Commission Website: National Inquiry into Children in Immigration Detention

Click

here to return to the Submission Index

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 child’s health

and nutritional status is by assessing the individual child’s 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 child’s nutritional needs, there should be

an initial assessment of the child’s 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 child’s 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 children’s 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 baby’s 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.