Stop gagging asylum seekers’ doctors – warns BMJ

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IN THE British Medical Journal this week, two doctors criticise Australia for passing legislation that may be used to silence doctors working with asylum seekers.

The Border Force Act 2015 says that from July 2015 contracted workers including doctors, nurses, and other healthcare professionals face a prison sentence of up to two years for blowing the whistle on substandard medical care given to asylum seekers in detention centres.

Dr David Berger at Broome Hospital in Western Australia, argues that the only reason to suppress doctors in this way, ‘is to avoid embarrassing revelations about how Australia is flouting its international humanitarian obligations towards refugees and is subjecting them to treatment that violates the United Nations Convention Against Torture’.

To submit to a gagging order such as the Border Force Act 2015 ‘places doctors in direct opposition to our professional duty to promote the best interests of our patients at all times,’ he writes. ‘It is a moral travesty of the Australian government to put healthcare workers in this invidious position simply to safeguard its own blushes and to further its inhumane policy initiatives.’

Holding governments to account through the conscience of the people is democracy in action, he says. ‘Without information this cannot happen, and democracy must fail. This is why, except when the reasons not to are absolutely overwhelming, information must be open,’ he added.

Berger calls on all right minded people, people of conscience, and lovers of democracy and accountability ‘to petition the Australian government to repeal this repressive legislation and to promote openness, accountability, and protection for whistleblowers everywhere’.

David Berger is an employee of Western Australia Country Health Service (WACHS) and has been asked to state clearly that these opinions are his own and do not in any way represent the views of WACHS.

In a second article, Professor David Isaacs, a children’s doctor in New South Wales has seen the suffering among detainees in Nauru, one of Australia’s off-shore immigration centres. He believes this is the first time in Australian history that doctors have faced imprisonment for telling the truth about serious harms being inflicted on their patients.

He says he was ‘utterly appaled’ by the Spartan living conditions on Nauru and by the treatment meted out to detainees. And he points to strong evidence showing that the harsh conditions under which children and adults are held and uncertainty about their fate, ‘are highly detrimental to mental health’.

He calls on Australian and foreign doctors to boycott working in detention centres – and asks healthcare staff to continue to consider publicising abuses of patients that they witness. And he urges colleagues worldwide ‘to protest against repressive legislation which tries to silence doctors from telling the truth about conditions harming their patients, and which is a serious blow to the democratic process’.

• On Thursday, a UNHCR report showed that worldwide displacement from wars, conflict, and persecution is at the highest levels recorded, and accelerating fast. UNHCR’s new annual Global Trends report shows a sharp escalation in the number of people forced to flee their homes, with 59.5 million people forcibly displaced at the end of 2014 compared to 51.2 million a year earlier and 37.5 million a decade ago. The increase since 2013 was the highest ever seen in a single year.

UNCHR said: ‘The main acceleration has been since early 2011 when war erupted in Syria, propelling it into becoming the world’s single largest driver of displacement. In 2014, an average of 42,500 people became refugees, asylum seekers, or internally displaced every day, representing a four-fold increase in just four years.

‘Worldwide, one in every 122 humans is now either a refugee, internally displaced, or seeking asylum. Were this the population of a country, it would be the world’s 24th biggest.’

UNHCR’s report shows that in region after region, the number of refugees and internally displaced people is on the rise. In the past five years, at least 15 conflicts have erupted or reignited: Eight in Africa (Côte d’Ivoire, Central African Republic, Libya, Mali, northeastern Nigeria, Democratic Republic of the Congo, South Sudan and this year in Burundi); three in the Middle East (Syria, Iraq, and Yemen); one in Europe (Ukraine) and three in Asia (Kyrgyzstan, and in several areas of Myanmar and Pakistan).

UNHCR warned: ‘Few of these crises have been resolved and most still generate new displacement. In 2014 just 126,800 refugees were able to return to their home countries, the lowest number in 31 years … Among recent and highly visible consequences of the world’s conflicts and the terrible suffering they cause has been dramatic growth in numbers of refugees seeking safety by undertaking dangerous sea journeys, including on the Mediterranean, in the Gulf of Aden and Red Sea, and in Southeast Asia.’

UNHCR’s Global Trends report shows that in 2014 alone 13.9 million became newly displaced – four times the number in 2010. Worldwide there were 19.5 million refugees (up from 16.7 million in 2013), 38.2 million were displaced inside their own countries (up from 33.3 million in 2013), and 1.8 million people were awaiting the outcome of claims for asylum (against 1.2 million in 2013). UNHCR said: ‘Alarmingly, over half the world’s refugees are children.’

Syria is the world’s biggest producer of both internally displaced people (7.6 million) and refugees (3.88 million at the end of 2014). Afghanistan (2.59 million) and Somalia (1.1 million) are the next biggest refugee source countries. UNHCR notes: ‘Conflict in Ukraine, a record 219,000 Mediterranean crossings, and the large number of Syrian refugees in Turkey – which in 2014 became the world’s top refugee-hosting nation with 1.59 million Syrian refugees at year’s end – brought increased public attention, both positive and negative, to questions to do with refugees.

‘In the EU, the biggest volume of asylum applications was in Germany and Sweden. Overall, forced displacement numbers in Europe totalled 6.7 million at the end of the year, compared to 4.4 million at the end of 2013, and with the largest proportion of this being Syrians in Turkey and Ukrainians in the Russian Federation.

‘The massive suffering from Syria’s war, with 7.6 million people displaced internally, and 3.88 million people displaced into the surrounding region and beyond as refugees, alone made the Middle East the world’s largest producer and host of forced displacement. Adding to the alarmingly high totals from Syria was new displacement of least 2.6 million people in Iraq, where as a result 3.6 million people were internally displaced as of the end of 2014, as well as 309,000 people newly displaced in Libya.

‘Often-overlooked, Africa’s numerous conflicts, including in Central African Republic, South Sudan, Somalia, Nigeria, Democratic Republic of Congo and elsewhere, together produced immense forced displacement totals in 2014, on a scale only marginally lower than in the Middle East.

‘In all, sub-Saharan Africa had 3.7 million refugees and 11.4 million internally displaced people, 4.5 million of whom were newly displaced in 2014. The 17 per cent overall increase excludes Nigeria, as methodology for counting internal displacement changed during 2014. Ethiopia replaced Kenya as the largest refugee-hosting country in Africa and the fifth largest worldwide. Long one of the world’s major displacement producing regions, the number of refugees and internally displaced people in Asia grew by 31 per cent in 2014 to 9 million people.’