Health care for asylum seekers on Nauru and Manus Island

Health Refugees Right of asylum Australia Manus Island Nauru

This paper sets out the key clauses of the government contract for health care provision to asylum seekers on Nauru and Manus Island, and examines their adequacy in providing for mental and physical health needs.


With the recent return to processing of asylum seekers in Regional Processing Centres (RPCs) on Nauru and Manus Island, a major concern for refugee advocates and human rights groups is the mental health status of asylum seekers being accommodated in these facilities. This concern stems from the perceived lack of specialist mental health resources available and the indefinite nature of detention. Previous experience has shown that offshore processing of asylum seekers can have serious consequences for both physical and mental health.

Amnesty International raised concerns about the physical health of asylum seekers in its November 2012 review of the Nauru Offshore Processing Facility, as conditions in the processing centres, such as heat, lack of shade and inadequate accommodation, were considered to be contributing to poor physical health. More recently, the ABC program Four Corners highlighted the conditions in the Nauru and Manus Island processing centres, and the concerns of former staff about access to health care and the health status of asylum seekers in this context.

As at 27 May 2013, there were 430 asylum seekers on Nauru and 302 on Manus Island. The combined total capacity of the facilities on Nauru and Manus Island is expected to reach around 2,100 by the end of 2013 (600 on Manus Island and 1,500 on Nauru). Current capacity is 500 on Manus Island and 528 on Nauru.

The provision of health care to asylum seekers on Nauru and Manus Island is governed by the ‘Heads of Agreement’ between the Commonwealth of Australia (represented by the Department of Immigration and Citizenship (DIAC)) and International Health and Medical Services (IHMS) (the contract). The contract was tabled in the Senate on 21 September 2012, with the payment schedule and financial details redacted. Despite this, some financial details are known, such as that IHMS will be paid $22 million for the provision of health care for six months from 14 December 2012. The contract was not published online and is only available from the Senate Table Office. In the absence of an online document, this background note will set out the key clauses of the contract and examine their adequacy in providing for the mental and physical health needs of asylum seekers being detained in RPCs.

IHMS has provided health care services in immigration detention facilities in Australia since 2006. As at March 2012, the value of the two contracts with IHMS (one for a six year period covering services for Christmas Island and one for a five year period covering the mainland) was estimated to be $769.3 million. In 2010–11 more than 100,000 individual health services were delivered in immigration detention facilities. The number of IHMS community-based health service providers increased by 40 per cent to more than 700 in 2010‑11. These providers deliver services to the community detention network on behalf of IHMS. There is no provision in the contract to penalise the organisation for underperformance.

In May 2013, the Government announced that families who arrive by boat would be considered for bridging visas in the community, but would be subject to the same ‘no advantage’ principle as those held on Nauru and Manus Island. It is likely that these asylum seekers will not have the same access to health care services as those on Nauru and Manus Island, as they will not have access to Medicare and it does not appear that DIAC has a specific contract for the provision of health care services to this group in Australia. Exploration of this issue is outside the scope of this paper.

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