central theme of the Convention.[82]

Positive measures may be needed to ensure child asylum seekers are heard

and their needs met.

Article 12, point

1 and 2, of the Convention on the Rights of the Child stipulates that:

12.1 States

Parties shall assure to the child who is capable of forming his or her

own views the right to express those views freely in all matters affecting

the child, the views of the child being given due weight in accordance

with the age and maturity of the child.

12.2. For this purpose, the child shall in particular be provided the

opportunity to be heard in any judicial and administrative proceedings

affecting the child, either directly, or through a representative or

an appropriate body, in a manner consistent with the procedural rules

of national law.

There are several points in the Convention on the Rights of the Child

that repeat children's right to participation. Indeed, participation

is one of the Convention's key values but remains one of the basic challenges

for signatories of the Convention.

The Convention on

the Rights of the Child has re-emphasised the importance for children

to have the right to participate in decision-making processes that may

be significant in their lives and to affect decisions taken in their regard

at family, school or community levels. However, there are a myriad of

cultural factors that may inhibit the implementation of processes that

promote children's rights with particular attention to freedom of expression

and participation in decision-making. Unless providers responsible for

detention centres are aware of these cultural factors, the right of the

child to participate in decision-making is violated. As Manderson [83]

puts it:

Culture is patterned;

it is not arbitrary. It involves ritual actions, shared understandings

and expectations. Cultural rules govern the most ordinary actions including

those actions which we take for granted and that affect our health:

how we eat, eliminate, rest, and recreate.

People in detention centres come from different ethnic backgrounds and

do not share the same cultural values. In some cultures, girls are often

more vulnerable, less valued and more subject to neglect and abuse than

boys. Staff in detention centres may be unaware of these possible factors

that could contribute to less health seeking behaviour on the part of

or on behalf of girls. Carol Bellamy, UNICEF Executive Director

stated:

Deprived of the opportunity to receive an education and to participate

in their societies as equals to men, millions of girls are relegated

to subsistence and domestic chores instead of attending school and building

a future. At the same time, the widespread undervaluing of girls and

women is evidenced by their denial of access to basic health care.

It may be necessary for culturally trained staff to actively promote

and support health promotions and interventions aimed at girls in detention

centres.

Sexual and Reproductive Health

Adolescent boys and girls in any culture can have problems associated

with their sexuality and reproductive health. Where the traditional

cultural support has been weakened because of the despair and frustration

of parents, adolescents can be faced with seemingly insurmountable problems.

Female reproductive

issues

Among the groups currently in detention centres are young females

from cultures where genital infibulation or circumcision is practised.

This practice has been termed female genital mutilation in the western

world and is the medically unnecessary modification by cutting and stitching

of female genitalia. In many societies, particularly from the Horn of

Africa and the Middle East, it is considered an important cultural practice.

The procedure typically occurs at about 7 years of age, but women suffer

severe medical complications throughout their adult lives. Adolescent

girls who have undergone this procedure are much more at risk of urinary

tract infections than 'normal' adolescent girls. Young girls in any culture

are often shy to consult health professionals, particularly about reproductive

issues. For these young girls, consultation with a health practitioner

who has not been culturally prepared can be particularly traumatic. The

reaction of the health practitioner can be, often unconsciously, quite

judgmental. Although interventions to prevent the continuation of this

practice are important, it is not the place of the health professional

to challenge patients consciously or subconsciously about the practice.

A negative reaction can deter young women from seeking medical help and

therefore exacerbate potentially dangerous conditions as well as causing

further cultural alienation. This example further underlines the extreme

importance of cross cultural training for health professionals working

with asylum seekers.

Afghan women have

come from a culture where they were denied access to health care if there

were no female health professionals available. It is important that female

health professionals are available in Australian facilities because these

women may accept health care from a female professional better than from

a male.

Several informants

have described the process of accessing sanitary napkins. Women have to

go through a tedious process of filling a form including the date and

time, and other personal details and submit the form to a particular person

at a particular time. They are supplied with ten pads and face possible

questioning by a staff member, who is not always a woman, if more are

needed. [86]

The above examples

of intimidating service provision for women would be even more intimidating

for adolescent girls.

Staff and service

provision

It is paramount that children in detention have access to culturally

appropriate care. Services should be provided with careful attention to

the language, culture, and developmental stage of each child. Direct service

providers of the same ethnic background would enhance the access of children

to services in detention centres. For details regarding staff training

see Section 2.

Communication

The process of getting a message across in an environment characterised

by ethnic, cultural and linguistic diversity such as detention centres

is vulnerable to hitches and malfunction. Indeed the access to and utilisation

of available services is dependent upon effective communication and a

common value-base. Linguistic and cultural barriers can combine to prevent

children accessing and utilising the most basic services for growth and

development. Some of the communication problems that are likely to occur

in detention centres include:

  • Participation

    in conversation: some children are bound to communication rules by their

    cultures. In some cultures for example, children cannot interject during

    a dialogue nor can they ask questions. This limit children's capacity

    to express their needs or request help.

  • Intonation: Intonation

    patterns have different cultural connotations. For example, the rising

    tone at the end of a sentence which characterises the Australian English

    has the potential to be misinterpreted by some culture as 'being angry'

    and in some other as 'asking a question', and hence creating confusion

    and communication breakdown.

  • Difficulties

    with communicating in English: Access to providers who speak their languages

    and who understand their cultures is crucial.

Use of interpreters

The effectiveness of interpreting services is dependent on whether

the organisation has measures in place, such as use of interpreting guidelines

or a policy requiring competence in staff concerning working with interpreters.

Commonly, when interpreters

from the detainee community are used, they will be men rather than women

because men are more likely to speak English. This situation can impact

on women's or children's willingness to freely discuss some health or

domestic issues with health care providers. The use of family and community

members as translators is inappropriate because of issues of confidentiality

and quality so must be discouraged.

The presence of quality

assurance mechanisms for translation services and ongoing training of

staff on how to work with interpreters should be part of the accreditation

procedures or organisations working with asylum seekers.

Cultural competence

and its significance

What is Cultural Competence?

Cultural competence in health care is defined as the ability of individuals

and systems to respond respectfully and effectively to people of all cultures,

in a manner that affirms the worth and preserves the dignity of individuals,

families, and communities. Cultural Competence is a crucial skill for

health care providers, who deal daily with diverse people.

The culturally competent health provider, for example:

  • has the knowledge

    to make an accurate health assessment, one which takes into consideration

    a patient's background and culture

  • has the ability

    to convey that assessment to the patient, to recognize culture-based

    beliefs about health and to devise treatment plans which respect those

    beliefs

  • is willing to

    incorporate models of health and health care delivery from a variety

    of cultures into the biomedical framework

To be culturally

competent, a provider should acknowledge culture's profound effect on

health outcomes and should be willing to learn more about this powerful

interaction.

Much has been written

about the hazards of ignoring cultural factors in diagnosis and treatment

of immigrant patients. Other research documents the fact that culturally

competent care improves diagnostic accuracy and increases adherence to

recommended treatment. [87]

The following questions

are of concern

  • Are children

    provided with culturally appropriate opportunities to talk about concerns,

    ideas and questions that they may have?

  • Are there detainees

    who could provide regular cultural activities for children such as non-formal

    education, play and recreation?

  • Are providers

    and management personnel working in detention centres cross-culturally

    trained?

  • Have adolescent

    women been consulted and their cultural practices respected in the design

    and delivery of services, eg health promotion activities?

  • Is the food provided

    culturally and socially acceptable, palatable and digestible?

  • Is the recruitment

    of health and community workers gender balanced and culturally appropriate?

  • Do facilities

    for children meet accepted cultural norms?

The preamble to the

Convention of the Rights of the Child underlines the importance of the

traditions and cultural values of each people, for the protection and

harmonious development of the child. At the individual staff level, the

HREOC inquiry must look at the dynamics of personal assumptions, biases,

prejudice, stereotypes, expectations and perceptions, past experiences

and feelings of individual staff in the service organisation. At the organisational

level, the inquiry must look at the culture, leadership, work structure,

contractual agreements, and policies and procedures or practices of organisation

involved in the care of asylum seekers. The inquiry should particularly

address the following questions:

  • What are the broader

    diversity and cross-cultural challenges facing the organisation?

  • What are the

    organisation's initiatives and responses to these challenges?

  • Are responses

    to the challenges being dealt with by the organisation in a systemic

    fashion

  • requiring cross

    cultural competence as part of their own accreditation?

  • providing cross-cultural

    training, to all staff rather than individual staff?

  • How do the organisation's

    leaders and employees perceive diversity? As a human resource intervention?

    As a skill development or educational intervention? As a public relation

    effort? As a way to avoid discrimination, abuse, maltreatment of children

    in detention centres

Steps toward cultural

competence

Those who seek to standardise a culture's beliefs and practices are

dealing in stereotypes. Nevertheless, there are steps we can all take

to improve the level of cultural competence in care facilities.

  • Involve immigrants

    in their own care

  • Learn more about

    culture, starting with your own

  • Speak the language,

    or use a trained interpreter

  • Ask the right

    questions and look for answers

A change in organisational

strategy is paramount in trying to address the needs of diverse groups

such as children in detention centres. They are born to parents from different

backgrounds and service providers need to be aware that they cannot meet

the needs of children in detention centres with a 'one fits all' approach.

The principle of diversity stipulates that having policies in place is

not enough. Organisations must ensure that all of their leaders are proactively

working to create and lead a respectful workplace, one free from abuse,

harassment and discrimination and one that promotes cultural harmony.

Although the communities

in detention centres reflect a range of members of a common community

including teachers, lawyers and health workers, skills within the community

are rarely beneficially employed. The UN guidelines recommend that community

members who know and can help their communities be integrated into the

service delivery system. Members who can contribute include health workers,

teachers, child care workers, religious leaders and community leaders.

Recommendations

  • Restore cultural

    normalcy. Children should not be accommodated in detention centres.

    With their families, they should be housed in the community.

The social and

mental well-being of all refugees, but particularly of refugee children,

can be most effectively assured by the quick re-establishment of normal

community life. [88]

  • Ensure cultural

    competency of staff and officials through accreditation procedures and

    ongoing cross cultural training.

  • Ensure quality

    assurance mechanisms and ongoing training of staff on how to work with

    interpreters as part of the accreditation procedures for organisations

    working with asylum seekers.

  • Employ accredited

    interpreters exclusively.

  • Involve members

    of the asylum seekers community in programs and education for children,

    including religious programs. The presence of these sorts of programs

    can be very beneficial for the physical and mental health and development

    of children.

  • Ensure the presence

    of mechanisms to prevent officials or members of other groups reacting

    in a negative manner to the cultural or religious beliefs and practices

    of detainees, particularly children

  • Cultural considerations

    must be taken into account with respect to food type, preparation and

    serving, particularly considering the traditional roles of family members

    in relation to the child's food. It is therefore vital that children

    in immigration detention are provided with food that is culturally and

    religiously appropriate and that it is possible for the child's family

    members to prepare and serve the food in accordance with the family's

    cultural practices, including appropriate times of day.

Section

4.

Nutritional issues associated with mandatory detention of refugee children

School of Health Sciences, Faculty of Health and Behavioural Sciences,

Deakin University, Melbourne

Cate Burns

The appropriateness of the food and nutrition enjoyed or otherwise by

asylum seekers in detention can be measured against several benchmarks.

These standards are

  • food is a human

    right,

  • provision of

    adequate food for healthy growth and physical, social and psychological

    well being,

  • food must be safe

    to eat and

  • food must be culturally

    appropriate.

It remains to be

determined whether food and nutritional status of children in detention

meets these standards.

Let us first outline the food and nutrition standards sanctioned by the

UN which have been agreed to by the Australian Commonwealth Government

and standards set down by Correctional Authorities in Australia.

Food Security

Everyone, adult and child, should be food secure. Food security incorporates

not only the notion of nutritional adequacy but also hygiene, cultural

appropriateness and acquisition of food in a manner that is consistent

with human dignity. Food security is thus defined as;

Access by all

people at all times to enough food for an active, healthy life. Food

security includes at a minimum: the ready availability of nutritionally

adequate and safe foods, and an assured ability to acquire acceptable

foods in socially acceptable ways (eg, without resorting to emergency

food supplies, scavenging, stealing, or other coping strategies). [89]

Right to health

- Nutrition a core obligation

The International Committee on Economic, Social and Cultural Rights

(ICESCR) has identified six core obligations on the right to health under

Article 12, which include:

  • access to health

    facilities

  • nutritionally

    adequate and safe food

  • basic shelter,

    sanitation and safe drinking water

  • essential drugs

  • equitable distribution

    of all health facilities

  • a public health

    strategy and plan of action

This Article states

that juveniles deprived of their liberty and refugee children must receive

food that meets their nutritional needs and basic requirements of hygiene.

Rights of the

Child - Nutritious, culturally appropriate food and adequate water

The Convention on

the Rights of the Child states that upmost measures should be taken to

provide children with nutritionally adequate food to prevent malnutrition.

The Convention goes further to insist that children should enjoy the highest

standard of health (and nutrition) rather than merely the absence of disease

(or malnutrition). The Convention also states that children have the right

to enjoy their culture and religion and therefore the right to eat culturally

appropriate foods, served in culturally appropriate ways. The Convention

states the children must have an adequate supply of clean water.

States Parties

shall pursue full implementation of [the right of the child to the highest

attainable standard of health] and, in particular, shall take measures

… to combat disease and malnutrition… through the provision

of adequate nutritious foods. [90]

In those States

in which ethnic, religious or linguistic minorities or persons of indigenous

origin exist, a child belonging to such a minority … shall not

be denied the right, in community with other members of his or her group,

to enjoy his or her own culture [or] to profess and practice his or

her own religion. [91]

States Parties

shall pursue full implementation of [the right to health] and, in particular,

shall take appropriate measures… to combat disease and malnutrition…

through the provision of adequate … clean drinking-water, taking

into consideration the dangers and risks of environmental pollution.

[92]

Food and Nutrition

The UNHCR Guidelines

for the Care and Protection of Children (1994) provides a checklist related

to food and food provision. The following questions are relevant in the

Australian detention context:

  • Are children

    receiving adequate quantity and quality of food?

  • Is food provided

    culturally and socially acceptable, palatable and digestible?

  • Have nutrition

    monitoring and surveillance systems been set up?

  • Is there evidence

    of any deficiency diseases among children, especially girls, or among

    pregnant or lactating women?

  • Is breast-feeding

    being promoted and the use of bottles discouraged?

  • Is the use of

    milk products being monitored and adhered to according to UNHCR (or

    appropriate) policy?

  • Are appropriate

    measures being taken to prevent and reduce micro-nutrient deficiencies?

  • Is there a need

    for training of nutrition staff in carrying out necessary interventions?

These issues are

addressed in the following part of the submission.

Australian Standards

Australasian Standards for Juvenile Custodial Facilities

In Australia the standards have been set for the provision of food

for juveniles in detention. These Standards most closely pertain to the

situation of refugee children in detention. Australasian Correctional

Management, the company running detention centres for the Australian Government,

falls under the jurisdiction of these Standards. The Australasian standards

for juveniles in custodial care are based on UN rules for the Protection

of Juveniles Deprived of their Liberty. The Australasian Standards state:

Young people are

provided with a variety of foods of satisfactory quality in sufficient

quantities; meals are nutritious, meet special dietary needs, and their

choice and preparation is influenced by young people's preferences

Sample Indicators

[93]

A. Policy, procedure

and practices in relation to food preparation and nutrition are consistent,

and reflect the standard

B. Food services comply with applicable sanitation and health codes

C. Young people report satisfaction with the centre's food services

D. Cultural and age-appropriate diets are provided, and religious requirements

are observed.

Using the rights

of children with respect to food and nutrition as a framework we will

test reports of food provision and intake by children in detention to

determine whether their physical, social and cultural needs are being

met. Unfortunately we do not have direct access to observe either the

food provided or the consumption of that food by the children. We have

therefore relied on the reports of observers.

Physical needs

Safe food

Sometimes the

meat served in Woomera was rotten and people fell ill and had to be

admitted to hospital [94]

This report of 'rotten'

food is indicative of microbiological contamination of the food served

in detention.

We have no way of

knowing whether in fact, it was rotten. However, with meals one of the

few events to break up the monotony of the unstructured meaningless days

in detention, and where there is no control over any other aspects of

life, it is not surprising that food becomes the focus of dissatisfaction.

Complaints about

food have been echoed by all ex-detainees and ex-staff we have interviewed.

Mares [95] describes the situation at Port Hedland that

resulted in marked improvement of the food situation and the morale of

detainees. Innovations by the catering manager allowed food to be planned

and prepared by chosen representatives of the cultural groups.

However, microbiological

contamination, particularly by food handlers, is the greatest food safety

risk. This causes food poisoning from infection or toxins produced by

the contaminant organism. Any reported instance of food poisoning, particularly

of a severity to require hospitalisation indicates poor food hygiene practices

in food service to detainees. Food Service in institutions must comply

with Hazard Analysis and Critical Control Point (HACCP) system to maintain

food hygiene and safety. The consequences of food poisoning in children

may be life threatening. Food poisoning can cause fever, vomiting, diarrhoea

and gastro-intestinal upset which will lead to dehydration. The smaller

the child and the hotter the ambient temperature more likely it is that

food poisoning will cause dehydration and cardiac-failure.

Authorities should

be alert to the potentially serious consequences of infections and diarrhoea

in marginally nourished children

Nutritional needs

Status on arrival

Asylum Seekers coming

to Australia from countries in Africa, Former Yugoslavia and Middle East

may have experienced nutritional deficiencies in their countries of origin

or during travelling. Many of these countries have been identified by

the WHO as low-income food deficit countries (LIFDC) where indices of

food insufficiency, principally undernutrition among children under 5

years, are high. [96] Therefore children arriving in

Australia as refugees or asylum seekers may be malnourished before even

setting foot on Australian soil. Furthermore, refugees may come to Australia

after time spent either in refugee camps or living with relatives, friends

or strangers in non-camp settings. The nutritional status of refugees

in both camp settings and in non-camp settings has been characterised

as poor. [97] [98] An appropriate

initial health assessment as described in Section 2 would identify any

problems associated with nutritional status and provide guidelines for

ongoing management.

Food has critical

nutritional, cultural and social dimensions for the well being and development

of all children. According to the World Declaration and Plan of Action

for Nutrition, children are the most nutritionally vulnerable group of

people in the world. Specific requirements, updated for children who live

in refugee camps and developing countries have been extensively documented.

Any provision of food for children in detention must at least reach these

standards [99] [100] [101]

[102]

Long term nutrition

and food needs

The following reports

indicate that predictably, in the absence of appropriate food in detention

centres, parents have been purchasing snacks which are both costly and

nutrient-poor. Some children in detention eat poorly and lose weight.

According to an ex-detainee [103]

Most of the

children hated the food that was given at the detention centre

Because of

this they lived on chips and sweets which were expensive, but the parents

bought them if they could afford to 15 packs of chips cost $5

Children lost

a considerable amount of weight

The maintenance of

appropriate nutritional standards is vital to the normal healthy development

of every child. The nutritional adequacy of a child's diet can be measured

against the Recommended Dietary Intakes RDI.[104] Micro-nutrient

deficiencies may be caused by conditions in the child's country of origin,

the often long and arduous journey to Australia and the unfamiliar food

and conditions upon arrival in Australia. If child asylum seekers are

eating a diet that is nutritionally adequate according to the Australian

RDI this will alleviate any nutrient deficiency.

Children and adolescents

need energy for growth, work and play. During the growths spurts of early

childhood and adolescence energy and nutrient needs are higher than for

young adults. Adolescents actually have the highest nutrient requirements

overall. For example the energy requirements for a 1 year old child are

435kJ/kg and for an adult 130kJ/kg. A child's energy and nutrient needs

are high but their capacity is small or as is the case in detention, their

appetite can be erratic or compromised. Therefore they require a more

frequent food intake than adults. There is no evidence from the report

of observers that children in detention were eating the quantity and quality

of food required to meet their nutritional needs.

Three meals a day

are served in detention centres and this routine may be quite appropriate

for adults. However, it is recommended that children under 5 years eat

a smaller amount in about five meals per day because their stomachs are

smaller. [105] [106] [107]

Some of the practical

issues of feeding children have to be taken into consideration. The practical

issues include children's small capacity, erratic interest in food, the

need for supervision by an adult to ensure intake and the knowledge that

eating best is a family experience. There is no evidence that any of these

factors have been taken into consideration in the facilities where these

children have been detained. It should be noted that the experience of

providing adequate and appropriate food at the Safe Havens led the responsible

authorities to make the following recommendations:

  • monitoring of

    children's choices

  • creation of 'family

    friendly' eating environment

  • availability

    of between-meal foods

  • attention to

    infant feeding practices.

There is no evidence

that the experience of the Safe Havens with respect to food and children

has been heeded. The children who are currently detained have the same

needs and problems as the children who spent time in the Safe Havens.

It is reported that

snacking foods like milk, fruit, biscuits have not been available in detention

centres throughout the day and when requested only given in limited quantity,

but children are reported to be eating nutrient poor snacks such as chips

and sweets.

There is evidence

that some children became overweight in detention centres from eating

excessive quantities of high calorie purchased snacks or sweets provided

by visitors. [108] This consumption of food other than

that provided indicates that the food was not culturally appropriate nor

appropriate to the needs and wants of children.

In some detention

centres, visitors provide some extra food for families but they are only

allowed to bring in two plastic take-away containers per visitor. Rooms

are frequently searched and possessions such as gifts of food may be confiscated

arbitrarily by the guards. However, it is also unlikely that these contributions

would foster a balanced diet. [109]

Children and adolescents

require nutrient-dense meals and snacks, ie not 'empty-kilojoules' foods.

Table 1 gives the relative energy and nutrient quantity for a selection

of both nutritious and non-nutritious snacks. Those snacks which were

reported to have been consumed by the children in detention have been

highlighted. It is apparent from Table 1 that the highlighted foods contain

kilojoules but not much else. They can be considered as 'sometimes' foods

but should not make up a large part of a child's diet. Healthy alternatives

(some suggestions listed) should be made available to children throughout

the day.

Table 1. Energy

content and nutrient density of snack foods

Food Energy(kJ)

Calcium mg Iron mg Vitamin A (ug) Vitamin C (mg)

Milk (250ml) 700 310 0.1 78 3

Fruit Bun 1 850 75 1.0 2 0

Banana(1) 250 20 0.20 12 3

Orange Juice (300ml) 350 5 0.17 11 20

Rice pudding(1 cup) 1200 280 0.1 25 0

Potato crisps (30g) 700 2 0.08 0 0

Sweet biscuits (2) 600 1 0.05 0 0

Soft drink (375ml) 655 0 0 0 0

Cordial (300ml) 350 1 0 0 0

BBQ Snacks (50g) 1030 14 0.6 7 0

As important as the

availability of nutritious meals and snacks for children is the participation

of their parents in the choice of foods and even food preparation. We

discuss this again later. But at this point it must be emphasised that

the choice of foods for children must not only be nutritionally appropriate

but also appropriate to their culture. The selection of foods should be

made in consultation with parents to ensure that the children can be encouraged

to eat foods they like and to which they are accustomed.

Children in detention

are likely to be nutritionally compromised on arrival. If the food they

receive in detention is inadequate or inappropriate their nutritional

status will be further worsened. They will lose weight, fail to meet growth

targets for their age and develop micronutrient deficiencies such as anaemia

or scurvy.

Exposure to sunlight

(Vitamin D status)

There is evidence that children in detention have limited exposure

to sunlight. Under-exposure to sunlight has implications for Vitamin D

status. Children are born with approximately 9 months reserve. Clinicians

working in the community with refugee children from Middle Eastern countries

have reported concern about symptoms of rickets (manifestation of Vitamin

D deficiency). [110] An appropriate initial assessment

would identify manifestations of nutritional deficiencies in children

on arrival and mechanisms for ongoing management could be put in place.

Providing access to appropriate play areas with adequate exposure to sunlight

would be an obvious action.

The nutritional

needs of pregnant women and mothers and infants

A range of sources including staff, visitors and ex-detainees have

provided information that supports the following statements:

  • After delivery

    no special advice is given regarding breastfeeding

  • Mother and

    Child Health services are not provided

  • There is too

    much bureaucracy involved in accessing any infant formulae

  • There are no

    proper nutrition or health services for children under one

  • Mother and

    Child Health (MCH) services, if available, would provide advice about

    weaning. Age appropriate weaning foods should be available

  • Some parents

    do give their infants cow's milk after 6 months

  • No advise regarding

    feeding is available

  • There are no

    weaning foods

  • A family is

    allowed 2 litres of milk each week and it is left to the family how

    this is distributed. Some mothers do feed their infants with milk that

    is rationed

Our sources [111]

also indicated there were no facilities for boiling and preparing milk

for infants.

The Plan of Action

arising out of the 1990 World Summit for Children states that '[m]aternal

health, nutrition and education are important for the survival and well-being

of women in their own right and are key determinants of the health and

well-being of the child in early infancy.' [112] Australia

is obliged under Article 24(2)(d) of the Convention to 'ensure appropriate

pre-natal and post-natal care for mothers'. [113] This

includes ensuring that the special nutritional needs of pregnant women

and new mothers are met. Poor maternal nutrition is associated with various

disorders in babies and with low birth weight. [114]

Mothers also have increased nutritional needs whilst breastfeeding and

may need education and encouragement to breastfeed their babies. The World

Health Organisation recommends exclusive breastfeeding for six months,

with introduction of complementary foods and continued breastfeeding thereafter

as an important aspect of a baby's diet.[115] It is

reported that age-appropriate complementary foods for babies between 6

and 12 months and for toddlers are not available.

Water

Water for washing

and drinking was only available in the toilets but towards the end of

her stay, they were given small tanks nearby that stored drinking water.

(Source 2) Water

ran hot because the pipes were in the sun. People tried to run the water

long enough for it to cool but got into trouble for wasting the water.

After that the water was turned off during the day time. [116]

There is evidence

that the supply of water may be compromised in the detention centres.

A major factor affecting the health of children as well as adults is the

availability of clean water. The human body comprises 50-60% water. Infants

are more at risk than adults because they have a greater surface area

to body volume and a higher metabolic rate.

Australia is obliged

under the Convention

to provide every child in immigration detention with adequate clean drinking

water. The drinking water provided to children in immigration detention

should be readily available and easily accessible at all times. The UNHCR

recommends that a minimum of twenty litres of drinkable water is required

for each person every day for cooking and drinking.

Social, cultural

and psychological needs

  • Family eating

    - social skills with food, mother/child bonding

  • One parent

    had to stay behind to take care of the kids while the other went to

    eat

  • This meant

    that on most days families did not eat together

  • Many of the

    children were aggressive, irrational and crying most of the time

  • They were unhappy

    children

  • They were disobedient

    and craved for attention

  • Mothers ..

    were often so frustrated just being in detention that they took out

    their frustrations on their children in many ways

    [117]

Food and culture

The importance of

food, friendship and communication has been enshrined in proverbs and

sayings. [118]

Communication

and food are the things that one lives by

Somali proverb

Give the guest

food to eat even though yourself are starving

Arabic saying

Food is a universal

medium for expressing sociability and hospitality. Food serves an important

social function. It is offered as a gesture of friendship; the more elaborate

the fare, the greater the implied intimacy or degree of esteem. In detention,

detainees are denied the right or ability to enjoy the social benefits

of taking food and sharing food. The eating environment is not conducive

to social exchange. The service of food is not consistent with custom

or social exchange. Fieldhouse explains that in many cultures (specifically

those from which detainees come) to not provide food is to fail socially

and thus lose status. This situation also undermines the cultural role

models that provide children with security.

In order that children

develop positive attitudes to eating and meal times their behaviour should

be modelled on positive behaviours of the parents. In situations where

food resources are scarce (or unappealing) and where children are reared

in an atmosphere of anxiety and deprivation a negative predisposition

to sharing food is created. [119]

There are many benefits

of establishing a healthy feeding relationship between parent and child.

[120] Satter states that an appropriate feeding relationship

supports a child's developmental tasks and helps the child to develop

positive self-esteem. It helps the child to learn to discriminate between

feeding cues and respond appropriately to them. It enhances the child's

ability to consume a nutritionally adequate diet and to regulate the quantity

of food consumed. These premises are supported by extensive research.

[121] There may be tremendous cultural variability

with respect to the degree of control care givers exert over food consumption

in infants and children. [122] According to Dettwyler,

it has been noted that parent-child power relationships are usually established

around the control of food consumption. Parental authority and children's

obedience to and respect for their parents are major values within many

traditional cultures. Hence the effect of detention on the parent-child

food relationship may heighten these power relationships or go beyond

a relationship either positive or negative to neglect as parental depression

or anxiety worsens. In either case there will be a detrimental effect

on the child's food intake.

Links between

food and mental health

It has been observed that as the period of detention increases parents

become depressed and anxious. This anxiety and depression impacts on their

children's eating habits both by increasing psychological distress of

children and also by impairing the parent's ability to eat with and feed

their children. See also Section 1 of this submission.

There is a strong

literature linking food and mental health. Ancel Keys [123]

and his colleagues at the University of Minnesota in 1945 carried out

experiments in which they starved conscientious objectors. This food deprivation

had a dramatic negative on psychological well-being. The devastating effects

that starvation and hunger have had on the physical, social and mental

well-being of millions of children and adults is well-documented in developing

countries. [124]

Detainees' lack of

control of food selection and preparation is one of the biggest contributors

to frustration in an environment that not only lacks structure but provides

no indication of the outcome of the situation in which the asylum seekers

are forced to live.

Detention has been

shown to reduce appetite. This effect is probably due to anxiety and depression.

Consistent with this effect is weight loss. In detention poor food intake

has been noted in both parents and children. It has been observed that

children have lost weight. On the other hand, there are cases where compulsive

eating has been a result of depression and there are reports of detainees,

including children, arriving at a healthy weight but becoming overweight

and lethargic after prolonged detention. [125]

Eating well and in

company has been shown to improve psychological well-being. [126]

As has been noted family commensality, ie eating together has been shown

to have a strong relationship with social and scholastic success of children.

[127]

It has been noted

across many cultures that when food is scarce women often do without,

to the detriment of their health and strength, in order to ensure that

their children received adequate nourishment. It is a mark then of the

stress under which female detainees suffer that their anxiety in detention

overrides normal mothering behaviour.

Cultural aspects

of food service

  • Food served

    was rice which was not properly cooked, boiled vegetables and meat.

  • None of the

    people enjoyed it because it was prepared badly

  • Some of the

    women helped in cleaning and chopping but not cooking the meal itself

  • They were told

    the meat was halal but wondered [128]

    I wouldn't feed that food to a dog [129]

In addition to meeting

physical needs to refugees, food is of great cultural and social significance.

[130]

It has been observed

in the detention centres that the food provided is not culturally appropriate

or served in culturally sensitive manner. Cultural considerations must

be taken into account with respect to food type, preparation and serving,

particularly considering the traditional roles of family members in relation

to the child's food. It is therefore vital that children in immigration

detention are provided with food that is culturally and religiously appropriate

and that it is possible for the child's family members to prepare and

serve the food in accordance with the family's cultural practices (including

appropriate times of day).

Patterns of food

preparation, distribution and consumption reflect the dominant type of

social relationships in a society. Food is a language for a culture. They

are expressions of status and social distance, of political power and

of family bonds. Food is extensively used in social intercourse as a means

of expressing friendship and respect. This is evident in both developed

and developing countries. However, practices associated with food may

be more important in cultures from developing countries where the tradition

has a strong influence. There is no culture that promotes solitary eating.

Eating and eating together improves social well-being. Furthermore the

significance of culturally appropriate foods may be heightened for refugees,

more so for those in detention. Food may become focus for anger and unrest.

This experience was notable in the Safe Havens. In the Victorian Safe

Havens at Puckapunyal and Portsea food intake and morale improved with

a 'family friendly' environment in dining room with order of service consistent

with custom and with family needs.

In many traditional

cultures women have a primary role in food getting and preparation. Food

preparation confirms women's place in household and social expectations

are fulfilled.[131] It could be argued that feeding

literally produces family. The importance of the 'normal' family roles

is discussed in Section 3.

Initial assessment

of nutritional status / growth monitoring

Initial medical

assessment did NOT include assessment of children by a child specialist.

There was nothing specific for children like assessment of development

etc ….. [132]

The Child Health

Nurse visiting Maribyrnong reports no weights or heights taken on children

[133]

There is general

international consensus that the best way to measure a child's health

and nutritional status is by assessing the individual child's growth against

standard weight-for-height, height-for-age and weight-for-age charts such

as those produced by the World Health Organisation, taking into account

cultural and geographic differences in child development. In order to

evaluate a child's nutritional needs, there should be an initial assessment

of the child's height and weight upon arrival, and careful ongoing monitoring

of any micronutrient deficiencies that the child may have. The initial

assessment is discussed in detail in Section 2.

Conclusions

Children and their

families should be accommodated in the community where they can make their

own decisions about food purchases and preparation.While children remain

in custody:

  • There should be

    consultation with parents to ensure food is culturally appropriate.

  • They require

    adequate quantity and quality of food and frequency of food intake.

  • Food provided

    must be culturally and socially acceptable, palatable and digestible

    and served at appropriate times.

  • The community

    must be involved in decisions about the type of food that would be acceptable

    and in the preparation of food.

  • Nutrition monitoring

    and surveillance systems must be established and mechanisms put in place

    for ongoing management of nutrition-related problems including deficiency

    diseases among children, especially girls, or among pregnant or lactating

    women.

  • Breast-feeding

    must be promoted and supported and where breast feeding is not possible

    adequate professional support must be available to promote appropriate

    feeding practices.

  • The use of infant

    feeding bottles should be discouraged.

  • The use of milk

    products must be monitored according to UNHCR (or appropriate) policy.

  • Weaning foods

    for babies between 6 and 12 months must be available together with age-appropriate,

    culturally appropriate food for toddlers.

  • Appointed staff

    need expertise in nutrition including the cultural aspects of food and

    nutrition monitoring.


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111. Interview with professional visitor to Maribyrnong,

March 2002.

112. What's There to Eat?: The practical guide to feeding

families. Department of Human Services, Victoria, 2000.

113. Skull S. (paediatrician) April 11, 2002. Personal

communication.

114. Interviews with professional visitors to detention

centres and ex-detainees.

115. Plan of Action for Implementing the World Declaration

on the Survival, Protection and Development of Children in the 1990s,

UNICEF, 1990; http://www.unicef.org/wsc/plan.htm#Role.

116. See also article 12(2), Convention on the Elimination

of All Forms of Discrimination of All Forms of Discrimination against

Women (CEDAW), ratified by Australia in 1983, which obliges it to 'ensure

to women appropriate services in connection with pregnancy, confinement

and the post-natal period, granting free services where necessary, as

well as adequate nutrition during pregnancy and lactation.'

117. Poor nutrition in pregnant women may cause spina

bifida (associated with inadequate folate intake) and iodine deficiency

disorders (permanent mental retardation associated with inadequate iodine

intake): The Royal College of Paediatrics and Child Health and the King's

Fund (1999), The Health of Refugee Children: Guidelines for Paediatricians,

London.

118. World Health Organisation (2001), 'Note for the

Press No.7', 2 April 2001; www.who.int/inf-pr-2001/en/note2001-07.html.

119. Interview with ex-Woomera staff member, February

11, 2002.

120. Interview with female ex-detainee, January 31,2002.

121. Fieldhouse P. Food and Nutrition - Customs and

culture Chapman and Hall 1995.

122. Birch LL . The control of food intake by young

children in E. Capaldi (ed). Taste, Experience and Feeding. 1990. American

Psychological Association, Washington DC.

123. Satter E. Comments from a practitioner on Leanne

Birch's research. J Am Diet Assoc. 1987 Sep;87(9 Suppl):S41-3.

124. Birch LL The control of food intake by young children

in E. Capaldi (ed). Taste, Experience and Feeding. 1990. American Psychological

Association, Washington DC.

125. Dettwyler KA Styles of Infant feeding:parent/caretaker

control of food consumption in young children. Research reports. American

Anthropologist 1989; vol 91;696-703.

126. Keys A, Brozek J, Henschel A, Michelson O and Taylor

HL 1950. The biology of human starvation. The University of Minnesota

Press, Minneapolis.

127. FAO 1999

128. Reported in an interview with a professional visitor

to Maribyrnong in March 2002.

129. Mullins LC, Cook C, Mushel M, Machin G. A comparative

examination of the characteristics of participants of a senior citizen

nutrition and activities programme. Activities, Adaptation and Aging 1993;

17(3):15-37.

130. Allen DE, Patterson ZJ and Warren GL. Nutrition,

family commensality and Academic performance among high school youth.

J. Home Economics 1970 vol 62(5):333-7

131. Interview with young female ex-detainee January

31, 2002.

132. Comment from a guard reported in an interview with

a professional visitor to Maribyrnong in March 2002.

133. Burns C, Webster K, Crotty P, Ballinger M, Vincenzo

R, Rozman M. 2000 Easing the Transition:Food and Nutrition issues of new

arrivals. Health Promotion J Aust 200010(3):230-235.

134. Murcott A. The social significance of the cooked

dinner in South Wales. Soc.Sci. Inf. 1982; 21;4-5.

135. Nurse - ex-Woomera staff member, personal communication

February 2002.

136. Reported in an interview with a professional visitor

to Maribyrnong in March 2002.

Last

Updated 9 January 2003.