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A last resort? - Summary Guide: Physical Health

A last resort?

National Inquiry into Children in Immigration Detention

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    A Last Resort? - SUMMARY GUIDE. A Summary of the important issues, findings and recommendations of the National Inquiry into Children in Immigration Detention

    Physical Health

    I am primarily a paediatric

    doctor. I saw many of the children in [Woomera] … and really

    so many of their problems relate directly to the prolonged and indeterminate

    nature of their detention, which is a combination of the very harsh

    and isolated physical environment, the poor accommodation facilities

    and the lack of resources for their mental health and their leisure


    Former Woomera doctor, evidence

    to the Inquiry

    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

    of children.


    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

    they wanted.

    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.

    When we were in the detention

    centre and someone was sick, headache or sick and they would say,

    ‘Just drink water.’ … My sister has a problem

    with her eyes. She said her eyes were so painful and she went to

    the doctor who said, ‘You just have to drink water’.

    Now we come to Sydney and the doctor says she has a problem in her


    Teenage girl, Sydney focus group

    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.

    Cultural awareness

    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.

    We had a lot of difficulty not

    being able to speak very good Farsi or Arabic, and most of the detainees

    [in Woomera] had very little or no English ... I remember one specific

    instance when a seven or eight year old child was brought in screaming

    with blood pouring from his lip. And somebody said that he had been

    assaulted. Eventually we found an interpreter who was able to get

    the hysterical mother to explain that, no, he had been playing soccer

    and had tripped on the rocky ground and cut his mouth open on the


    Former Woomera doctor, evidence

    to the Inquiry

    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.

    Inquiry finding

    Despite the efforts of individual staff members,

    the Commonwealth failed to take all appropriate measures to ensure

    that children in detention could enjoy the highest attainable standard

    of health – especially in the remote detention centres. This

    resulted in a breach of the Convention on the Rights of the Child.

    © Human Rights and Equal Opportunity Commission. Last updated 13

    May 2004.

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