A recent issue of the British medical journal, The Lancet, underscores the growing tendency of governments in industrialised countries to lock asylum seekers in detention centres and the consequent psychological and physical health effects faced by the detainees.

The journal made particular reference to the mandatory detention system in Australia, where all those entering the country without a visa are detained irrespective of their physical and psychological condition and whether they are seeking refugee status. Detainees have almost no legal rights and are subject to forcible deportation after a limited review of their case.

Around 3,500 asylum seekers, including 450 children are held in Australian detention centres; the majority in facilities resembling concentration camps in remote desert areas thousands of kilometres from major cities. Most of the detainees have fled from Iraq, Iran, Afghanistan and Palestine and about 300 have been in these centres for more than a year.

The Australian government has actively sought to conceal conditions inside the centres by blocking access to the media, social workers, refugee groups and researchers. Allegations of child abuse by former staff members forced the minister earlier this year to order a narrowly defined inquiry which confirmed cases of intimidation, verbal abuse, humiliation and failure to follow procedures.

The two articles in the Lancet on Australia underline the barriers facing medical researchers seeking to examine the health of detainees.

The first was written by a refugee, Dr Aamer Sultan, who has been detained for nearly two years since fleeing Iraq in May 1999. He has used his time at the Villawood Detention Centre in Sydney to build up a dossier on the psychological impact of detention on refugees. He wrote in the Lancet that the handling and treatment of detainees, “appears arbitrary, deliberately harsh, culturally insensitive, and highly disrespectful in a context where there is a significant lack of emotional and psychological support or care.”

Sultan found that out of those who had been in detention for 12 months, the rate of severe depression was more than 90 percent. Of the 36 Villawood detainees held for over a year, 33 are “experiencing clear evidence of severe depressive symptoms,” while the other three have mild depressive symptoms. Twenty-two of the 36 detainees are receiving anti-depressant drugs.

According to Sultan, six detainees have developed “clear psychotic symptoms” evidenced by “admission to acute psychiatric units or on the basis of other psychiatric assessments.” Five detainees “show strong aggressive-impulse and persistent self-harming behaviors.” He pointed out that detention had caused the problems as the individuals showed few of the symptoms on arrival.

In a report based on the Lancet findings, ABC Radio interviewed two former detainees from the Woomera detention center who are now living in Adelaide. Nazeem, who was detained with his wife and four children, explained the impact of detention on their children. He said that his children were previously polite and attentive but detention at Woomera changed them. “And once they met the other children and, obviously, they were frustrated there. And it had a really bad effect on their behavior. And they have gone almost wild,” he said.

Medical researcher Zachary Steel told ABC Radio that Dr Sultan had further evidence of the negative affects of detention on children that had not been included in his Lancet article. He discovered bed wetting—a symptom of high levels of psychological stress—was particularly prevalent among children held in the Villawood detention centre.

The second Australian study involved Tamil asylum seekers. One of the researchers, Patrick McGorry, explained in a recently published book, Borderline, that he had been denied access to the detention centres because the government regarded the issue as politically sensitive. He made the point that he had not confronted the same difficulty conducting mental health surveys in the prison system in the state of Victoria in the late 1980s.

As a result of the ban, McGorry was forced to shift the focus of his study to asylum seekers who had been recently released. He compared them with those were living in the community. The research showed that the detained group “reported greater exposure to torture and other forms of persecution in their home country, and they manifested much higher levels of depression, panic, post-traumatic stress symptoms, somatic distress, and suicidal urges compared to the community group.”

A cruel irony

McGorry made the point that asylum seekers who leave their country under extreme threat are those most likely to leave “in haste and without documentation, hence placing themselves at greater risk of being detained” in the West. “The cruel irony is that instead of providing special care for the most traumatised individuals fleeing persecution, western countries may be subjecting them to the very conditions that are likely to hinder psychological recovery,” he said.

His comments underscore the callousness of the Australian government's immigration policy. The fact that refugees and their families are locked up in poor conditions, with little legal recourse and treated as criminals is based on the assumption that their reasons for seeking asylum are illegitimate. Moreover as McGorry's research makes clear those refugees most in need of assistance are precisely the ones that are least likely to receive any, compounding the risk of health and psychological problems.

A spokesman for Immigration Minister Philip Ruddock dismissed the Lancet research, saying: “We are not aware of the three [researchers] spending much, if any time in the detention centres and some of the observations would appear to be based on misconception... Most of the problems of violence relate to people who have been found not to be refugees but who were angry or upset they had wasted thousands and sometimes tens of thousands of dollars on paying to get here.”

Apart from the slur on refugees, the spokesman's comments ignore the obvious point that the government itself has barred researchers from the detention centres. Commenting on the response, Lancet writer Zachary Steel said: “[I]t's come to such a level where there's so many multiple sources of information pointing to the same conclusion. That it's really incumbent upon him [Ruddock] to demonstrate that detention has not caused this high level of suffering.”

The maltreatment of asylum seekers in Australia is part of a far broader international problem. According to statistics in another Lancet article by Steel, Derrick Silove and Richard Mollica, there are an estimated 150 million people living outside their country of birth, 15 million are classed as refugees and 22.3 million are considered people “of concern” by the UN.

The authors comment: “Administrative obstacles have prevented the systematic investigation of the general and mental health of detainees. In 1999, the New York Times reported that 90 detainees had contracted tuberculosis from a fellow asylum seeker. Inadequacies in dental treatment, in the medical investigation of physical complaints, and in antenatal care have drawn comment from several human rights organisations worldwide. Psychological distress among inmates is reflected in suicide attempts, acts of mass violence, group breakouts, rioting, burning of facilities, and sporadic hunger strikes.”

Criticising the policy of detention, they write: “Politicians offer glib rationalisations for the detention policy—in particular, that detention is the only way of sending a message of deterrence to unauthorised immigrants. Yet the contradictions in political rhetoric are becoming increasingly extreme. Free trade is exalted as a virtue, but the free movement of people is regarded as a sovereign threat and a challenge to the material prosperity of the West.”

While they insist that “human rights are universal” and “convenience and administrative simplicity cannot justify the mistreatment of asylum seekers,” the authors are at a loss to explain the rise of anti-immigrant bigotry and the increasingly harsh measures used against refugees in country after country. Their alternative to detention is to allow refugees to live in the community but subject to restrictions: monitoring systems, financial bonds to ensure compliance with legal procedures and the establishment of temporary forms of asylum.

The only really humane approach to asylum seekers, however, is to grant them full citizenship rights and access to a full range of assistance and services in order to overcome the traumas that they have suffered.