This paper provides an update on the health situation for refugees and asylum seekers sent to Papua New Guinea (PNG) by the Australian government. Since 2013, Australia has been sending asylum seekers arriving in its territory by boat to the remote Pacific island nations of Nauru and PNG. Around 700 refugees and asylum seekers remain in PNG, mostly on Manus Island, after nearly five years in limbo. They lack safety and security in the country, which has high levels of violence, particularly against refugees and other vulnerable persons. Attempts to settle refugees in PNG have failed. While dozens of refugees have recently been settled in the United States under a bilateral agreement with the Australian government, hundreds of people are likely to remain in the country unless Australia ends offshore processing and accepts these refugees and asylum seekers into Australia, or finds safe third countries for them. It is within this context that the Australian government has begun winding back service provision, including critical health care, to refugees in its care in PNG.
Australia has an obligation to realise the right to the highest attainable standard of health for the refugees and asylum seekers it has sent to PNG. In spite of this, health services, including critical mental health support, have been reduced over the last six months for a refugee population that has amongst the highest recorded rate of mental illness in the world. Two suspected suicides in August and October 2017 underscore the need for increased, and not reduced, mental health care.
On 30 April 2018, the Australian government ended its contract with health service provider, International Health and Medical Services (IHMS). The Australian government has now engaged Pacific International Hospital (PIH) to support the general healthcare needs for refugees and asylum seekers, while also relying on public hospitals for after hours and emergency care. By shifting health care responsibilities to local contractors and the public health system, the Australian government has limited the availability, accessibility and quality of health care for refugees and asylum seekers.
Australia has gone to extraordinary lengths and enormous cost to implement its harmful and illegal offshore detention policy, which is severely limiting refugees and asylum seekers’ access to health care. Refugees and asylum seekers live in accommodation, with security, meals, medication, health care all currently provided by the Australian government or its contractors. Refugees and asylum seekers are not free to reside or travel elsewhere in the country (or leave) and cannot seek employment without permission from PNG Immigration officials, which has been difficult for a number of refugees to obtain. They are entirely dependent on the Australian government to provide and pay for health care. Unlike local residents and foreigners, refugees and asylum seekers cannot travel freely within the country or seek medical care through their own means. They are held in PNG as a means of deterrence and punishment. As a result, and until such time as Australia ends offshore processing, Australia is responsible for ensuring that all refugees and asylum seekers have access to necessary and quality health care, including by transfer to Australia.
Australia could easily address these concerns by providing affordable and quality health care within its territory. This would mean dismantling offshore ‘processing’ of asylum seekers and bringing people to Australia, something the government refuses to do. In the interim, Australia must ensure that health care and facilities are maintained, comparable to Australian standards, and not reduced for refugees and asylum seekers in its care. Failure to do so will further endanger the mental and physical health of a population Australia has already spent five years neglecting.