Wednesday, June 02, 2004

Murder by neglect: How Australia is killing its asylum seekers

by Jessica Perini
June 2004

With a sense of unease I pick up magazines, glance at the smiling made-up faces, and throw them back on the pile. I shift uncomfortably in chairs made for short-term sitting—five minutes at the max—an hour later my back starts to ache. I’m only here for the sniffles, some sympathy and a few antibiotics to stem this current bout of flu, so I shouldn’t feel this way. But I can’t help it. Doctors make me nervous. I’ve been seeing quite a lot of them lately, but it makes little difference to that little fearful voice inside.

I think then to the asylum seekers I visit in Surry Hills and wonder if they feel the same when sitting in such chairs, staring at the door to the doctor’s office, willing it to open. In some countries, medics and doctors serve an altogether different purpose. The asylum seekers tell me that medical personnel are often used by governments to inflict torture by extracting teeth, cutting off fingers and electrocuting people. What is worse is that some of these asylum seekers have been forced to wield scalpels and wires against people or risk their own death or the death of their families. But mostly, torture is inflicted to damage the soul and inflict fear; not to produce visible damage to the body. Doctors in so many other countries are often forced to harm and not heal. So, if I approach a doctor with a sense of unease, imagine the fear of the asylum seeker, finally approaching a doctor, after years of living in fear of such a person.

Sylvia Winton, co-ordinator of the Asylum Seekers’ Centre (ASC), Surry Hills, helps asylum seekers everyday. Sitting in her shared office in this old home which belongs to the Good Shepherd Sisters, Sylvia explains, “Among the people who come here are those who are in the latter stages of their refugee claims—perhaps at the Federal Court or even at the final level of appeal: to the Minister for Immigration for a Humanitarian visa.”

Many asylum seekers who come to the Centre do not have permission to work. Ms Winton explains, “At various stages in the refugee process permission to work is denied. None more inexplicably than at the last appeal, the Humanitarian stage, when the applicant is saying, ‘if I do not fit the strict definition of a “refugee”, would you, Minister for Immigration, consider granting me a humanitarian visa, because I believe I am still not safe to return to my country’.”

Without permission to work, there is no access to Medicare. This government ruling is indiscriminate: whether father, a child, a mother or a family. You have no access to Centrelink, to pharmaceutical assistance and no free health care. “Without work,” says Ms Winton, “how do you provide this essential care for yourself and your family?”

Many asylum seekers end up in the ASC at Surry Hills, needing a variety of support services, including medical care. But treating them is not always easy. Getting them to the doctor is a start, but patients who have been victims of torture may have fears and anxieties about physical examination.

Treating asylum seekers here in Australia, takes a special sort of person. “Dr Mark is excellent,” says Hossein, who fled from his native Iran. “He helps you get referrals if you need them and speaks to specialists for you.”

Dr Mark Harris, Professor of General Practice at the University of New South Wales, has been working as a volunteer doctor for the ASC for three-and-a-half years.

He speaks of the special care needed for asylum seekers, “Many suffer from chronic diseases such as heart disease, high blood pressure, diabetes, arthritis and stomach ulcers. They are more likely to suffer from depression, anxiety or post-traumatic stress disorder and to have musculo-skeletal problems from injuries in war or during imprisonment.”

Dr Harris plays an essential role in providing evidence to courts of law for asylum seeker cases. Often asylum seekers are not believed when they claim to have been tortured. Dr Harris spends time talking to specialists about torture and reading up on the issue. Asylum seekers often have difficulty talking about torture, but scars can often tell stories that asylum seekers cannot.

As well as providing essential reports for court cases, Dr Harris administers to the more common needs of asylum seekers such as high blood pressure, asthma, diabetes, heart disease and arthritis. Asylum seekers can be more susceptible to certain maladies as most are under a great deal of stress. This stress has to do with their experiences not only before they left home, but also when they got here.

Many asylum seekers have had to endure indefinite periods of detention, and a long-drawn out process of rejection after rejection. Some asylum seekers who do prove their need for protection are given temporary protection visas; which means that after three years they have to re-present their cases and prove once again that they need asylum. This on-going limbo can place enormous physical and mental strains on people. Stress has been linked to many complications in health care; heart and digestive problems to name but two.

Asylum seekers can be difficult to diagnose. “Post-traumatic stress disorder frequently does not present in a very obvious way,” says Dr Harris. Language and cultural differences can mean that health concerns go undiagnosed.

As I sit in the courtyard of the ASC chatting with people I do wonder about what’s hidden behind their smiles. I know that in some countries crying is considered a weakness, so asylum seekers may feel great shame in showing their true feelings, putting on a smiling mask, so that depression is buried deep inside. Many do smile, as we sit and chat about their homelands, about the beauty of Iraq or the heat of Africa.

But depression can erupt in destructive ways, “For most asylum seekers, it is the psychological torture that wears them down,” says Ms Winton. “The number of times I have sat with a suicidal asylum seeker I could not count. The incidents are always memorable though. These are not people who want to end their lives, but people who cannot endure the torture that the process [of applying for an Australian visa] demands.”

Sylvia remembers one event, “After his discharge from hospital, I sat with Tefese on a beach. ‘Do you really want to end it?’ I asked, ‘No, but I know that if I am returned I will be killed and I would rather kill myself than have the army in my country kill me when Australia sends me back’.” It took over three years for this man to be granted a Humanitarian Visa. His refugee claims were not believed.

Like Tefese, many asylum seekers live with such fear that the impact on their health is devastating. The potential cost to the Australian health system, if they are eventually accepted as refugees, is also great.

Some children are not taken to a doctor because the family is not eligible for Medicare. “We just sit it out,” said a father recently. Children miss school; immunisations are not checked or available.

That’s why the ASC plays such an important role, not only for on-going care, but also as a first step to specialised care. Dr Harris relies on the goodwill of fellow doctors and hospitals and in 10-15% of cases calls on specialists for help. “Most specialists when asked to help on a pro bono basis are very helpful. I usually approach people I know or who are associated with the University, which helps.”

“We are limited in terms of the medical care by the associated costs. We can negotiate imaging from St Vincents and Mater Hospitals and some pathology through various providers. However there are limits to the number of patients we can ask them to see. We also often have to pay for medicines for patients.”

Hossein, who was released from detention after three years with no visa, and no permission to work, is now being treated by Dr Harris for hypertension and diabetes as well as other medical issues. Before arriving in Australia Hossein was perfectly fit and well. The ASC gives Hossein approximately $160 per month for medications alone, and Dr Harris treats him on a weekly basis.

Beverly Hilsden, a nurse working for the ASC, can have contact with 20 asylum seekers per day, and says that one of the greatest challenges is getting around the bureaucracy that exists in most hospitals. “Once we have reached the limit of services these hospitals can offer for free, we have to bargain for medical care.”

Such bargaining is not uncommon at the ASC, in one case a woman, Rosalie, presented herself at the hospital where she had booked in over a month before. Eight months pregnant and suffering from depression, she was told by hospital office staff that because her Medicare card had now been cancelled, she could not be treated. Rosalie turned to Beverly at the Centre. Beverly rang other hospitals and managed to find someone who was willing to treat the woman. “If an Australian woman had come in me in such a state [38 weeks pregnant with abdominal pains] I would have certainly called an ambulance. But ambulances are expensive and most asylum seekers without the right to work cannot afford that extra expense. I was conscious of helping her solve the problem, without creating a much greater problem.”

In Rosalie’s case Beverly was able to contact a gynaecologist who immediately took over her care. She also called the people staying with Rosalie and informed them of what to do if the young mother-to-be became further distressed.

Beverly’s role is sometimes more that of a social worker than a nurse. When Rosalie first came into the Centre Beverly had to establish the facts of her financial position; Did she have Medicare, or if not, did she or her husband have permission to work? If they did have permission to work, how much could they pay the hospital and how quickly?

Beverly then had to call hospitals in Rosalie’s area. As an asylum seeker Rosalie is considered in many hospitals to be an overseas patient, and private at that. This is akin to being an overseas student studying in Australia; you pay full overseas rates. Some hospitals charge special rates for asylum seekers, even then, paying such fees is impossible. One hospital charges $2900 for a woman to give birth. The special rate for asylum seekers is $2200. For Rosalie, whether its $2900, or $2200, either amount is unfeasible.

For an ante natal clinic an individual can expect to pay $3000 up front. For the first night of a hospital stay, $600. In many cases the asylum seeker is asked for evidence of their ability to pay and the name of a guarantor. Of course, for many this is not possible. This is where Beverly comes in. “Nurses and doctors have a responsibility to a sick human being,” she says. “If we can inform the doctors of what is happening before patients get to them, then we can hope for a better outcome.”

Beverly has worked with the most disadvantaged people in Australia, including indigenous people, the homeless, HIV sufferers, street-based sex workers, yet she says of asylum seekers, “I have never come across such a marginalised group.”

She is still shocked by people in hospitals who judge asylum seekers to be ‘queue jumpers’ and unworthy of treatment. “The government has done a good job of vilifying these people in the eyes of Australians,” she says. “But I am still amazed that a young child or a mother can be denied medical care.”

The ASC medical program is under threat with its major funding body this week considering pulling out. Ms Winton states that if this happens the effects for people like Hossein, Tefese and Rosalie would be devastating. On-going medical care to asylum seekers is especially important. “To have to bargain and beg every time a person needs help would obviously be detrimental to asylum seekers, but also the people working at the Centre,” says Ms Winton.

“Having a doctor and nurse on-site means that other people at the Centre can get on with other duties such as organising living arrangements, legal assistance, English lessons and job training for the asylum seekers, so that they can get on with their lives as best they can.”

Ms Winton’s hopes for the future of the Centre are humble, “Doctors for children would be great. Someone who would see an asylum seeker family free of charge, a dentist, perhaps a deal with a pharmaceutical company so we can provide some free medications to people.” But what she would most like is to not have to beg for services every time an asylum seeker is in need of help. “Asylum seekers should have medical services and these should be a ‘right’ not a privilege, just like those afforded to any other human being in Australia.”

So, in retrospect, sitting in this doctor’s office, I know that I am immensely privileged. I have access to Medicare, private health insurance, and tax cuts to ease the discomfort of my flu and my dislike of doctors. I thank goodness for my large blessings, and wish one day asylum seekers may, like me, be able to take for granted, for what they currently beg.


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