A last resort? - Summary Guide: Physical Health

As mentioned previously, under the Convention on the Rights of the Child, children held in immigration detention have a right to grow up in a healthy environment and to achieve 'the highest attainable standard of health'.

Most Inquiry evidence regarding children's health related to children's psychological health. However, children's physical health is closely related to their mental health. For instance, depression and lethargy can mean that a child does not want to eat and they miss out on the nutrition they need. Serious mental health problems can lead to attempts to self-harm.

However, it became apparent throughout the course of the Inquiry that, despite the efforts of health staff, the detention environment and the standard of medical care available had an impact on the physical health of children.

Creating a healthy environment

The Department has a responsibility to ensure that children in detention have a healthy environment in which to live. Shelter, clothing, food and hygiene are all factors that contribute to the physical health of children.

Food

The Inquiry was told that the strict regime of serving three meals a day did not suit the eating habits of children - in fact, most children prefer to 'graze'. In addition, some parents would go without food to create another meal for their children or give them the food that they wanted.

Evidence presented to the Inquiry showed that the food varied in quality between the detention centres and over time and that the menu was sometimes unappetising and monotonous for children - especially over long periods of time in detention.

The provision of baby formula at Woomera was uneven for substantial periods of time. In addition, there was no evidence that individual assessments of children were made to identify and address any pre-existing nutritional deficiencies.

Accommodation

At certain periods of time families were living in crowded conditions which caused discomfort and stress. This became less of a problem as detainee populations decreased over 2002.

Hygiene

Much of the cleaning in remote detention centres was done by detainees who were paid an equivalent of one dollar per hour. During periods of tension and unrest in the facilities, however, some of these jobs were not done and there were inadequate systems in place to maintain an appropriate level of hygiene.

Physical surroundings and climate

The extreme heat and cold of remote detention centres contributed to health problems. Medical staff said that dehydration was common among children and adult detainees. Children complained that rocky surfaces and the absence of grass meant that they hurt themselves playing. The Inquiry also heard complaints about eye and skin infections caused by the glare, dirt and dust storms.

Providing health services

When children arrive in detention facilities they undergo two types of health assessments. Firstly, there is a public health screening to identify communicable diseases, such as typhoid and tuberculosis. Secondly, a screening takes place to identify the general health needs of each detainee.

Assessment and treatment

Children arriving from countries all over the world may have ailments that are not common to Australia and need specialised assessment procedures. However, evidence received by the Inquiry suggested that the initial assessments may have failed to pick up special medical conditions of child detainees and that there was no regular follow-up. There was no routine hearing tests for children and no routine testing of sight for children above five years of age.

Children also felt that, at times, medical staff did not take their concerns seriously. The submission of the NSW Commission for Children and Young People quotes children who say that no matter what ailment they had medical staff would recommend 'water and Panadol'. This was consistent with interviews conducted by the Inquiry.

Access to health staff

All immigration detention centres have health care staff available for treatment, including nurses and doctors. However, at various times detention centres were understaffed. A triage system set up to deal with staffing problems led to delayed treatment in some cases, causing distress to children and parents.

Qualifications of health staff

Many of the doctors and nurses that Inquiry staff met were highly professional and caring. However, it seems that many were not trained to identify and address the possible special medical conditions of child asylum seekers and that there were insufficient staff with paediatric training.

This problem was compounded by the difficulty in recruiting and retaining staff for work in remote immigration detention facilities. In these circumstances, it is even harder to recruit personnel with the necessary mix of skills and experience.

Cultural awareness

The cultural awareness of medical staff also affects the quality of health care that children in detention receive. For instance, some female children and mothers may feel that it is inappropriate for medical assessments and examinations to be done by a male nurse or doctor.

Although there were some efforts to improve cultural awareness, the specifics of that training remain unclear. Health staff at Woomera commented that everything they had learned was through the detainees.

Availability of interpreters

Providing on-site interpreters to help with medical examinations has been a persistent problem in some detention centres, particularly Port Hedland. The Department Manager at that facility reported an absence of on-site interpreters over a period of 19 months.

The absence of interpreters has a dual impact on children. For children who do not speak English, medical examinations can be intimidating and inaccurate. In addition, children who do speak English often end up interpreting for their parents.

Access to external doctors and hospitals

Medical centres within detention facilities are only intended to provide initial, primary care. It is the Department's policy that detainees who can't be treated within detention centres are referred to off-site specialists and hospitals. In remote detention centres in particular, the absence of clear procedures for referral, and the difficulties that come with isolation, were frustrating for doctors and led to delays.

Access to dental care

All centres reported managing demand for dental services as a major problem. Because of advanced dental problems in the detainee community, most visiting dentists spent all their time on pain relief and extractions, with no time left over to provide children with the preventative dental care they needed. In June 2002, ACM staff took steps to develop guidelines to improve dental services. However, dental care remained an issue in some centres in late 2002.

Pre and post natal care

While efforts were made to provide pre- and post-natal care to women and their babies, the location of the remote detention centres and the restrictions that come with the detention environment meant that women about to give birth were sometimes separated from husbands and other children for weeks at a time.