Abstract
Australian immigration detention has received persistent criticism since its introduction almost 25 years ago. With the recent introduction of offshore processing, these criticisms have intensified. Riots, violence, self-harm, abuse and devastating mental health outcomes are all now well documented, along with a number of deaths. Clinicians have played a central role working in these environments, faced with the overarching issue of delivering healthcare while facilitating an abusive and harmful system. Since the re-introduction of offshore processing a number of authors have begun to discuss the possibility of a boycott. While taking such action may lead to change, further discussion is needed, not only in relation to the impact of a boycott, but whether it is possible for clinicians to engage with this system in more productive, ethical ways. This article utilises a framework proposed by Lepora and Goodin (On complicity and compromise, Oxford University Press, Oxford, 2013) that provides a structured approach to examine complicity and seeks to explore how clinicians have engaged with Australian immigration detention and ultimately whether they should continue to do so.
Similar content being viewed by others
References
Australian Heads of Schools of Social Work. 2006. We’ve boundless plains to share: The first report of the People’s Inquiry into Detention. Australian Council of Heads of Schools of Social Work.
Australian Human Rights Commission. 2012. Immigration detention and human rights. http://humanrights.gov.au/human_rights/immigration/detention_rights.html.
Australian Human Rights Commission. 2013. Asylum seekers, refugees and human rights. http://www.humanrights.gov.au/publications/asylum-seekers-and-refugees.
Australian Human Rights Commission. 2014. The forgotten children: National inquiry into children in immigration detention. Sydney: Australian Human Rights Commission.
Australian National Audit Office. 2016. Delivery of health services in onshore immigration detention. ANAO Report No. 13 2016–17, Performance Audit.
Australian Parliamentary Select Committee. 2015. Taking responsibility: Conditions and circumstances at Australia’s regional processing centre in Nauru. Select Committee on the Recent allegations relating to conditions and circumstances at the Regional Processing Centre in Nauru. Australian Parliament: Canberra.
Australian Senate Legal and Constitutional Affairs References Committee. 2014. Incident at the manus island detention centre from 16 February to 18 February 2014. Canberra: Australia
Berger, D., and S.H. Miles. 2016. Should doctors boycott working in Australia’s immigration detention centres? Britich Medical Journal 352: i1600.
Borrello, E., and Glenday, J. 2015. Gillian Triggs: Tony Abbott says government has lost confidence in human rights commission president. Australian Broadcasting Corporation News. http://www.abc.net.au/news/2015-02-24/gillian-triggs-says-brandis-wants-her-to-quit-rights-commission/6247520.
Briskman, L., and D. Zion. 2014. Dual loyalties and impossible dilemmas: Health care in immigration detention. Public Health Ethics 7(3): 277–286.
Bull, M., E. Schindeler, D. Berkman, and J. Ransley. 2013. Sickness in the system of long-term immigration detention. Journal of Refugee Studies 26(1): 47–68.
Christmas Island Medical Officer’s Letter of Concern. 2013. The Guardian Australia. http://www.theguardian.com/world/interactive/2014/jan/13/christmas-island-doctors-letter-of-concern-in-full.
Coffey, G. 2006. ‘Locked up without guilt or sin’: The ethics of mental health service delivery in immigration detention. Psychiatry, Psychology and Law 13(1): 67–90.
Cunningham, S.A., K. Mitchell, K.V. Narayan, and S. Yusuf. 2008. Doctors’ strikes and mortality: A review. Social Science and Medicine 67(11): 1784–1788.
Doherty, B. 2016. ‘Baby Asha’ and Nauru protests held as hospital staff oppose transfer The Guardian Australia.
Doherty, B., and Hurst, D. 2015. UN accuses Australia of systematically violating torture convention. The Guardian Australia. http://www.theguardian.com/australia-news/2015/mar/09/un-reports-australias-immigration-detention-breaches-torture-convention.
Dudley, M. 2003. Contradictory australian national policies on self-harm and suicide: The case of asylum seekers in mandatory detention. Australasian Psychiatry 11(1 suppl): S102–S108.
Essex, R. 2014. Human rights, dual loyalties, and clinical independence: Challenges facing mental health professionals working in Australia’s immigration detention network. Journal of Bioethical Inquiry 11(1): 75–83.
Essex, R. 2016a. Healthcare and clinical ethics in Australian offshore processing centres: a review of the literature. The International Journal of Human Rights 20(7): 1039–1053.
Essex, R. 2016b. A community standard: Equivalency of healthcare in Australian immigration detention. Journal of Immigrant and Minority Health. doi:10.1007/s10903-016-0438-7.
Farrell, P. 2015. IHMS, the healthcare giant at the heart of Australia’s asylum system—explainer The Guardian Australia. http://www.theguardian.com/australia-news/2015/jul/21/ihms-the-healthcare-giant-at-the-heart-of-australias-asylum-system-explainer.
Farrell, P., Jabour, B., and Evershed, N. 2015. ‘Grab from the excuse bag’—how health firm IHMS tackled asylum seeker targets The Guardian Australia. http://www.theguardian.com/australia-news/2015/jul/22/grab-from-the-excuse-bag-how-health-firm-ihms-tackled-asylum-seeker-targets.
Green, J.P., and K. Eagar. 2010. The health of people in Australian immigration detention centres. Medical Journal of Australia 192: 65–70.
Grewcock, M. 2013. Australia’s ongoing border wars. Race & Class 54(3): 10–32.
Isaacs, D. 2015a. Are healthcare professionals working in Australia’s immigration detention centres condoning torture? Journal of Medical Ethics 42(7): 413–415.
Isaacs, D. 2015b. Nauru and detention of children. Journal of Paediatrics and Child Health 51(4): 353–354.
Isaacs, D. 2015c. Doctors should boycott working in Australia’s immigration centres and must continue to speak out on mistreatment of detainees-despite the law. British Medical Journal (Clinical Research Ed.) 350: h3269.
Koutroulis, G. 2003. Detained asylum seekers, health care, and questions of human(e)ness. Australian and New Zealand Journal of Public Health 27(4): 381–384.
Laughland, O. 2014a. Christmas Island detainees stripped of basic medication, inquiry told. The Guardian Australia, http://www.theguardian.com/world/2014/jul/31/immigration-department-detention-child-mental-health-inquiry. Accessed 05 Aug 14.
Laughland, O. 2014b. Asylum seeker on life support was given ‘outstanding’ care, says scott morrisson. The Guardian Australia.
Lepora, C., and R.E. Goodin. 2013. On complicity and compromise. Oxford: Oxford University Press.
Mares, S., and J. Jureidini. 2004. Psychiatric assessment of children and families in immigration detention—clinical, administrative and ethical issues. Australian and New Zealand Journal of Public Health 28(6): 520–526.
Marr, D., and Laughland, O. 2014. Australia’s detention regime sets out to make asylum seekers suffer, says chief immigration psychiatrist. The Guardian Australia. http://www.theguardian.com/world/2014/aug/05/-sp-australias-detention-regime-sets-out-to-make-asylum-seekers-suffer-says-chief-immigration-psychiatrist.
Metcalfe, D., R. Chowdhury, and A. Salim. 2015. What are the consequences when doctors strike? British Medical Journal 351: h6231.
Moss, P. (2015). Review into recent allegations relating to conditions and circumstances at the Regional Processing Centre in Nauru.
Newhouse, G. 2015. Let me clear up the government’s clarification of the Border Force Act. The Guardian Australia. http://www.theguardian.com/commentisfree/2015/jul/08/let-me-clear-up-the-governments-clarification-about-the-border-force-act.
Om, J. 2014. Leaked Immigration document reveals disagreements with detention centre doctors. Australian Broadcasting Coporation News. http://www.abc.net.au/news/2014-12-12/medical-staff-treating-asylum-seeker-advocating-for-detainees/5962106.
Om, J. 2015. Immigration Department aware of sexual abuse allegations against children for 17 months but failed to act, say former Nauru workers. Australian Broadcasting Coporation News. http://www.abc.net.au/news/2015-04-07/nauru-letter-of-concern-demands-royal-commission/6374680.
Phillips, J., and H. Spinks. 2013. Immigration detention in Australia. Canberra: Parliamentary Library.
Ruiz, M., Bottle, A., and Aylin, P. 2013. A retrospective study on the impact of the doctors’ strike in England on 21 June 2012. Journal of the Royal Society of Medicine.
Safi, M., and Farrell, P. 2015. AMA joins protest against asylum law that can jail detention centre staff, The Guardian Australia.
Sanggaran, J.-P., G.M. Ferguson, and B.G. Haire. 2014. Ethical challenges for doctors working in immigration detention. Medical Journal of Australia 201(7): 1–3.
Sanggaran, J.-P., and D. Zion. 2016. Is Australia engaged in torturing asylum seekers? A cautionary tale for Europe. Journal of Medical Ethics 42(7): 420–423.
Sultan, A., and K. O’Sullivan. 2001. Psychological disturbances in asylum seekers held in long term detention: A participant-observer account. Medical Journal of Australia 11: 593–596.
The Border Crossing Observatory. 2016. Australian Border Deaths Database. http://artsonline.monash.edu.au/thebordercrossingobservatory/publications/australian-border-deaths-database/.
Young, P., and M.S. Gordon. 2016. Mental health screening in immigration detention: A fresh look at Australian government data. Australasian Psychiatry 24(1): 19–22.
Zion, D., L. Briskman, and B. Loff. 2009. Nursing in asylum seeker detention in Australia: Care, rights and witnessing. Journal of Medical Ethics 35(9): 546–551.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Essex, R. Healthcare and complicity in Australian immigration detention. Monash Bioeth. Rev. 34, 136–147 (2016). https://doi.org/10.1007/s40592-016-0066-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40592-016-0066-y