Health, Social Movements, and Australian Immigration Detention

Australia’s policy of mandatory immigration detention has been criticized both domestically and internationally. Among these criticisms, it has been described as cruel and degrading¹ and a crime against humanity,² and has been likened to torture.³ Since its introduction in 1992, tens of thousands of adults and children have been detained in squalid conditions and for protracted (and occasionally indefinite) periods of time. Many wait years to receive any news about their refugee status.

The most controversial aspect of Australia’s policies has been the recent reintroduction of “offshore processing” on Nauru and Manus Island (Papua New Guinea). Offshore processing was introduced in 2001, repealed, and then reintroduced in 2012. Whereas all centers have witnessed sexual and physical assaults, violence, riots, self-harm, and suicide, offshore processing is uniquely damaging as it was explicitly introduced as a deterrent to Australia’s relatively small number of boat arrivals. The suffering of those on Manus Island and Nauru continues to be purposeful. The center on Nauru was opened in 2015, days before an Australian High Court challenge; in April 2016, Papua New Guinea’s Supreme Court ruled that the Manus Island detention center was illegal. Although both centers are now open, with people generally free to come and go, conditions have become increasingly dangerous, with local communities both hostile and at times overtly violent toward refugees and asylum seekers.

CAN MORE BE DONE?

This suffering has been a direct result of Australian government policy, which has explicit political ends and observable political consequences. It is well recognized that the government is evasive and even combative regarding these issues; however, there remains a dissonance in precisely how these issues should be approached within the Australian health care community. For example, although all major professional health care bodies have opposed these policies and called for change, most of them have also supported health care as usual within the centers, thus implicitly reducing health and health care to biomedical activities and issues of justice and rights to clinical and ethical dilemmas. These policies deserve more than strongly worded statements and condemnation. The limitations of current approaches need to be more squarely acknowledged, and action must be taken beyond what is often found in the traditional repertoire of clinical and public health professionals.

Fortunately, there are a number of individuals and organizations that have led the way in taking such action. Before some examples are discussed, however, the question arises, why are clinicians and professional bodies being held responsible? The harms of this system and the government’s refusal to act on evidence have already been outlined here; few would deny that these circumstances are exceptional, and for most, this would be reason enough to act. Clinicians, however, have also played a central role in allowing this system to function, providing health care within detention centers. They thus have a particular responsibility to take action, which is only amplified by the close relationship between health, human rights, and justice.

PROTEST AND SOCIAL MOVEMENTS

Doctors4refugees is one such example of an organization that has taken vocal action. They have not only acted as advocates but have effectively used the media in cases of substandard care and abuse, exposing such treatment (or lack thereof) and prompting the government to act.⁴ Individual clinicians have used their experiences working within detention to bring to light the devastating consequences of these policies, even breaking the law to do so; others have called for clinicians to boycott the centers.⁵ Clinicians have also effectively acted to disrupt the system, refusing to discharge children from hospitals and return them to detention.⁶ Such actions show not only how clinicians may leverage their power by using the media, but also how they may use their positions to disrupt or resist these policies.

The health care community’s repertoire, of course, extends beyond the examples cited here. If future action is to be effective, however, there are a number of factors that need to be considered, which leads to a final important point. Among a number of other insights, the social movements literature provides a starting point to begin to consider how movements act, how they organize, and the political conditions under which they operate. It has until now been underused. Most fundamentally, this literature moves beyond blunt calls to action or identifying an obvious lack of political will; it recognizes social change as dynamic, complex, and explicitly political. Beyond Australian immigration detention, the social movements literature has broader relevance. At a time when the cooperation of government cannot be taken for granted and evidence and reasoned argument appear to be under increasing threat, it recognizes that health, justice, and human rights often have to be fought for.