Nearly nine in 10 children brought from offshore processing on Nauru to Australia were suffering physical health conditions, including malnutrition and dental disease, while almost 80% reported one or more mental health symptoms, new research has revealed.
Nearly half – 45% – had reported suicidal ideation, a suicide attempt, or self-harm.
The deleterious impact of conditions in detention on Nauru has been previously revealed as particularly acute on children: by psychiatrists on the island who said conditions were “inherently toxic” and akin to “torture”; by Médecins Sans Frontières who reported mental health on the island was in “crisis” and amongst the worst the organisation had seen anywhere in the world; and through public revelations like the Nauru Files, more than 2,100 incident reports which revealed systemic sexual and physical abuse of children and widespread self-harm and suicide attempts.
There are no children left in offshore processing on Nauru, and the detention centre is empty: though it remains in abeyance, on standby for future arrivals by boat.
The new research, published in the BMJ’s Archives of Disease in Childhood, found physical and mental health problems faced by almost all children and young people in the sample population.
More than half of the children had been held on Nauru for more than four years.
Lead author of the study, Dr Lahiru Amarasena, a paediatrician and PhD student at the school of women’s and children’s health at UNSW, said the research added to the evidence that immigration detention is a harmful practice for children.
“These poor health outcomes were almost universal in our sample of children and young people who experienced forced migration and were exposed to the policy of indefinite mandatory detention,” she said.
For the study, researchers retrospectively analysed detailed health assessments of 62 children completed by paediatricians and child and adolescent psychiatrists from 10 health services across Australia.
The study showed physical health problems were present in 89% of children brought from the Nauru offshore processing regime, most commonly malnutrition (24%), dental disease (21%) and abdominal pain (16%).
Mental health conditions were formally diagnosed in 44% of the study sample, but nearly eight in 10 (79%) had one or more mental health symptoms – including self-harm or suicide ideation or attempts (45%).
The rates of physical and mental health conditions were comparable to previous studies of children exposed to immigration detention and far higher than in non-detained refugees or general Australian populations.
The study also found 94% of children and young people in the sample survey had exposure to one adverse childhood experience in their lifetime: 21% had been exposed to four or more ACEs.
Most of them, 63%, had witnessed trauma in their lifetime, and 40% had been exposed to abuse or neglect.
More than three-quarters – 77% – of school-aged children had had their schooling disrupted.
At its peak, 222 children and young people were held in detention on Nauru. Some were released into the Nauruan community after their refugee status was formally recognised. There are no children left in offshore processing on Nauru: a small number has been resettled in “third countries”, such as the US and New Zealand. Most children were transferred to Australia on temporary visas.
The policy of offshore processing and indefinite mandatory detention remains Australian government policy: future child asylum seekers who arrive by boat are potentially subject to indefinite offshore detention.
Amarasena said the researchers - from universities and health services across Australia - acknowledged the small sample size.
“It’s challenging to obtain comprehensive cohort samples with vulnerable populations under added stress where there may also be language and cultural barriers. Even though there was a significant effort to reach out to as many children as possible, the sample size is small, which impacts on the generalisability of results,” Amarasena said.
“We acknowledge the limitations, given that this is a cross-sectional study with a small sample size, but we know from other studies and international reports that no time in detention has been determined to be safe, and the United Nations recommends avoidance of detention practices for children.”
