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Report: Indefinite Despair

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Medical report shows disastrous impact of Australia’s offshore processing policy

  • MSF is today releasing the first independent medical data demonstrating the extreme mental health suffering on Nauru, due to the Australian policy of indefinite offshore processing

  • Among the 208 refugees and asylum seekers we treated, 60 per cent had suicidal thoughts and 30 per cent had attempted suicide

  • This report shows that it was the situation on Nauru that was most damaging to their mental health

CANBERRA - Médecins Sans Frontières (MSF) is today releasing the first independent medical data demonstrating the extreme mental health suffering on Nauru, due to the Australian policy of indefinite offshore processing.

MSF strongly reiterates its urgent call for the Australian government to end this policy and immediately evacuate all refugees and asylum seekers – men, women and children from Nauru to avoid further deterioration of their health.

According to the medical report Indefinite Despair, the mental health suffering on Nauru is among the most severe MSF has ever seen around the world, including in projects providing care for victims of torture.

“The medical data we release today confirms the heart-breaking reality that I witnessed on Nauru,” says Dr Christine Rufener, clinical psychologist and MSF mental health activities manager.

“Every day I worried which of my patients might attempt to take their own lives, because after five years of waiting people had lost all sense of hope.”

Among the 208 asylum seekers and refugees MSF treated on Nauru, 124 had suicidal thoughts and 63 had attempted suicide.

Twelve adults and children who MSF treated were diagnosed with resignation syndrome, existing in a semi-comatose state and unable to eat or drink.

Lack of control and loss of hope

Although three-quarters of refugee and asylum seeker patients reported experiencing traumatic events before reaching Nauru, such as conflict situations or detention, our report shows that it was the situation on Nauru that was most damaging to their mental health.

A total of 65 per cent of asylum seekers and refugee patients felt they lacked control over their lives, and these patients were significantly more likely to be suicidal or diagnosed with major psychiatric conditions.

“While many of our patients had experienced trauma, it was the Australian policy of indefinite processing that destroyed all their hope for the future and devastated their mental health,” says Dr Rufener.

More than one-third of asylum seeker and refugee patients were separated from close family members.

People who were split from their families because some members had been medically evacuated from the island – a tactic used by the Australian government to coerce medically evacuated refugees to return to Nauru – were 40 per cent more likely to be suicidal.

Key figures

Among the 208 asylum seekers and refugees MSF treated on Nauru (November 2017-October 2018):

124 HAD SUICIDAL THOUGHTS

63 HAD ATTEMPTED SUICIDE

12 WERE DIAGNOSED WITH RESIGNATION SYNDROME

65 % FELT THEY LACKED CONTROL OVER THEIR LIVES

62 % WERE DIAGNOSED WITH MODERATE OR SEVERE DEPRESSION

Nauruan patients also left behind

In 11 months on Nauru, MSF provided mental healthcare to 285 patients, including Nauruans, refugees and asylum seekers. A total of 1,526 consultations were provided for refugees and asylum seekers, and 591 for Nauruans.

The Nauruan government forced MSF to leave the island in early October, when more than 200 patients were still under our care. MSF remains deeply concerned for the ongoing care of the patients we left behind, Nauruan nationals, asylum seekers and refugees.

The mental health situation of Nauruans was also severe; almost half MSF’s Nauruan patients had psychosis, with many requiring psychiatric hospitalisation that was not available.

End this brutal policy of offshore containment now

Strikingly, more than half of MSF’s Nauruan patients showed improvements in their mental health functioning under MSF’s care, while only 11 per cent of asylum seeker and refugee patients improved.

“Our Nauruan patients’ mental health improved in a way that was not mirrored in our asylum seeker and refugee patients, despite receiving the same quality of care,” says Dr Stewart Condon, president of MSF Australia.

“This illustrates that living under a policy of indefinite processing creates a perpetual state of despair, making it impossible for asylum seekers and refugees to recover.”

“The current mental health crisis on Nauru is tragically predictable,” Dr Condon continues.

“After five years of arbitrary deprivation of liberty, the situation is desperate. The Australian government must stop this brutal policy and immediately evacuate all refugees and asylum seekers from Nauru, as well as Manus island. There is no time to waste.”

MSF calls on Australia to immediately end the containment of asylum seekers and refugees offshore.

MSF welcomes any resettlement options, including New Zealand’s, as long as they are fast, voluntary, respect family unity and allow for people to rebuild their lives and mental health.