As It Happens

Doctor condemns Australia for restricting medical evacuations for refugees detained offshore

An Australian doctor who spent nearly a year working on the detention island Nauru says it's "hard to fathom" why lawmakers would repeal a law that allowed doctors to send refugees to the country for medical treatment. 

It will be up to politicians, not doctors, to decide who is eligible for treatment

Refugee advocates hold placards as they participate in a protest in Sydney, Australia, against the treatment of asylum-seekers at Australia-run detention centres located at Nauru and Manus Island. (David Gray/Reuters)
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An Australian doctor who spent nearly a year working on the detention island Nauru says it's "hard to fathom" why lawmakers would repeal a law that allowed doctors to send refugees to Australia for medical treatment. 

On Wednesday, Australian lawmakers voted to revoke the medical evacuation (medevac) policy that was enacted 10 months ago. 

Since 2013 Australia has detained refugees and asylum seekers indefinitely who arrive by sea on Manus Island in Papau New Guinea, and on Nauru. The UN has condemned the practice, but approximately 466 people are still on the islands. 

Nick Martin is the former senior medical officer on Nauru, and he wrote about the medevac repeal in The Guardian. Here is part of his conversation with As It Happens host Carol Off. 

Now that this medevac has been revoked, how will Australia decide who of these people on these detention islands will get medical attention?

It looks like they'll go back to the old system, which existed before medevac was in place, and that was a very haphazard way of going about choosing who needed to get medical attention or not. 

In the past the doctors, of which I was one of them, would recommend refugees did get transferred for investigation and treatment, but then that decision would go to a pretty faceless committee who would usually just say no or ignore the recommendation and sometimes would only decide to move a refugee once there's a threat of legal action. 

And so the system that did exist was very inefficient. It was unbelievably slow. And it meant that there was no real proper triaging or correct triaging of a patient who moved.

Nick Martin was the senior medical officer on Nauru from November 2016 and August 2017. (Submitted by Nick Martin)

Why did the Australian government make this change, revoke this medevac, and revert back to the old system?

It is hard to fathom. I think that's been the most difficult thing really. Of all the things, all the challenges facing Australia and the rest of the world right now, they decided to focus on repealing medical care for about 500 people. 

But I think a lot of it is that when they lost the bill ... some nine months ago, that's the first time the government had lost a vote for 90 years. And I think a lot of it was annoyance frankly or hurt feelings about that and they set their sight on saying, no we're going to do this.

Australia's Home Affairs Minister has suggested that medevacing people, refugees, from these ... detention islands for medical treatment in Australia is a backdoor. It's a way to sneak into the country. What do you say to that? 

I think if you're going to get on a boat, a leaky boat, at great expense, having fled your home anyway —  bear in mind that 90 per cent of these people have been assessed as being genuine refugees —  to go to a fairly hostile offshore, very remote little Island and spend around six or seven years in the vague hope that at some point you might just get ill enough to get transferred to Australia … that's a pretty long bow to draw. 

Minister [Peter] Dutton has also demonized refugees over the years of every description whether it be African gangs or the Lebanese community. He calls the refugees offshore rapists and murderers and terrorists frequently. And so I think he'll say anything to try and justify his fairly brutal, callous position.

What kinds of ailments are we talking about here? What reasons would they be brought to Australia to get any kind of medical treatment? 

I think overwhelmingly now it's psychiatric reasons and that's after six or seven years in indefinite detention, the burden of mental illness on the islands is quite unbelievable. 

But also lots of other just general things that if you're in a remote town in Canada you could get fixed up pretty quickly … just by one trip to a bigger hospital. So let's say you have a breast lump, something like that. That can be excluded as being nasty by one scan but that's not available on Nauru. 

In this Aug. 2, 2013, photo, a group of asylum seekers hold up their identity after landing in Manus Island, Papua New Guinea. (Eoin Blackwell/AAP Image, via the Associated Press)

We've spoken with a number of people who have been on those islands, both as doctors and as refugees. One of them, Amir Sahragard, who's now in Canada through a private sponsorship. And he told us, as I'm sure you've heard, just horror stories of what it was like. He spent six years on Manus Island and it seriously damaged his mental health. He did get treatment in Australia before he came to Canada. 

So now what happens to people like Amir, now that this has been revoked?

Well he's lucky to get away and I think it's wonderful that Canada has accepted him. I think it's a phenomenal show of humanity and decency. 

But the frustrating thing is it was so avoidable. But this is always going to happen as long as you have indefinite detention. So yeah we'll have a whole cohort of refugees who tried to seek help from Australia and Australia effectively has damaged them for life. 

This Sept. 4, 2018, photo show a refugee settlement on Nauru. (Jason Oxenham/The Associated Press)

You wrote in a letter …  to Australians, "who seem to delight in the ongoing cruelty being inflicted on these vulnerable people." You said that, "Australia just became a little crueller and a little more sadistic." 

Do [Australians] support what's happening? 

Australian people are being fed a diet of absolute racist rhetoric ... by the political parties in charge saying this is a huge threat.  

There will be some [Australian people] who seem to delight in punching down on refugees. And that's just tragic really.

I think Australians are fundamentally a decent people, much like everyone's decent, but for some reason the Australian government has a bee in its bonnet about people who arrive by boat, which is just a very bizarre thing to hang your hat on.


Written and produced by Sarah Jackson.