Like most Western countries, Australia removes, or ‘deports’, asylum seekers whose applications for refugee protection are refused. This is the logical outcome of a fair and reliable refugee assessment system, an outcome that maintains the integrity and strength of refugee protection and limits potential abuse by non-refugees seeking residency. In Australia this outcome is prescribed as a process of law.

But what happens to asylum seekers while the law runs its course? Outstripping its Western counterparts, Australia maintains a range of asylum policies which contribute to the deterioration of the physical and mental health of asylum seekers while their claims for protection are being processed. Such policies include the use of mandatory, indefinite detention (both on-shore and off-shore) and bridging visas with conditions which deny access to health care, permission to work or income support. The impact of these policies are compounded by the length of time asylum seekers live under these conditions in uncertainty and fear.

The government has maintained and furthered these policies despite evidence of the significant damage which is inflicted on this vulnerable population. These policies result in an asylum seeker’s right to health being left unfulfilled for years at a time. Australia fails to fulfil this responsibility in multiple and varied ways: some asylum policies and practices cultivate ill health; some limit or prevent the treatment of ill health; and some fail to prevent ill health.

This strong association between ill health and the asylum process in Australia has significant implications when considering the practical and moral dilemmas involved in removal. It also introduces greater levels of responsibility for the future health of asylum seekers in countries of return.

For most asylum seekers, removal is a traumatic event leading to a difficult future in countries struggling to meet the basic needs of their populations. For removees who are seriously ill, removal can mark the “beginning of the end” as they anticipate the rapid deterioration of their health in places unable to provide adequate conditions of care. This is most likely when someone is removed to a country with limited basic resources, poor health care services or which is in the midst of an ongoing war or violent instability.

These conditions are not generally considered adequate reasons to prevent removal, as the returned asylum seekers are returning to the unfortunate circumstances faced by all people in their country of origin. As Australia is unable to offer visas to all individuals living in such situations, it is argued we have no responsibility to offer relief to those seriously ill individuals facing removal. Such dispassionate logic has allowed Australia to pursue removal outcomes with a serious disregard for the health and wellbeing of removees. It has also neglected our responsibility towards those whose health has deteriorated as a result of Australia’s damaging policies.

Our interviews highlighted the devastating consequences of these policies for individuals. One asylum seeker became destitute after living on a bridging visa with no work rights or income support. He took a job illegally in order to avoid starvation. As a result, he was taken into immigration detention for breaching his visa conditions. While in detention, he experienced stomach pains and was treated for ulcers. With the support of a charity, he was released from detention on another bridging visa. In the community, a doctor took pity on him and treated him as a patient for free. He was soon diagnosed with oesophageal cancer, not ulcers. The cancer progressed quickly, and as the man was ineligible for health care he struggled to obtain proper treatment. In the terminal stages of the illness, he was threatened with removal as his application for protection has been refused at all levels. Clearly unfit for travel, he lived out his remaining months in Australia living off the charity of others while his illness progressed without appropriate access to treatment or palliative care.

Another man held in immigration detention for many years became severely depressed and suicidal. Such severe mental health issues have been linked to long term detention. His claims for refugee protection were finally refused at all levels. In the days before he was removed, he was held in an isolation room within the detention centre for observation as he was considered to be at a high risk of suicide. The bible was removed from the room in case he tore out the pages to choke himself to death. Two mental health professionals assessed him as being suicidal and, consequently, unfit for travel. Despite these concerns for his mental health, he was removed to a country with no arrangements for support or handover on arrival.

These are two of the men who have lived out the drastic consequences of asylum policy. Recent changes within the Department of Immigration and Citizenship have made some major progress in the asylum and removal practices. However, the underlying policies remain unaltered. Changes must be made to ensure Australia’s policies are not detrimental to the health and wellbeing of asylum seekers. Plans to implement removal should be reconsidered for seriously ill individuals who have no prospect of ongoing care on return.

There are gross inequalities throughout the world in terms of health care, wealth and security, and the removal of seriously ill asylum seekers from Australia brings to light these stark differences. The current system means this tragic reality is compounded by the actions of the Australian government. Removing asylum seekers from Australia is a painful consequence of government policy. Removing those whose illness has been cultivated, or even induced, by government policy is an abhorrent neglect of responsibility.