IAN WEBSTER. Amid chaos, ethics.

Speaking particularly of the treatment people in Manus and Nauru, Professor Ian Webster argues that in this secular and chaotic world, the values and principles of the professional codes of health workers could be used to frame their future contributions to a civil and humane society.

This week’s Lancet had two articles about Australia, one a celebration and the other, a criticism. The thirty years of outstanding contribution of the Kirby Institute at UNSW to HIV/AIDS and hepatitis C research, prevention and treatment was celebrated.

The criticism – an open letter from the Global Coalition of Health Professionals Against Immigration Detention addressed to Prime Ministers Malcolm Turnbull and Theresa May. It called for the immediate end to the detention of asylum seekers and refugees.

The letter was posted on November 5th when, in Australia, thousands of doctors marched to protest the inhumane treatment of refugees and asylum seekers in our detention centres and in support of colleagues who risked imprisonment as they exposed the abuses being conducted in our name on Nauru and Manus Island. In the same Lancet the editor despaired at the impact Donald Trump’s election would have on public health – repeal of the Affordable Health Care Act, winding back of sexual and reproductive health, belligerence towards Muslims, Latinos and other minorities, deportation of “illegal immigrants” and his belief that climate change is a “hoax”.

In August, the British Medical Journal carried an editorial, “Australia’s torture of asylum seekers”, which called for direct action by the health professions. The first-hand evidence of the harms, especially to children, had failed to stop the violation of human rights in Australia’s detention centres and the Government was using criminal sanctions to suppress the truth.

Globally, Australians ‘punch above their weight’ on important issues of public health but now the international medical community was challenging our reputation as a humane and socially just society.

I was preparing to give a talk to the weekly physicians’ meeting at the local hospital when, in the background, I could hear Radio National. Everywhere it seemed there were breakdowns in international and civil order. First, in the Religion and Ethics Report, Robert Manne described the writings of the Jordanian Islamist, Abu Musab al-Zarqawi who advocated brutal and savage measures against Shi’a Muslims. The news items continued – with accounts of Russia and African states withdrawing from the International Criminal Court, refugees drowning in the Mediterranean, Trump’s presumptive cabinet appointees and, the final straw – the bombing of the last hospital standing in Aleppo.

That hospitals, once sanctuaries for the sick and disabled, were now being targeted turns upside-down everything we take for granted in humanitarian law and respect for non-combatant rescuers. In the Syrian conflict, 382 health facilities have been attacked and 757 health professionals have been killed, according to the Physicians for Human Rights.

My talk that morning, in comparison, dealt with prosaic and clinical issues. But I was acutely aware of the bright-faced medical students, interns, registers and other health staff in the audience, all hoping to create their futures in health and medicine.

I told them of the Sydney rally in which, among the five thousand marchers, were medical students, doctors in training, nurses, health professionals, senior doctors and families, all proud of their colleagues who, in the face of political pressure and threats of criminal sanctions, had spoken – the medical evidence – of the traumas being perpetrated on Nauru and Manus Island.

I wanted to tell them how privileged they were to be part of these professions, not because of the intellectual challenges and satisfactions, but because in this secular and chaotic world, the values and principles of their professional codes could be used to frame their future contributions to a civil and humane society.

Ian Webster is Emeritus Professor of Public Health and Community Medicine, UNSW.

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