Commission Website: National Inquiry into Children in Immigration Detention
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Submission to the National
Inquiry into Children in Immigration Detention from
The Dietitians Association
of Australia (DAA)
Food and Nutrition Issues
Associated with Mandatory Detention of Children
Executive Summary
Refugees are a group
at high nutrition risk. There is a strong duty of adequate nutritional
care for institutionalised persons. The Dietitians Association of Australia
(DAA) is the largest member organisation for nutrition professionals in
Australia. It is notable that DAA has been unable to identify significant
input by nutrition professionals into the planning or provision of care
for asylum seekers in Australia.
Sources available
to DAA raise questions in respect to the standards of nutritional care
and management of children in detention. It is of real concern that the
authorities may not even be aware of the extent of the nutritional disadvantage
of these people due to the lack of adequate assessment and monitoring.
If, as is feared, current conditions do not meet international standards,
government policy should be reviewed to enable asylum seekers to better
access government and non-government support in the community.
Introduction
DAA is a national
body representing over 2000 dietitians throughout Australia. Dietitians
are the experts in food and nutrition and provide practical advice based
on scientific evidence. DAA strives to advocate for better food, better
health, better living for all. It is from this perspective that the Association
strongly supports the inquiry by the Australian Human Rights and Equal
Opportunity Commission into the conditions of children in immigration
detention.
The Australian Commonwealth
Government has agreed to international standards sanctioned by the United
Nations Committee on Economic, Social and Cultural Rights on the right
to health under Article 12, ICESCR. Six core obligations under this convention
include:
- Access to health
facilities
- Nutritionally
adequate and safe food
- Basic shelter,
sanitation and safe drinking water
- Essential drugs
- Equitable distribution
of all health facilities
- A public health
strategy and plan of action
This submission outlines
some of the key considerations in the determination of whether Australian
Detention Centres are reaching our obligations of supporting children
through meeting their food and nutritional needs at a critical time in
their physical and mental development.
The lack of access
to first hand information is a key, and rather telling issue for health
professionals concerned about the welfare of asylum seekers in the care
of the Australian Government. The only information available to dietitians
and other health professionals to date has been through personal communications
with visiting professionals or reports from ex staff or ex detainees.
To the best of our knowledge no dietitian has been involved in the planning
or provision of food services or nutritional assessment and management
of detainees nor has any been allowed access to detention centres.
The UN Convention
on the Rights of the Child has highlighted the following;
Article 24 : States
Parties shall pursue full implementation of (the right of the child to
the highest attainable standard of health) and, in particular, shall take
measures to combat disease and malnutrition through the provision
of adequate nutritious foods.
Initial and Ongoing Food and
Nutrition Support for Children
Reported communications
with an ex detention centre staff and visiting health professionals have
indicated that initial assessment of children in detention did not include
assessment by a child health or nutrition specialist. There were no specific
procedures in place to assess initial nutritional status, nor records
of ongoing growth monitoring including height and weights.
Asylum seekers coming
to Australia come from countries in the Middle East, Africa, former Yugoslavia
and may have experienced nutritional deficiencies in their countries of
origin or during travelling. These countries have been identified by the
WHO as low-income food deficit countries (LIFDC). In the abovementioned
countries indices of food insufficiency, principally undernutrition among
children under five years, are high. Therefore children arriving in Australia
as refugees or asylum seekers may be malnourished before even setting
foot on Australian soil. Furthermore, refugees may come to Australia after
time spent either in refugee camps or living with relatives, friends or
strangers in non-camp settings, where food access is problematic. The
nutritional status of refugees in both camp settings and in non-camp settings
has been characterised as poor. An appropriate initial health assessment
would identify any problems associated with food intake and behaviour,
growth and nutritional status and provide guidelines for ongoing support
and management. This is especially critical for children under five who
are more nutritionally vulnerable than adults.
There is general
international consensus that the best way to measure a childs health
and nutritional status is by assessing the individual childs growth
against standard weight-for-height, height-for-age and weight-for-age
charts such as those produced by the World Health Organisation, taking
into account cultural and geographic differences in child development.
In order to evaluate a childs nutritional needs, there should be
an initial assessment of the childs height and weight upon arrival
and ongoing monitoring of growth using a growth chart. Micronutrient deficiencies,
for example, iron deficiency should be identified early so appropriate
intervention and careful ongoing monitoring can occur.
Further indicators of high
standards for nutritional assessment and management would include:
- The use of WHO
endorsed growth charts (ie. National Centre for Health Statistics NCHS)
for the initial assessment and ongoing monitoring of every child under
12 years in detention.
- The existence
of policies and protocols to ensure ongoing follow-up and intervention
for children assessed as being at risk of weight loss; poor growth or
excessive weight gain. Referral protocols for child health nurses, paediatricians
or dietitians as appropriate.
- Strategies to
ensure interventions or recommendations are communicated and understood
by parents through interpreters if necessary.
- Protocols established
for biochemical, haematological and immunological testing and deworming
if children are considered at risk of nutritional deficiencies.
- Established communication
channels with food service staff for provision of special dietary requirements
for children with identified nutrition issues.
Nutritional Requirements
for Children
Various personal
communications with individuals who have visited detention centres and
families released from detention have indicated generally that:
- Food in detention
centres is provided at three mealtimes during the day with limited access
between times.
- That no food is
allowed to leave the canteen.
- If children are
sick or asleep in their rooms food cannot be taken back to them, they
have to come to the canteen if they want to eat at that meal.
- The only food
provided outside mealtimes is available in a kiosk that sells foods
like chocolate, crisps, soft drinks and lollies. Prices are higher than
in similar outlets outside detention centres.
- No nourishing
snacks or drinks are available free of charge between meals for children.
- Most of the children
intensely disliked the food in the detention centre.
- The environment
(eating in public) in which food is taken is completely alien to refugees
and it does not support good behaviour and the development of family
relationships.
Children have particular
nutritional requirements that are not easily catered for in a food service
operation designed for adults. This is especially important for those
children who are assessed to be underweight or deficient in micronutrients
as mentioned above.
A childs energy
and nutrient needs are high but their capacity is small or as is the case
in detention, their appetite can be erratic or compromised. For example,
the energy requirements for a one year old child are 435kJ/kg and for
an adult 130kJ/kg. Therefore they require a more frequent food and fluid
intake than adults. There is no evidence from the report of observers
that children in detention were eating the quantity and quality of food
required to meet their nutritional needs.
If only three meals
a day are served in detention centres this is likely to be insufficient
for children; especially infants and toddlers. It is recommended that
children under five years eat a smaller quantity of food distributed throughout
five meals or nutritious snacks a day.
Some of the practical
issues of feeding children should be taken into consideration. The practical
issues include childrens small capacity, fussy eating, erratic interest
in food, the need for supervision by an adult to ensure intake and the
knowledge that eating best is a family experience.
There are also indications
that some children became overweight in detention centres from eating
excessive quantities of high calorie purchased snacks or sweets provided
by visitors. The consumption of food other than that provided may indicate
that the food provided was not timely, insufficient in quantity or culturally
inappropriate for the needs of children.
It is reported that
nutrient dense snacking foods like milk and fruit, have not been available
in detention centres throughout the day and when requested only given
in limited quantity. Children have instead been reported to be eating
nutrient poor or empty-kilojoules snacks such as chips and
sweets.
Children in detention
are likely to be nutritionally compromised on arrival. If the food they
receive in detention is inadequate or inappropriate their nutritional
status will be further worsened. They will lose weight, fail to meet growth
targets for their age and develop micronutrient deficiencies such as anaemia
or scurvy.
Further indicators of high
standards in the provision of nutritionally adequate food for children
would include:
- The involvement
of dietitians in providing resources for menu planning for detention
centres.
- Attention to the
provision of a variety of foods from the core food groups on a daily
basis; in sufficient quantity and quality to ensure nutritional adequacy
for all detainees.
- The provision
of culturally acceptable, nutritious choices for children; including
weaning foods.
- The provision
of crockery and cutlery suitable for small children.
- Attention to the
provision of additional nutritional requirements of pregnant and breastfeeding
women.
The Nutritional Needs of
Pregnant Women and Breastfeeding Mothers
A range of sources
including staff, visitors and ex detainees have provided information that
supports the following statements:
- Breastfeeding
is not actively encouraged in detention. For example a breastfeeding
mother only had access to one set of clothing, which was not maternity
clothing i.e. not suitable for breastfeeding. Food safety issues for
the infant occurred because of dirty clothing of mother. Large barriers
existed for this mother to overcome in terms of trying to breastfeed
her infant.
- There are no weaning
foods.
- There is little
access to advice regarding feeding, e.g. a mother who could not continue
breastfeeding was then given formula for her infant. She could not read
the instructions on the formula package and received little assistance
in helping to feed her infant.
Australia is obliged
under Article 24(2)(d) of the Convention on the Elimination of All Forms
of Discrimination Against Women (CEDAW) to ensure appropriate pre-natal
and post-natal care for mothers.
This includes ensuring
that the special nutritional needs of pregnant women and new mothers are
met. Poor maternal nutrition is associated with various disorders in babies
and with low birth weight. Mothers also have increased nutritional needs
whilst breastfeeding and may need education and encouragement to breastfeed
their babies. The WHO recommends exclusive breastfeeding for six months,
with introduction of complementary foods and continued breastfeeding thereafter
as an important aspect of a babys diet.
Further indicators
of high standards in nutritional care and management for pregnant and
breastfeeding mothers would include:
- Nutritional assessment
and weight monitoring of pregnant women.
- Ensure access
for pregnant and breastfeeding new mothers to child health nurses or
breastfeeding consultants for support with breastfeeding and other feeding
issues for young infants. The existence of policies and protocols to
ensure ongoing follow-up and intervention for women assessed as being
at risk of nutritional deficiency e.g. Vitamin D deficiency or iron
deficiency. Referral protocols for medical staff or dietitians as appropriate.
- Protocols for
the release of medical information and referral to relevant health professionals
in the community for families that leave detention centres.
Social, Cultural and Psychological
Needs
Article 30, of the
Convention on the Rights of the Child states the following:
In those States
in which ethnic, religious or linguistic minorities or persons of indigenous
origin exist, a child belonging to such a minority shall not be
denied the right, in community with other members of his or her group,
to enjoy his or her own culture [or] to profess and practice his or her
own religion.
Reports of personal
communications with ex detention centre staff, ex detainees or visiting
professionals have revealed the following issues:
- Cultural foods
are not routinely provided in detention.
- The Halal food
available is often frozen and lacks variety.
- People do not
enjoy the food provided.
- Some of the women
helped in cleaning and chopping but not cooking the meal itself.
- Many of the children
were aggressive, irrational and crying most of the time.
Food is far more
than nutrients. Food is a universal expression of cultural identity, sociability
and nurturing. Parents inability to control food provision for children
that is culturally and religiously significant can further heighten anxiety
and family relationships in detention. In order for children to develop
positive attitudes to eating and mealtimes their behaviour should be modelled
on positive behaviours of parents. The anxiety associated with detention
is unlikely to be conducive to the establishment of normal healthy eating
habits in children. Stress associated with detention would be likely to
lead to poor appetite along with other symptoms amongst families.
Recommendations
1. That appropriately
qualified and experienced Accredited Practising Dietitians be involved
in planning and standard setting at government level to ensure adequate
nutritional care across the system.
2. That Accredited
Practising Dietitians be involved in assessment and care provision at
detention centre level.
3. That DAA be invited
to contribute to an official visitor program to ensure maintenance of
standards and transparency.
4. The government
policy of detention of asylum seekers should be reviewed if adequate nutrition
welfare standards cannot be established and maintained.
Conclusion
Children and their
families should ideally be accommodated in the community where they have
access to services and are able to make decisions about food selection
and preparation. While children remain in detention this submission has
attempted to outline nutritional standards that would be expected to ensure
Australia is achieving its international obligations under UN conventions.
Sources available to DAA raise some questions in respect to the standards
of nutritional care and management of children in detention. If current
conditions do not meet international standards it is imperative that government
policy be reviewed to enable asylum seekers to better access government
and non-government support in the community. DAA would be pleased to recommend
members who could provide expert advice and assistance to investigate
these issues more fully and make recommendations to improve services.
Contact Information
Noel Roberts
Professional
Services Director
Dietitians
Association of Australia
1/8 Phipps
Close
Deakin ACT
2600
E-mail: <nationaloffice@daa.asn.au>
Telephone:
02 6282 9555
Fax: 02 6282
9888
Last
Updated 9 January 2003.