Refugee HeALTH

Question 1

Describe the definition of refugee and issues with definition

Answer 1

“A person who, owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.”

Issues with refugee definition:
- excludes sex/gender
- non-state entities i.e. Roma, Palestinians
- internal displacement
- unstable states eg Venezuela
- note also that different countries implement it differnetly
- note also that not all countries who signed it ratified it eg Au

Question 2

Describe Australia’s issues regarding immigration and refugees

Answer 2

Australia’s Pioneering Initiatives

• Permanent immigration detention
• Remote or off-shore immigration detention
• Long-term detention of children
• Temporary protection for valid refugees
• Gagging laws for workers in immigration
• Excising Australian land for immigration law
• “The island solution”

Children and Mandatory Detention

• 1989: Removal to remote immigration detention camps
• 1992: Mandatory immigration detention (Keating government)
• 1999: Temporary protection visas (Howard government)
• 2001: Tampa election. Children overboard scandal. Pacific solution. Boats turned around. SIEV X disaster.
• 2004: No Constitutional barrier to immigration detention for life
• 2007: Abolish Temporary protection visas and Pacific solution
• 2010: Sri Lankan and Afghan claims processing suspended. Community detention. Christmas Island boat disaster.
• 2011: Bridging visas
• 2012: Pacific solution again. No advantage rule. Involuntary returns.
• 2014: Screening out and in at sea. Return by sea. UNHCR: Profound concerns
• 2016: SHEV and TPV. Mass invitations to apply for protection
• 2020: Christmas Island processing centre opened again
• 2021: PNG stopped PNG-based processing as unconstitutional
• 2023: No offshore refugees in Nauru or PNG
• 2023: High Court rules that indefinite detention with no prospect of return to the country “unlawful”
• 2023: Resolution of Status visas instituted for 30,000 onshore asylum seekers
• 2024: Nauru in use again for offshore processing

Question 3

Discuss challenges for medical practitioners

Answer 3

Challenge 1:
Mandatory, long-term immigration detention is guaranteed to have psychiatric and medical consequences, particularly upon children.
Question: How can the medical profession influence government policy?

Challenge 2:
Immigration detention medical services do not have accountable medical oversight (as do prisons).
Question: How can the medical profession ensure the improvement of medical services in immigration detention centres?
Note: RACGP develops standards for health services in IDCs.

Challenge 3:
Offshored refugee processing services are consciously removed from view.
Question: How can the medical profession provide any advice or ensure accountability?

Challenge 4:
Doctors were gagged under the Border Force Act.
Question: What happens if you speak out?

Challenge 5:
Should you perform a fitness-to-fly assessment on an asylum seeker about to be deported?

Challenge 6:
Here is a person living illegally who has evaded detection by Border Protection agents.
Question: Should you inform Villawood?

Challenge 7:
Australia is at the forefront of restrictive immigration policies for border-crossing asylum seekers.
Question: What is your responsibility internationally?

Challenge 8:
Should you speak out publicly or work within the system?
Question: Is it possible to do both?

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Challenges for medical workers:
- unity, professional bodies speaking up
- PMO collaboration with detection medical officers, separation from DHA
- communication between people in and out
- protest
- complicated: to engage - whether truthfully or untruthfully, or not engage
- 6: you should not, it is not your duty to do so
- to make clear that the situation is not normal
- 8: yes you can, especially with seniority/talking to those who can