A last resort?
National Inquiry into Children in Immigration Detention
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As mentioned previously, under the Convention on
the Rights of the Child, children held in immigration detention have
a right to grow up in a healthy environment and to achieve 'the highest
attainable standard of health'.
Most Inquiry evidence regarding children's health related
to children's psychological health. However, children's physical health
is closely related to their mental health. For instance, depression and
lethargy can mean that a child does not want to eat and they miss out
on the nutrition they need. Serious mental health problems can lead to
attempts to self-harm.
However, it became apparent throughout the course of the
Inquiry that, despite the efforts of health staff, the detention environment
and the standard of medical care available had an impact on the physical
health of children.
Creating a healthy environment
The Department has a responsibility to ensure that children
in detention have a healthy environment in which to live. Shelter, clothing,
food and hygiene are all factors that contribute to the physical health
The Inquiry was told that the strict regime of serving three
meals a day did not suit the eating habits of children - in fact, most
children prefer to 'graze'. In addition, some parents would go without
food to create another meal for their children or give them the food that
Evidence presented to the Inquiry showed that the food varied
in quality between the detention centres and over time and that the menu
was sometimes unappetising and monotonous for children - especially over
long periods of time in detention.
The provision of baby formula at Woomera was uneven for substantial
periods of time. In addition, there was no evidence that individual assessments
of children were made to identify and address any pre-existing nutritional
At certain periods of time families were living in crowded
conditions which caused discomfort and stress. This became less of a problem
as detainee populations decreased over 2002.
Much of the cleaning in remote detention centres was done
by detainees who were paid an equivalent of one dollar per hour. During
periods of tension and unrest in the facilities, however, some of these
jobs were not done and there were inadequate systems in place to maintain
an appropriate level of hygiene.
Physical surroundings and climate
The extreme heat and cold of remote detention centres contributed
to health problems. Medical staff said that dehydration was common among
children and adult detainees. Children complained that rocky surfaces
and the absence of grass meant that they hurt themselves playing. The
Inquiry also heard complaints about eye and skin infections caused by
the glare, dirt and dust storms.
Providing health services
When children arrive in detention facilities they undergo
two types of health assessments. Firstly, there is a public health screening
to identify communicable diseases, such as typhoid and tuberculosis. Secondly,
a screening takes place to identify the general health needs of each detainee.
Assessment and treatment
Children arriving from countries all over the world may have
ailments that are not common to Australia and need specialised assessment
procedures. However, evidence received by the Inquiry suggested that the
initial assessments may have failed to pick up special medical conditions
of child detainees and that there was no regular follow-up. There was
no routine hearing tests for children and no routine testing of sight
for children above five years of age.
Children also felt that, at times, medical staff did
not take their concerns seriously. The submission of the NSW Commission
for Children and Young People quotes children who say that no matter what
ailment they had medical staff would recommend 'water and Panadol'. This
was consistent with interviews conducted by the Inquiry.
Access to health staff
All immigration detention centres have health care staff
available for treatment, including nurses and doctors. However, at various
times detention centres were understaffed. A triage system set up to deal
with staffing problems led to delayed treatment in some cases, causing
distress to children and parents.
Qualifications of health staff
Many of the doctors and nurses that Inquiry staff met were
highly professional and caring. However, it seems that many were not trained
to identify and address the possible special medical conditions of child
asylum seekers and that there were insufficient staff with paediatric
This problem was compounded by the difficulty in recruiting
and retaining staff for work in remote immigration detention facilities.
In these circumstances, it is even harder to recruit personnel with the
necessary mix of skills and experience.
The cultural awareness of medical staff also affects the
quality of health care that children in detention receive. For instance,
some female children and mothers may feel that it is inappropriate for
medical assessments and examinations to be done by a male nurse or doctor.
Although there were some efforts to improve cultural awareness,
the specifics of that training remain unclear. Health staff at Woomera
commented that everything they had learned was through the detainees.
Availability of interpreters
Providing on-site interpreters to help with medical examinations
has been a persistent problem in some detention centres, particularly
Port Hedland. The Department Manager at that facility reported an absence
of on-site interpreters over a period of 19 months.
The absence of interpreters has a dual impact on children.
For children who do not speak English, medical examinations can be intimidating
and inaccurate. In addition, children who do speak English often end up
interpreting for their parents.
Access to external doctors and hospitals
Medical centres within detention facilities are only intended
to provide initial, primary care. It is the Department's policy that detainees
who can't be treated within detention centres are referred to off-site
specialists and hospitals. In remote detention centres in particular,
the absence of clear procedures for referral, and the difficulties that
come with isolation, were frustrating for doctors and led to delays.
Access to dental care
All centres reported managing demand for dental services
as a major problem. Because of advanced dental problems in the detainee
community, most visiting dentists spent all their time on pain relief
and extractions, with no time left over to provide children with the preventative
dental care they needed. In June 2002, ACM staff took steps to develop
guidelines to improve dental services. However, dental care remained an
issue in some centres in late 2002.
Pre and post natal care
While efforts were made to provide pre- and post-natal
care to women and their babies, the location of the remote detention centres
and the restrictions that come with the detention environment meant that
women about to give birth were sometimes separated from husbands and other
children for weeks at a time.
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