Submission to the Senate Legal and Constitutional Affairs Committee inquiry into the Migration Amendment (Repairing Medical Transfers) Bill 2019 by Dr Tanya McIntyre, 15 August 2019 Submission overview and concerns This submission outlines my views on refugees and asylum seekers 1 in need of medical evacuation from Papua New Guinea and Nauru to Australia, as enabled by the Home Affairs Legislation Amendment (Miscellaneous Measures) Act 2019 , referred to herein as the “medevac law”. I am concerned that people who are physically and mentally unwell are denied medical treatment. I am appalled that this is done to uphold government policy that is explicit in its aim to inflict ongoing harm on one group of people to try to compel them to return to the harm they fled as refugees, and to warn others of the harm they would also suffer if they try to seek refuge in Australia. I am concerned about this brutal and inhumane treatment of refugees. It does not befit the fair, democratic and compassionate principles that we like to think underpin Australian society and polity. My experience with refugees in Australia’s offshore detention regime In 2012 I began visiting refugees in Australian immigration detention. In 2014 I completed a Graduate Certificate in Australian Migration Law and Practice. My other credentials include a PhD in Asian studies. Since 2014 I have met and communicated with refugees detained by Australia on Nauru and Manus Island after 19 July 2013 when offshore detention became more than a temporary processing regime and became a feature of the practice of permanent exile of people who sought protection in Australia. In 2015 I registered as a migration agent and began providing migration assistance to refugees in Australia’s immigration detention network. Since 2015, I have been a member of Darwin Asylum Seeker Support and Advocacy Network (DASSAN) through which I assisted sending e-books to refugees on Manus Island and Nauru and distributing a hardship fund to refugees, including in Papua New Guinea. In 2017 I lived in Wewak in Papua New Guinea for several months. I worked for a local non- government organisation to establish monitoring and evaluation systems for a project that supports market vendors, who were mainly women, to elevate the status of their work into the formal economy as a regulated and safe working environment. 1 The terms ‘refugee’ and ‘asylum seeker’ generally refer to, respectively, people found to be refugees through a refugee determination process and people seeking asylum but not found to be refugees either through a refugee determination process or not having yet undergone or completed a refugee determination process. However, in this submission, I hereon refer to both groups as refugees. This is for ease of reference and to not distract from the subject of medical needs by delving into immigration status issues. It also acknowledgement that many people in Papua New Guinea and Nauru not yet found to be refugees are still requesting their refugee claims be assessed or reviewed according to the principles of the UN Refugee Convention and the UN guidelines on determining refugee status. Submission to Senate Committee by Dr Tanya McIntyre Medevac Law Page 1 of 5 While living in Wewak in 2017, I made two trips to Manus Island, for approximately two weeks on each occasion, and met some of the refugees held there since 2013. In April-May 2019, I visited Manus Island for approximately three weeks, and Port Moresby for approximately a week. I was devastated to see everyone I had met on Manus Island in 2017 suffering further and sharp decline in their health and wellbeing. In 2017, people I met on Manus Island had descended to a level of despair and hopelessness lower than I have ever seen in the years I have interacted with refugees. Yet by 2019, the same people had crashed to unimaginably gut wrenching pits of despair and hopelessness. Whereas in 2017 people were relatively engaged and welcomed the opportunity to exchange stories and experiences, by 2019 the same people apologetically struggled to even go out of their guarded accommodation due to their incapacity to cope with life. In recent months, I have been assisting more than 20 refugees with their applications under the medevac law. This involves gathering their medical records and contextual information about factors affecting their health and wellbeing, responding to emergencies including suicide attempts, and referring to appropriate services where possible. Observations of Wewak medical services – a comparative example of regional Papua New Guinea Medical services in the regional town of Wewak may be loosely compared to that of Lorengau on Manus Island. However, Wewak is not as remote as Manus Island. Wewak is situated on the north coast of the main island of Papua New Guinea, and is larger and better-resourced than Lorengau. Wewak population is around 30,000. Lorengau population is around 7,000. Wewak medical services, although substandard, are likely better than medical services in Lorengau. Moreover, Wewak is not overwhelmed by a population of ‘foreigners’. Whereas the large number of refugees in Lorengau in recent years has placed additional demand on already substandard medical services. While living in Wewak, I visited a patient at the Wewak Hospital. I also knew two Australians who worked at Wewak Hospital – one in administration and another as a surgeon. The patient I visited at Wewak Hospital was my co-worker’s father from a nearby village. He was a fit, lean and strong man in his mid-fifties who developed diabetes undiagnosed until some of his toes fell off after rotting from a small, infected wound. Through several weeks in a ward of about 40 patients in one large room, while one of his daughters slept on the floor of the hospital by his bed and provided necessary care for him that the hospital could not provide, he underwent two amputations of his leg – the first below the knee and the second above the knee. Shortly after the second amputation he died, as the infection was not contained. The Australian administrative worker I knew at Wewak Hospital told me about the impact of funding constraints. For example, a doctor employed to deliver outreach services to the villages around Wewak was only funded for wages but not for travel or program support so the doctor could not deliver any services. Additionally, when administrative staff were not paid wages for months, they did not attend work, or attended but failed to undertake duties. The Australian surgeon I knew at Wewak Hospital told me that, despite the commendable skills and commitment of medical professionals, the hospital was extremely under-resourced of both equipment and medical expertise. For example, the hospital had no independent electricity supply, so during frequent power blackouts doctors used torches and mobile phone lights to see as they completed surgery in the dark. Further, doctors worked extremely long hours and were constantly challenged to perform procedures that stretched their competencies. Patients routinely died preventable deaths that Submission to Senate Committee by Dr Tanya McIntyre Medevac Law Page 2 of 5 in Australia would invoke full investigation yet no follow up in Wewak Hospital ever occurred. There was no scrutiny of medical or systemic failure. I also knew of a disabilities service in Wewak that did not pay its employees for months, so instead of attending work, physiotherapists and other professionals resorted to selling garden produce in local markets to make ends meet. I bought some of their produce. General observations about the health of refugees held in Papua New Guinea All the refugees I met in Papua New Guinea suffered chronic physical complaints for years, and struggled increasingly with serious mental health conditions. Their treatment was mainly ineffective medication. Doctors often say and write reports that their illnesses are caused or exacerbated by stress and anxiety, resulting from their being held in Papua Guinea indefinitely. Medications are often changed due to lack of availability and for trial – this has particularly detrimental effect on refugees taking psychotropic medications. Food quality and diet is poor, increasingly so since Australia withdrew in October 2017 from directly operating the centres. Activities have declined since Australian operational withdrawal, for example with closure of prayer spaces and gyms. Almost all refugees I met had eating and sleeping disorders due to chronic pain, gastro issues and mental health issues, and were taking pain killers and tranquilisers. Some refugees suffered complex conditions that required surgery. Some had suffered botched surgery, resulting in disability. Some suffered injuries from assaults, resulting in disability and mental ill health. At least half the refugees I met reluctantly admitted to self-harming or attempting suicide – I suspect higher actual incidence. Individual cases of refugees and medical evacuation I outline below three cases of refugees I know and have assisted in their efforts to be medically evacuated to Australia. These three cases exemplify the need for medevac law to be retained. The first case is about a refugee evacuated before introduction of the medevac law. The second case is about a refugee evacuated under the medevac law. The third case is about a refugee remaining in Port Morseby whose application under the medevac law is pending. Case 1: Refugee evacuated from Nauru prior to medevac law A refugee on Nauru who I communicated with for about a year suffers multiple serious physical and mental health conditions. He lived in a tent on Nauru for most of five years. He suffers extreme loneliness and longing for family and community that he is now forever separated from. He has serious neurological and heart conditions, and severe anxiety and depression, for which he was not treated on Nauru.