(The following letter appeared in the MJA Insight on 27 November 2017)

WE are senior Australian clinicians who write in our individual capacity to express our concerns about the ongoing health and well-being of the former detainees still based on Manus Island and now in alternative accommodation. They, like all human beings, have a universal right enshrined in the United Nations charter to health and well-being. Their political and citizenship status should not affect this right. All politicians regardless of their political party should respect the human right to health and themselves be strong advocates of health for all without discrimination.

• We are deeply concerned about the ongoing refugees physical and mental health;
• There are reports of poor hygiene and sanitation, limited supply of electricity and inadequate living conditions. All of these exacerbate disease and ill-health;
• We are not aware of accurate information on the health status of the refugees since the official closure of the Manus Island Australian-governed facility;
• We are concerned about the harm and the adverse publicity to the international reputation of Australia, its government and its people.

Urgent action is required:

• We believe that there should be an immediate, independent review of the health status of those still on Manus;
• We are prepared both to participate in this and to nominate appropriate, independent and credible clinicians;
• We are of the opinion that such a review should ideally be made in conjunction with senior Papua New Guinean clinicians who would take the responsibility for informing their government.

We are willing to conduct this review pro-bono, arranging the appropriate mix of clinical specialties. We would require the Australian government to negotiate the diplomatic permissions and officially sanction travel to and within PNG, as well as agree to clinical assessment of willing individuals.

We believe that the humanitarian issues take precedence over politics. This is a matter beyond immigration and border control, but one that affects the health of people and others perceptions of our great nation.

Yours sincerely and with great concern at the current situation,

Professor David A Watters OBE ChM FRCSEd FRACS Alfred Deakin Professor of Surgery, Deakin University Past President Royal Australasian College of Surgeons

Laureate Professor Nicholas J. Talley MD, PhD, FRACP, FAFPHM, FAHMS University of Newcastle, Newcastle, Australia Past President Royal Australasian College of Physicians Past Chair Council of Presidents of Medical Colleges

Mr Philip Truskett AM FRACS Prince of Wales Hospital, Sydney Past President Royal Australasian College of Surgeons

Dr Lindy Roberts FANZCA FFPMANZCA FAICD Specialist Anaesthetist and Specialist Pain Medicine Physician Sir Charles Gairdner Hospital, Perth WA Past President of Australian and New Zealand College of Anaesthetists

Professor Patrick McGorry AO FRCP FRANZCP Executive Director Orygen Professor Youth Mental Health, University of Melbourne President, International Association for Youth Mental Health NHMRC Principal Research Fellow President, Schizophrenia International Research Society

Professor David Fletcher FRACS Director of Surgery, Fiona Stanley Hospital Professor of Surgery, University of Western Australia

Professor Kingsley Faulkner AM Cit WA MB BS FRACS MDA (Hons) School of Medicine, Fremantle, University of Notre Dame Australia Past President, Royal Australasian College of Surgeons

Dr Liz Marles FRACGP Past President RACGP

Professor Bastian M. Seidel PhD, MACHI, MRCGP, FRACGP Current President, The Royal Australian College of General Practitioners

Professor Bala Venkatesh, MBBS, MD (Int.Med), FRCA, FFARCSI, MD(UK), FCICM Past President, College of Intensive Care Medicine (ANZ)

Adjunct Associate Professor Frank R Jones FRACGP Immediate Past President of the Royal Australian College of General Practitioners

A/Prof Christopher Milross MD FRANZCR FRACMA FAICD Past President Royal Australian and New Zealand College of Radiologists

Dr Mukesh Haikerwal AO RACGP Professor School of Medicine Flinders University, Adelaide Past President AMA Past President AMA VIC

Professor Malcolm Hopwood MPM MD FRANZCP Professor of Psychiatry, University of Melbourne Past President Royal Australia and New Zealand College of Psychiatrists

A/Professor Michael Hollands FRACS Westmead Hospital, Sydney Past President Royal Australasian College Surgeons Past Chair Council of Presidents of Medical Colleges

Dr Lee Gruner FRACMA FHKCCM GAICD Immediate Past President Royal Australasian College of Medical Administrators

Dr Genevieve Goulding FRANZCA Senior staff specialist anaesthetist, Royal Brisbane & Womens Hospital Immediate Past President, Australian & New Zealand College of Anaesthetists

Professor Lucie Walters Professor Rural Postgraduate Medical Education, Flinders Rural Health South Australia Immediate Past President Australian College of Rural and Remote Medicine