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Health issues of asylum seekers and refugees

Health issues of asylum seekers and refugees This paper is written on behalf of the West Australian Branch of the Australasian Faculty of Public Health Medicine. As public health physicians, we feel it is important that public health professionals should contribute constructively to address the needs of a socially deprived, marginalised group with high rates of physical and psychiatric morbidity. Depending on the definition, there are between 18 and 48 million asylum seekers and refugees in the world. Most seek protection in neighbouring countries, largely in Africa and Asia, rather than coming to North America, Europe and Australasia. Contrary to popular belief, numbers of successful applications to Australia’s humanitarian program have actually fallen. This article attempts to correct misperceptions and misapprehensions about the effect of asylum seekers on the public health. Public health professionals should lobby for changes to Government policy that at present leave asylum seekers vulnerable to a cycle of poverty, ill-health and limited access to health services. (Aust N Z J Public Health 2002; 26: 8-10) Stephen Kisely Primary Care Mental Health Unit, University of Western Australia Margaret Stevens Office of Cancer Planning, Health Department of Western Australia Bret Hart Population and Community Health Program, North Metropolitan Health Service, Western Australia Charles Douglas Eastern Perth Public & Community Health Unit, Western Australia he 2001 federal election and conse quent media coverage have high lighted the issue of asylum seekers and refugees in Australia. The issue is of particular relevance for Western Australia given recent arrivals to Christmas Island and the fact that almost 50% of Australia’s detention centres (Perth, Curtin and Port Hedland) are in the State. As public health physicians, we feel it is important that public health professionals should contribute constructively to correcting misperceptions and addressing the needs of a socially deprived, marginalised group with high rates of physical and psychiatric morbidity. This article does not enter into the debate about the numbers of asylum seekers that the Australian Department of Immigration and Multicultural Affairs (DIMA) should accept, but concentrates on insisting that we provide asylum seekers with the health care to which they are entitled on human rights grounds. The extent of the problem Estimating the total number of asylum seekers and refugees in the world is difficult, as definitions differ. The Australian Government defines asylum seekers as those who apply for recognition, while Submitted: January 2002 Accepted: January 2002 reserving the term refugee for those granted protection visas.1, 2 Depending on the definition, estimates vary between 18 and 48 million.3, 4 Most seek protection in neighbouring countries, largely in Africa and Asia, but increasing numbers are coming to North America, Europe and Australasia.4 Australia’s humanitarian program, which has a maximum of 12,000 places per year, consists of onshore and offshore components.1, 2, 5 The offshore component covers applications made overseas by refugees, and others who are in humanitarian need and have close links to Australia. The onshore component covers applications made within Australia. Applicants may have arrived as students or visitors, or have entered without authority. The former can apply for refugee status and are granted a bridging visa while their claim is being processed, provided that the application is made within 45 days. They may remain in the community and if their original visa permits, or has expired, they may seek work and are eligible for Medicare, Australia’s national health system, and other government services. However, if applicants entered as a visitor or student, they are unable to work until their particular visa has expired.6 If they Correspondence to: Stephen Kisely, Primary Care Mental Health Unit, University of Western Australia, 16 The Terrace, Fremantle WA 6160. Fax: (08) 9336 5505; e-mail: stephenk@cyllene.uwa.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2002 VOL. 26 NO. 1 Point of View Health issues of asylum seekers apply after having spent 45 days in Australia they are issued with a bridging visa, but are not allowed to seek work, nor to receive benefits. If their claim is successful, they are given a protection visa (PV), which gives them permanent residence and full entitlements to benefits. 2 Those arriving without authority are held in detention centres while their claims are processed. If their application is successful they are released from detention and granted a Temporary Protection Visa (TPV), which gives them the right to work, access to Medicare and some other benefits,7 but not the comprehensive support arrangements available to those on PVs. They are not allowed to leave the country, nor are their families allowed to join them. Since September 2001, they cannot apply for a PV after 36 months, but have their TPV reviewed and renewed if it is considered appropriate. The onshore component has been of growing importance and the subject of most media interest as it includes those arriving by boat. Until a decade ago, there were fewer than 500 onshore applications a year from people in Australia.2 By 1999/2000, there were 12,713 applications.1 Contrary to popular perception, the numbers of successful applications to Australia’s humanitarian program have actually fallen, as onshore applications (those made in Australia) have been counted against the 12,000 allocation since 1997. Previously they were in addition to the 12,000 places.1 There are a number of other misconceptions. Only a third of successful applications come from the Middle East or Southern Asia, with another third coming from Europe and 18% from Africa.1 Until 1999, the majority of unauthorised arrivals came by air rather than boat.8 In terms of formal psychiatric diagnoses, there have only been a few studies of relatively small numbers in countries such as Australia, Europe and Japan.15 About a third suffer from major depression, an equal number from anxiety and a further 13% from post-traumatic stress disorder. Are existing government policies exacerbating the problem? Concerns about uncontrolled migration have encouraged some destination countries to adopt policies of deterrence in which increasingly restrictive measures are being imposed on asylum seekers.15 In Australia these include confinement in detention centres, restriction of the right to appeal, and temporary rather than permanent asylum. These policies may be counter-productive by aggravating pre-existing medical problems and may actually compromise public health. Some asylum seekers are held in detention facilities for considerable periods of time. A 1998 report in Australia identified more than 80 detainees who had been held in detention between two and five years.20 Housing refugees in crowded conditions can facilitate the spread of infectious disease. In America, 90 asylum seekers contracted tuberculosis from a fellow detainee.21 If the spread of malaria is of concern, it makes little sense to house refugees in Curtin in the far north of Western Australia, where exposure to potential vectors is greatest and the disease most likely to become established.11 Detention may also harm the mental health of asylum seekers. Asylum seekers in detention have high rates of attempted suicide15, 22 and hunger strikes. They also show significantly higher levels of depression, suicidal ideation, post-traumatic stress, anxiety and panic attacks than asylum seekers, refugees and immigrants from the same country living in the community.15 In Australia, the Human Rights and Equal Opportunity Commission has suggested that the boredom and frustration of prolonged detention together with social isolation may be responsible for outbreaks of violence, including domestic violence, among detainees and between detainees and officials.20 Single women and children may be at increased risk of abuse and exploitation when confined in mixed-sex detention facilities.15 Concerns have been raised about the health care provided in these settings.15, 23 These include the blanket prescription of anthelmintics and anti-malarials irrespective of infective status, inappropriate use of analgesics in which physical investigations should have been undertaken, and excessive prescription of tranquillisers. The physical isolation of centres such as Curtin and Port Hedland compounds these problems, as does the reliance on rural health services, which are often over-stretched and understaffed. The situation in the temporary camps dotted around the South Pacific is even less clear. When refugees leave detention centres, social isolation, limited communication between Federal and State governments, absence of funding for interpreting services and restricted access to Medicare for those on bridging visas without work rights, further Medical and psychiatric problems Prevalence of nutritional and infectious diseases such as hepatitis, parasitical disease and tuberculosis reflects the rates of the country of origin, but are all treatable.3, 9, 10 Although they may have higher rates of physical morbidity, asylum seekers do not present a risk to public health if they have access to appropriate health care. A British study concluded that the recent entry of refugees was likely to be only a minor factor in the national increase in tuberculosis.11 Social deprivation and limited access to health services were more important predictors.11 Malaria is more likely to be reintroduced to Australia as a result of erosion of public health infrastructure or global warming,12 rather than by unauthorised asylum seekers. Symptoms of depression and anxiety, panic attacks, or agoraphobia are common and are often reactions to past experiences and current social circumstances.3, 13, 14 More than 20% of asylum seekers in Australia reported experiencing previous torture, a third reported imprisonment for political reasons, and a similar number reported the murder of family or friends.15-18 In one British study, 65% of Iraqi refugees had a history of systematic torture during detention.19 These experiences are compounded by the rigours of reaching safety, social isolation, poverty, hostility and racism.3 2002 VOL. 26 NO. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Kisely et al. Point of View compromise subsequent health.24, 25 Not only does this disadvantage the individuals concerned, but also it has implications for public health. There are also reports of asylum seekers who have been discharged to the community without written medical records to give to their doctors outside. The situation is compounded by limitations on access to government services such as welfare, employment and language classes for those on TPVs. Individuals can potentially enter a cycle of poverty and declining health with increased vulnerability to disease. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Health issues of asylum seekers and refugees

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Publisher
Wiley
Copyright
Copyright © 2002 Wiley Subscription Services
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2002.tb00263.x
Publisher site
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Abstract

This paper is written on behalf of the West Australian Branch of the Australasian Faculty of Public Health Medicine. As public health physicians, we feel it is important that public health professionals should contribute constructively to address the needs of a socially deprived, marginalised group with high rates of physical and psychiatric morbidity. Depending on the definition, there are between 18 and 48 million asylum seekers and refugees in the world. Most seek protection in neighbouring countries, largely in Africa and Asia, rather than coming to North America, Europe and Australasia. Contrary to popular belief, numbers of successful applications to Australia’s humanitarian program have actually fallen. This article attempts to correct misperceptions and misapprehensions about the effect of asylum seekers on the public health. Public health professionals should lobby for changes to Government policy that at present leave asylum seekers vulnerable to a cycle of poverty, ill-health and limited access to health services. (Aust N Z J Public Health 2002; 26: 8-10) Stephen Kisely Primary Care Mental Health Unit, University of Western Australia Margaret Stevens Office of Cancer Planning, Health Department of Western Australia Bret Hart Population and Community Health Program, North Metropolitan Health Service, Western Australia Charles Douglas Eastern Perth Public & Community Health Unit, Western Australia he 2001 federal election and conse quent media coverage have high lighted the issue of asylum seekers and refugees in Australia. The issue is of particular relevance for Western Australia given recent arrivals to Christmas Island and the fact that almost 50% of Australia’s detention centres (Perth, Curtin and Port Hedland) are in the State. As public health physicians, we feel it is important that public health professionals should contribute constructively to correcting misperceptions and addressing the needs of a socially deprived, marginalised group with high rates of physical and psychiatric morbidity. This article does not enter into the debate about the numbers of asylum seekers that the Australian Department of Immigration and Multicultural Affairs (DIMA) should accept, but concentrates on insisting that we provide asylum seekers with the health care to which they are entitled on human rights grounds. The extent of the problem Estimating the total number of asylum seekers and refugees in the world is difficult, as definitions differ. The Australian Government defines asylum seekers as those who apply for recognition, while Submitted: January 2002 Accepted: January 2002 reserving the term refugee for those granted protection visas.1, 2 Depending on the definition, estimates vary between 18 and 48 million.3, 4 Most seek protection in neighbouring countries, largely in Africa and Asia, but increasing numbers are coming to North America, Europe and Australasia.4 Australia’s humanitarian program, which has a maximum of 12,000 places per year, consists of onshore and offshore components.1, 2, 5 The offshore component covers applications made overseas by refugees, and others who are in humanitarian need and have close links to Australia. The onshore component covers applications made within Australia. Applicants may have arrived as students or visitors, or have entered without authority. The former can apply for refugee status and are granted a bridging visa while their claim is being processed, provided that the application is made within 45 days. They may remain in the community and if their original visa permits, or has expired, they may seek work and are eligible for Medicare, Australia’s national health system, and other government services. However, if applicants entered as a visitor or student, they are unable to work until their particular visa has expired.6 If they Correspondence to: Stephen Kisely, Primary Care Mental Health Unit, University of Western Australia, 16 The Terrace, Fremantle WA 6160. Fax: (08) 9336 5505; e-mail: stephenk@cyllene.uwa.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2002 VOL. 26 NO. 1 Point of View Health issues of asylum seekers apply after having spent 45 days in Australia they are issued with a bridging visa, but are not allowed to seek work, nor to receive benefits. If their claim is successful, they are given a protection visa (PV), which gives them permanent residence and full entitlements to benefits. 2 Those arriving without authority are held in detention centres while their claims are processed. If their application is successful they are released from detention and granted a Temporary Protection Visa (TPV), which gives them the right to work, access to Medicare and some other benefits,7 but not the comprehensive support arrangements available to those on PVs. They are not allowed to leave the country, nor are their families allowed to join them. Since September 2001, they cannot apply for a PV after 36 months, but have their TPV reviewed and renewed if it is considered appropriate. The onshore component has been of growing importance and the subject of most media interest as it includes those arriving by boat. Until a decade ago, there were fewer than 500 onshore applications a year from people in Australia.2 By 1999/2000, there were 12,713 applications.1 Contrary to popular perception, the numbers of successful applications to Australia’s humanitarian program have actually fallen, as onshore applications (those made in Australia) have been counted against the 12,000 allocation since 1997. Previously they were in addition to the 12,000 places.1 There are a number of other misconceptions. Only a third of successful applications come from the Middle East or Southern Asia, with another third coming from Europe and 18% from Africa.1 Until 1999, the majority of unauthorised arrivals came by air rather than boat.8 In terms of formal psychiatric diagnoses, there have only been a few studies of relatively small numbers in countries such as Australia, Europe and Japan.15 About a third suffer from major depression, an equal number from anxiety and a further 13% from post-traumatic stress disorder. Are existing government policies exacerbating the problem? Concerns about uncontrolled migration have encouraged some destination countries to adopt policies of deterrence in which increasingly restrictive measures are being imposed on asylum seekers.15 In Australia these include confinement in detention centres, restriction of the right to appeal, and temporary rather than permanent asylum. These policies may be counter-productive by aggravating pre-existing medical problems and may actually compromise public health. Some asylum seekers are held in detention facilities for considerable periods of time. A 1998 report in Australia identified more than 80 detainees who had been held in detention between two and five years.20 Housing refugees in crowded conditions can facilitate the spread of infectious disease. In America, 90 asylum seekers contracted tuberculosis from a fellow detainee.21 If the spread of malaria is of concern, it makes little sense to house refugees in Curtin in the far north of Western Australia, where exposure to potential vectors is greatest and the disease most likely to become established.11 Detention may also harm the mental health of asylum seekers. Asylum seekers in detention have high rates of attempted suicide15, 22 and hunger strikes. They also show significantly higher levels of depression, suicidal ideation, post-traumatic stress, anxiety and panic attacks than asylum seekers, refugees and immigrants from the same country living in the community.15 In Australia, the Human Rights and Equal Opportunity Commission has suggested that the boredom and frustration of prolonged detention together with social isolation may be responsible for outbreaks of violence, including domestic violence, among detainees and between detainees and officials.20 Single women and children may be at increased risk of abuse and exploitation when confined in mixed-sex detention facilities.15 Concerns have been raised about the health care provided in these settings.15, 23 These include the blanket prescription of anthelmintics and anti-malarials irrespective of infective status, inappropriate use of analgesics in which physical investigations should have been undertaken, and excessive prescription of tranquillisers. The physical isolation of centres such as Curtin and Port Hedland compounds these problems, as does the reliance on rural health services, which are often over-stretched and understaffed. The situation in the temporary camps dotted around the South Pacific is even less clear. When refugees leave detention centres, social isolation, limited communication between Federal and State governments, absence of funding for interpreting services and restricted access to Medicare for those on bridging visas without work rights, further Medical and psychiatric problems Prevalence of nutritional and infectious diseases such as hepatitis, parasitical disease and tuberculosis reflects the rates of the country of origin, but are all treatable.3, 9, 10 Although they may have higher rates of physical morbidity, asylum seekers do not present a risk to public health if they have access to appropriate health care. A British study concluded that the recent entry of refugees was likely to be only a minor factor in the national increase in tuberculosis.11 Social deprivation and limited access to health services were more important predictors.11 Malaria is more likely to be reintroduced to Australia as a result of erosion of public health infrastructure or global warming,12 rather than by unauthorised asylum seekers. Symptoms of depression and anxiety, panic attacks, or agoraphobia are common and are often reactions to past experiences and current social circumstances.3, 13, 14 More than 20% of asylum seekers in Australia reported experiencing previous torture, a third reported imprisonment for political reasons, and a similar number reported the murder of family or friends.15-18 In one British study, 65% of Iraqi refugees had a history of systematic torture during detention.19 These experiences are compounded by the rigours of reaching safety, social isolation, poverty, hostility and racism.3 2002 VOL. 26 NO. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Kisely et al. Point of View compromise subsequent health.24, 25 Not only does this disadvantage the individuals concerned, but also it has implications for public health. There are also reports of asylum seekers who have been discharged to the community without written medical records to give to their doctors outside. The situation is compounded by limitations on access to government services such as welfare, employment and language classes for those on TPVs. Individuals can potentially enter a cycle of poverty and declining health with increased vulnerability to disease.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Jan 1, 2002

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