Commission Website: National Inquiry into Children in Immigration Detention
Click here to return to the Submission Index
Submission to the National
Inquiry into Children in Immigration Detention from
the Melbourne International
Health and Justice Group
- About
the Melbourne International Health and Justice Group
- Executive
Summary
- The
Global situation and population movement
- International
standards concerning the rights of refugees and asylum seekers
- Section
1: mandatory detention of asylum seekers in Australia: its impact on
children and the need for alternative approaches
- Section
2: the impact of detention on the health of refugee children
- Section
3: exploration of cross-cultural issues and barriers to delivering culturally
competent services in detention centres
- Section
4: nutritional issues associated with mandatory detention of refugee
children
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]
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.
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.
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.
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.
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.
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.
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
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).
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
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]
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.
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.
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.
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
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
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
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
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.
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.
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
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.
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
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)
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
34. Alice Tay, (2000) 'Treatment of refugees should come
from the heart', Sydney Morning Herald
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
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.
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.
