I am a paediatrician. I specialise in paediatric infectious diseases but also work as a general paediatrician. For the last 10 years, I and my colleagues have run a Refugee Clinic at the Children’s Hospital at Westmead, where we assess child asylum seekers and refugees. The initial aim of this clinic was to screen children for treatable infectious diseases like tuberculosis and malaria and for other non-infectious conditions like rickets. However, the whole nature of the assessment has changed of late.
Over the ten years, we have seen a very large number of children who have been in detention centres. It has become increasingly apparent that many of the children we see are suffering from post-traumatic stress and this number has risen steadily so that currently more than half of all the asylum seeker children we see are suffering from post-traumatic stress. This may be because we are increasingly aware of post-traumatic stress and ask more searching questions, but often a history of the symptoms of post-traumatic stress is easy to obtain. Young children have nightmares and sleep disturbance including sleep-walking. They are fearful and cling to their parents. They may start wetting their beds or pooing their pants. They may have problem behaviours, such as being defiant, angry or irritable. They may have somatic symptoms such as head-aches or abdominal pain. Older children may self-harm.
Many of these children were exposed to traumas in their countries of origin and undertook perilous journeys, which clearly contribute to their stress. However, the trauma of being in detention centres without knowledge of when they will be released clearly adds to the stress and compounds the problem. Children are particularly vulnerable if their parents are struggling to cope with the trauma.
We are able to refer our most severely affected children to a dedicated psychologist working in the Department of Psychological Medicine in our hospital. The NSW Service for the Treatment and Rehabilitation of Torture and
Trauma Survivors STARTTS is a useful resource for adults and children with post-traumatic stress.
Impact of length of detention on children
Unequivocally, we find that the longer a family is in detention, the greater the stress on the child and on their parents. Mounting parental stress in turn increases the stress on children.
Measures to ensure the safety of children
Although traumatised children in detention are referred to specialist mental health staff occasionally, this is the exception rather than the rule. Children in detention who are suffering from post-traumatic stress need to be seen by a paediatrician to see if they need specialist mental health assessment.
Education, recreation, maternal and infant health services
Australia is a co-signatory to the UN Convention on the Rights of the Child which states that all children have the right to be provided with a safe environment and with adequate health-care and education. We have an obligation to provide these to children under our care, whether they are citizens, permanent residents, refugees or asylum seekers. This includes asylum seeker children on Manus Island or Nauru. Australia cannot abdicate its responsibility to asylum seeker children by preventing them reaching the mainland.
The separation of families across detention facilities in Australia
Separation of families is fortunately uncommon, but when it does occur it can have a disastrous effect on children’s mental health.
The guardianship of unaccompanied children in detention in Australia
Unaccompanied minors have often left their entire family behind and are in urgent need of being able to contact them and to stay in contact. Closed detention is particularly inappropriate for these highly vulnerable children. There is a clear conflict of interest in having the same person who is detaining the child as the person who is legally responsible for their welfare (i.e. the Minister). The role of advocate for the child has to be independent of judicial decisions about the child’s fate.
Assessments conducted prior to transferring children to be detained in ‘regional processing countries’
Children in offshore detention should have appropriate screening tests and catch-up vaccinations and be adequately protected against malaria.
Progress made during the last 10 years
There has been only minor progress in the last 10 years. It was acknowledged by the previous Government that children should not be in detention at all. The number of children in community detention has grown slowly but steadily. According to DIAC, however, in September 2013 there were still over 1000 children in immigration detention facilities and alternative places of detention (not community detention). There are no current figures available on the number of children in immigration detention or their whereabouts. This is disturbing. We need more transparency. No child should be detained unnecessarily in a detention centre.
Australia has a duty of care to asylum seekers under International Law, which includes protecting them. Delaying decisions about their fate and imprisoning asylum seekers and their children in detention centres is a dereliction of that duty of care. Whether or not the asylum seekers are eventually accepted as refugees, it is counter-productive and cruel to increase their mental health problems by inappropriately draconian measures such as detention.
Professor David Isaacs is a Consultant pediatrician at the Children’s Hospital at Westmead and Clinical Professor in Paediatric Infectious Disease, University of Sydney