theatre facilities, a short-stay type ward area, an ambulance with improved resuscitation facilities,
improved quality ultrasound and a mental health clubhouse/drop in room.”cclxxix
gaps in physical health screening systems including a lack of health screening in children - there are
inefficiencies in adult health screening with “rapid turnaround” policies resulting in people being returned
to Australia, and there is a lack of health screening in children, which is not appropriate in the situation of
transfer to an offshore processing environment” ... It also observed that “there are critical issues with the
lack of health screening for children in held detention, including those transferred for offshore
processing.” cclxxx
people in the Nauru Offshore Detention Centre were not being screened for illnesses like tuberculosis and
hepatitis, nor for parasite infections (like Giardia and Strongyloides stercoralis), known to be common
among refugee cohorts. The Subcommittee noted that the immigration department protocols for
screening are sound, but that they are not implemented. There was also no child developmental
surveillance, which is an important component of mental health monitoring. Failure to properly screen
means that asylum seekers may not being delivered health care that meets their particular needs, and
that health and disability issues can arise after transfer. cclxxxi
“[c]rowded living conditions” which create public health risks. This is especially so given concerns over
sanitation and water, and the fact that many people had not been properly screened or vaccinated.cclxxxii
Detainees on Nauru also reported problems with vermin, pests and the tent accommodations in which
they live, to the Subcommittee: “the tents leaked with rain (wetting bedding), mosquitoes prevented
sleep at night, and that there were spiders, rats and scorpions.”cclxxxiii
immunisation programs were not being comprehensively delivered on Nauru, generating particular risks
for children.cclxxxiv There is only a limited history and examination of children under 11 years, no blood
screening under 15 years. The Subcommittee on Physical and Mental Health says that these practices are
not sufficient to detect hepatitis B and latent tuberculosis, nor for parasite infections (like Giardia and
Strongyloides stercoralis), known to be common among refugee cohorts. The Subcommittee also found
that immunisation programs were not being comprehensively delivered.cclxxxv The Subcommittee also
noted that “[i]ncomplete immunisation is an avoidable risk factor for outbreaks of vaccine preventable
diseases such as measles, mumps, rubella, chicken pox, pertussis and influenza, which are more likely in
close living conditions.”cclxxxvi
“[b]ased on current prevalence data, there are likely to be multiple children with undiagnosed blood
borne virus infections such as hepatitis B, and up to 50 per cent of children will have latent tuberculosis
infection with their risk of developing active tuberculosis increased by young age, recent migration and
social stressors, all of which are relevant in this setting. Currently there is no child developmental
surveillance, which is also an important form of mental health monitoring. The lack of child health
screening means health issues and disability are likely to arise after transfer.” cclxxxvii
crowded living conditions and the environment of the Nauru Offshore Detention Centre would be likely to
lead to outbreaks of communicable diseases.cclxxxviii The Subcommittee made a number of risk
management recommendations including comprehensive vaccination, education about hand washing,
access to hand sanitisers, and mosquito control and surveillance.
conditions in the Nauru Offshore Detention Centre are likely contributing to poor mental health:
“[c]rowded, hot and humid living conditions in an enclosed detention environment with minimal access to
meaningful activities, for prolonged periods, with uncertain endpoints. Adults described boredom,
hopelessness and helplessness, and very limited access to activities. Many people described an
overwhelming sense of uncertainty about progress, and information dissemination was repeatedly
identified as an issue ... People spoke of extreme difficulties sleeping due to the heat, and mosquitoes,
exacerbating mental health issues.” cclxxxix
identified the particular mental health risk factors that apply to asylum seeker populations: “people in
held detention have a number of significant risk factors for adverse mental health outcomes, including
past trauma and sometimes torture, family separations and loss, disruption of community, education and
employment, prolonged uncertainty, a sense of being trapped, a lack of understanding or trust in the RSD
process, and feelings of hopelessness.” ccxc
reported its concerns about the absence of a full time psychiatrist in Nauru Offshore Detention Centre. ccxci