MSF staff outline grave dangers to refugees after Nauru halts mental health services

CANBERRA — A day after Médecins Sans Frontières condemned Nauru for halting “desperately needed” mental health services on the island, the government has hit back, accusing the organization of being “political activists” who worked to advance their “political agenda” against Australia’s offshore processing policy for asylum seekers and refugees.

During a press conference in Sydney Thursday, three MSF staff shared the harrowing situation of many asylum seekers and refugees on the island, including the limited mental health care Nauruans receive. MSF was offering free psychological and psychiatric services to “everyone living” in Nauru as part of their “one door for all policy,” until the government asked them to cease operations last Friday “within 24 hours,” MSF Executive Director for Australia Paul McPhun said.

“[We] invested time to try and negotiate to bring a commission of senior responsible people within the organization to meet [with the government] and try to hash out what the reasons were etc. But we never received a response,” he said.

At a press briefing on Friday in Geneva, Switzerland, United Nations Refugee Agency spokesperson Catherine Stubberfield urged that Australia move refugees and asylum seekers out of offshore detention, citing grave health concerns and worsening of conditions.

In a statement posted on its website and shared on its social channels Friday, the Nauru government attacked MSF.

“It has become very clear that they were never here to help Nauruans as was their initial representation to government to gain entry into Nauru. They were here as political activists and it was self-evident from the statement made by MSF representatives referring to our sovereign nation, which is our beloved home, as an ‘open air prison.’ This was least expected from an organisation proclaiming to be an international humanitarian organisation,” the government wrote.

But even before the most recent government decision, MSF said they were already finding it “increasingly difficult” to work on the island in the past few months. Three staff visas were already not renewed prior to the decision, McPhun said.

“It’s not been an easy relationship. The very idea of us being there and treating asylum seekers and refugees as well as Nauruans was not accepted by all. I mean it was clearly agreed: Cabinet met twice to ratify this agreement, but it wasn’t necessarily widely shared,” he said.

“We found there were many obstacles [and] it was difficult to collaborate, it was difficult to share information in the interest of patients, it was difficult to get access to everywhere we would have liked to have gone, particularly in the interest of individual patients who might have been at a severe and high-risk moment.”

The decision, MSF warned, left children as young as 9 at risk of suicide. Hope of a new home for declared refugees has all but disappeared after five years of waiting for a solution.

Representatives for Australia and Nauru who were in attendance at the World Health Organization’s 69th session for the Regional Committee for the Western Pacific in Manila, the Philippines, this week made no mention of the mental health situation on the island during their interventions, even during discussions on noncommunicable diseases.

The latest situation is part of a continuing saga involving the governments of Australia and Nauru ignoring global criticisms of offshore detention. Years of reports provide evidence of the increasing health concerns among refugees and asylum seekers as part of Australia’s offshore processing in Nauru and Manus Island as well as international rebuke.

In November 2016 the U.N. Special Rapporteur on the Human Rights of Migrants François Crépeau called Australia’s refugee policy “cruel, inhuman and degrading.” And in July 2017, the U.N. High Commissioner on Refugees Filippo Grandi criticized Australia for going back on an agreement that it would resettle vulnerable refugees with families in Australia.

Most recently, incoming U.N. human rights chief Michelle Bachelet had harsh words for Australia in her opening statement to the Human Rights Council in September.

“Australia, a member of this council that has suggested it might withdraw [from the Global Compact for Migration], should join the consensus of the global community, adopt the compact and revise the country’s policies with respect to people arriving at its borders without a visa,” Bachelet said. “The current offshore processing centers are an affront to the protection of human rights.”

The risk to the physical and mental health of children in particular has reached an alarming state, with legal intervention required to ensure children as young as 2 receive appropriate health care. But despite this, Nauru has been shown it is willing to defy Australian court orders for transfers.

For many on Nauru, the deal between Australia and the United States for a refugee swap was the last hope — a hope that is fading with a harder U.S. position on immigration. The swap was expected to help resettle 1,250 refugees from both Nauru and Manus Island. But just 418 have been resettled.

This is despite New Zealand Prime Minister Jacinda Arden repeatedly offering to settle refugees from Nauru and Manus Island in New Zealand — an offer refused for seemingly encouraging people smugglers to take unsafe journeys to reach new homes.

"We don't go around making a big song and dance about it,” Prime Minister Scott Morrison said in an interview on Sky News Australian on Friday when asked about the situation described by MSF. “We just get on and help people and provide the care that is necessary.”

The UNHCR in its statement noted that more than a quarter of the refugee population have been returned to Australia on medical grounds, though “even this number is significantly lower than the total with acute health needs, particularly with regard to mental health.”

“UNHCR does not agree with the government of Australia’s assertion that such cases are solely ‘matters for Papua New Guinea and Nauru,’ with Australia having simultaneously designed, financed, and managed the system in which these two developing and underresourced countries participate,” Stubberfield said.