Health care: universal right or Australian privilege?

Last week, for the first time, women in Victoria were able to enter abortion-providing services without fear of harassment and intimidation. The safe access zone legislation is the culmination of a hard-won battle by activists and policy-makers, and is rightly being widely celebrated.

In the same week, the Federal Court in Melbourne heard that a woman, known as S99, was denied access to abortion altogether after she was raped while detained on Nauru at the hands of the Australian Government.

In court, David Nockels, a senior Immigration Department official, explained that, in spite of the medical recommendations of five different senior doctors, this woman was not given access to the surgery she required. The reason for maintaining offshore detention centres, he said, was to prevent refugees and asylum seekers from coming to Australia, even for medical treatment, except under exceptional circumstances. Circumstances that did not include provision of abortion, a service that would be safe and readily available in Australia, for a woman raped while in the custody of our Government.

Abortion is illegal in Nauru. Despite specialists' advice to transfer this woman to Australia for a surgical abortion, she was transferred to Papua New Guinea (PNG), where abortion is also illegal and health services are inadequately equipped to deal with her epilepsy. On Friday, the Federal Court found that Australia had a duty of care to ensure the woman received a safe and legal abortion, though not necessarily in Australia and her fate remains uncertain.

This is a repeated pattern, with Australia transferring at least two women to PNG after requesting abortions, and a conscious disregard of the legality of the procedure, and that women procuring abortions in PNG face up to seven years' imprisonment. Yesterday, Peter Dutton announced that Abyan, a Somali woman raped on Nauru who subsequently requested an abortion, had given birth. The restriction of the rights of women in Australia's detention centres represents a far cry from the freedom Australian women are currently celebrating for themselves.

Since this federal government was elected, we have seen 14 people die from suicide, inappropriate or inadequate medical attention, and injuries sustained in detention. Omid Masoumali, died in late April, and a 21-year-old woman, Hodan Yasin, is in a critical condition in Brisbane, after delayed evacuations to Australia. Both Hodan and Omid required urgent medical attention after setting themselves on fire. Medical attention that was not available, or not provided, in Nauru.

A 24-year-old Iranian refugee, Hamid Khazaei, died in Brisbane in September 2014, after delayed transfer from Manus Island detention centre. When a skin infection on his leg led to sepsis, he should have been treated with routine antibiotics. Those antibiotics were unavailable at the centre, and his emergency evacuation was delayed by Australian administration and Canberra-based bureaucrats who questioned the judgement of the medical team. His death was preventable.

In their advice to Australian travellers, the Government describes healthcare facilities in PNG, including in Port Moresby, as "poor by Australian standards", and explains that evacuation to Australia is "often the only option for serious illnesses or accidents". Yet, after doctors diagnosed Hamid with sepsis (widely considered an extremely serious illness with a high mortality rate), the decision was made to evacuate him to Port Moresby rather than to Australia, and even that decision was questioned and the response delayed.

Despite a series of strong statements from the Australian Medical Association and other health professionals, the Australian Government continues to endanger lives by keeping refugees detained in unacceptable and unsafe conditions on Manus Island and Nauru. There is no doubt that detention, and particularly indefinite detention, is detrimental to health. In addition to the risk to physical health and life highlighted by the cases above, the Australian Human Rights Commission found that 85% of parents and children in detention had their mental health negatively affected while in detention.

The recent assertion by Peter Dutton that advocacy groups are inciting refugees to self-harm is as ludicrous as it is insulting. The frequent reports of self-harm, suicide attempts, and high levels of psychological morbidity among those detained in Australian detention centres clearly highlight the unacceptable conditions under which these people are kept. Reports of sexual assault, rape, abuse, and self-immolation are common. Denying the role of detention in the psychological morbidity of detained refugees, despite regular clarification from mental health professionals, represents, at best, wilful ignorance on the part of Mr Dutton.

What makes the negative health consequences of Australia's "Pacific Solution" particularly difficult to swallow is that they were entirely predictable. Refugees already face a higher burden of physical and psychological illness, and housing these people within resource-poor settings with already struggling healthcare systems, is clearly inappropriate. Further, it is entirely foreseeable that relocating people to remote tropical islands will result inhigher rates of tropical diseases including malaria, Dengue fever, Zika virus, measles, tuberculosis, HIV, typhoid fever, and other infections.

While the Border Force laws aim to gag us, the Australian Medical Association, the World Medical Association, and the Medical Board's Code of Conduct, compel doctors to advocate for our patients, and to speak out against legislation, practices or services that are inadequate or threaten health. We know beyond reasonable doubt that detention poses an unacceptable risk to mental and physical health.

Pregnant women, children, LGBT+ people, and those with chronic illness or disability face additional challenges. Detention in places like Nauru and PNG, where abortion and homosexuality are illegal and medical facilities are inadequate for the complex needs of refugees, is particularly inappropriate. In its detention of refugees, Australia defies advice from the UN Committee Against Torture and the recommendations of Australian medical and health care professionals and faces international criticism, but ultimately accepts responsibility for the welfare of those in its custody. Although these people may be housed out of immediate sight on Pacific islands and the Government may try to prevent people speaking out, this is our problem and we can no longer ignore it.