– Time to Speak On Refugees

Australian Medicine Monday, 3 February, 2014

Silence in the face of evil is itself evil … Not to speak is to speak. Not to act is to act. Dietrich Bonhoeffer

LESS than 2 weeks before Christmas last year, the Abbott government notified medical members of the Immigration Health Advisory Group that the Group had been disbanded.

The Immigration Health Advisory Group (IHAG), with prominent health professionals among its members including a past AMA federal vice-president and past president of the Royal Australian and New Zealand College of Psychiatrists, gave independent, unbiased advice to the government of the day. Was that why it was disbanded?

The hypothesis that the government doesn’t want unbiased advice was reinforced by Prime Minister Tony Abbott’s subsequent labelling of the public’s desire for information on asylum seekers as “idle curiosity”, and Immigration Minister Scott Morrison’s decision to terminate weekly scheduled press briefings.

Recent research published in the MJA found substantial unmet health needs, a lack of transparency and high levels of psychiatric morbidity among asylum seekers in detention in Darwin. As bad as conditions are in Darwin, the conditions in Australia’s offshore facilities are reportedly worse.

Doctors working on Christmas Island have detailed medical practices that include unsafe antenatal care and no specialised child protection or psychiatry services. Doctors complain that necessary drugs are either not supplied or are supplied late, and unnecessary delays in transferring seriously ill patients to mainland hospitals is placing lives in avoidable jeopardy.

Detention practices on Manus Island are reportedly even worse.

Suicide is now reportedly the leading cause of death among detainees, as one would expect from a policy that leaves already traumatised people in indefinite detention, uncertain of their fate, some in conditions unfit for human habitation. If we were to deliberately design a system sufficiently cruel to promote suicide, this would be a good start.

The Australian Government is obliged, as a signatory to the UN Convention and protocol relating to the status of refugees, to provide the same standard of health care to detainees as is available to the general population. There can be little doubt Australia is in breach of that convention, as well as the Convention on the rights of the child.

The AMA’s position statement, which all doctors should be familiar with, incorporates the World Medical Association’s Declaration of Tokyo. It defines torture as “the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason” (my emphasis).

It also declares that: “The physician shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty ...”

Deliberately hidden from public scrutiny, the Australian Government is building a legacy to shame us for generations. It is a torturous system in which no doctor can ethically participate.

Doctors must stand above sectarian political interests when it comes to the wellbeing of our patients, for to act otherwise is to ally ourselves with those who share neither our ethics nor our concern for human lives.

Such abuse cannot be tolerated by us in any setting, for any reason. That’s why Doctors for Refugees was established, with a founding committee that includes a former AMA state president, Dr Richard Kidd, and state vice-president (myself) among its members.

As doctors we can fight with the angels or stand silent with the devil. As Bonhoeffer reminds us, it is the only choice we have.

Dr Michael Gliksman (@MGliksmanMDPhD) is a physician in private practice. He is an AMA federal councillor, and a member of the Australian Red Cross International Health Law Committee and Doctors for Refugees. The views expressed here are his own.


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