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Submission to the National Inquiry into Children in Immigration Detention from

the Melbourne International Health and Justice Group



About the Melbourne International Health and Justice Group

(The MIHJG is a coalition of people from various institutions not the institutions themselves)

Department of Justice and Youth Studies at the Royal Melbourne Institute of Technology
The Department of Justice and Youth Studies (JYS) is part of the Faculty of Education, Language and Community Services (FELCS) at RMIT University. JYS offers undergraduate courses in Criminal Justice Administration and Youth Affairs, as well as Masters by Research and PhD programs. The two undergraduate courses offered are designed to educate professionals and others whose work is directed to enabling groups and individuals to improve their ability to control their own lives within the framework of community aims and goals. JYS and FELCS staff are actively involved in research and teaching that addresses issues of globalisation and localisation, cultural diversity and the development of strategies for inclusive community services and social development.

Associate Professor Scott Phillips has extensive experience in social policy development. His research interests cover multiculturalism, policies and strategies for responding to the needs of people from diverse linguistic and cultural backgrounds, multicultural drugs education and the role of organised sport in promoting social development among culturally diverse youth. He teaches in the fields of ethnography and public policy.

The Centre for International Health, Macfarlane Burnet Institute for Medical Research and Public Health
The Centre for International Health (CIH) at the Macfarlane Burnet Institute for Medical Research and Public Health (Burnet Institute) leads the Institute's collaboration with other Australian, overseas government, and international agencies to promote the health of populations in less developed countries. The CIH provides technical support, program management, assistance with public health policy development, and training related to communicable disease prevention and control in the broader context of community-based primary health care and refugee health care.

CIH staff have been actively involved in emergency preparedness and response programs and work closely with the Office of the United Nations High Commissioner for Refugees, the World Health Organization, the International Committee of the Red Cross and many non-governmental organisations to develop technical guidelines and conduct training courses. Members of staff are involved in training Australian and International personnel for work in refugee and emergency settings.

The Centre for Culture Ethnicity and Health
Established in 1993 by the Victorian government when an agreement was established between the then Department of Health and Community Services (DHS) and the North Richmond Community Health Centre (NRCHC) to establish a Centre for Ethnic Health, the Centre for Culture Ethnicity and Health (CEH) was to play a major strategic role as a provider of information, research, and education and training with an emphasis upon the promotion of organisational cultural change in mainstream health and welfare agencies.CEH is seen as a principal resource and clearing house in the area of health and cultural and linguistic diversity, to the primary health care sector in Victoria.

Department of Public Health Nutrition, School of Health Sciences, Faculty of Health and Behavioural Sciences, Deakin University
The School of Health Sciences is committed to excellence in teaching, research and service. Its major focus is on enhancing understanding of the behavioural, biological and social determinants of health and human performance. This fundamental knowledge underpins the development, implementation and evaluation of innovative strategies designed to enhance health and human performance, and informs our teaching programs.
Strategic focus of major research programs includes nutrition and physical activity in population health and social and cultural determinants of population health. The School and the University support staff including Dr Cate Burns using research and expertise to inform discussion in the National Inquiry into Children in Immigration Detention. Dr Cate Burns has particular expertise in social nutrition and nutrition of vulnerable groups.

Introduction
The concerns of the Melbourne International Health and Justice Group

The members of the Group are concerned with the health of all asylum seekers in detention but of special concern for this submission is the health of children in detention.

Children are fragile, dependent and developing; if the support system is weak, they are among the very first to suffer. Children must always be seen in the context of their families and community. Although age-specific requirements for the nutrition and health for example, of refugee children should be addressed as part of food and medical programs for the general refugee population, specific activities have to be undertaken for children. Above all it must be remembered that children are not small adults. Their needs are quite specific and immediate.

The submission appeals to all stakeholders concerned, notably the Australian government and service providers to provide a forum to address the issue of asylum seekers. Alternative methods that accord with the Convention on the Rights of the Child and other International and Australian standards and based on sound ethical and moral principles could be debated.

The circumstances with respect to children in detention centres, the diversity of their backgrounds and the number and status of children may vary from one centre to another. We will not focus on particular details, however. Rather, we are addressing our concerns in terms of an evidence-based picture of the detention experience of asylum seekers in Australia. While there may be no single common feature of experience across all the detention centres, there are, in our view, resemblances between the centres as to the sorts of experiences and issues that asylum seekers face as a consequence of being detainees in those centres. Our submission is based on addressing the impact of these characteristic features of the migration detention experience.

Our concerns extend to the several hundred asylum seekers detained on Manus Island of Papua New Guinea and in Nauru. It is reported that around one third of the people on Manus Island are children under 17 years of age and around 50 small children are included. [1]

The Melbourne Group for International Health and Justice is particularly concerned by the Government's policy whereby asylum seekers are 'farmed out' to other countries as part of the so-called 'Pacific solution' rather than providing refuge according to international obligations for people seeking refuge in Australia. Although these people are not criminals they are detained in secure inaccessible camps. It is not possible to monitor the conditions of their incarceration. However there are clearly human rights violations involved:

  • This 'solution' places asylum seekers in the position of being stateless and, therefore, having no rights of redress should they seek to have a decision made in Australia reviewed.

A policy designed to place people in precisely this situation of being stateless flies in the face of giving people (especially desperate asylum seekers) a genuine fair go.

Equally, the 'Pacific solution' is no solution at the policy level. In fact, it has the potential to do Australia actual harm. We have been perceived by our Pacific neighbours to be bullying small island states into accepting refugees on our behalf. As reported on Foreign Correspondent (ABC, 17 April 2002) there are suggestions by some of our Pacific neighbours that Australia's foreign policy in this area is being prosecuted in terms of payments and development assistance inducements. These are being perceived and portrayed by some Pacific countries (as the ABC program revealed) as bribes.

There is also the realisation in Australia that the amount of taxpayers' money spent by the Government to deliver refugee determination services at great expense in offshore locations, far exceeds the amount required for providing services to people onshore in Australia.

  • It does not make any sound policy sense to allocate a substantial amount of scarce budget resources to shipping asylum seekers offshore to centres built, owned and operated offshore by the Australian Government only to then assess many asylum seekers as legitimate refugees who must either be shipped back to Australia or be offered a payment to resettle in an alternative country.

The secrecy surrounding these centres means that information concerning provision of services and conditions is not available. However, there are several principles involved. Standards of care for refugees are set by UNHCR and other international bodies Equal Australian standards could be expected. Both Papua New Guinea and Nauru are developing countries that struggle to provide services to their own people. We believe it is immoral to expect these countries to extend their scarce resources, or even use resources supplied by outsiders, to care for people who are Australia's responsibility. Alternatively, standards of care may not be met. We are aware that malaria is endemic in the Manus Island area. The question arises as to whether, in line with refugee health protocols, pregnant women and children under five years are provided with appropriate malaria chemoprophylaxis. [2] [3]

Without transparency and accountability, these issues cannot be monitored.

The Group's principles

The Group endorses the underlying principles of the UNHCR's Guidelines that children who are seeking asylum should not be detained and the Preamble of the UN Convention on the Rights of the Child that covers the need for a healthy, supportive family environment as a prerequisite for a healthy child. Implicit in the principles is that release of children from detention or non-detention of children must not result in their separation from their families or guardians.

The Group expects that, as a signatory to the UN Convention on the Rights of the Child, the Australian government will use this document as a major reference point in the care of all children who are asylum seekers and will move swiftly towards the release of children and their families into the community. Article 37 of the Convention requires that the detention of minors shall be used only as a measure of last resort and for the shortest appropriate period of time and Article 22 requires that States take appropriate measures to ensure that minors who are seeking refugee status or who are recognised refugees, whether accompanied or not, receive appropriate protection and assistance.

Call for leadership

The group calls upon the Australian government (and all political parties) to show bipartisan leadership in basing our treatment of refugees on sound ethical principles associated with the Universal Declaration of Human Rights as well as the fundamental values associated with neighbouring, peace and justice. It is time for leadership to be shown in establishing that the inhumane treatment of refugee children (and their parents/guardians) is unacceptable to the community standards of the Australian people.

Executive summary

As an introduction, we provide a brief overview of the global situation and population movement, international standards concerning the rights of refugees and asylum seekers including standards for the care of refugee children in detention and Australian standards for health care of children in detention.
Then the submission addresses the issues of refugee children in detention in Australia in four sections:

1. Mandatory detention of asylum seekers in Australia: its impact on children and the need for alternative approaches
2. The impact of detention on the health of refugee children
3. Exploration of cross-cultural issues and barriers to delivering culturally competent services in detention centres
4. Nutritional issues associated with mandatory detention of refugee children.

The evidence-based picture of the detention experience for asylum seekers in Australia presented in this submission suggests there is an urgent need for Australia to re-consider its approach to receiving asylum seekers and processing their claims to refugee status.

Keeping people in de-humanising lock-ups, where adults, young people and children experience violence, vilification and abuse, can only worsen their mental health outcomes as well as those of our society in general when traumatised asylum seekers are eventually released into the community.

The Melbourne Group for International Health and Justice is also concerned by the Government's policy whereby asylum seekers are 'farmed out' to other countries as part of the so-called 'Pacific solution' rather than providing refuge according to international obligations for people in distress who have sought refuge in Australia.

As a society, we threaten to do ourselves collective psychological harm if we continue turning a blind eye to the incarceration and mistreatment of desperate people who, by whatever means available to them, have sought refuge in our midst.

The Australian Government should consider how an alternative to mandatory detention could be designed and implemented so that we can balance legitimate concerns about national security with humanitarian obligations to assist desperate people seeking refuge from persecution for themselves and their families.

This submission recommends that the Australian government give immediate priority to examining the cost effectiveness of a community-based approach to the reception, detention, determination, integration and resettlement of refugees as described in Section 1. More broadly, the submission calls upon all political parties to commit to leading the community in a bipartisan process of rethinking and redesigning our policy approach to asylum seekers and refugees.
Specifically, the following recommendations are made:

Health Issues

Accommodation in the community is recommended. However, until a policy of release of detainees is in place there must be compliance with basic standards of health care for families and children in detention.

It has been shown that community involvement does not seem to be a priority in detention centres. However, refugee community participation could enhance the delivery of the following programs that should be present as a minimum:

  • Family health services with emphasis on women and children's health services and the appointment of women health professionals and involvement of health workers from the refugee community
  • Access to appropriate curative care for common problems
  • Health promotion services with emphasis on women and children's health services
  • Immunisations
  • Appropriate hygiene and sanitation facilities
  • Health education for families with attention to the needs of adolescents for information about Sexually Transmitted Infections. Special attention should be paid to all health services needed by adolescent girlsExclusive appointment of independent appropriately trained staff or provision for relevant training, including cross cultural training, before commencement of duties.

Cultural Issues

  • Restore cultural normalcy. Children should not be accommodated in detention centres. With their families, they should be housed in the community.

The social and mental well-being of all refugees, but particularly of refugee children, can be most effectively assured by the quick re-establishment of normal community life. [4]

  • Ensure cultural competency of staff and officials through accreditation procedures and ongoing cross cultural training.
  • Ensure quality assurance mechanisms and ongoing training of staff on how to work with interpreters as part of the accreditation procedures for organisations working with asylum seekers.
  • Employ accredited interpreters exclusively.
  • Involve members of the asylum seekers community in programs and education for children, including religious programs. The presence of these sorts of programs can be very beneficial for the physical and mental health and development of children.
  • Ensure the presence of mechanisms to prevent officials or members of other groups reacting in a negative manner to the cultural or religious beliefs and practices of detainees, particularly children.
  • Cultural considerations must be taken into account with respect to food type, preparation and serving, particularly considering the traditional roles of family members in relation to the child's food. It is therefore vital that children in immigration detention are provided with food that is culturally and religiously appropriate and that it is possible for the child's family members to prepare and serve the food in accordance with the family's cultural practices, including appropriate times of day.

Issues associated with nutrition

Children and their families should be accommodated in the community where they can make their own decisions about food purchases and preparation.
While children remain in custody:

  • There should be consultation with parents to ensure food is culturally appropriate.
  • They require adequate quantity and quality of food and frequency of food intake.
  • Food provided must be culturally and socially acceptable, palatable and digestible and served at appropriate times.
  • The community must be involved in decisions about the type of food that would be acceptable and in the preparation of food.
  • Nutrition monitoring and surveillance systems must be established and mechanisms put in place for ongoing management of nutrition-related problems including deficiency diseases among children, especially girls, or among pregnant or lactating women.
  • Breast-feeding must be promoted and supported and where breast feeding is not possible adequate professional support must be available to promote appropriate feeding practices.
  • The use of infant feeding bottles should be discouraged.
  • The use of milk products must be monitored according to UNHCR (or appropriate) policy.
  • Weaning foods for babies between 6 and 12 months must be available together with age-appropriate, culturally appropriate food for toddlers.

Appointed staff need expertise in nutrition including the cultural aspects of food and nutrition monitoring.

Methodology used in this submission

In preparation for this submission we interviewed staff, service providers, observers and ex-detainees. In addition we consulted

  • International documents concerned with the rights of children and with the health care of children
  • International standards for the care of refugees and asylum seekers, particularly children
  • Australian standards relevant to the care of children in custodial facilities
  • International and Australian literature concerned with refugees and asylum seekers
  • Reports and publications prepared by concerned individuals and agencies
  • Relevant media accounts

In certain cases individuals are not identified in the text due to the need to protect their identity.

Abbreviations

ABC Australian Broadcasting Corporation
ACM Australasian Correctional Management
AMA Australian Medical Association
CIH Centre for International Health (Burnet Institute)
CRC Convention on the Rights of the Child
DIMIA Department of Immigration, Multicultural and Indigenous Affairs
HIV Human immunodeficiency virus
ICCPR International Covenant on Civil and Political Rights
MCH Mother and Child Health
MJA Medical Journal of Australia
NEDA National Ethnic Disability Alliance
STI Sexually transmitted infection
UNHCR United Nations High Commission for Refugees
UNICEF United Nations Childrens Fund

The Global situation and population movement

Large-scale movements of refugees and other forced migrants have become a defining characteristic of the contemporary world. The global refugee problem has confronted the world with a range of practical and ethical dilemmas. Countries close to areas of conflict are faced with caring for millions of refugees while countries further afield, such as Australia, are not beyond the reach of a small number of people each year, desperate for refuge. Refugees and other displaced persons will continue to seek refuge, even in places such as Australia, which are very remote from their own countries.

Refugees are defined as people who have crossed international borders fleeing war or persecution for reason of race, religion, nationality, or membership in particular social and political groups. They are protected by several international conventions. In the International conventions, the term 'refugee' includes a person in need of international protection, regardless of the legality or illegality of her or his status in the country of refuge and whether or not refugee status has been recognized formally. This term includes asylum-seekers whose claims to refugee status have not been definitively evaluated and other persons of concern to the High Commissioner's office. [5]

The vulnerability of asylum seekers

Displaced people are often suffering the devastating effects of exhaustion, bereavement, separation from loved ones, family and community, ill-health or injury, poor shelter and water supplies and inadequate food availability. Whenever people are uprooted, for whatever reason, they are placed at an increased risk of physical and emotional ill health. The public health consequences of population displacement have been extensively documented (Toole and Waldman . [6] Trauma prior to and during their exodus is an important determinant of the health status of refugees on arrival in a country of asylum. Harassment, physical violence and grief will in many cases have added to the trauma of flight.

All of the above elements combine to reduce the physical and emotional reserves of the affected population. Inappropriate care on arrival at their destination can only exacerbate the problems. With the removal of control of all aspects of their daily life, increased manifestations of depression and even of destructive behaviour including sexual violence are not uncommon.

All issues that impact on the health of families in detention will clearly impact on the health of the children. Children are at grave risk of suffering permanent psychological injury.

We know so much more about the brain, and how it influences future mental health problems and now we couldn't do any worse if we want to guarantee poor mental health outcomes.

Dr Shanti Raman, Paediatrician, 2002 [7]

Dr Michael Dudley, chairman of Suicide Prevention Australia and head of the faculty of Child and Adolescent Psychiatry at the Royal Australian College of Psychiatry, the profession's peak professional organisation visited Woomera in January 2002 and said that conditions at Woomera for the children were akin to those in a concentration camp and he described long term impact on children's health such as withdrawal and bedwetting that could be expected. [8]

International standards concerning the rights of refugees and asylum seekers

UNHCR's Guidelines on applicable Criteria and Standards relating to the Detention of Asylum-Seekers state in the Introduction that

The detention of asylum-seekers is in the view of UNHCR inherently undesirable. This is even more so in the case of vulnerable groups such as single women, children, unaccompanied minors and those with special medical or psychological needs. Freedom from arbitrary detention is a fundamental human right, and the use of detention is, in many instances, contrary to the norms and principles of international law. Article 37 of the Convention on Human Rights explains that detention must be 'used only as a measure of last resort and for the shortest appropriate period of time'.

UNHCR, 1999; This document relates also to the UN 1951 Convention and the 1967 Protocol relating to the Status of Refugees. Geneva, Switzerland.

UNHCR's Guidelines on applicable Criteria and Standards relating to the Detention of Asylum-Seekers, February 1999 in Section 3 of the introduction explain that provision for protection of refugees applies not only to recognised refugees but also to asylum-seekers pending determination of their status, as recognition of refugee status does not make an individual a refugee but declares him to be one.
UNHCR's Guideline 3 explains that, in conformity with Executive Committee Conclusion No. 44 (XXXVII) 1986, the detention of asylum-seekers may only be resorted to, if necessary:

(i) to verify identity. This relates to cases where identity may be undetermined or in dispute.
(ii) to determine the elements on which the claim for refugee status or asylum is based.

This statement means that the asylum-seeker may be detained exclusively for the purposes of a preliminary interview to identify the basis of the asylum claim. This would involve obtaining essential facts from the asylum-seeker as to why asylum is being sought and would not extend to a determination of the merits or otherwise of the claim. This exception to the general principle cannot be used to justify detention for the entire status determination procedure, or for an unlimited period of time.

The guidelines relating to the detention of asylum-seekers further state that

Detention of asylum-seekers which is applied for purposes other than those listed above, for example, as part of a policy to deter future asylum-seekers, or to dissuade those who have commenced their claims from pursuing them, is contrary to the norms of refugee law.

The Executive Committee Conclusion No. 44 (1986) discusses the limited circumstances when asylum seekers can be detained, and sets out basic standards for their care.

Standards for the Care of Refugee Children in Detention

International standards that are particularly relevant to the protection of children are 'Refugee Children: Guidelines for protection and care' ( UNHCR 1994) and the Convention on the Rights of the Child.

These documents cover issues of

  • Alternatives to detention
  • Guidelines on Protection and Care including all aspects of health care including the training of staff.
  • Unaccompanied minors

Refugee children: Guidelines on protection and care UNHCR 1994 provides a sound basis from which to examine the care of refugee children in detention in Australia. These guidelines are based on the relevant Articles of the UN Convention on the Rights of the Child and do not conflict with the standards expected in mainstream Australia nor with the relevant aspects of standards for health care of children in the juvenile justice systems in Australia. Of particular interest also, are the United Nations Rules for the Protection of Juveniles Deprived of their Liberty, 1990.

Australian Standards
Australian standards for health care of children in detention

In Australia, there are standards for management of health care of children in custody. The application of these standards is limited in that they are intended for juveniles who are being punished for breaking Australian laws.

Children seeking asylum are not in the category of 'being punished' and have rights beyond those of children in juvenile justice custody. However the standards for Juvenile Custodial Facilities determine that health care must at least equal the health care provided for children in mainstream Australian communities.

The New South Wales document, Standards for Juvenile Custodial Facilities [9] states that the underlying principle for care of children in custody is adherence to the United Nations Rules for Protection of Juveniles Deprived of their Liberty, 1990.

The State Government of Victoria, Department of Human Services' 'Framework for the Delivery of Juvenile Justice Health Services, September 2001', also states as a principle for the delivery of health services that quality of health care must be at least equivalent to mainstream services and also at a minimum meet national and relevant international standards of service provision to juvenile justice clients.

ABC radio reported [10] that the South Australian government was not satisfied that standards applied at Woomera met the South Australian standards. The South Australian authorities were informed that these standards did not apply as Woomera was a Commonwealth Government installation.

The provision of services to asylum seekers in detention in Australia is contracted to specialist companies but the Terms of Reference provided by DIMIA indicate that there must be compliance with certain standards which are set out in the Schedule: Immigration Detention Standards. This document covers all aspects of detention functions and includes reference to factors that impact on health and care of children in particular.

A stated underlying principle is that Immigration detention is required by the Migration Act and is administrative detention, not a prison or correctional sentence. Nevertheless the detention centres in Australia all exhibit characteristics of secure prisons including surrounds of high wire fences topped with razor wire.

Section 1.
Mandatory detention of asylum seekers in Australia: its impact on children and the need for alternative approaches
Associate Professor Scott Phillips
RMIT University, Melbourne, Australia

Introduction

There is a growing body of evidence of psychological disturbances among refugees held in long term detention in Australia. And the mental health implications affect children as well as adults.

  • Medical researchers Sultan and O'Sullivan [11] have reported that the psychological reaction patterns of detainees whose claims are unsuccessful 'are characterised by stages of increasing depression, punctuated by periods of protest, as feelings of injustice overwhelm them.' They observe that 'these reactions have a marked secondary impact on their children in detention.'
  • Steel and Silove [12] also have noted that research studies in Australia and elsewhere suggest that detained asylum seekers (including children) may have experienced greater levels of previous trauma than other refugees, and this could contribute to their mental health problems, in that detention provides a re-traumatising environment.

This section of the submission does three things. First, it provides an evidence-based picture of the experience of being in mandatory detention as an asylum seeker in Australia. There are by now considerable and alarming eye-witness accounts and first-hand reports that show how the current Australian mandatory detention regime for asylum seekers systematically diminishes and abrogates the human rights of asylum-seeking children and adults (particularly parents) held in detention. The detention system does this by subjecting adults and children to physical and psychological abuse. In doing so, the detention system for asylum seekers contributes to worsening the mental health of Australian society as a whole when traumatised detainees are eventually released into the general community.

Second, the evidence base will be used to argue the urgent need for the Australian Government to reconsider and alter its current arrangements for receiving asylum seekers and assessing their claims to refugee status. In this context, the submission will outline alternative approaches that would better meet our legitimate national security and public health concerns as well as our long-established humanitarian undertakings and obligations to assist asylum seekers in a compassionate, considerate and caring way.

Third and finally, the submission calls upon the Australian Government (and all the political parties) to show bipartisan leadership in basing our treatment of asylum seekers on sound ethical principles associated with the Universal Declaration of Human Rights as well as the fundamental values associated with neighbouring, peace and justice. It is time for leadership to be shown in establishing that the inhumane treatment of asylum-seeking children (and their parents/guardians) is unacceptable to the community standards of Australian people.

1. The detention experience of asylum seekers
In preparing this submission, I have worked with colleagues in the community health sector, universities and public health research institutes. On the basis of our interviews with detainees, detention centre workers and former detainees now living in the community, cross-checked with written reports by health workers, detainees and detention centre visitors, we have been able to assemble a very clear picture of the asylum seeker's experience of detention here in Australia.

Although there is some variability of conditions across the different detention centres run by Australasian Correctional Management (ACM), there are nevertheless several recurring characteristic features of the detention experience in these centres. The experience of mandatory detention is proving to be particularly damaging not only for adults but also for the children and adolescents whose lives are bound up with the mandatory detention system. The characteristic features of the detention experience of asylum seekers may be highlighted as follows:

A. Intimidating physical environment:
Detainees find themselves faced with an essentially intimidating prison-like environment.

  • Centres typically are surrounded by several layers of high fencing. These fences are topped with razor wire.
  • Security checkpoints control the access and egress of visitors to the centres.
  • There are multiple daily musters involving adults and children.
  • There are also nightly head counts, which may occur any time between 2 am and 5.30 am.
  • A public address system operates almost constantly from 7 am to 9 pm. [13]

B. Intimidating human environment:
Detainees are subject to a range of intimidatory behaviours and procedures.

  • When being transported to and from medical and legal appointments, detainees are routinely handcuffed.
  • They may have sedatives prescribed by doctors to facilitate their containment and removal rather than for any genuine medical reason.
  • They may be rendered isolated and unable to communicate their needs, because of a lack of readily available interpreter services.
  • They may be confined in their rooms during crises, such as hunger strikes or breakouts. Confinement can include the subjection of parents and young children to solitary confinement (in one case a father and his baby were placed in solitary confinement for a period of 13 days ).[14]
  • They may be denied access to telephones, faxes, postal services and visitors.
  • They may experience a sense of uncertainty regarding the rules that govern daily life, as these can be changed arbitrarily, at the discretion of each detention officer. As Sultan and O'Sullivan report:

Some detainees have suffered intimidation and reprisals after acts of advocacy, protest or revolt. Authorities have instituted room searches, confinement in solitary cells, restrictions in receiving visitors, and obstacles to accessing legal representation or medical care. During a hunger strike in July 2000, all electrical power and water supplies to the cell block where the hunger strikers were residing were cut off, affecting uninvolved women and children. [15]

C. Sense of boredom and aimlessness:
Due to a general insufficiency of activities, recreational resources and educational activities, detainees are subjected to long periods of unstructured time. The dearth of adequate childcare facilities, coupled with the cramped conditions families usually live in, means that children have insufficient opportunities for play as well as education. These conditions give rise to feelings of boredom, aimlessness and apathy especially when people have been detained for extended periods of time. [16]

D. Nutritional inadequacy:
There are common reports of detainees being served standardised institutional food that is culturally inappropriate. This is no small matter, as some people are unable to eat culturally inappropriate food, which means that their nutritional needs are not being met properly. Details concerning issues associated with nutrition are provided in Section 4.

E. Cultural identity diminished:
Detainees regularly experience a sense of their cultural identity being diminished. They are subjected to culturally inappropriate service delivery, staff behaviour and communication. Experiences of discrimination and lack of respect shown to them by detention officers and other officials give rise to feelings of stigmatised identity. Issues associated with culture are dealt with in detail in Section 3.

F. Exposure to violent incidents:
The Human Rights and Equal Opportunity Commission, in its 1998 report on the conditions of detained unauthorised arrivals, noted evidence of violence between detainees - especially within families - as well as between detainees and custodial officers. [17]

G. Mental health deterioration:
Medical health professionals have noted a pattern of mental health deterioration, with each successive depressive stage closely associated with each stage in the refugee determination process. Four stages are identifiable: (1) a non symptomatic stage; (2) a primary depressive stage; (3) a secondary depressive stage; and (4) a tertiary depressive stage. These have been well characterised elsewhere, so I will only summarise the observations of others here. [18]

The non-symptomatic stage is associated with the early months of detention - prior to the primary refugee determination decision. While the detainee is shocked and disoriented they are sustained by a sense of hope that their detention will be short-lived once their claim of refugee status is upheld.

The primary depressive stage occurs after a detainee receives a negative decision and realises that they face the prospect of forced repatriation or continued detention in Australia for an indefinite period while they apply for a review of the negative decision. Depressed detainees commonly enter a primary revolt stage which manifests itself variously: some become protestors (engaging in hunger strikes); others become advocates (seeking to raise public awareness of the realities experienced by detainees); and some become aggressors (becoming involved in confrontations, riots and violent incidents with guards and other detainees).

The secondary depressive stage is consequent upon the rejection of the asylum seeker's application by the Refugee Review Tribunal. The depressive reaction at this stage becomes more severe and debilitating. These detainees now virtually cease communicating their concerns to others and become largely withdrawn. Some may become passive resisters and attempt escape.

The tertiary depressive stage is predominantly characterised by hopelessness, passive acceptance of their fate and a pervasive fear of being targeted or punished by the managing authorities. Paranoid tendencies lead detainees to become untrusting of people. Detainees in this stage of depression spend long periods of time alone, and develop psychotic symptoms such as delusions and auditory hallucinations. In the most extreme cases people engage in repeated acts of self harm resulting in a need to be hospitalised.

H. Disrupted sense of security and psychological stability among children:
There is evidence in our media on an almost daily basis of young children and adolescents held in refugee detention centres being exposed to highly stressful instances of violence and abuse. The long-term effects of this can only be imagined at this stage. What is clear is that they have experienced disruptions in their developmental pathway due to breaks in their schooling, possible loss of a parent or both parents (through death or separation) and the trauma associated with their initial decision to flee their country of origin. [19]

The primary effect on children of the detention environment, exposure to hunger strikes, demonstrations, episodes of self-harm and attempted suicide, and forcible removal procedures, is that a child's sense of security and stability is disrupted. [20] A secondary impact is mediated via the child's parents, whose ability to be nurturing and protective parents is diminished as they progress through the successive stages of depression associated with the asylum seeker's detention experience. Depressed parents are at risk of becoming neglectful or abusive of their dependent children as the course of their own detention progresses.

Psychological disturbances experienced by children are wide and varied. These include separation anxiety, sleep disturbances, nightmares, bed wetting and impaired cognitive development. Sultan and O'Sullivan report that 'at the most severe end of the spectrum, a number of children have displayed profound symptoms of psychological distress, including mutism, stereotypic behaviours, and refusal to eat or drink'. Children of parents who reach the tertiary depressive stage appear to be particularly vulnerable of developing a range of psychological disorders. [21]

Visit any migration detention centre in Australia and a similar texture of experiences will emerge. The detainees I have visited and spoken with, for instance, have made the following points:

  • They are not criminals - but are treated like criminals in prison.
  • On being admitted to the centre they suddenly realise they are being treated as 'illegal immigrants' instead of 'refugees' who justifiably fear persecution.
  • People do not know what is happening inside the detention centres. The detainees I visited do not have access to grass and trees. Children play on plastic play frames inside the centre. A fare of boiled rice, meat (undercooked with blood still showing) and coagulated vegetables is provided, with no reference to people's cultural requirements - for instance, for halal food or for unleavened bread. People's rooms are cramped and unhealthy.
  • Some have been held in isolation cells for extended periods - 45 days in one case, six months in another.
  • Detainees are traumatised by what they allege is brutal treatment by staff. The people I visited were reeling from the harsh treatment of a detainee who had protested vigorously after some staff threatened him with deportation. I was told that the detainee had spent two days in an isolation cell and was now faced with being deported before he could complete his asylum application. On expressing his frustration physically (his English being quite poor) he was (allegedly) severely manhandled. One detainee said he himself could not sleep after this incident. I also heard of a woman, a young mother of three children, who fainted in her room upon hearing the screams of the detainee as he was (allegedly) bashed by the centre staff.
    If accounts such as these are true (and we need some way to verify them independently) we have grounds for serious concern about the wellbeing and human rights of asylum seekers in detention centres.

2. Alternative approaches

The above picture of the detention experience for asylum seekers in Australia suggests there is an urgent need for Australia to re-consider its approach to receiving asylum seekers into our midst and processing their claims to refugee status. The current environment is evidently humiliating, terrifying and abusive, and this is having a profoundly negative impact on the development of children and adolescents caught up in this system through no fault of their own.

The psychological impact of detention
The nature of the impact can best be gleaned from the accounts of parents or children themselves. The following statements come from affidavits by detainees.
The mother of a boy who was held in a solitary confinement cell without access to a toilet recounts how her son described the experience to her. (Names have been anglicised to protect the family.)

My son, Andrew, later described to me his experience in detention. He said in words to the effect of: 'I needed to go to the toilet and called the guards. After a few minutes four guards came rushing down the corridor. They broke into my cell wearing CERT [Centre Emergency Response Team} gear and armed with blocking cushions. They pushed me back and held me against the wall. One guard held my legs, the other held my hands behind my back. A third guard used his arm to encircle my neck and hold me tightly. I thought I would choke. The fourth guard swore at me. When I answered back, the officer punched me in the face.' [22]

It is understandable that parents held in detention are concerned about the effect the experience has on their children. One detainee, released after 17 months into the Perth community on a Temporary Protection Visa and separated from his family who remain in the Port Hedland detention centre, speaks for all asylum-seeking parents when he says:

Since being in detention Charlotte, now 16 years old, and Jessie, now 12, have changed completely. While I was in Port Hedland with them they became more and more anxious and distressed. They began to lose interest in eating food and had difficulty sleeping. The whole family is living in a room that is 2.8 by 2.5 metres. [23]

I do not propose to list case after case here. These are well documented by now, and can be readily reviewed by inspecting published cases posted on the Children Out of Detention (Chilout) website.

My point is simply this: that many of the children and young people in detention (as at December 2001, some 582 - 53 being unaccompanied minors) are being exposed to violence, degradation and abuse. They are seeing instances of self harm and attempted suicide. And they are being confined in ways that abrogate their human rights. They are living in conditions at the detention centres that violate the United Nations Convention on the Rights of the Child (CRC).

Jaqueline Everitt, an advocate for asylum seekers who is reading for a Masters in international law, has put the matter cogently, when she states:

Is there any other country prepared to lock up endlessly, children who have not been charged with any crime? These children, who have already suffered in their own country, who have made a frightening and perilous journey to get to Australia and are possibly already among the most traumatised of the world's children, have their trauma compounded by being taken to a forbidding place and locked behind the razor wire, their rights neatly incised.

They are out of sight of the Australian people. If we don't see them, we don't know they're human. They can't be real.

It's an irony that Australian law provides for mandatory reporting of suspected child abuse by professionals - and mandatory locking up of child asylum seekers. We call both these practices government policy. One protects, the other destroys. [24]

Statements such as those by Everitt, and more recently a wave of statements of concern by a broad range of citizens, suggest the need to rethink the current approach to receiving and processing asylum seekers who come to our shores seeking protection from persecution and abuse.

The call for alternatives

Professor Alice Tay, President of the Human Rights and Equal Opportunity Commission, as early as December 2000, called upon the Australian Government to develop a fresh approach to the issue of asylum seekers, including considering a community release program. In a press article at the end of 2000, Professor Tay noted:

There are alternatives. They have been used elsewhere and Australia should explore the options and implement alternatives as a matter of priority. [25]

Most recently the Head of Amnesty International, when visiting this country in early March, called upon the Australian Government to consider alternatives to its approach. Calls such as these reinforce the view that the time for exploring and implementing more humane alternatives is now.
But just what are these alternatives?

This submission will outline some of the main alternatives proposed by the UNHCR and then point to two particularly noteworthy alternatives: one developed by the Swedish government after addressing similar issues to those which we are currently facing, the other proposed by our own Human Rights and Equal Opportunity Commission (HREOC).

The UNHCR Revised Guideline on Applicable Criteria and Standards relating to the Detention of Asylum Seekers (February 1999) address the issue of alternatives to detention. The fourth guideline specifies that alternatives to the detention of an asylum seeker pending a determination of their status should be considered. Choices about appropriate alternatives would need to be based on assessment of each individual's particular circumstances and the prevailing local conditions. The fourth guideline spells out the main alternatives to detention that could be considered by governments. These are reproduced here (in italics):

(i) Monitoring Requirements.
Reporting Requirements:
Whether an asylum-seeker stays out of detention may be conditional on compliance with periodic reporting requirements during the status determination procedures. Release could be on the asylum-seeker's own recognisance, and/or that of a family member, NGO or community group who would be expected to ensure the asylum-seeker reports to the authorities periodically, complies with status determination procedures, and appears at hearings and official appointments.
Residency Requirements:
Asylum-seekers would not be detained on condition they reside at a specific address or within a particular administrative region until their status has been determined. Asylum-seekers would have to obtain prior approval to change their address or move out of the administrative region. However this would not be unreasonably withheld where the main purpose of the relocation was to facilitate family reunification or closeness to relatives.
(ii) Provision of a Guarantor/ Surety
Asylum seekers would be required to provide a guarantor who would be responsible for ensuring their attendance at official appointments and hearings, failure of which a penalty most likely the forfeiture of a sum of money, levied against the guarantor.
(iii) Release on Bail
This alternative allows for asylum-seekers already in detention to apply for release on bail, subject to the provision of recognisance and surety. For this to be genuinely available to asylum-seekers they must be informed of its availability and the amount set must not be so high as to be prohibitive.
(iv) Open Centres
Asylum-seekers may be released on condition that they reside at specific collective accommodation centres where they would be allowed permission to leave and return during stipulated times.
These alternatives are not exhaustive. They identify options which provide State authorities with a degree of control over the whereabouts of asylum-seekers while allowing asylum-seekers basic freedom of movement.
[26]

Discussion of the alternatives
Elements of these UNHCR guideline approaches have been developed elsewhere. The Australian Government should consider how an alternative to mandatory detention could be designed and implemented so that we can balance legitimate concerns about national security with humanitarian obligations to assist desperate people seeking refuge from persecution for themselves and their families.

The Swedish Government's experience in this regard is instructive. A paper by Grant Mitchell, the Coordinator of the Asylum Seeker Project, Hotham Mission, Melbourne, has drawn attention to the lessons that Australia could learn from Sweden in this area of public policy. [27] As Mitchell notes:

Sweden has been successful in building a functioning reception process that allows for a just and humane treatment of asylum seekers while they await a decision, addresses national security concerns and effectively removes failed refugee-claimants. Sweden has also been successful in quickly integrating resettled refugees into society.

Mitchell explains how most asylum seekers in Sweden live freely in the wider community.

Once a person has been cleared by immigration and has indicated that they wish to seek asylum, she or he is taken initially to the Carlslund Refugee Reception Centre, close to the main international airport in Stockholm. At this central reception centre they are signed in and have a Caseworker allocated to them. [28]

The Caseworker's role is to explain the refugee determination process and the rights and entitlements that asylum seekers have while they await a decision on their refugee status. In addition, caseworkers ensure that each client's asylum application is processed correctly and that interpreters and legal representation are made available where necessary.

The Carlslund Refugee Reception Centre encompasses a refugee medical centre, accommodation, a group home for unaccompanied minors, the Carlslund Detention Centre, and for the Migration Board (which is the government body responsible for the reception and processing of asylum seekers in Sweden). After spending at least 2 weeks in the Carlslund Reception Centre, to complete the initial application and to undertake health or support need assessments, an asylum seeker is moved to one of Sweden's regional refugee centres while they await a decision. Where an applicant has family or close friends in Sweden they can choose to live with them. This occurs in more than half of all cases.

In the majority of cases, an asylum seeker's application will take more than four months to determine. In such cases, the applicant is entitled to work. Free housing is made available to asylum seekers, but they must provide for themselves if they have enough money. For a fee of around A$10, emergency medical and dental procedures and prescriptions are provided. Asylum seeker children receive the same medical coverage as Swedish children. [29]

Mitchell's paper reveals the Swedish system as providing a supportive and engaging physical and human environment. Regional refugee centres comprise groups of flats and apartments in small communities close to a central office reception, which includes childcare and recreation facilities. Asylum seekers are required to visit the reception office at least monthly for their allowance, news on their application and need and risk assessment.

Caseworkers assigned to each asylum seeker by the Migration Board make these assessments and, where appropriate, refer clients for medical care, counselling and other services. Caseworkers are also must provide 'motivational counselling', to prepare the asylum seeker for all possible immigration outcomes and to assess the risk of their absconding should they receive a negative decision. Asylum seekers in urban areas work in a similar way with a caseworker, whom they are required to visit at the local Migration Board office. All asylum seekers awaiting a decision are encouraged to participate in some form of organized activity such as English or Swedish lessons if they are not working.

The Swedish system has not always been like this. Mitchell notes that prior to comprehensive changes being introduced in 1997, the Swedish approach was similar to the detention regime which operates in Australia, and the Swedish Government faced many of the issues that currently face Australia. He writes:

Many of these problems, including riots, mass hunger strikes and worker safety have been addressed due to comprehensive changes by the Swedish government following an inquiry in 1997. The changes included:

  • The removal of private contractors and the police from the detention centres
  • Dividing detention into 3 categories: initial health, security and identity checks; investigation; realising return for individuals at high risk of absconding
  • Implementing a caseworker system aimed at need and risk assessment, the informing of rights and preparing detainees for all possible immigration outcomes
  • Increasing transparency in management and operation, with centres to be run more like closed institutions than prisons
  • Ensuring all staff are trained to work with asylum seekers and show appropriate cultural and gender sensitivity and respect to all detainees
  • Increasing access for NGOs, clergy, researchers, counsellors and the media
  • Allowing for freedom of information, such as access to internet, NGOs and the option to speak to the media
  • Allowing for regular meetings between staff and detainees on the running of the centres and ensuring detainees are aware of complaint mechanisms
  • Ensuring legal counsel and the right to appeal is available
  • Ensuring no children are held in detention for extended periods and removing families as soon as possible.

Mitchell concludes that Sweden's integrated approach to detention and reception has been helped by the caseworker system - especially by preparing clients for either return or settlement. Furthermore, the system of release into the community after initial checks has resulted in a significant reduction in public outcry, not only in relation to the use of tax payer's money but also as regards the previous system of detention. The reduced use of detention, when coupled with the caseworker system, has not led to large numbers of asylum seekers absconding.

Finally, detention is not completely excluded from the Swedish system. Asylum seekers living in the community who are assessed as likely to abscond prior to receiving a final decision are placed in detention for removal. But these instances are rare, because the caseworker system has encouraged failed refugee claimants to comply and return after a final decision has been made. Mitchell notes that this compliance has been achieved by:

  • Providing 'motivational counselling', including coping with a decision and preparation to return;
  • providing three options to asylum seekers: voluntary repatriation; escort by caseworkers; or escort by police; and
  • providing incentives for those who choose to voluntarily repatriate, including allowing time to find a third country of resettlement, paying for return flights, including domestic travel and allowing for some funds for resettlement. [30]

Australia and asylum seekers alike could benefit from introducing a system along the lines adopted in Sweden. Indeed, a similar sort of approach has already been suggested by the Human Rights and Equal Opportunity Commission (HREOC) in its 1998 report Those who've come across the seas: Detention of unauthorised arrivals. The alternative option proposed by HREOC has been outlined by the President of HREOC, Professor Alice Tay, as follows:

This option proposes community release while claims are finalised. People who present a real threat to national security or public order would not be released. Individual assessments would be made on the risk of absconding. Most could and should be released on their own promise to report as needed to deal with their claims. [31]

In its bare outlines, this system would not be too dissimilar from the Swedish model, suitably adapted to Australian circumstances. It would allow us to move back towards a moderate, compassionate and humane approach to the issue of receiving, processing and settling asylum seekers. And it would help us to take a more humane and constructive approach to removing and re-settling unsuccessful applicants.

What is required now is to see the issue in terms other than nationalistic xenophobia. It is possible to preserve Australia's legitimate self interest while nonetheless upholding universal human rights consistent with our international obligations. And this will require clear and ethical leadership.

3. Time for a new sort of leadership on the refugee issue

Alice Tay has rightly called for a fresh approach to be taken to the way our national community deals with asylum seekers. As she observes:

Some time in the past decade we lost our compassion towards asylum-seekers and became insular and hard-hearted. Australia's refugee policy is moving from a humanitarian one to a punitive one: from a relatively liberal assessment of individual circumstances against our international obligations to preventing entry and punishing those who slip through the net. [32]

Regrettably, the two main political parties in Australia have adopted this more or less punitive approach. And this has been done largely because political leaders have been concerned to calibrate their policy stances in accord with what they perceive as community opinion on the issue of refugees. The xenophobia associated with Hansonism and the One Nation Party has had a lot to do with the way that the two major parties have effectively demonised refugees and portrayed them as a threat to Australia's national security.

But this is an issue that requires leadership on sound ethical principles appropriate to ensuring not only Australia's future but its role in developing a just and sustainable global society. Leadership of this kind is not possible if the focus is only upon alignment of policies with popular opinion so as to secure national electoral ascendancy.

As Alice Tay reminds us:

Sadly, the mandatory detention of asylum-seekers and others who arrive without visas is popular with a community more concerned about continuing to enjoy reasonable prosperity than sharing a little of it with the needy. It is also worth mentioning that the two main political parties are more or less in agreement on how to deal with the errant and desperate few who enter the country without authorisation. In balancing national security interests and individual human rights, the pendulum has swung too far in the direction of border protection and national security. There are times when one must turn away from the will of the people and swim against that tide; times when the humanitarian obligation should be paramount. Now is the time to rethink Australia's policy of mandatory detention. [33]

Alice Tay is not alone in calling for such a rethink and leadership against the grain of popular sentiment.

Malcolm Fraser (the former Liberal Prime Minister) recently has formed a broad alliance of citizens from across the political spectrum who are concerned to pressure the current Government to develop a more humane approach taken to the way Australia receives and processes asylum seekers.

Greg Barns, a former Howard Government adviser and now the endorsed Liberal Party candidate for the 2002 Tasmanian state election, also has called upon the Government to reconsider its approach to this issue. He observed in a recent press article that 'the problem with the current policy by the Howard Government towards asylum seekers is that it actually devalues the humanity of asylum seekers through its characterisation of them as offenders against humanity'. [34] He notes the British Conservative Party's Home Affairs spokesperson, Humfrey Malins, who recently observed that mandatory detention of asylum seekers is unjustifiable because these 'people have not committed any offence. They are not criminals'. [35]

Justice Marcus Einfeld has been vocal also in calling upon the Government and the community to take a fresh and humane approach to addressing the needs of asylum seekers. Faith community leaders are also joining the chorus. The list could be extended. The point to draw from these expressions of concern is surely this: A policy of mandatory detention of asylum seekers is inhumane and unjustifiable. It flies in the face of compassion and logic. It is out of keeping with the golden rule of treating others as we would want to be treated that underlies commonsense morality.

Any policy that involves locking up the children of asylum seekers is doubly indefensible. Not only does it defy logic, ie their parents have not committed an offence by seeking asylum from persecution, so neither they nor their children should be locked up in the first place. It also contravenes the UNHCR's Guidelines and the UN Convention on the Rights of the Child (CRC). For example, Articles 2, 3, 9 22 and 27 of the UN CRC make it clear that detention of children is not in the best interests of the child and is inherently discriminatory. Article 2 specifically requires States to protect children from discrimination or punishment on the basis of the status, activities, expressed opinions or beliefs of a child's parents, legal guardians or family members. As a signatory to these UN instruments, Australia urgently needs to rethink its approach.

The time has come for us to look at how we can best align our national security and economic concerns with our international commitments to promote human rights and build a just and sustainable world order. For, in the context of globalisation, it is simply not possible to secure the one without the other.

This submission recommends that the Australian government give immediate priority to examining the cost-effectiveness of a community-based approach to the reception, detention, determination, integration and resettlement of refugees. More broadly, the submission calls upon all political parties to commit to leading the community in a bipartisan process of rethinking and redesigning our policy approach to refugees.

We are in a particular moment of our history where there seems to be a growing sensibility among our people that the way we deal with refugees could be done not only differently but better. The former senior public servant, John Menadue, has reminded us of this:

In the end, the government must abandon its xenophobia and punishment of the vulnerable and traumatised. It must abandon mandatory imprisonment. It doesn't work. Australia has a self interest as well as a humanitarian responsibility in this. Refugees have made, and continue to make, an outstanding contribution to his country. They are risk takers, highly motivated and prepared to leave everything for the sake of a new start for themselves and their children in a new country. We need more of that spirit in Australia. [36]

We could, indeed, do with more of that spirit. But what is required to grow that spirit in Australia is a fresh commitment to principles of justice and fair treatment.

We need to commit openly, as a national community, to welcoming and assisting any adults and children who seek safe harbour and new beginnings on our shores.

We need to put in place policies and procedures that protect vulnerable global citizens, especially children, from abuse and trauma when they venture amongst us, against all odds, in search of freedom, hope and justice.

We need to show wisdom and leadership on this issue. And these have to be built on a clear recognition that securing our future development will not be based on exclusionary concerns with protecting national borders from desperate people doing desperate things in desperate circumstances.

We must recognise that our future development and stability can only be assured if it is grounded on an ethic of inter-existence and productive diversity. By welcoming risk takers, and offering them a chance to contribute to the development of Australia and the world, we are most likely to build a humane, tolerant, diverse and capable national community. And in doing that we will contribute to securing not only our own national stability but also to a truly just and peaceful world.

Conclusion

We have, by now, heard reports from former workers in detention centres of the brutal conditions inside them. We have, by now, read accounts and seen television footage of people driven to extremes of personal action to try to have their conditions improved or to escape them. As a result, Australians increasingly are forming a shared view that the operations of these detention centres are not transparent and are out of line with community standards.

There is enough evidence in the public domain to suggest that the Government should move beyond its detention regime for asylum seekers and towards a community-based reception regime.

Keeping people in de-humanising lock-ups, where adults, young people and children experience violence, vilification and abuse, can only worsen their mental health outcomes as well as those of our society in general when traumatised asylum seekers are eventually released into the community.

Ultimately this is a question of upholding people's human rights.

All people, especially those fleeing from persecution, should be treated with dignity and compassion. It is their right.

As a society, we threaten to do ourselves some collective psychological harm, if we continue turning a blind eye to the incarceration and mistreatment of desperate people who, by whatever means available to them, have sought refuge in our midst.

Australia's detention centres have become silent places where people from different backgrounds, but with the same sentiments, fears and hopes as all human beings, are being systematically denied some of their most basic freedoms.

  • They are unable to exercise their right to freedom of speech.
  • They are denied their right to freedom of association.
  • Children in detention are denied their right to free public education.
  • But, perhaps most alarming with respect to mental health, they are denied their right to freedom from fear.

These freedoms, these liberties, are part of the universal notion of what it is to be human. At the moment, we live in a state that is taking liberties - liberties that are intrinsic to all people, as human beings, as citizens of the world. We are all being diminished as a result.
It is, by now, incumbent on all of us to speak up and speak out about ensuring the rights of all people, whatever their background, whatever their circumstances, to a just and dignified life.

For it is through creating the conditions in which all people can exercise their fundamental human rights that we can best promote the mental, physical and social health of all people in Australia as well as the wider world, now and into the future.

Section 2.
The impact of detention on the health of refugee children
The Centre for International Health (CIH), Macfarlane Burnet Institute for Medical Research and Public Health Beverley Snell and Michael Toole

This section provides observations on the lives of children and their families in Australian detention centres and offers informed assessment of likely long term impacts on health. In addition, the authors suggest more appropriate responses.

Definition of health
In line with the WHO definition of health, the group sees health as not merely the absence of disease but as a state of complete physical and emotional wellbeing.

Family and living environment

The child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding. [37]

The following questions arise:

  • Are families living together?
  • Do they have sufficient privacy?
  • What is being done to enable refugee families to live in dignity and provide care and protection for their children?
  • How do the general living arrangements and social organization of the refugee population affect the protection and care of children?
  • What are the normal activities in the community to assist children who have difficulties?

Observations

There is evidence that in Australian detention centres families are housed in cramped conditions with very little privacy. In many cases families are housed in units of multiple groups separated only by a curtain. There are few facilities for family activities. Adults have no control over their daily lives or that of their children.

Families may be separated from each other because they did not all arrive together. It is reported that people are housed in different sections of detention centres according to the stage of the processing of their claims. Frustration is increased by the fact that detainees are unaware of the progress of their appeals for refugee status and they are rarely able to communicate with relatives and friends. In many cases, families remaining in the country from which they fled do not know whether the detainees are alive or dead or conversely, the detainees don't know whether their family members are alive or dead.

Impact
In these conditions both parents and children suffer. Parents become frustrated, tired and impatient and have difficulty in being good parents. Children are exposed to the psychological distress and despair of parents living in confined conditions with little control over their lives, and unaware of their legal status as refugees. Children cry, fight, or become very withdrawn. Parental distress and anxiety can seriously disrupt the normal emotional development of their children and can contribute to both psychological and physical illness. Examples of the psychological impact of these conditions are also discussed in Section 1.

Recreation
The relationship between nutrition and physical activity is integral to a child's development. Nutrition is dealt with in detail in Section 4.

Article 6(2), Convention on the Rights of the Child explains
States Parties shall enure to the maximum extent possible the survival and development of the child.
Article 31(1), Convention on the Rights of the Child declares
State Parties recognise the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts.

Observations
Of concern are reports from detention centres that children have very restricted facilities for play, for example a small internal section in the men's area at Maribyrnong, external areas of bare earth in the blazing sun with no appropriate facilities at Woomera where more than 100 children are held.

The following reports from the sources cited in this submission [38] illustrate conditions in Australian detention centres

  • There is little room for children to crawl or run around and play.
  • They need to be let out into the open where it is extremely hot (about 50 degrees) or very cold
  • Children do have a few toys to play with but very often they are not interested in playing because they are so confined.

An ex-detainee explained that there was no organised child care in Woomera when she was there. She volunteered to run daily child care activities but there were no facilities provided.

  • I looked after 13 children in childcare
  • I would entertain them with videos of cartoons
  • There were about 3 cycles and the kids were constantly fighting over them
  • There was only one swing for about 50 children and constant fights over who would play on the swing

Rest, leisure, play and recreation are vital for the healthy development of the child. In order to ensure the appropriate development of children in immigration detention and provide them with the highest attainable standard of health, they must be provided with opportunities, spaces, equipment and education that encourage and facilitate physical activity and sport. [39]

Interaction with the physical environment is stated to be an innate and necessary propensity in all people, including children. [40] The quality of play experience for children will be related to the environment in which it takes place.

Australia's obligations under the Convention extend beyond merely treating illness to ensuring the development of the child to the maximum possible extent, [41] and preventing, treating and rehabilitating disabilities. [42]

The UNHCR Guidelines for the care and protection of children state that
Refugee camps, settlements or reception centres should have play areas from the outset. The play areas must be free from hazards and must fit in with the rest of the community.

The United Nations rules for the Protection of Juveniles deprived of their Liberty require that
The design and physical environment should be in keeping ….. with the need for privacy, sensory stimuli, opportunities for association with peers and participation in sports, physical exercise and leisure time activities

Impact
Normal development milestones like crawling, walking, talking may be delayed because of lack of space and the opportunity to move and the atmosphere of despair and frustration that inhibits normal interaction. According to Dr Shanti Raman, Paediatrician : [43]

Young babies and toddlers seem not to be reaching key milestones in their development.

  • Their social and communication skills are behind.
  • They're not talking, not engaging.
  • There's a definite lack of curiosity, what we call a dull effect, a lethargy.

Physical manifestations of frustration in children include bed-wetting and mutism. [44] The psychological impact of these conditions is discussed in detail in Section 1 of this submission.

Pliskin [45] describes social and cultural problems of Iranians brought on by revolution, war, immigration, and changes in family status as being expressed as narahati - depression, nervousness, sadness and anger that are usually masked or expressed nonverbally through sulking or not eating. Children exposed to this sort of family behaviour commonly respond with disturbed behaviour but also by exhibiting symptoms of somatised illness. The illness can be manifest physically as well as mentally with for example, headaches, tiredness, abdominal pain and gastric disturbances. It is important that clinicians trained to understand these problems are employed. But more important is the support of the family to remain a nurturing unit. Montgomery and Foldspang [46] are among authors who stress the prime importance of the family environment in maintaining the health of children.

Community support
Isolation between families in different sections of detention centres can prevent access to the support mechanisms that may be available within communities and have a very negative effect on psychological and emotional wellbeing. The UNHCR guidelines stress the importance of involving members of the refugee community in community activities to support families. The question arises - are there persons among the refugee community who could provide regular activities for refugee children such as non-formal education, play and recreation? The communities reflect most facets of a common community, there are teachers, lawyers, health workers, etc. So skills within the community could be beneficially employed in many areas.

Health workers who know and can help their communities should be integrated into the health delivery system (recommended by UN guidelines). Community teachers, child care workers and other leaders are also important. It is doubtful whether these approaches are encouraged.

Environmental Safety
Safety in both the living environment and the built environment are crucial to the maintenance of family wellbeing and security. There is little specific evidence about safety standards in detention centres. We recommend that HREOC examine facilities and ensure that there is compliance with national occupational health and safety standards.

The Australasian Standards for Juvenile Custodial Facilities specifies that centres as a whole must comply with occupational health and safety standards and provide a safe living environment. These Australasian standards use the United Nations rules for the Protection of Juveniles as their reference point.
The United Nations rules for the Protection of Juveniles deprived of their Liberty state

… [they] have the right to facilities and services that meet the requirements of health and dignity
…. the design and structure of detention facilities should be such as to minimise the risk of fire and ensure safe evacuation from the premises. There should be an effective alarm system in the case of fire, as well as formal and drilled procedures to ensure the safety of juveniles.
Concerning the built environment, the Australasian standards specify that standards are in line with the United Nations rules for the Protection of Juveniles deprived of their Liberty in that

Services meet the requirements for health and human dignity

Of further concern to us are reports of access to toilet facilities. In some cases the toilet block can be up to 500 m away. Because of the distance from the toilet block and the environment, children have been known to wait until they are incontinent. [47] Female ex-detainees have reported their unease about passing men 'who hang around' the toilet block and mothers will not allow their children to go to the toilet blocks alone. Visitors and ex-detainees have described the toilets in Woomera detention centre as being 'filthy and splattered with blood'. [48] [49] [50] This situation does not comply with the UN Rules specifying that

Sanitary installations should be so located and of a sufficient standard to enable every juvenile to comply with their physical needs in privacy and in a clean and decent manner

Health services
The UN Committee on Economic, Social and Cultural Rights has identified six core obligations on the right to health under Article 12, which 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

Initial assessment
In line with the recommendations of the Royal College of Paediatricians and Child Health [51] we believe it is important that children among families seeking asylum are initially assessed by a clinician with expertise about children. Any problems identified will need to be addressed according to best practice in Australia. Growth assessment is routine procedure for Australian children.

Observation
It has been reported that initial assessments are carried out by a Registered Nurse not by paediatricians nor clinicians with specialised knowledge of children. They focus on conditions of 'public health importance only'. [52] There is no evidence that health professionals who conduct the initial assessments have any training in the conditions that may be unfamiliar in Australia but which may be present among newcomers nor is there any evidence that they have any cross-cultural training. The preparation of a health file for each child as a basis for ongoing health care, is not an outcome of the initial assessment. The UNHCR Guidelines specify the need for personal records, including health records, for each child.

Impact
If a comprehensive health assessment is not undertaken, conditions affecting eyes, ears, skin, teeth, gums, etc as well as growth and development may not be detected. There may also be conditions uncommon in Australia and unfamiliar to Australian clinicians that should be noted. Examples might be nutritional deficiencies and conditions associated with parasites. We consider that there should be awareness of previous common problems of the populations represented by people detained in the centres. An initial assessment also provides a benchmark against which to measure any health developments and to guide subsequent health responses.

Without a personal health file, it would be difficult for health professionals to care adequately for each child and provide appropriate follow-up.

Appropriate curative services including dental services
It is crucial that children have the benefit of an effective primary health care program including a health monitoring program. In order to deliver effective primary health care a comprehensive initial assessment, on which to base ongoing care, is needed for each individual. Personal records for each child will enable ongoing health assessments and monitoring of children's psychological and physical development. The file (record) should follow the child through the detention centre and into the community when the child is released. We are pleased to note that immunisation against vaccine-preventable diseases is undertaken in all detention centres and records are maintained appropriately and provided to the child or carers on release.

The UNHCR Guidelines state, not only that it is necessary to ensure that children have the benefit of an effective primary health care program, but that health services should be implemented with the full participation of the community.

According to our informants, services provided are solely curative and provided by staff without cross cultural training and without special training in the management of disorders that are common in the home countries of detainees. Monitoring of children's psychological or physical development is not an integral part of the health services.

Problems have arisen regarding durable solutions when refugees have been inappropriately diagnosed by mental health professionals without adequate experience regarding the situational stress reactions or sufficient cross-cultural skills and understanding.

Specialised services are needed. Special difficulties such as trauma from witnessing or being a victim of torture, sexual assault or other forms of violence, require the involvement of a qualified mental health professional trained to work with children. Such a professional should preferably be of the same ethnic background as the refugees or at least have good cross-cultural skills. Her/his role could be either to provide treatment directly or to guide and support members of the family or community to do so.

Removal from the family unit should be avoided. Unless it is necessary to prevent abuse or neglect, a child should not be separated from her/his family and community for treatment. Even if it is not possible to get the specialised help the child needs, all positive action to normalise the life of the child is good.

Commonly reported symptoms of displaced children have been somatic complaints, social withdrawal, attention problems, anxiety, and depression. Zivcic [53] assessed the health of Croatian adolescents who had been displaced by war and found displaced children manifested more negative emotions (especially sadness and fear) than did their local peers, based on self-report as well as parents' and teachers' reports. Sikic [54] showed that hyperactivity, anxiety and psychosomatic disturbances to be rare in non-displaced children; more frequent in refugee, and most expressed in displaced children.

Access to health services
The processes involved in consulting health professionals have been described by ex-detainees, staff and observers. Detainees have to satisfy guards of their needs in order to consult health professionals. Informants have also referred to the processes should a detainee require treatment outside a centre or admission to hospital. Detainees may be handcuffed or otherwise restrained and accompanied by one or more guards. Small children may be accompanied by a parent but a guard is also present. This procedure raises questions of confidentiality as well as maintenance of dignity.

Access is multidimensional concept and includes consideration of the number and type of services, staffing, cultural appropriateness and communication skills of staff. Issues associated with culture and communication are addressed in Section 3.

The Australian Medical Association (AMA) has asserted that within and beyond detention centres, detainees are often deprived of basic medical care, particularly emergency care. The AMA has argued that the government should provide temporary access to Australia's universal subsidised system of health care. This provision would be in line with Australian standards for custodial care of children that recommend care at least equal to care in the mainstream community. [55] [56] [57]

This provision would also ensure access to essential drugs in line with the UN Committee on Economic, Social and Cultural Rights core obligations and also in line with the Rules for the Protection of Juveniles Deprived of their Liberty, United Nations 1990:

Every juvenile shall receive adequate medical care, both preventive and remedial, including dental, ophthalmological and mental health care, as well as pharmaceutical products and special diets as medically indicated

It has been reported that without access to Australia's universal subsidised system of health care, detainees have been denied access to the most appropriate medication because of cost. [58]

Other incidents have also been reported that highlight the need for access to appropriate care. At Villawood, for example, where despite formal recommendations by medical practitioners in February for a patient to receive specialist care, and repeated informal requests by independent doctors nothing occurred until finally this patient became moribund. She was a first time mother and her child was considered at risk from her condition. At that time a lawyer organised an emergency independent assessment and reported that it had been difficult to achieve given DIMIA and ACM bureaucracy. This action resulted in an emergency admission to hospital. A second similar case occurred a week later. Pressure had been exerted by ACM to resist specialist interventions on the basis of budgetary considerations. [59]

We would recommend that any health staff employed should be independent of ACM to avoid conflict of interest.

Dental care is not routinely available in detention centres and it has been reported that conservative procedures are not available and that dental pain is treated with paracetamol - a mild analgesic. However, extractions are performed.

Public health practitioners must be concerned to learn that the dentist's main activity is tooth extraction and that the main health 'treatment' was advice to 'drink more water' [60]

Women's' Health services
The UNHCR guidelines stress the importance of the appointment of women health professionals. There is no evidence of attention to family health services, appointment of female health professionals or specialised women's services.

We asked informants whether refugee women have access to primary health care services which provide for the monitoring of the health of pregnant and lactating women. According to our informants regular antenatal care is provided by nurses in detention centres. However, while it is reported that the contractors prefer midwives, they do not ask for nor provide cross cultural training for their employees.

The procedures associated with delivery vary between detention centres. It has been reported that the practice of sending women alone for delivery to a hospital far from the detention centre has resulted in women waiting as long as possible and sometimes being involved in an obstetric emergency without appropriate medical support.

According to our informants there is no routine MCH support for women. Formulae for infant feeding are not available so by default, breast-feeding is 'promoted' without support. Use of milk products is not monitored and cow's milk is reported to be used inappropriately for infants less than 12 months old. There are reports of formulae being provided to mothers of infants by friends in the community.

According to our informants there is no nutritional status surveillance of infants and young children, see Section 4.

Adolescents:
The UNHCR guidelines raise the questions:

  • Are the health services meeting the health needs of children and adolescents?
  • Are additional female health professionals/or community health care workers required?

Although adolescents may have adult bodies and perform many adult roles, generally speaking they have not fully developed the emotional maturity and judgment, nor achieved the social status, of adults that come with life experience. In refugee situations, adolescents do need the 'special care and assistance' given them by the CRC: they are still developing their identities and learning essential skills. When the refugee situation takes away the structure they need, it can be more difficult for them to adjust than for adults. Their physical maturity but lack of full adult capabilities and status also make them possible targets of exploitation, such as in sexual abuse.

Refugee Children: Guidelines on protection and care 1994

It has been reported that there are no special services available for adolescent boys or girls.

Culturally appropriate and sensitive services are needed to provide accessible services to both boys and girls and adolescent boys and girls have specific health and emotional needs that will need to be addressed. Special cultural issues associated with young females are discussed in Section 3.

Afghan women have come from a culture where they were denied access to health care if there was no female health professional available. It is important that female health professionals are available in Australian facilities because these young women may seek health care from a female professional before a male.

There are also structural conditions that have a negative impact on the reproductive health of adolescent girls in particular, eg lack of privacy about person health and no cross-cultural staff training. A young female ex-detainee described how women have to complete a form including the date and personal details when they need sanitary towels. They are supplied with ten pads and face possible questioning by a staff member, who is not always a woman, if more are needed. [61]

Suggested activities
Group activities should emphasize peer leadership. Sports, group discussions and community projects are examples. They can support adolescents in making the transition to adulthood by discussions on issues such as sexuality and adjusting to the host country culture.

Health education for families, including the risks and means of preventing diseases with public health importance; including sexually transmitted infections (STI)/HIV infections can be included. Particular attention should be focussed on the need of adolescents for such information and special attention should be paid to services needed by adolescent girls.

Separated children
The following are the key concepts addressed by the United Nations High Commission for Refugees in relation to separated children who are seeking protection as refugees that we feel are relevant to this enquiry.

  • The identification, care and protection of separated children are high priorities.
  • All work with separated children should be in keeping with the provisions of the UN Convention on the Rights of the Child and other international, regional and national instruments.
  • Care arrangements for separated children should, wherever possible, be based on family and community responsibilities for children. Institutional forms of care should be avoided wherever possible but the risks involved in foster programs also have to be acknowledged.
  • The importance of careful and coordinated planning amongst those agencies involved in developing programs on behalf of separated children cannot be underestimated. This includes ensuring that any activities do not in themselves lead, be it inadvertently, to further separations.
  • It must not be assumed that a child arriving without family is unaccompanied.

The following questions arise

  • Are there children who are alone?
  • Are the special needs of unaccompanied children in confinement being addressed?
  • Sometimes grandparents send children to seek asylum because their parents have been killed
  • There was a young girl who was alone and had a small sibling to care for
  • The father had arrived earlier. When his wife and children arrived they were accommodated in a separate part of the centre because their applications were at a different stage

The above cases were described by ex-detainees and visitors to centres.

A reported incident [62] involved children being separated from their mother who was mentally unwell. They were housed outside the centre. The mother remained inside and her condition deteriorated until she was also released. When she was reunited with her children in the community her condition improved.

Another case at Villawood [63] involved the removal under guard of a young woman suffering post-natal depression, from her 10 month old child who remained at the centre.

We believe such interventions would be more likely to exacerbate problems. They also contravene Key Concept 6 of the UNCHR guidelines on the care of separated children that activities undertaken by agencies should not lead to further separation.

Two issues arise: If children are separated by authorities from parents, for whatever reason, it is crucial that they are accommodated with a family of their own culture and preferably known to them. Easy access to the detained parent is extremely important. However, the second issue - of detention - is the real problem. The whole family would be much better accommodated in the community. Again the inappropriateness of detention per se is highlighted.

Levenson and Sharma describe the standards adopted by the Royal College of Paediatricians and Child Health as a basis for the care of unaccompanied children seeking asylum.[64] Those standards are in line with the key concepts of the United Nations High Commission for Refugees relating to the care of unaccompanied children.

Children with disabilities

  • Have disabled children been registered and assessed?
  • What is their gender and age?
  • What are the nature and extent of their disabilities?
  • What are the cultural attitudes towards different disabilities?
  • Are families of disabled children provided with help to cope with the specific needs of the child ?

The answers to the above questions will guide the care of disabled children in detention.Further questions arise. It is doubtful whether these questions could be answered in the affirmative.

  • Are steps being taken to allow each disabled child to reach their potential?
  • Are there community-based, family-focused rehabilitation services?
  • Are children with disabilities integrated into the usual services and life of the community, such as schooling?
  • What additional measures are required to ensure the rehabilitation and well-being of refugee children with disabilities?

It is reported that as of February 1, 378 children were residing in detention centres and of these 16 children (or 4.2%) were disabled (Port Hedland and Woomera). [65]

Types of disability include: cerebral palsy, hearing impairment, vision impairment, acute dwarfism, trauma, Perthe's disease (atrophy of the femur), cardiac, asthmatic and genetic disabilities.

According to the National Ethnic Disability Alliance (NEDA), the Department has 'reassured' it that all necessary steps are taken to ensure that the needs of these children are met. However, NEDA is 'totally opposed to any child with a disability being detained in detention centres', especially as detained children are likely to come from a non-English speaking backgrounds. NEDA says such detention is a violation of children's human rights and the organisation is making a submission to HREOC's National Inquiry into Children in Immigration Detention. [66]

Issues related to nutritional status
A comprehensive initial assessment by appropriately qualified staff would identify problems associated with nutrition and procedures could be put in place for ongoing management.

Section 4 covers issues associated with nutrition in detail

Staff and training
The UNHCR Guidelines for the care of children is one of many documents that stress the importance of employing health staff with specific cross-cultural training as well as specific training for working with refugee populations. If trained staff is not available, training must be provided by the institution. The guidelines specify the need for appropriate preventive, public health and curative services. They also stress the importance of appointing women health professionals.

According to our informants, staff members are not appointed on the basis of their training for working with refugee populations, nor is there emphasis on recruiting female personnel. Services provided are solely curative and provided by staff without cross-cultural training and without special training for work in a system that requires management and referral according to relevant protocols. The section of this submission on Culture and the health of children in detention provides details about cross-cultural issues. Staff could also benefit from familiarity with disorders that are common in the home countries of detainees and from special training concerning those disorders. As explained in the introduction to the submission, the CIH staff have worked closely with the Office of the United Nations High Commissioner for Refugees, the World Health Organization, the International Committee of the Red Cross and many non-governmental organisations to develop technical guidelines and conduct training courses for health professionals working with refugees.

It would appear that in Australian detention centres, there are no treatment guidelines or protocols to cover the responsibilities of different levels of staff. Nurses and other middle level health providers are forced to rely on their own individual judgments. Most recruited staff members are trained to work in Australian settings. Although they are committed to their strict Codes of Conduct, many ex staff have reported the difficulties associated with maintaining their own ethical standards in an environment where the highest priority was securing the asylum seekers. It has been reported [67] that nurses are recruited primarily for suitability in a correctional environment.

An ex-detainee described a range of situations where nurses would not allow patients to see a doctor when the patients felt the problem needed a doctor's attention. [68] Staff and ex-detainees have indicated that paracetamol (a mild analgesic) is prescribed for 'everything'

A doctor working at Woomera was concerned that nursing staff were forced out of their depth to supervise procedures that would normally require expert supervision [69]

In reference to the prescription of paracetamol by nurses, nurses are not allowed to prescribe prescription only (S4) drugs so they are legally limited in what they may prescribe and it is clear that this response will not always be appropriate. The use of appropriate transparent treatment guidelines for different levels of staff would overcome problems associated with determining different levels of responsibilities. They would also provide patients with clear expectations of the responsibilities of different levels of health staff. There are many examples of treatment guidelines and training for health workers in refugee settings that could be used as models. The World Health Organisation, for example, provides a range of models. [70] [71]

Evidence of health promotion activity has not been documented although in Woomera, warnings about skin cancer from excessive sun exposure are reported. There has been little shade available and only minimal sunscreen distributed.

There is no evidence of training for staff for detection of outbreaks of problems of public health importance. In the Australian detention context these problems might include respiratory tract infections because people are forced to live indoors in cramped conditions, nutritional disorders because of inappropriate diet or they may include outbreaks of problems that are common in the country of origin but uncommon and unfamiliar in Australia.

Recommendations
Asylum seekers should not be detained. Children particularly, should not be detained but their release from detention must not involve separation from their families. Until a policy of release is in place there must be compliance with basic standards of care for families and children in detention.

It has been shown that community involvement does not seem to be a priority in detention centres. However, refugee community participation could enhance the delivery of the following programs that should be present as a minimum:

  • Family health services with emphasis on women and children's health services and the appointment of women health professionals and involvement of health workers from the refugee community
  • Access to appropriate curative care for common problems
  • Health promotion services with emphasis on women and children's health services
  • Immunisations
  • Appropriate hygiene and sanitation facilities
  • Health education for families with attention to the needs of adolescents for information about STIs. Special attention should be paid to all health services needed by adolescent girls
  • Exclusive appointment of independent appropriately trained staff or provision for relevant training, including cross cultural training, before commencement of duties.

Section 3.
Exploration of cross-cultural issues and barriers to delivering culturally competent services in detention centres

Centre for Culture Ethnicity and Health
Andre Renzaho, Centre for Culture Ethnicity and Health; Demos Krouskos, North Richmond Community Health Centre

Introduction
This section of the submission will address cross-cultural issues related to service delivery in detention centres and how these issues impact upon the health and welfare of children in particular. In exploring these cultural issues, we use the Convention on the Rights of the Child and other international documents to elucidate some specific key issues, supported by accounts from former detainees.

Cross-cultural issues in detention centres
The Centre for Culture Ethnicity and Health (CEH) is concerned with the health and welfare of asylum seekers but of particular interest for this submission are cross-cultural issues related to children in detention centres.

The UNHCR, in its guidelines on applicable criteria and standards for the detention of asylum seekers, refers to detention as:

a mechanism which seeks to address the particular concerns of States related to illegal entry requires the exercise of great caution in its use to ensure that it does not serve to undermine the fundamental principles upon which the regime of international protection is based
Guideline 3. states further that

[detention] should not be used as a punitive or disciplinary measure for illegal entry or presence in the country, and should be avoided for failure to comply with administrative requirements or breach of reception centre, refugee camp, or other institutional restrictions.

The Convention on the Rights of the Child state

The importance of the traditional and cultural values of each people for the protection and harmonious development of the child' must be taken into account
Preamble, Convention on the Rights of the Child

Every child who belongs to an 'ethnic, religious or linguistic' minority or indigenous group has the right, in community with other members of his or her group, to enjoy his or her culture, to profess and practice his or her own religion, or use his or her own language (Article 30).

In those States in which ethnic, religious or linguistic minorities … 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, to profess and practice his or her own religion, or to use his or her own language.
Article 30, Convention on the Rights of the Child.

Children in detention have a history of exposure to war, organised violence and human rights violation and flight. They have often been exposed to their parents' traumatic experiences before arrival in Australia. During incarceration in detention centres they are further exposed to the psychological distress and despair of parents who are not only living outside their culture, but have little control over their lives and are kept unaware of their legal status as refugees. Children are exposed to parents who no longer behave according to their cultural norms. Parental distress and anxiety can seriously disrupt the normal emotional development of their children and can contribute to growing alienation between child and parent. Under normal circumstances, parents provide the primary role model for their children, contributing significantly to the development of their identities and to their acquisition of skills and values. In a detention situation children often lose their role models.

Every society has a unique body of accumulated knowledge, which is reflected in its social and religious beliefs, and ways of interpreting and explaining the world around them. By learning the values and traditions of their culture, children learn how to fit into their family, community and the larger society. Service providers cannot meet the needs of children in detention centres with a 'one fits all' approach.

Living conditions and the integrity of the family
The best way to help refugee children is to help their families, and one of the best ways to help families is to help the community. … Most often, programmes are designed to help the family assist and protect their children and to assist the community in supporting the family and thereby protecting the child. [72]

The child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding.

Preamble, Convention on the Rights of the Child
In detention centres, families are accommodated in an environment that is very different from the cultural environment with which their children are familiar. The family members cannot perform their routine tasks such as planning and undertaking their daily activities. They cannot even be involved in decision making about the food they will eat. Even when both parents are present, their potential for continuing to provide role models for their children is likely to be hampered by the loss of their normal livelihood and pattern of living.

The continuity of experience required for normal childhood development may be further undermined for refugee children when they come into contact with different cultures. In detention centres, the language, religion and customs of other groups in the centres, as well as that of officials and other workers may be quite different from those of the refugee community. In such cross-cultural situations, in particular in the context of detention, children 'lose' their cultural identity more quickly than adults.

Family relationships and dynamics

  • Are children living with their respective families as a whole?
  • Do detention centres offer an environment that enable parents to provide culturally appropriate care for their children?
  • What is the impact of general living arrangements and social organisation of detention centres on the care of children?

The preamble of the Convention on the Rights of the Children recognises that

the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding

Factors such as seeing their parents involved in hunger strikes, exposure to verbal harassment, exchanges between adult detainees and ACM staff, the remoteness of certain detention centres and extremes of weather create an environment in sharp contrast with an atmosphere of happiness, love and understanding.

The emotional and mental distress associated with the above conditions interfere with children's physical, intellectual, psychological, cultural and social development. It is illustrated by one of the pleading notes from children. [73]

It is clear that detention centres violate Article 39 of the Convention on the Rights of the Child which specifies that:
States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self-respect and dignity of the child.

Such an environment also violates Articles 18.2 of the Convention on the Rights of the Child which stipulates
For the purpose of guaranteeing and promoting the rights set forth in the present Convention, States Parties shall render appropriate assistance to parents and legal guardians in the performance of their child-rearing responsibilities and shall ensure the development of institutions, facilities and services for the care of children.

Dehumanisation
The culture of detention centres can have a dehumanising effect on both the detainees and staff. Many ex staff have reported the difficulties associated with maintaining their own ethical standards in an environment where the highest priority was securing the asylum seekers and there are reports of other staff who, isolated from the influence of their own standards, fit in more with the culture of detention. The wide use of numbers rather than names for detainees is just one of many factors that contribute to dehumanisation of individuals.

Children's right to a name is connected with their identity and must be respected always, including through registration and record-keeping in Australia. A teacher at Port Hedland told how children replied with their numbers when she asked their names. [74] The practice of using numbers rather than names when referring to or addressing detainees has been reported widely. The issue was followed up with the Minister, Mr Ruddock, on April 10.[75] He stated that use of the number in place of a name contravened his instructions to service providers.

Article 8 of the CRC:

1. States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations as recognized by law without unlawful interference.
2. Where a child is illegally deprived of some or all of the elements of his or her identity, States Parties shall provide appropriate assistance and protection, with a view to re-establishing speedily his or her identity.

Preservation of religion
Children must be able to profess and practise their religion. They must also be able to use their own language. Both these rights must be able to be exercised not only in the child's immediate family circle, but also in conjunction with members of the child's community. [76]

Religion includes theistic and non-theistic beliefs. It is important that the child is able to renew religious and ritual practices which may have been disrupted during refugee or migrant movement. These practices are important physical manifestations of the child's culture and assist in preserving the identity of the child. The UNHCR stresses the benefit to community mental health of festivals and rites of passage:

Religious festivals and rites of passage such as birth, transition into adulthood, marriage and death are extremely important in unifying a community and in conferring identity on its individual members. The importance of such activities to community mental health should not be underestimated. For example, the provision of extra food for communal meals, or other material assistance for funerals (burial cloths, coffins, firewood, etc.) can give vital emotional support and sustain culture through a crisis. [77]

There is evidence that some religious practitioners have visited detention centres but they have been mainly Christian. Although their visits have been appreciated, we do not believe this response to be the most appropriate. [78]

In order to practice their religion [79] along with other members of their group, a child should have access to 'books and other items of religious observance and instruction and a diet in keeping with his or her religion' They should be allowed to attend regular religious services. Parents' responsibilities in ensuring their children receive appropriate teaching and practice should be specifically recognised. There may be qualified religious representatives among the detainees who should be encouraged to support their communities.

Preservation of language
Language is an important element of a child's identity and any loss of the child's first language may have long-term consequences for the child. [80] Child asylum seekers must be able to retain and, where necessary, become literate in their mother tongue, in addition to learning the local language. While children's rights to use their own language under the Convention may not necessarily include being taught entirely in that language, it may require that part of their education be in their first language, particularly for young children. [81]

Although the communities in detention centres reflect most facets of a common community - there are teachers, lawyers, health workers, etc. skills within the community are rarely beneficially employed. The UN guidelines recommend that community members who know and can help their communities be integrated into the health delivery system. Others who can contribute are teachers including language teachers, child care workers and community leaders. In addition, children's participation in planning and developing their own activities is crucial.

Nutritional considerations
The relationship between health, culture and food is discussed in detail in Section 4. Serious micronutrient deficiencies in child asylum seekers may be the result of the child not having access to a balanced diet of culturally acceptable food. This situation may be the result of inability of family members to contribute to food preparation, or not being able to fulfil cultural or religious practices surrounding food preparation and consumption or inappropriate or unpalatable food provided institutionally.

The environment in which the child is detained must meet some cultural requirements to allow the child to participate and to promote growth and development. Be it playgrounds, family relationships or family commensality, they must be as familiar as possible to the child's cultural environment. In detention centres, design of menus, playground facilities, and the family environment may not necessarily meet certain cultural norms of children from specific ethnic backgrounds.

Children's participation in and equity of access to services in detention centres
The participation of children capable of forming their own views in decision-making is a central theme of the Convention.[82] Positive measures may be needed to ensure child asylum seekers are heard and their needs met.

Article 12, point 1 and 2, of the Convention on the Rights of the Child stipulates that:

12.1 States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.
12.2. For this purpose, the child shall in particular be provided the opportunity to be heard in any judicial and administrative proceedings affecting the child, either directly, or through a representative or an appropriate body, in a manner consistent with the procedural rules of national law.
There are several points in the Convention on the Rights of the Child that repeat children's right to participation. Indeed, participation is one of the Convention's key values but remains one of the basic challenges for signatories of the Convention.

The Convention on the Rights of the Child has re-emphasised the importance for children to have the right to participate in decision-making processes that may be significant in their lives and to affect decisions taken in their regard at family, school or community levels. However, there are a myriad of cultural factors that may inhibit the implementation of processes that promote children's rights with particular attention to freedom of expression and participation in decision-making. Unless providers responsible for detention centres are aware of these cultural factors, the right of the child to participate in decision-making is violated. As Manderson [83] puts it:

Culture is patterned; it is not arbitrary. It involves ritual actions, shared understandings and expectations. Cultural rules govern the most ordinary actions including those actions which we take for granted and that affect our health: how we eat, eliminate, rest, and recreate.
People in detention centres come from different ethnic backgrounds and do not share the same cultural values. In some cultures, girls are often more vulnerable, less valued and more subject to neglect and abuse than boys. Staff in detention centres may be unaware of these possible factors that could contribute to less health seeking behaviour on the part of or on behalf of girls
. Carol Bellamy, UNICEF Executive Director stated:
Deprived of the opportunity to receive an education and to participate in their societies as equals to men, millions of girls are relegated to subsistence and domestic chores instead of attending school and building a future. At the same time, the widespread undervaluing of girls and women is evidenced by their denial of access to basic health care.
It may be necessary for culturally trained staff to actively promote and support health promotions and interventions aimed at girls in detention centres.
Sexual and Reproductive Health
Adolescent boys and girls in any culture can have problems associated with their sexuality and reproductive health. Where the traditional cultural support has been weakened because of the despair and frustration of parents, adolescents can be faced with seemingly insurmountable problems.

Female reproductive issues
Among the groups currently in detention centres are young females from cultures where genital infibulation or circumcision is practised. This practice has been termed female genital mutilation in the western world and is the medically unnecessary modification by cutting and stitching of female genitalia. In many societies, particularly from the Horn of Africa and the Middle East, it is considered an important cultural practice. The procedure typically occurs at about 7 years of age, but women suffer severe medical complications throughout their adult lives. Adolescent girls who have undergone this procedure are much more at risk of urinary tract infections than 'normal' adolescent girls. Young girls in any culture are often shy to consult health professionals, particularly about reproductive issues. For these young girls, consultation with a health practitioner who has not been culturally prepared can be particularly traumatic. The reaction of the health practitioner can be, often unconsciously, quite judgmental. Although interventions to prevent the continuation of this practice are important, it is not the place of the health professional to challenge patients consciously or subconsciously about the practice. A negative reaction can deter young women from seeking medical help and therefore exacerbate potentially dangerous conditions as well as causing further cultural alienation. This example further underlines the extreme importance of cross cultural training for health professionals working with asylum seekers.

Afghan women have come from a culture where they were denied access to health care if there were no female health professionals available. It is important that female health professionals are available in Australian facilities because these women may accept health care from a female professional better than from a male.

Several informants have described the process of accessing sanitary napkins. Women have to go through a tedious process of filling a form including the date and time, and other personal details and submit the form to a particular person at a particular time. They are supplied with ten pads and face possible questioning by a staff member, who is not always a woman, if more are needed. [86]

The above examples of intimidating service provision for women would be even more intimidating for adolescent girls.

Staff and service provision
It is paramount that children in detention have access to culturally appropriate care. Services should be provided with careful attention to the language, culture, and developmental stage of each child. Direct service providers of the same ethnic background would enhance the access of children to services in detention centres. For details regarding staff training see Section 2.

Communication
The process of getting a message across in an environment characterised by ethnic, cultural and linguistic diversity such as detention centres is vulnerable to hitches and malfunction. Indeed the access to and utilisation of available services is dependent upon effective communication and a common value-base. Linguistic and cultural barriers can combine to prevent children accessing and utilising the most basic services for growth and development. Some of the communication problems that are likely to occur in detention centres include:

  • Participation in conversation: some children are bound to communication rules by their cultures. In some cultures for example, children cannot interject during a dialogue nor can they ask questions. This limit children's capacity to express their needs or request help.
  • Intonation: Intonation patterns have different cultural connotations. For example, the rising tone at the end of a sentence which characterises the Australian English has the potential to be misinterpreted by some culture as 'being angry' and in some other as 'asking a question', and hence creating confusion and communication breakdown.
  • Difficulties with communicating in English: Access to providers who speak their languages and who understand their cultures is crucial.

Use of interpreters
The effectiveness of interpreting services is dependent on whether the organisation has measures in place, such as use of interpreting guidelines or a policy requiring competence in staff concerning working with interpreters.

Commonly, when interpreters from the detainee community are used, they will be men rather than women because men are more likely to speak English. This situation can impact on women's or children's willingness to freely discuss some health or domestic issues with health care providers. The use of family and community members as translators is inappropriate because of issues of confidentiality and quality so must be discouraged.

The presence of quality assurance mechanisms for translation services and ongoing training of staff on how to work with interpreters should be part of the accreditation procedures or organisations working with asylum seekers.

Cultural competence and its significance
What is Cultural Competence?
Cultural competence in health care is defined as the ability of individuals and systems to respond respectfully and effectively to people of all cultures, in a manner that affirms the worth and preserves the dignity of individuals, families, and communities. Cultural Competence is a crucial skill for health care providers, who deal daily with diverse people.
The culturally competent health provider, for example:

  • has the knowledge to make an accurate health assessment, one which takes into consideration a patient's background and culture
  • has the ability to convey that assessment to the patient, to recognize culture-based beliefs about health and to devise treatment plans which respect those beliefs
  • is willing to incorporate models of health and health care delivery from a variety of cultures into the biomedical framework

To be culturally competent, a provider should acknowledge culture's profound effect on health outcomes and should be willing to learn more about this powerful interaction.

Much has been written about the hazards of ignoring cultural factors in diagnosis and treatment of immigrant patients. Other research documents the fact that culturally competent care improves diagnostic accuracy and increases adherence to recommended treatment. [87]

The following questions are of concern

  • Are children provided with culturally appropriate opportunities to talk about concerns, ideas and questions that they may have?
  • Are there detainees who could provide regular cultural activities for children such as non-formal education, play and recreation?
  • Are providers and management personnel working in detention centres cross-culturally trained?
  • Have adolescent women been consulted and their cultural practices respected in the design and delivery of services, eg health promotion activities?
  • Is the food provided culturally and socially acceptable, palatable and digestible?
  • Is the recruitment of health and community workers gender balanced and culturally appropriate?
  • Do facilities for children meet accepted cultural norms?

The preamble to the Convention of the Rights of the Child underlines the importance of the traditions and cultural values of each people, for the protection and harmonious development of the child. At the individual staff level, the HREOC inquiry must look at the dynamics of personal assumptions, biases, prejudice, stereotypes, expectations and perceptions, past experiences and feelings of individual staff in the service organisation. At the organisational level, the inquiry must look at the culture, leadership, work structure, contractual agreements, and policies and procedures or practices of organisation involved in the care of asylum seekers. The inquiry should particularly address the following questions:

  • What are the broader diversity and cross-cultural challenges facing the organisation?
  • What are the organisation's initiatives and responses to these challenges?
  • Are responses to the challenges being dealt with by the organisation in a systemic fashion
  • requiring cross cultural competence as part of their own accreditation?
  • providing cross-cultural training, to all staff rather than individual staff?
  • How do the organisation's leaders and employees perceive diversity? As a human resource intervention? As a skill development or educational intervention? As a public relation effort? As a way to avoid discrimination, abuse, maltreatment of children in detention centres

Steps toward cultural competence
Those who seek to standardise a culture's beliefs and practices are dealing in stereotypes. Nevertheless, there are steps we can all take to improve the level of cultural competence in care facilities.

  • Involve immigrants in their own care
  • Learn more about culture, starting with your own
  • Speak the language, or use a trained interpreter
  • Ask the right questions and look for answers

A change in organisational strategy is paramount in trying to address the needs of diverse groups such as children in detention centres. They are born to parents from different backgrounds and service providers need to be aware that they cannot meet the needs of children in detention centres with a 'one fits all' approach. The principle of diversity stipulates that having policies in place is not enough. Organisations must ensure that all of their leaders are proactively working to create and lead a respectful workplace, one free from abuse, harassment and discrimination and one that promotes cultural harmony.

Although the communities in detention centres reflect a range of members of a common community including teachers, lawyers and health workers, skills within the community are rarely beneficially employed. The UN guidelines recommend that community members who know and can help their communities be integrated into the service delivery system. Members who can contribute include health workers, teachers, child care workers, religious leaders and community leaders.

Recommendations

  • Restore cultural normalcy. Children should not be accommodated in detention centres. With their families, they should be housed in the community.

The social and mental well-being of all refugees, but particularly of refugee children, can be most effectively assured by the quick re-establishment of normal community life. [88]

  • Ensure cultural competency of staff and officials through accreditation procedures and ongoing cross cultural training.
  • Ensure quality assurance mechanisms and ongoing training of staff on how to work with interpreters as part of the accreditation procedures for organisations working with asylum seekers.
  • Employ accredited interpreters exclusively.
  • Involve members of the asylum seekers community in programs and education for children, including religious programs. The presence of these sorts of programs can be very beneficial for the physical and mental health and development of children.
  • Ensure the presence of mechanisms to prevent officials or members of other groups reacting in a negative manner to the cultural or religious beliefs and practices of detainees, particularly children
  • Cultural considerations must be taken into account with respect to food type, preparation and serving, particularly considering the traditional roles of family members in relation to the child's food. It is therefore vital that children in immigration detention are provided with food that is culturally and religiously appropriate and that it is possible for the child's family members to prepare and serve the food in accordance with the family's cultural practices, including appropriate times of day.

Section 4.
Nutritional issues associated with mandatory detention of refugee children
School of Health Sciences, Faculty of Health and Behavioural Sciences, Deakin University, Melbourne
Cate Burns
The appropriateness of the food and nutrition enjoyed or otherwise by asylum seekers in detention can be measured against several benchmarks. These standards are

  • food is a human right,
  • provision of adequate food for healthy growth and physical, social and psychological well being,
  • food must be safe to eat and
  • food must be culturally appropriate.

It remains to be determined whether food and nutritional status of children in detention meets these standards.
Let us first outline the food and nutrition standards sanctioned by the UN which have been agreed to by the Australian Commonwealth Government and standards set down by Correctional Authorities in Australia.

Food Security
Everyone, adult and child, should be food secure. Food security incorporates not only the notion of nutritional adequacy but also hygiene, cultural appropriateness and acquisition of food in a manner that is consistent with human dignity. Food security is thus defined as;

Access by all people at all times to enough food for an active, healthy life. Food security includes at a minimum: the ready availability of nutritionally adequate and safe foods, and an assured ability to acquire acceptable foods in socially acceptable ways (eg, without resorting to emergency food supplies, scavenging, stealing, or other coping strategies). [89]

Right to health - Nutrition a core obligation
The International Committee on Economic, Social and Cultural Rights (ICESCR) has identified six core obligations on the right to health under Article 12, which 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 Article states that juveniles deprived of their liberty and refugee children must receive food that meets their nutritional needs and basic requirements of hygiene.

Rights of the Child - Nutritious, culturally appropriate food and adequate water

The Convention on the Rights of the Child states that upmost measures should be taken to provide children with nutritionally adequate food to prevent malnutrition. The Convention goes further to insist that children should enjoy the highest standard of health (and nutrition) rather than merely the absence of disease (or malnutrition). The Convention also states that children have the right to enjoy their culture and religion and therefore the right to eat culturally appropriate foods, served in culturally appropriate ways. The Convention states the children must have an adequate supply of clean water.

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. [90]

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. [91]

States Parties shall pursue full implementation of [the right to health] and, in particular, shall take appropriate measures… to combat disease and malnutrition… through the provision of adequate … clean drinking-water, taking into consideration the dangers and risks of environmental pollution. [92]

Food and Nutrition

The UNHCR Guidelines for the Care and Protection of Children (1994) provides a checklist related to food and food provision. The following questions are relevant in the Australian detention context:

  • Are children receiving adequate quantity and quality of food?
  • Is food provided culturally and socially acceptable, palatable and digestible?
  • Have nutrition monitoring and surveillance systems been set up?
  • Is there evidence of any deficiency diseases among children, especially girls, or among pregnant or lactating women?
  • Is breast-feeding being promoted and the use of bottles discouraged?
  • Is the use of milk products being monitored and adhered to according to UNHCR (or appropriate) policy?
  • Are appropriate measures being taken to prevent and reduce micro-nutrient deficiencies?
  • Is there a need for training of nutrition staff in carrying out necessary interventions?

These issues are addressed in the following part of the submission.

Australian Standards
Australasian Standards for Juvenile Custodial Facilities
In Australia the standards have been set for the provision of food for juveniles in detention. These Standards most closely pertain to the situation of refugee children in detention. Australasian Correctional Management, the company running detention centres for the Australian Government, falls under the jurisdiction of these Standards. The Australasian standards for juveniles in custodial care are based on UN rules for the Protection of Juveniles Deprived of their Liberty. The Australasian Standards state:

Young people are provided with a variety of foods of satisfactory quality in sufficient quantities; meals are nutritious, meet special dietary needs, and their choice and preparation is influenced by young people's preferences

Sample Indicators [93]

A. Policy, procedure and practices in relation to food preparation and nutrition are consistent, and reflect the standard
B. Food services comply with applicable sanitation and health codes
C. Young people report satisfaction with the centre's food services
D. Cultural and age-appropriate diets are provided, and religious requirements are observed.

Using the rights of children with respect to food and nutrition as a framework we will test reports of food provision and intake by children in detention to determine whether their physical, social and cultural needs are being met. Unfortunately we do not have direct access to observe either the food provided or the consumption of that food by the children. We have therefore relied on the reports of observers.

Physical needs
Safe food

Sometimes the meat served in Woomera was rotten and people fell ill and had to be admitted to hospital [94]

This report of 'rotten' food is indicative of microbiological contamination of the food served in detention.

We have no way of knowing whether in fact, it was rotten. However, with meals one of the few events to break up the monotony of the unstructured meaningless days in detention, and where there is no control over any other aspects of life, it is not surprising that food becomes the focus of dissatisfaction.

Complaints about food have been echoed by all ex-detainees and ex-staff we have interviewed. Mares [95] describes the situation at Port Hedland that resulted in marked improvement of the food situation and the morale of detainees. Innovations by the catering manager allowed food to be planned and prepared by chosen representatives of the cultural groups.

However, microbiological contamination, particularly by food handlers, is the greatest food safety risk. This causes food poisoning from infection or toxins produced by the contaminant organism. Any reported instance of food poisoning, particularly of a severity to require hospitalisation indicates poor food hygiene practices in food service to detainees. Food Service in institutions must comply with Hazard Analysis and Critical Control Point (HACCP) system to maintain food hygiene and safety. The consequences of food poisoning in children may be life threatening. Food poisoning can cause fever, vomiting, diarrhoea and gastro-intestinal upset which will lead to dehydration. The smaller the child and the hotter the ambient temperature more likely it is that food poisoning will cause dehydration and cardiac-failure.

Authorities should be alert to the potentially serious consequences of infections and diarrhoea in marginally nourished children

Nutritional needs
Status on arrival

Asylum Seekers coming to Australia from countries in Africa, Former Yugoslavia and Middle East may have experienced nutritional deficiencies in their countries of origin or during travelling. Many of these countries have been identified by the WHO as low-income food deficit countries (LIFDC) where indices of food insufficiency, principally undernutrition among children under 5 years, are high. [96] 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. The nutritional status of refugees in both camp settings and in non-camp settings has been characterised as poor. [97] [98] An appropriate initial health assessment as described in Section 2 would identify any problems associated with nutritional status and provide guidelines for ongoing management.

Food has critical nutritional, cultural and social dimensions for the well being and development of all children. According to the World Declaration and Plan of Action for Nutrition, children are the most nutritionally vulnerable group of people in the world. Specific requirements, updated for children who live in refugee camps and developing countries have been extensively documented. Any provision of food for children in detention must at least reach these standards [99] [100] [101] [102]

Long term nutrition and food needs

The following reports indicate that predictably, in the absence of appropriate food in detention centres, parents have been purchasing snacks which are both costly and nutrient-poor. Some children in detention eat poorly and lose weight. According to an ex-detainee [103]

Most of the children hated the food that was given at the detention centre

Because of this they lived on chips and sweets which were expensive, but the parents bought them if they could afford to 15 packs of chips cost $5

Children lost a considerable amount of weight

The maintenance of appropriate nutritional standards is vital to the normal healthy development of every child. The nutritional adequacy of a child's diet can be measured against the Recommended Dietary Intakes RDI.[104] Micro-nutrient deficiencies may be caused by conditions in the child's country of origin, the often long and arduous journey to Australia and the unfamiliar food and conditions upon arrival in Australia. If child asylum seekers are eating a diet that is nutritionally adequate according to the Australian RDI this will alleviate any nutrient deficiency.

Children and adolescents need energy for growth, work and play. During the growths spurts of early childhood and adolescence energy and nutrient needs are higher than for young adults. Adolescents actually have the highest nutrient requirements overall. For example the energy requirements for a 1 year old child are 435kJ/kg and for an adult 130kJ/kg. 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. Therefore they require a more frequent food 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.

Three meals a day are served in detention centres and this routine may be quite appropriate for adults. However, it is recommended that children under 5 years eat a smaller amount in about five meals per day because their stomachs are smaller. [105] [106] [107]

Some of the practical issues of feeding children have to be taken into consideration. The practical issues include children's small capacity, 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 is no evidence that any of these factors have been taken into consideration in the facilities where these children have been detained. It should be noted that the experience of providing adequate and appropriate food at the Safe Havens led the responsible authorities to make the following recommendations:

  • monitoring of children's choices
  • creation of 'family friendly' eating environment
  • availability of between-meal foods
  • attention to infant feeding practices.

There is no evidence that the experience of the Safe Havens with respect to food and children has been heeded. The children who are currently detained have the same needs and problems as the children who spent time in the Safe Havens.

It is reported that snacking foods like milk, fruit, biscuits have not been available in detention centres throughout the day and when requested only given in limited quantity, but children are reported to be eating nutrient poor snacks such as chips and sweets.

There is evidence that some children became overweight in detention centres from eating excessive quantities of high calorie purchased snacks or sweets provided by visitors. [108] This consumption of food other than that provided indicates that the food was not culturally appropriate nor appropriate to the needs and wants of children.

In some detention centres, visitors provide some extra food for families but they are only allowed to bring in two plastic take-away containers per visitor. Rooms are frequently searched and possessions such as gifts of food may be confiscated arbitrarily by the guards. However, it is also unlikely that these contributions would foster a balanced diet. [109]

Children and adolescents require nutrient-dense meals and snacks, ie not 'empty-kilojoules' foods. Table 1 gives the relative energy and nutrient quantity for a selection of both nutritious and non-nutritious snacks. Those snacks which were reported to have been consumed by the children in detention have been highlighted. It is apparent from Table 1 that the highlighted foods contain kilojoules but not much else. They can be considered as 'sometimes' foods but should not make up a large part of a child's diet. Healthy alternatives (some suggestions listed) should be made available to children throughout the day.

Table 1. Energy content and nutrient density of snack foods

Food Energy(kJ) Calcium mg Iron mg Vitamin A (ug) Vitamin C (mg)
Milk (250ml) 700 310 0.1 78 3
Fruit Bun 1 850 75 1.0 2 0
Banana(1) 250 20 0.20 12 3
Orange Juice (300ml) 350 5 0.17 11 20
Rice pudding(1 cup) 1200 280 0.1 25 0
Potato crisps (30g) 700 2 0.08 0 0
Sweet biscuits (2) 600 1 0.05 0 0
Soft drink (375ml) 655 0 0 0 0
Cordial (300ml) 350 1 0 0 0
BBQ Snacks (50g) 1030 14 0.6 7 0

As important as the availability of nutritious meals and snacks for children is the participation of their parents in the choice of foods and even food preparation. We discuss this again later. But at this point it must be emphasised that the choice of foods for children must not only be nutritionally appropriate but also appropriate to their culture. The selection of foods should be made in consultation with parents to ensure that the children can be encouraged to eat foods they like and to which they are accustomed.

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.

Exposure to sunlight (Vitamin D status)
There is evidence that children in detention have limited exposure to sunlight. Under-exposure to sunlight has implications for Vitamin D status. Children are born with approximately 9 months reserve. Clinicians working in the community with refugee children from Middle Eastern countries have reported concern about symptoms of rickets (manifestation of Vitamin D deficiency). [110] An appropriate initial assessment would identify manifestations of nutritional deficiencies in children on arrival and mechanisms for ongoing management could be put in place. Providing access to appropriate play areas with adequate exposure to sunlight would be an obvious action.

The nutritional needs of pregnant women and mothers and infants
A range of sources including staff, visitors and ex-detainees have provided information that supports the following statements:

  • After delivery no special advice is given regarding breastfeeding
  • Mother and Child Health services are not provided
  • There is too much bureaucracy involved in accessing any infant formulae
  • There are no proper nutrition or health services for children under one
  • Mother and Child Health (MCH) services, if available, would provide advice about weaning. Age appropriate weaning foods should be available
  • Some parents do give their infants cow's milk after 6 months
  • No advise regarding feeding is available
  • There are no weaning foods
  • A family is allowed 2 litres of milk each week and it is left to the family how this is distributed. Some mothers do feed their infants with milk that is rationed

Our sources [111] also indicated there were no facilities for boiling and preparing milk for infants.

The Plan of Action arising out of the 1990 World Summit for Children states that '[m]aternal health, nutrition and education are important for the survival and well-being of women in their own right and are key determinants of the health and well-being of the child in early infancy.' [112] Australia is obliged under Article 24(2)(d) of the Convention to 'ensure appropriate pre-natal and post-natal care for mothers'. [113] 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. [114] Mothers also have increased nutritional needs whilst breastfeeding and may need education and encouragement to breastfeed their babies. The World Health Organisation recommends exclusive breastfeeding for six months, with introduction of complementary foods and continued breastfeeding thereafter as an important aspect of a baby's diet.[115] It is reported that age-appropriate complementary foods for babies between 6 and 12 months and for toddlers are not available.

Water

Water for washing and drinking was only available in the toilets but towards the end of her stay, they were given small tanks nearby that stored drinking water.

(Source 2) Water ran hot because the pipes were in the sun. People tried to run the water long enough for it to cool but got into trouble for wasting the water. After that the water was turned off during the day time. [116]

There is evidence that the supply of water may be compromised in the detention centres. A major factor affecting the health of children as well as adults is the availability of clean water. The human body comprises 50-60% water. Infants are more at risk than adults because they have a greater surface area to body volume and a higher metabolic rate.

Australia is obliged under the Convention to provide every child in immigration detention with adequate clean drinking water. The drinking water provided to children in immigration detention should be readily available and easily accessible at all times. The UNHCR recommends that a minimum of twenty litres of drinkable water is required for each person every day for cooking and drinking.

Social, cultural and psychological needs

  • Family eating - social skills with food, mother/child bonding
  • One parent had to stay behind to take care of the kids while the other went to eat
  • This meant that on most days families did not eat together
  • Many of the children were aggressive, irrational and crying most of the time
  • They were unhappy children
  • They were disobedient and craved for attention
  • Mothers .. were often so frustrated just being in detention that they took out their frustrations on their children in many ways [117]

Food and culture

The importance of food, friendship and communication has been enshrined in proverbs and sayings. [118]

Communication and food are the things that one lives by

Somali proverb

Give the guest food to eat even though yourself are starving

Arabic saying

Food is a universal medium for expressing sociability and hospitality. Food serves an important social function. It is offered as a gesture of friendship; the more elaborate the fare, the greater the implied intimacy or degree of esteem. In detention, detainees are denied the right or ability to enjoy the social benefits of taking food and sharing food. The eating environment is not conducive to social exchange. The service of food is not consistent with custom or social exchange. Fieldhouse explains that in many cultures (specifically those from which detainees come) to not provide food is to fail socially and thus lose status. This situation also undermines the cultural role models that provide children with security.

In order that children develop positive attitudes to eating and meal times their behaviour should be modelled on positive behaviours of the parents. In situations where food resources are scarce (or unappealing) and where children are reared in an atmosphere of anxiety and deprivation a negative predisposition to sharing food is created. [119]

There are many benefits of establishing a healthy feeding relationship between parent and child. [120] Satter states that an appropriate feeding relationship supports a child's developmental tasks and helps the child to develop positive self-esteem. It helps the child to learn to discriminate between feeding cues and respond appropriately to them. It enhances the child's ability to consume a nutritionally adequate diet and to regulate the quantity of food consumed. These premises are supported by extensive research. [121] There may be tremendous cultural variability with respect to the degree of control care givers exert over food consumption in infants and children. [122] According to Dettwyler, it has been noted that parent-child power relationships are usually established around the control of food consumption. Parental authority and children's obedience to and respect for their parents are major values within many traditional cultures. Hence the effect of detention on the parent-child food relationship may heighten these power relationships or go beyond a relationship either positive or negative to neglect as parental depression or anxiety worsens. In either case there will be a detrimental effect on the child's food intake.

Links between food and mental health
It has been observed that as the period of detention increases parents become depressed and anxious. This anxiety and depression impacts on their children's eating habits both by increasing psychological distress of children and also by impairing the parent's ability to eat with and feed their children. See also Section 1 of this submission.

There is a strong literature linking food and mental health. Ancel Keys [123] and his colleagues at the University of Minnesota in 1945 carried out experiments in which they starved conscientious objectors. This food deprivation had a dramatic negative on psychological well-being. The devastating effects that starvation and hunger have had on the physical, social and mental well-being of millions of children and adults is well-documented in developing countries. [124]

Detainees' lack of control of food selection and preparation is one of the biggest contributors to frustration in an environment that not only lacks structure but provides no indication of the outcome of the situation in which the asylum seekers are forced to live.

Detention has been shown to reduce appetite. This effect is probably due to anxiety and depression. Consistent with this effect is weight loss. In detention poor food intake has been noted in both parents and children. It has been observed that children have lost weight. On the other hand, there are cases where compulsive eating has been a result of depression and there are reports of detainees, including children, arriving at a healthy weight but becoming overweight and lethargic after prolonged detention. [125]

Eating well and in company has been shown to improve psychological well-being. [126] As has been noted family commensality, ie eating together has been shown to have a strong relationship with social and scholastic success of children. [127]

It has been noted across many cultures that when food is scarce women often do without, to the detriment of their health and strength, in order to ensure that their children received adequate nourishment. It is a mark then of the stress under which female detainees suffer that their anxiety in detention overrides normal mothering behaviour.

Cultural aspects of food service

  • Food served was rice which was not properly cooked, boiled vegetables and meat.
  • None of the people enjoyed it because it was prepared badly
  • Some of the women helped in cleaning and chopping but not cooking the meal itself
  • They were told the meat was halal but wondered [128] I wouldn't feed that food to a dog [129]

In addition to meeting physical needs to refugees, food is of great cultural and social significance. [130]

It has been observed in the detention centres that the food provided is not culturally appropriate or served in culturally sensitive manner. Cultural considerations must be taken into account with respect to food type, preparation and serving, particularly considering the traditional roles of family members in relation to the child's food. It is therefore vital that children in immigration detention are provided with food that is culturally and religiously appropriate and that it is possible for the child's family members to prepare and serve the food in accordance with the family's cultural practices (including appropriate times of day).

Patterns of food preparation, distribution and consumption reflect the dominant type of social relationships in a society. Food is a language for a culture. They are expressions of status and social distance, of political power and of family bonds. Food is extensively used in social intercourse as a means of expressing friendship and respect. This is evident in both developed and developing countries. However, practices associated with food may be more important in cultures from developing countries where the tradition has a strong influence. There is no culture that promotes solitary eating. Eating and eating together improves social well-being. Furthermore the significance of culturally appropriate foods may be heightened for refugees, more so for those in detention. Food may become focus for anger and unrest. This experience was notable in the Safe Havens. In the Victorian Safe Havens at Puckapunyal and Portsea food intake and morale improved with a 'family friendly' environment in dining room with order of service consistent with custom and with family needs.

In many traditional cultures women have a primary role in food getting and preparation. Food preparation confirms women's place in household and social expectations are fulfilled.[131] It could be argued that feeding literally produces family. The importance of the 'normal' family roles is discussed in Section 3.

Initial assessment of nutritional status / growth monitoring

Initial medical assessment did NOT include assessment of children by a child specialist. There was nothing specific for children like assessment of development etc ….. [132]

The Child Health Nurse visiting Maribyrnong reports no weights or heights taken on children [133]

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 careful ongoing monitoring of any micronutrient deficiencies that the child may have. The initial assessment is discussed in detail in Section 2.

Conclusions

Children and their families should be accommodated in the community where they can make their own decisions about food purchases and preparation.While children remain in custody:

  • There should be consultation with parents to ensure food is culturally appropriate.
  • They require adequate quantity and quality of food and frequency of food intake.
  • Food provided must be culturally and socially acceptable, palatable and digestible and served at appropriate times.
  • The community must be involved in decisions about the type of food that would be acceptable and in the preparation of food.
  • Nutrition monitoring and surveillance systems must be established and mechanisms put in place for ongoing management of nutrition-related problems including deficiency diseases among children, especially girls, or among pregnant or lactating women.
  • Breast-feeding must be promoted and supported and where breast feeding is not possible adequate professional support must be available to promote appropriate feeding practices.
  • The use of infant feeding bottles should be discouraged.
  • The use of milk products must be monitored according to UNHCR (or appropriate) policy.
  • Weaning foods for babies between 6 and 12 months must be available together with age-appropriate, culturally appropriate food for toddlers.
  • Appointed staff need expertise in nutrition including the cultural aspects of food and nutrition monitoring.

1. Williams E. Foreign Correspondent. ABC TV April 17, 2002.
2. Centres for Disease Control. Famine affected, refugee and displaced populations, Recommendations for public health issues. MMWR 1992. 41 (RR 13).
3. Toole MJ, Waldman R. Prevention of excess mortality in refugees and displaced populations in developing countries. JAMA 1990. 163 (24): 3296-302.
4. UNHCR Guidelines on Protection and Care (1994), ch 2.
5. UNHCR's Guidelines on Applicable Criteria and Standards relating to the Detention of Asylum-Seekers February 1999.
6. Toole MJ, Waldman R. Refugees and displaced persons. Journal of the American Medical Association 1993 270 (5): 600-605
7. Rahman S. Comment on Lateline, ABC TV 19/3/2002. (A panel of psychiatrists and psychologists were discussing the impact of detention on asylum seekers with Margot O'Neill)
8. Dudley M. ABC 774 PM 22/01/02
9. New South Wales Department of Juvenile Justice. Australasian Juvenile Justice Administrators: Standards for Juvenile Custodial Facilities , 1999
10. PM, ABC Radio March 30, 2002
11. Sultan A, O'Sullivan K. Psychologial disturbances in asylum seekers held in long term detention: a participant-observer account. MJA 2001, 175: 587 - 589.
12. Steel Z, Silove D. The mental health implications if detaining asylum seekers. MJA 2001; 175: 596-599.
13. This account of the dimensions of the detention experience draws extensively upon A. Sultan and K. O'Sullivan, 'Psychological disturbances in asylum seekers held in long term detention: a participant-observer account', in Medical Journal of Australia [MJA] 2001; 175: 593 - 596; Tony Stephens, 'Barbed-wire playground', Sydney Morning Herald 15 December 2001, citing the findings of Dr Michael Dudley, a senior lecturer in psychiatry, reporting on the exposure of children to intimidating conditions at a conference on refugees in early December.
14. Lucy Clark. 'When we do nothing about child abuse', Daily Telegraph 8 February 2002
15. Lucy Clark. 'When we do nothing about child abuse', Daily Telegraph 8 February 2002
16. Personal communication from ex detainees as reported to Beverley Snell, Centre for International Health, Macfarlane Burnet Institute for Medical Research and Public Health; Sultan and O'Sullivan, op cit; Chilout, 'Here is not for Children', www.chilout.org.1e.htm (accessed on 14.02.2002)
17. Reported in Z. Steel and D. Silove, 'The mental health implications of detaining asylum seekers' in MJA 2001; 175: 596 - 599.
18. Sultan A, O'Sullivan K. Psychologial disturbances in asylum seekers held in long term detention: a participant-observer account. MJA 2001, 175: 587 - 589.
19. S. K. Phillips. 'Multiculturalism, advocacy and mental health: The connections between cultural diversity and social wellbeing', Paper delivered at 'Thinking Well - Mental Health and Wellbeing: Everybody's Business' Conference, Preston, 20 - 21 September 2001: 6.
20. Peter Stephens reports on the case of Shayan Bardraie, an Iranian refugee boy who has been separated from his parents at the Villawood detention centre and located in a home in Hornsby. He only sees his parents for two hours each week, when they visit him under escort by three guards. Stephen reports on advice from Dr Aamer Sultan at Villawood, who says that, as Shayan has witnessed his parents' helplessness, he has started to lose faith in them as a source of security. See Tony Stephens, 'Barbed-wire playground', Sydney Morning Herald 15 December 2001, citing the findings of Dr Michael Dudley, a senior lecturer in psychiatry, reporting on the exposure of children to intimidating conditions at a conference on refugees in early December.
21. Sultan A, O'Sullivan K. Psychologial disturbances in asylum seekers held in long term detention: a participant-observer account. MJA 2001, 175: 587 - 589.
22. From 'Portion of an affidavit of an Iraqi woman (Robin's Mother) in detention', in 'Conditions in Detention', in www.chilout.org/18e.htm (Accessed 5 March 2002)
23. from 'Portion of an affidavit of an Iranian man', in op cit.
24. Jacqueline Everitt, cited in Tony Stephens, 'Barbed-wire playground', Sydney Morning Herald 15 December 2001, citing the findings of Dr Michael Dudley, a senior lecturer in psychiatry, reporting on the exposure of children to intimidating conditions at a conference on refugees in early December.
25. Alice Tay, (2000) 'Treatment of refugees should come from the heart', Sydney Morning Herald
26. 19 December 2000.
27. Office Of The United Nations High Commissioner For Refugees Geneva, UNHCR Revised Guidelines On Applicable Criteria And Standards Relating To The Detention Of Asylum Seekers (February 1999), www.unhcr.org.au (Accessed 5 March 2002)
28. G. Mitchell, 'Asylum Seekers in Sweden'., available on www.chilout.org/5e.htm (Accessed 5 March 2002)
29. G. Mitchell, ibid
30. G. Mitchell, 'Asylum Seekers in Sweden'., available on www.chilout.org/5e.htm (Accessed 5 March 2002)
31. G. Mitchell, 'Asylum Seekers in Sweden'., available on www.chilout.org/5e.htm (Accessed 5 March 2002)
32. A. Tay, 'Treatment of refugees should come from the heart', in Sydney Morning Herald, Tuesday, 19 December 2000
33. ibid.
34. Alice Tay, (2000) 'Treatment of refugees should come from the heart', Sydney Morning Herald
35. 19 December 2000.
36. G. Barns, 'A genuine liberal should respect liberty for all: Government policy on asylum seekers devalues humanity', Australian, (1 February 2002): 9
37. cited without source in G. Barns, op cit.
38. J. Menadue, 'Stop Mandatory detention. It has failed', Age, 1 Feb 2002: 15
39. Preamble, Convention on the Rights of the Child.
40. Ex-detainees, ex-workers and professional visitors to detention centres.
41. See Background Paper 3: Mental Health and Development.
42. See Background Paper 3: Mental Health and Development.
43. Article 6, Convention on the Rights of the Child.
44. Article 23, Convention on the Rights of the Child.
45. Raman S. Lateline ABC TV March 19, 2002. Op. Cit.
46. Sultan A, O'Sullivan K.. Psychological disturbances in asylum seekers held in long term detention: a participant-observer account. MJA 2001, 175: 593-596
47. Pliskin KL. Dysphoria and somatization in Iranian culture. West J Med 1992 Sep;157(3):295-300
48. Montgomery E, Foldspang A . Traumatic experience and sleep disturbance in refugee children from the Middle East. Eur J Public Health. 2001 Mar;11(1):18-22
49. Loff B, Snell B, Creati M, Mohan M.. MELBOURNE 'Inside' Australia's Woomera detention centre. Lancet 2002; 359: 9307. P 683
50. Mares P. Borderline. NSW Press 2001. Australia. P 44.
51. Mares S. Personal communication 12/3/2002)
52. Moore J. Personal communication 13/3/2002)
53. Levenson R, Sharma A. The Health of Refugee Children : Guidelines for Paediatricians. Royal College of Paediatricians and Child Health. 1999, London.
54. King K, Vodicka P. Screening for conditions of public health importance in people arriving in Australia by boat without authority. MJA Vol 175, 3/17 December 2001; 600-602.
55. Zivcic I. Emotional reactions of children to war stress in Croatia. Journal of American Academy of Child and Adolescent Psychiatry 1993 l; 32(4): 709-13.
56. Sikic N, Javornik N, Stracenski M, Bunjevac T, Buljan-Flander G. Psychopathological differences among three groups of school children affected by the war in Croatia. Acta Med Croatica 1997; 51(3): 143-9.
57. Victorian Department of Human Services. 2001. Framework for the Delivery of Juvenile Justice Services. State Government Victoria.
58. Australasian Juvenile Justice Administrators. 1999. Standards of Juvenile Custodial Facilities. Australasian Juvenile Justice Administrators.
59. Smith M. Asylum seekers in Australia. MJA 2001; 175: 587-589.
60. Mares P. Borderline. NSW Press. 2001. Australia. P 44.
61. These cases were described on ABC Lateline, March 27, 2002. Dr Bijou Blick (paediatrician) and Dr Louise Newman (Psychiatrist) who had intervened with Villawood staff were interviewed.
62. Whelan A. Refugees and population policy: a new language and ethical base is needed. In touch. Vol 19(2): March 2002. P 11.
63. Personal communication. Interview with young Iraqui female ex-detainee 31/1/2002
64. Personal communication. Information provided by a Psychologist visitor to Maribyrnong - 14/2/2002
65. ABC radio news item March 30, 2002. This case was also described in a personal communication with a professional visitor to Villawood.
66. Levenson R, Sharma A. The Health of Refugee Children : Guidelines for Paediatricians. Royal College of Paediatricians and Child Health. 1999. London.
67. UNity Summary 291 March 15, 2002
68. Executive Officer of NEDA, 2002, reported in UNity Summary 291 March 15, 2002
69. March 13, 2002. Ex-staff member Woomera - personal communication
70. January 31, 2002. Female ex-detainee - personal communication
71. Mares P. Borderline. 2001; NSW University press.; P 44.
72. WHO 2001. Integrated Management of Childhood Illness (IMCI) training package WHO; Geneva
73. World Health Organisation http//:www.who.int
74. UNHCR statement quoted in: Refugee Children: Guidelines on protection and care 1994 p 8.
75. Behind the wire: the detention centre debate, by Michelle Grattan at http://www.smh.com.au/news/0201/24/national/graphic1.html
76. Leaver E. Radio National Life Matters March 15, 2002.
77. Phillip Ruddock. ABC 7.30 Report April 10, 2002.
78. See also article 27, International Covenant on Civil and Political Rights.
79. UNHCR Refugee Children: Guidelines on Protection and Care, Chapter 3.
80. Mares P. Borderline. 2001. Sydney; UNSW Press. P 42-46.
81. See too, articles 18(1) and 27 ICCPR; article 1(1) Declaration on the Elimination of All Forms of Intolerance and of Discrimination Based on Religion or Belief.
82. Human Rights and Equal Opportunity Commission (HREOC), Immigration Detention Guidelines, para 5.1. See too Article 6 Declaration on the Elimination of All Forms of Intolerance and of Discrimination Based on Religion or Belief; Rule 42, UN Standard Minimum Rules for the Treatment of Prisoners; Rule 48, United Nations Rules for the Protection of Juveniles Deprived of their Liberty; see also Guideline 10 (viii) UNHCR (1999) Guidelines on applicable Criteria and Standards relating to the Detention of Asylum-Seekers
83. For example, if the child's asylum claim, along with that of the family, is rejected and they are repatriated to their country of origin, any loss of the child's mother tongue could be devastating to her or his future survival.
84. UNICEF Implementation Handbook, p413, UNHCR Guidelines on Protection and Care, ch 3. See generally, UNHCR Guidelines on Protection and Care, ch 8
85. Article 12, Convention on the Rights of the Child
86. Manderson L. Introduction: Does Culture Matter? In Janice Reid and Peggy Trompf. The Health of Immigrant Australia: A social Perspective.
87. 1990; Harcourt Brace Jovanovich, Marrickville, NSW
88. Interview with young female ex-detainee, January 31, 2002.
89. Minnesota Public Health Association's Immigrant Health Task Force. 1996. Six Steps Toward Cultural Competence. Minneapolis, MN: Minnesota Department of Health.
90. UNHCR Refugee Children: Guidelines on Protection and Care (1994), ch 2.
91. Expert working group of the American Institute of Nutrition, in Anderson, SA (Ed). Core indicators of nutritional state for difficult to sample populations. Journal of Nutrition, 1990; 120: 1557-1600.
92. Article 24, Convention on the Rights of the Child.
93. Article 30, Convention on the Rights of the Child.
94. Article 24(2)(c), Convention on the Rights of the Child.
95. Australasian Juvenile Justice Administrators Standards for Juvenile Custodial Facilities 1999.
96. Interview with young female ex-detainee January 31, 2002.
97. Mares P. Borderline. 2001; NSW Press.
98. The State of Food Insecurity in the World 1999 FAO (www.fao.org)
99. Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau. BMJ. 1999 Oct 2;319(7214):878-81.
100. Toole MJ, Waldman RJ. Priority health interventions in developing countries. Int Ophthalmol Clin. 1990 Winter;30(1):7-11
101. The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. Chapter 3, Minimum standards in nutrition www.sphereproject.org/handbook/nutrition.htm Appendix 2: Nutritional Requirements
102. World Health Organisation. Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva, WHO, 1999.
103. World Health Organisation et al. The management of nutrition in major emergencies. Geneva, WHO, 2000
104. World Food Program. Food and nutrition handbook. Rome, WFP, 2000
105. Interview with young female ex-detainee January 31, 2002
106. Commonwealth of Australia 1991
107. a Brown KH et al. Effects of dietary energy density and feeding frequency on total daily energy intakes of recovering malnourished children. American Journal of Clinical Nutrition, 1995, 62(1):13-18.
108. World Health Organisation. Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva, WHO, 1999./CHS/CAH/98.1
109. b Brown KH et al. Food & Nutrition Bulletin, 1995, 16:320-338
110. Interview with professional visitor to Maribyrnong, March 2002.
111. Interview with professional visitor to Maribyrnong, March 2002.
112. What's There to Eat?: The practical guide to feeding families. Department of Human Services, Victoria, 2000.
113. Skull S. (paediatrician) April 11, 2002. Personal communication.
114. Interviews with professional visitors to detention centres and ex-detainees.
115. Plan of Action for Implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s, UNICEF, 1990; http://www.unicef.org/wsc/plan.htm#Role.
116. See also article 12(2), Convention on the Elimination of All Forms of Discrimination of All Forms of Discrimination against Women (CEDAW), ratified by Australia in 1983, which obliges it to 'ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.'
117. Poor nutrition in pregnant women may cause spina bifida (associated with inadequate folate intake) and iodine deficiency disorders (permanent mental retardation associated with inadequate iodine intake): The Royal College of Paediatrics and Child Health and the King's Fund (1999), The Health of Refugee Children: Guidelines for Paediatricians, London.
118. World Health Organisation (2001), 'Note for the Press No.7', 2 April 2001; www.who.int/inf-pr-2001/en/note2001-07.html.
119. Interview with ex-Woomera staff member, February 11, 2002.
120. Interview with female ex-detainee, January 31,2002.
121. Fieldhouse P. Food and Nutrition - Customs and culture Chapman and Hall 1995.
122. Birch LL . The control of food intake by young children in E. Capaldi (ed). Taste, Experience and Feeding. 1990. American Psychological Association, Washington DC.
123. Satter E. Comments from a practitioner on Leanne Birch's research. J Am Diet Assoc. 1987 Sep;87(9 Suppl):S41-3.
124. Birch LL The control of food intake by young children in E. Capaldi (ed). Taste, Experience and Feeding. 1990. American Psychological Association, Washington DC.
125. Dettwyler KA Styles of Infant feeding:parent/caretaker control of food consumption in young children. Research reports. American Anthropologist 1989; vol 91;696-703.
126. Keys A, Brozek J, Henschel A, Michelson O and Taylor HL 1950. The biology of human starvation. The University of Minnesota Press, Minneapolis.
127. FAO 1999
128. Reported in an interview with a professional visitor to Maribyrnong in March 2002.
129. Mullins LC, Cook C, Mushel M, Machin G. A comparative examination of the characteristics of participants of a senior citizen nutrition and activities programme. Activities, Adaptation and Aging 1993; 17(3):15-37.
130. Allen DE, Patterson ZJ and Warren GL. Nutrition, family commensality and Academic performance among high school youth. J. Home Economics 1970 vol 62(5):333-7
131. Interview with young female ex-detainee January 31, 2002.
132. Comment from a guard reported in an interview with a professional visitor to Maribyrnong in March 2002.
133. Burns C, Webster K, Crotty P, Ballinger M, Vincenzo R, Rozman M. 2000 Easing the Transition:Food and Nutrition issues of new arrivals. Health Promotion J Aust 200010(3):230-235.
134. Murcott A. The social significance of the cooked dinner in South Wales. Soc.Sci. Inf. 1982; 21;4-5.
135. Nurse - ex-Woomera staff member, personal communication February 2002.
136. Reported in an interview with a professional visitor to Maribyrnong in March 2002.

Last Updated 9 January 2003.