Submission to the Human Rights and Equal Opportunity Commission in relation to the Inquiry into Children in Immigration Detention
The Impacts of Immigration Detention on the Health, Development and Wellbeing of Children
~ Executive Summary ~
The authors of this chapter argue that arbitrary and prolonged detention of children, under current Australian Immigration Detention Policy, is in contravention of international agreements to which the Australian government is a party.
This chapter presents compelling evidence that arbitrary and prolonged detention is entirely incompatible with children's health, development and wellbeing, and is a systematic abuse of their most basic human rights of children.
Drawing on the authors' clinical expertise, first hand reports from former workers and detainees from Australia's immigration detention centres, academic research and United Nations guidelines and conventions, this document assesses the likely impact of detention upon children's health. The first part of the document examines issues affecting the health status of children in detention, including social, environmental, emotional, parental, educational, nutritional and cultural factors, and examines the structural and staffing issues which would contribute to quality services for children in detention. Part B examines children with special needs (unaccompanied minors, children affected by trauma and children with disabilities), and the health needs of detained children once they have been released into the community.
The main points of this section of the submission are summarised as follows:
Part A: Issues Affecting the Health Status of Children in Detention
1. Social Environment
Aspects of the social environment are considered in terms of their effects on children's quality of life and long-term health. The quality of the social environment is considered in terms of social relationships in the family; "social capital" or community spirit; formal social relationships; child-parent attachment; family separation; and civic life skills.
The United Nations (UN) Convention on the Rights of the Child (CRC), outlines children's rights to a social environment which is conducive to their development. It is clear that the Australian immigration detention centre (IDC) system is not meeting these basic needs.
Inadequacies in the social environment of the Australian IDC system include: lack of privacy; impact of stress on adults' capacity to parent and support children; exposure of children to violence; lack of "social capital" in the detention centre culture; relationships with authority figures which are based on fear; the punitive and arbitrary nature of institutional life; disruption to the child-parent attachment, and to the child's sense of security; family separation resulting from the refugee flight and/or the asylum seeking process; and the lack of modelling for children of civic life skills.
2. Physical Environment
Based on what is known of the physical environmment at the Woomera center and other immigration detention facilities, the physical environment of IDCs lacks many of the basic conditions necessary to promote and protect children's health. These conditions include basic necessities such as shelter, food and water, as well as space and ventilation, safety, and comfort (temperature, bedding), all of which have an impact on children's physical and emotional health. Play, recreation and physical activity also fulfil crucial roles in child development, and the lack of opportunity for play and exercise is known to have serious long-term negative effects upon mental and physical health.
UN rules specify that juveniles in detention must have opportunities for sports, exercise and leisure activities, and the UN CRC also identifies children's rights to play and recreation.
Additionally there are safety concerns relating to the physical environment of IDCs, including compliance with safety standards, questions about the safety and sanitation of toilet and washing facilities, and the risk of injury faced by children in detention. The harsh physical environment of many IDCs, with prison-like features such as razor wire, high fences and walls, lack of gardens and play areas, and locked doors, may exacerbate detained children's trauma and distress.
3. Emotional Health
Although this area is covered in more detail in the mental health section of this submission, it is noted that emotional health has a profound effect upon children's overall health, development and wellbeing.
4. Parental Health and Wellbeing
The evidence suggests that the mental health of many adult detainees is being compromised within the IDC system. The mental health of parents has a direct effect upon children's health and development. The following conditions may have an impact on parents' mental health, and thus on children's wellbeing: lack of hope, leading to depression and anxiety; stress resulting from sole parenting without support networks; poor parental physical health, and its impact on parents' ability to care for their children.
Parental health may also be compromised by pre-existing health problems; lack of adequate nutrition, sleep and physical activity; emotional trauma prior to and since arrival, and whether the parent has been counselled for trauma; lack of ante-natal and maternal health care; and lack of support given to mothers during pregnancy, childbirth and breastfeeding.
5. Education
Education contributes to children's self-esteem, skills development, health, future employment prospects and income security. It is vital that children of all ages are given continuous opportunities for learning and education.
6. Food, Eating, Nutrition
Food and nutrition are essential to child health, and eating also has cultural and social functions which contribute to children's emotional health. Refugee children are at particular risk of micro-nutrient deficiency and related diseases. Children's nutrition depends furthermore on the health of pregnant and breastfeeding mothers, weaning of infants, and the variety of foods and nutrients given to children and adolescents at different stages of their growth and development. There is evidence to indicate that the nutritional needs of children in detention are not being adequately met, and that breastfeeding is not encouraged or supported adequately within any immigration detention facilities.
7. Culture and Health
The UN CRC outlines the rights of children to learn the values and traditions of their culture. For children in detention, these may be disrupted by refugee movement and broken connections with their culture of origin. The IDC environment further disrupts cultural norms and routines including traditions, religious practices and food preparation.
Children are more likely than adults to lose touch with their culture in cross-cultural situations, particularly under the strain of detention. Parental role models are diminished within the detention environment; the dehumanising practice of referring to detainees by numbers rather than names has a negative impact on cultural identity and self-esteem.
Religious festivals and rituals have a strong impact on community mental health, and the religious diversity within the detention environment needs to be respected and serviced with an appropriate range of religious instruction and pastoral visits. Children should be educated in their first language as well as English, and a balanced mix of male and female interpreters made available.
Specialised training is needed for health professionals in the detention system, particularly in relation to young women's sexual health and reproductive issues, and cultural practices such as female circumcision and the attendant medical complications. Staff within the IDC system should receive cross-cultural training, with a recognition of diversity at all levels of organisational strategy and structure. Health providers should aim for cultural competence, which acknowledges the impact of culture on health outcomes, and enables workers to make health assessments which encompass cultural considerations.
8. Administration of Health Care Services
While broad standards exist for health care provision in Australian IDCs, methods by which these standards are measured are not publicly available, and there are serious concerns about the system's lack of accountability. There are potential conflicts of interest within the IDCs' privatised systems and the influence of cost considerations upon provision of health services. It appears that staff training and recruitment processes within IDCs are inadequate, and that confidentiality agreements may compromise ethical standards. It is imperative that health and medical records are released with detainees into the community.
9. Access and Availability of Health Care
Refugees are more likely to experience a range of illnesses, including mental illness (depression, anxiety, post-traumatic stress disorder), undiagnosed chronic disorders such as diabetes, poor oral health, infectious diseases such as tuberculosis and intestinal parasites, and the direct physical effects of torture. Refugee children are more likely to suffer from delayed growth and development, and are at risk through lack of immunisation. Sexually active adolescents may also be at risk of Hepatitis B and C, and HIV.
Reports indicate that health care in IDCs falls short of professional standards in several respects: lack of privacy, inadequate staff ratios, lack of trained interpreters and scarcity of female interpreters, barriers to accessing health care, lack of specialist care, and restricted access to doctors, and the prevention of independent medical review. These indicators amount to deprivation of basic medical care to detained adults and children.
Military-style responses to hunger strikes and other crisis periods - for example, power and water supplies being cut off - affects children's physical and emotional health. It is unknown whether children are receiving regular health checkups, immunisation and dental health checks, and appropriate advice and treatment.
Part B: Special Needs
10. Unaccompanied Minors
Children may become separated from the family unit during the refugee process for many reasons. As at November 2001, there were 53 unaccompanied minors, some as young as 8 years old, living in Australian IDCs.
These children are highly vulnerable, with special health needs and complex attendant issues of consent, duty of care, and protection of the child's best interests. The health issues of unaccompanied children may go unidentified and overlooked in the absence of parents or guardians to monitor their health and seek out services on their behalf. 95% of unaccompanied minors in detention are boys, and they are at risk of sexual abuse from adult males.
The reunion of children with their families is paramount to the child's long-term psychological health, safety, development and wellbeing. The UN High Commission for Refugees recommends that unaccompanied minors ought never be detained, but should instead be cared for in the community, with family reunification an urgent priority.
Unaccompanied minors are entitled to special protection and assistance, according to the UN CRC; however, it is unknown whether Australian standards of care are being met in IDCs.
11. Trauma, Torture and Child Welfare Issues
Children in IDCs are likely to have experienced trauma as a result of events such as torture and murder of family members, perilous journeys to Australia, and exposure to violence in detention. Childhood trauma results in damage to child development processes, resulting in learning difficulties, abnormal socialisation, and poor physical health.
It is crucial that adequately trained staff assess detained children's needs in light of trauma responses, and provide children with opportunities for therapeutic play and appropriate counselling. The UN CRC outlines the state's responsibility to help child victims of trauma recover from their experiences of abuse, and reintegrate socially whilst being rigorously protected from further abuse or trauma.
12. Children with Disabilities
Early detection and intervention are important factors in reducing the impact of disabilities on children's development. Refugee children are at increased risk of disability, due to factors such as malnutrition, inadequate ante-natal care, vitamin deficiencies, and lack of immunisation. The rate of congenital malformations in Iraq has also risen dramatically in the past decade.
Staff in IDCs need cross-cultural training which gives them skills to work with disabled children and within different cultural groups' attitudes towards disabilities, in order to ensure the optimum protection, development and inclusion of children with disabilities in the detention system.
There is evidence that many children currently in IDCs have disabilities, including developmental disabilities. It is not known whether these conditions are adequately screened and assessed, or whether staff have adequate training for working with children with disabilities.
13. Children Now in the Community
The release of refugee children and their families into the community is extremely positive, however the rehabilitation process is often hampered by factors such as the lasting impacts of detention and trauma, and the constraints imposed by Temporary Protection Visas (TPVs).
Detention may affect children's coping abilities as well as family unity, and life in the detention environment does not adequately prepare children and families for life "outside" in the community.
TPVs are issued for three years, at which time the applicant must re-apply for refugee status. TPV holders do not have access to the settlement and language services available to those with permanent refugee status. Family reunification is the most pressing issue which affects children who are awaiting refugee status, separated from family who are in different phases of the assessment process.
TPV holders have access to Medicare benefits, but only basic needs are covered, and medical records from detention facilities are unavailable, restricting children's access to many health care programs.
Submission to the Human Rights and Equal Opportunity Commission in relation to the Inquiry into Children in Immigration Detention.
The Impacts of Immigration Detention on the
Health, Development and Wellbeing of Children.
April 29th, 2002.
Co-authored by
This submission has been co-authored by a variety of health professionals, doctors, nurses and epidemiologists currently working in the clinic setting, in the field and engaged in research. All are thoroughly skilled and experienced in the area of refugee health, human rights and refugee rights. The authors of this submission have been driven by their commitment to the human rights of refugees and asylum seekers and most particularly, to the human rights of children.
The work presented here is a compilation of academic research, first hand accounts of situations inside Australia’s immigration detention facilities and expertise drawn from the authors’ experience in the field. In particular, the authors would like to draw the attention of the Human Rights and Equal Opportunity Commission to sections of this submission entitled ‘Unanswered Questions’. These appear at the end of each Section and pose a series of questions to guide HREOC in their subsequent investigations. This is not intended to be prescriptive, but rather to steer certain lines of inquiry. It is hoped this will assist HREOC in determining accurate information in areas of concern where to date, the authors have been unable to so.
The authors of this submission would like to kindly acknowledge the assistance and cooperation of the Human Rights and Equal Opportunity Commission, The Refugee Council of Australia, the Multicultural Disability Advocacy Association, The Australian Red Cross, The Victorian Foundation for Survivors of Torture and Trauma, the New South Wales Department of Health Refugee Health Service and the Department of Immigration, Multicultural and Indigenous Affairs.
We would also like to extend our gratitude to the many individuals who have assisted in this process through offering their time, expertise and experience. We are also extremely grateful to those individuals who shared with us their experiences of working in and visiting Australia’s immigration detention facilities.
Most importantly we would like to thank the many refugees and asylum seekers who told us their stories with resolute courage and dignity.
TABLE OF CONTENTS PAGE
Introduction 6
Australia’s obligations to all children 7
Standards 7
Part A: Issues Affecting the Health Status of Children in Detention 10
Section 1: The Social Environment of the Child 10
1.1 Background 10
1.2 Social Capital or Community Spirit 11
1.3 Formal Social Relationships 11
1.4 Attachment 12
1.5 Family Separation 13
1.6 Civic Life Skills 13
1.7 Standards 14
1.8 Unanswered Questions 15
Section 2: The Physical Environment 16
2.1 Background 16
2.2 Living Conditions 16
2.3 Play, recreation and physical activity 17
2.4 Safety 19
2.5 Unanswered Questions 21
Section 3: Children’s Emotional Health and Development 22
3.1 Background 22
Section 4: Parental Health and Wellbeing and its Impact on Children 23
4.1 Background 23
4.2 Hope 23
4.3 Sole Parenting and Separation of Families 23
4.4 Parental Physical Health 24
4.5 Standards 24
4.6 Unanswered Questions 24
Section 5: Education and Child Health, Development and Wellbeing 27
5.1 Background 27
5.2 Learning, formal education and socialisation 27
5.3 Critical periods for learning and education 27
5.4 Standards 28
Section 6: Food, Eating and Nutrition 29
6.1 Background 29
6.2 Pregnant and breastfeeding women 30
6.3 Breastfeeding 30
6.4 Childhood Nutrition 30
6.5 Standards 31
6.6 Unanswered Questions 32
Section 7: Culture and Health 33
7.1 Background 33
7.2 Living Conditions 33
7.3 Dehumanisation 35
7.4 Religion 35
7.5 Preservation of language 36
7.6 Female reproductive issues 37
7.7 Cultural competence 37
7.8 Unanswered Questions 38
Section 8: Administration of Health Care Services 40
8.1 Background 40
8.2 Health care provision in Australian immigration detention centres 40
8.3 Funding of health care within immigration detention centres 40
8.4 Staffing of immigration detention centres 41
8.5 Record Keeping 42
8.6 Unanswered Questions 42
Section 9: Access and Availability of Health care Services in Detention 43
9.1 Background 43
9.2 Access to Health Care 43
9.3 Primary Health Care 45
9.4 Immunisation 45
9.5 Nutrition 46
9.6 First Aid and Safety 46
9.7 Unanswered Questions (developmental stages) 47
Part B: Special Needs 50
Section 10: Unaccompanied Minors 50
10.1 Background 50
10.2 Consent 50
10.3 Emotional Health of Separated Children 51
10.4 Best Interests of the Child 51
10.5 Standards 53
10.6 Unanswered Questions 53
Section 11: Trauma, Torture and Child Welfare Issues 55
11.1 Background 55
11.2 Trauma 55
11.3 The Effects of Trauma 55
11.4 Torture 55
11.5 Catering for the needs of traumatised children 56
11.6 Other child welfare issues 56
11.7 Standards 56
11.8 Unanswered Questions 57
Section 12: Children Living with Disabilities in Detention 58
12.1 Background 58
12.2 Risk factors for refugee children 58
12.3 Disability and culture 59
12.4 Standards 59
12.5 Current Situation 61
Unanswered Questions61
Section 13: Children Now in the Community 63
13.1 Background 63
13.2 Impacts of detention 63
13.3 Temporary Protection Visas 63
13.4 Access to medical services 64
13.5 Unanswered Questions 64
Reference List 65
Introduction
All children are entitled to a life that provides them with opportunities to reach their fullest potential. Despite the complete acceptance of this principle, the reality is that the Australian Government is depriving children of this opportunity. This submission highlights why having children live in immigration detention centers in Australia (and off shore) under the current system, subjects them to conditions that are not conducive to health. It is the opinion of the authors of this section of the submission that detention in all its forms, and particularly the way it is being implemented in this instance the Australian immigration detention centre system, is potentially extremely detrimental to the health of children. The evidence clearly shows that currently children’s rights are being grossly abused with regard to child health.
When considering the health of children in detention, it sometimes proves extremely difficult to differentiate between “health” and “emotional” or “mental health”. A significant amount of the content of this section of the report is concerned with health in its broadest sense, which includes the dimension of emotional health.
A recent ABC television program reported that Australia's doctors are expressing growing concern about children in Australian immigration detention centres.
Almost every independent medical body is now calling on the Howard government to remove children and their families from detention centres. Such widespread concerns have prompted doctors' representative bodies to take unprecedented action. For the first time, just about every independent medical body in Australia has united to call on the Federal Government to get children and their families out of the detention centres.[1]
The program showed interviews of a variety of child health experts all expressing the same concerns, but these concerns appear to be falling on deaf ears which means that the children in these centers continue to suffer.
Dr Jonothan Phillips, of the Committee of Medical Colleges stated:
This is a unique situation. It is a conservative profession and yet we are all speaking with one voice, all the specialists, and the AMA, and that has to mean something. Australian doctors are saying we have to do this differently and we have to do it soon.
However, repeated requests from the peak medical bodies, including the Australian Medical Association and all the specialist colleges, for an independent assessment review of the centres has been rejected by the Federal Government.
Children's development is shaped by physical and social environment, as well as by genetics. The importance of the relationships that babies and young children experience and the impact that these relationships have on the child’s development is one of the most significant conclusions of this research [2]. Of equal importance is the effect that the sum of all the experiences in the earliest years of life has on the child’s future [3]. Another important conclusion of this research is how the negative effects of stress on young children are extremely detrimental to the child [4].
It is recognised in the UNHCR Guidelines on the Protection and Care of Refugee Children that children in general are more vulnerable than adults. They are more susceptible to disease, malnutrition and physical injury. They need the support of adults, particularly their parents, not only for physical survival, but also for their development, psychological and emotional well being. Refugee children are even more vulnerable as crisis situations and chronic hardship can severely disrupt a child’s physical and emotional development. Parents may be too traumatised to appropriately care for their children or children may be separated from their families altogether [5].
Detention of asylum seekers, particularly children, in the view of the UNHCR is inherently undesirable. Not only is arbitrary detention an infringement on an individual’s right to freedom, there is grave concern for the adverse health effects arising from prolonged detention, and the potential for long-term sequelae, especially for the developing child who may have already suffered significantly in his or her home country.
Australia is morally and legally obliged to provide an environment for all children that is conducive to health. This will be addressed in detail elsewhere in this submission; however, mention will be made in this section where these issues are particularly relevant to child health. The moral obligation that the government has in protecting and promoting the health of all children is clear. As a signatory to the United Nations Convention on the Rights of the Child (CRC), the Australian Federal Government is also obliged to meet the requirements of the convention, and has undertaken to enact these provisions into national legislation. The Convention on the Rights of the Child recognises that specific conditions beyond the basic requirements of survival (i.e. food, water, shelter) are necessary “for the full and harmonious development of (the child’s) personality”, [6] and outlines these conditions in detail. It also recognises first and foremost that States are obliged to respect parents’ responsibility for providing guidance for their children and to support parents in doing so [7].
The Convention on the Rights of the Child will be cited throughout this section of the submission under the relevant headings. Other recognised standards, particularly those pertaining to refugees, will also be referred to in informing what the accepted standards are with regard to promoting and protecting children’s health throughout this section of the submission on child health.
The sections of the Convention on the Rights of the Child that address the general needs of children are as follows:
In the Preamble, it is noted that,
“in the Universal Declaration of Human Rights, the United Nations has proclaimed that childhood is entitled to special care and assistance”
and that,
“the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth”[8].
Article 3 states that,
“In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration”
and that,
“States Parties shall ensure that the institutions, services and facilities responsible for the care or protection of children shall conform with the standards established by competent authorities, particularly in the areas of safety, health, in the number and suitability of their staff, as well as competent supervision” [9]
Article 6 states that,
“States Parties recognize that every child has the inherent right to life”
and that,
“States Parties shall ensure to the maximum extent possible the survival and development of the child”[10]
Article 24 states that,
“States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health”
and that,
“States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services forth in the present Convention and in other international human rights or humanitarian instruments to which the said States are Parties” [11]
Article 27 states that,
“States Parties recognize the right of every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development” [12].
Article 37 states that,
“No child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and
shall be used only as a measure of last resort and for the shortest appropriate
period of time”[13].
The United Nations High Commission for Refugees (UNHCR) has also published a number of documents concerned with the needs of refugees. Two of these documents will be cited here to outline some general international standards with regard to the care and protection of child asylum seekers.
The UNHCR’s 1999 Guidelines on Applicable Criteria and Standards relating to the Detention of Asylum-Seekers states in the introduction that:
“The detention of asylum-seekers is in the view of UNHCR inherently undesirable. This is even more so in the case of vulnerable groups such as single women, children, unaccompanied minors and those with special medical or psychological needs. Freedom from arbitrary detention is a fundamental human right, and the use of detention is, in many instances, contrary to the norms and principles of international law,” [14].
Guideline 6, which is concerned with the detention of people under the age of 18 years, states that:
“..minors who are asylum-seekers should not be detained.”
It also states that:
“If children who are asylum-seekers are detained at airports, immigration holding-centres or prisons, they must not be held under prison-like conditions.”
And that if it proves impossible not to detain children:
“..special arrangements must be made for living quarters which are suitable for children and their families.”
Lastly, the UNHCR 1994 document Refugee Children: Guidelines on Protection and Care states that:
‘The best way to help refugee children is to help their families, and one of the best ways to help families is to help the community. … Most often, programmes are designed to help the family assist and protect their children and to assist the community in supporting the family and thereby protecting the child.’ [15]
In accordance with the documents cited above, it is the conclusion of the authors of this section that arbitrary and prolonged detention of children, under current Australian Immigration Detention Policy, is in contravention of international agreements to which the Australian government is a party. The most compelling argument to support this position is that arbitrary and prolonged detention is entirely incompatible with health, development and wellbeing and is a systematic abuse of the most basic human rights of children.
A former detainee of the Woomera Immigration Reception and Processing Centre has told this story.
“Many of the children were aggressive, irrational and crying most of the time. They were unhappy children. They were disobedient and craved attention. Mothers on the other hand were often so frustrated just being in detention that they took out their frustrations on their children in many ways.” |
Here, a brief outline will be given of how the social environment in which the child lives has a profound effect on their health, development and wellbeing, both in the short term - by effecting the child’s quality of life, and the long term - by effecting lifelong health and wellbeing.
The family is usually the primary setting for social interaction of children in the community and many children in detention. There are, however, many children in Australian immigration detention centers who are unaccompanied by immediate family. The specific needs of these children will be discussed in Section 10 of this report. It is well established that the quality of social relationships in a family are of paramount importance to child health, development and wellbeing [16]. Research indicates that within the family, the child’s relationship with his or her parent/s is of particular importance. Montgomery and Foldspang are among authors who stress the prime importance of the family environment in maintaining the health of children [17].
“The best way to help refugee children is to help their families, and one of the best ways to help families is to help the community. … Most often, programmes are designed to help the family assist and protect their children and to assist the community in supporting the family and thereby protecting the child.” [18]
Throughout a child’s growth and development, failure to provide appropriate services in a healthy environment, or to address problem issues such as family stress, can result in long-standing adverse physical and emotional health consequences. The Preamble to the United Nations Convention on the Rights of the Child identifies the need for a healthy, supportive family environment as a prerequisite for a healthy child.
The emotional and psychological impact of detention centre conditions affects the child-parent relationship and the parents' ability to care for and protect their children.The UNHCR Guidelines on Protection and Care stress the importance of involving members of the refugee community in community activities to support families [19].It is well established that exposure to violence is a potent risk factor for ongoing emotional and behavioural problems [20] [21]. The issue of exposure to violence is extremely pertinent to the quality of the social environment of children in immigration detention centers as it is well established that children in detention have been exposed to violence on many occasions. This will be addressed in Section 11 of this report, which addresses trauma and it’s effects on child health, development and wellbeing.
The health of parents, and specifically their mental health, has been shown to be of particular importance to the health, development and wellbeing of kids [22]. This is very important with regard to the quality of the social environment of the child and will therefore be addressed in its own right in this submission.
1.2 ‘Social Capital’ or Community Spirit
Social capital may also be referred to in layman's terms as "community spirit". It refers to various attributes of social organisation which encourage the cooperation of individuals and groups for mutual benefit [23]. It has consistently been shown to be associated with child health, development and wellbeing [24] [25] [26]. Social capital can be seen to be made up of the following four elements: trust, civic involvement, social engagement and reciprocity. Trust refers to how much individuals, groups and organisations (including authorities) can be relied upon to be consistent, fair and act in an expected and rational manner Civic involvement (or participation) refers to how much participation takes place with regard to directly or indirectly contributing to a community’s wellbeing. This concept is closely related to the development of civil life skills, which are discussed in a little more detail later in this section of the submission. Social engagement refers to the interactions that lead to connections and meaningful relationships among community members. These include both formal (e.g. schooling) and informal connections (e.g. family and friends), and reciprocity refers to the belief that one good deed will somehow be returned in some form in the future. This academic theoretical concept may be referred to in lay mans terms as community spirit.
With regard to the context of children in immigration detention centers in Australia and offshore, there have been multiple reports that lead one to believe that social capital or community spirit is severely lacking in immigration detention centers.
Formal social relationships include those with authorities and institutions and their representatives. For children in detention, the quality of formal social relationships, and children's relationships with authority figures, are very significant with regard to child health, development and wellbeing. The following stories have been told by a former detainee and have been verified in discussions with former health personnel, both from the Woomera center. They clearly demonstrate the importance of sensitivity on behalf of the authorities in detention centers. Without such sensitivity, dignity cannot be upheld.
Story 1
When women and teenagers, need sanitary napkins they have to go through a tedious process of filling in a form including the date and time, besides other personal details and submitting these to a particular person at a particular time. Each time they are given 10 pads. If by some chance they need any extra, the nurse does a thorough physical check before they are issued. |
Story 2
When any sort of problem arises, people are treated as prisoners. They make a request through one set of fencing. If the attendant on the other side feels it is reasonable the person is allowed to walk across and repeat the request to the authorities on the other side who then make the final decision on what needs to be done. There are more than one sets of fencing and gates to go through. This whole procedure is, according to this former detainee, usually “very unfriendly”. |
Story 3
In Woomera, there were four “musters” per day which involved the sighting of the identification of each detainee not just a head count. ‘Musters’ could take place at night when staff would shine torches into rooms, waking the detainees and ask for their identification. |
Such experiences could be very frightening for a child, negatively affecting their relationships with authority figures.
The formal relationships that asylum seekers have once they have left detention are also of importance. If families are supported by formal networks that assist them to meet their needs this will ease their transition, whereas if they are not given support they will find it difficult to cope in their new environment.
A relationship between mother and infant that is characterised by a secure attachment is of importance for both short and long-term child health and wellbeing [27] [28]. The child experiences adequate emotional security as a result of a sound parental attachment to explore his/her environment freely, both in the present and the future [29]. Mother infant attachment has been found to be associated with important attributes for health and development and wellbeing including persistence at challenging activities [30] [31], social competence [32] self reliance, and greater problem solving ability [33]. There is also evidence to suggest that the formation of a secure attachment to both their mother and father in infancy leads to increased social competency [34]. There is significant reason to believe that the attachment process for young children and their parents is likely to be severely disrupted in immigration detention centres. Parental mental health problems can severely disrupt attachment as can other factors in the social and physical environments of families including, for example, a lack of privacy and cramped conditions.
Another important point with regard to the quality of the social environment in immigration detention centers relates to the separation of family members as a direct result of incarceration and the process of fleeing their country of origin. Some examples of how family separation may occur are as follows:
· the separation of children from their parents as is the case with the many unaccompanied minors
· the separation of women and children from their husband/father. This can result in their immigration status being determined separately. Some of the family may remain in detention for a long time after other family members are released into the community
· Families may be separated because women and children are detained in separate quarters to men.
Being separated from loved ones can cause significant emotional stress. Studies have shown that keeping families together can decrease the likelihood of refugee children developing mental health problems later in life as a result of traumatic experiences associated with them fleeing their countries [35]. Trauma and it’s negative effects on child development will be discussed in more detail in Section 11 of the submission, but it is important to note that research supports the theory that loss of or separation from family members inflicts the highest degree of trauma on children [36].
The following cases were described by ex-detainees and visitors to centres:
… Sometimes grandparents send children to seek asylum because their parents have been killed. … There was a young girl who had a small sibling to care for. … The father had arrived earlier. When his wife and children arrived they were accommodated in a separate part of the centre because their applications were at a different stage. |
There is a reported instance of children being separated from their mother, who was mentally unwell. The mother’s condition deteriorated until she was also released and reunited with her children. This case is one of many that illustrate the inappropriateness of children being detained at all.
Two issues arise: If children are separated from their parents, by authorities, for whatever reason, it is crucial that they are accommodated with a family of their own culture and preferably known to them. Easy access to the detained parent is extremely important. However, the second issue – of detention – is the real problem. Again the inappropriateness of detention per se is highlighted.
Civic life skills include those that aid in the development of a civil society. Of specific importance is treating others with respect and an appreciation of diversity [37]. These skills may be learnt through learning cooperation and participation [38]. They are demonstrated by children through such practices as taking turns, not speaking rudely to others, and listening to others who are speaking [39]. Children learn these skills by ‘modeling’ or copying those around them. These skills are important for any child’s lifelong wellbeing even more important with regard to the immense challenges that detained children face integrating into a new and foreign society, if and when they are released into the community. Play also has a crucial role in children developing civic life skills, and will be discussed in more detail in Section 2.
The 1989 United Nations Convention on the Rights of the Child, to which Australia is a signatory, makes reference to requirements of the child with regard to the social environment within the preamble and various articles.
The Preamble states that,
“Convinced that the family, as the fundamental group of society and the natural environment for the growth and well-being of all its members and particularly children, should be afforded the necessary protection and assistance so that it can fully assume its responsibilities within the community”
and that,
“Recognizing that the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding”.
This is perhaps the most important statement within the convention with regard to children in detention because, as the evidence clearly shows there are many instances where children are growing up in an environment that is far from an atmosphere of happiness, love and understanding.
Article 5 states that,
“States Parties shall respect the responsibilities, rights and duties of parents or, where applicable, the members of the extended family or community as provided for by local custom, legal guardians or other persons legally responsible for the child, to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the present Convention,” [40].
Article 7 states that,
“The child shall be registered immediately after birth and shall have the right from birth to a name, the right to acquire a nationality and, as far as possible, the right to know and be cared for by his or her parents,” [41].
Article 9 states that,
“States Parties shall ensure that a child shall not be separated from his or her parents against their will, except when competent authorities subject to judicial review determine, in accordance with applicable law and procedures, that such separation is necessary for the best interests of the child,” [42].
Article 13 states that,
“The child shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of the child’s choice,” [43].
Article 14 states that,
“States Parties shall respect the rights and duties of the parents and, when applicable, legal guardians, to provide direction to the child in the exercise of his or her right in a manner consistent with the evolving capacities of the child,” [44].
1.8 Unanswered Questions
As with the physical environment, the social environment of immigration detention facilities will impact upon the way children develop emotionally, physically and socially. Isolation from other children of similar ages, the occurrence of abusive language or behaviour of adults, lack of appropriate stimulation and restrictions on the ability of children to play, explore and be creative are some of the issues of paramount importance to the social development of children.
Ø Are there opportunities for children to play and socialise with other children of similar ages?
Ø Are children exposed to abusive language and/or behaviour of adults?
Ø What mechanisms are in place to ensure the prevention of verbal or physical abuse of children?
Ø Should such an incident occur, how is this addressed, what actions take place and how transparent is this process?
Ø Is the infant able to form appropriate attachment with both or one parent?
Ø Does the child receive appropriate stimulation with regard to language, play, and touch?
These anecdotes provided by a former detainee are specific to the Woomera Immigration Reception and Processing Centre they paint a bleak picture of the physical environment with regard to promoting and protecting the health of children.
Accommodation is spartan and cramped. Families live in small caravans with no running water. It is hot. Sometimes there are 2 families in a caravan – separated only by a curtain. Caravans have no taps. Others live in very small rooms There is little room for children to crawl or run around and play. They need to be let out into the open where it is extremely hot (about 50 degrees) or very cold. Every two weeks people are given information on skin cancers but very little cream is given with the information. There is no shade outside. Toilets are about a 10-minute walk from the caravan sites. |
The physical environment of the child includes both the natural and artificial components of the surroundings and the issues of shelter, light, shade, noise, warmth, cold, ventilation, moisture, crowding, freedom, security, vegetation and greenery and safety which are all relevant to child health, development and wellbeing. Both natural and artificial environmental hazards are potent risk factors for children [45]. Children are considered to be at particular risk because they are sensitive to environmental hazards, and problems arising from exposure to environmental hazards in childhood can have long term and occasionally lifelong effects [46].
There are certain basic living conditions that are necessary for optimal health, and more specifically for healthy child development and wellbeing. These include necessities such as shelter, food and water as well as such factors as adequate space, satisfactory air quality and ventilation, safety and access to outdoor spaces and protection from environmental hazards.
The physical environment can also impact significantly on the opportunity for developing quality social relationships and the ability to access privacy. Basic issues of comfort including temperature, availability of appropriate bedding and chairs are also of significant importance with regard to emotional health.
Story
There have been reports from former detainees in some detention centers that all personal belongings are confiscated. This has included even photos of loved-ones. In some detention centers where belongings are not all confiscated, some belongings such as tape decks and tapes with music on them have been confiscated. |
A legal professional working with detainees in Woomera center has reported that:
Some people sleep in dormitories with about 16 people. These may be individuals or mixed families. |
Play and recreation, are extremely important for child health, development and wellbeing. For children of all ages, play provides opportunities to express themselves freely within safe boundaries and to start to understand and come to terms with adverse life experiences. Given the physical and psychological space for play, children who have survived the refugee experience can release strong feelings and let go of some of the tensions of the world around them.
Play has an important role in learning social and civic skills, and children need the opportunity to play with children of their own and other ages to learn how to relate to other people. For older children opportunities for culturally appropriate recreation activities, are also necessary. Play and physical activity are also important with regard to physical development and coordination.
Stories
Children do have a few toys to play with but very often they are not interested in playing because they are so confined. The weather in Woomera was so extreme, either very hot or very cold. Children could not be brought outside in that kind of weather A legal professional who visited Woomera has reported that she was told of a fourteen-year-old girl that had nothing to do – no opportunity for play, recreation, physical activity or even education for 7 months! This child was reportedly, and hardly surprisingly, extremely depressed. |
Physical inactivity during childhood is one of the key risk factors associated with increased risk of chronic disease morbidity and mortality [47].
Environmental risk factors for children include poor diet, lack of exercise, obesity and smoking [48]. It has been shown that these environmental risk factors exhibit stability over time [49]. That is, there is evidence that children who adopt these high-risk behaviours tend to maintain these behaviours through childhood and into adulthood [50] [51].
A consensus is emerging that physical activity may be one of the most important elements in achieving optimum physical and psychological health [52] [53]. There are many documented health benefits of higher levels of physical activity including greater bone mineral content, reduced adiposity and perhaps even more importantly, a reduction in anxiety and depression [54] [55] [56] [57]. Higher levels of physical activity also appear to delay adult mortality, primarily due to lowered rates of cardiovascular disease and cancer [58] [59] [60].
The best physical environment for children to learn are those that provide opportunities for adults to teach them by example (eg. use of equipment in the playground), which they can practice repeatedly, until confident and competent to undertake independently [61] [62] [63]. Children will only enjoy being physically active in an environment that stimulates and rewards them.
If children in detention do not receive regular exercise through lack of space, programs or facilities or parental encouragement, it is expected that their long-term health and well being will suffer, and the subsequent cost to the community as adults will be increased.
The 1990 United Nations rules for the Protection of Juveniles Deprived of their Liberty require that,
“The design and physical environment should be in keeping ….. with the need for privacy, sensory stimuli, opportunities for association with peers and participation in sports, physical exercise and leisure time activities,” [64].
With regard to opportunities for play and recreation, the following extract from the United Nations Convention on the Rights of the Child is important to consider.
Article 31 states that,
“States Parties recognize the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts”
and that,
“States Parties shall respect and promote the right of the child to participate fully in cultural and artistic life and shall encourage the provision of appropriate and equal opportunities for cultural, artistic, recreational and leisure activity” [65].
We have been unable to gather any anecdotal evidence about safety standards in detention centres. We recommend that HREOC examine facilities and ensure that there is compliance with national occupational health and safety standards.
The Australasian Standards for Juvenile Custodial Facilities specifies that centres as a whole must comply with occupational health and safety standards and provide a safe living environment. These Australasian standards use the United Nations rules for the Protection of Juveniles as their reference point.
The United Nations rules for the Protection of Juveniles Deprived of their Liberty state that,
“…[they] have the right to facilities and services that meet the requirements of health and dignity
…. the design and structure of detention facilities should be such as to minimise the risk of fire and ensure safe evacuation from the premises. There should be an effective alarm system in the case of fire, as well as formal and drilled procedures to ensure the safety of juveniles,” [66]
The following story concerning security was told by former detainees:
People do not like their children to go to the toilet alone. Even older people do not like to go alone specially at night. Children are known to ‘hang on’ because they don’t want to go to the toilet. They are scared of men ‘hanging around’ the toilets, especially at night. |
Concerning the built environment, the Australasian standards specify that standards are in line with the United Nations rules for the Protection of Juveniles Deprived of their Liberty in that,
“Services meet the requirements for health and human dignity,”[67]
Of concern are reports from detention centres that children have very restricted facilities for play. The UNHCR Guidelines for the care and protection of children state that,
“Refugee camps, settlements or reception centres should have play areas from the outset. The play areas must be free from hazards and must fit in with the rest of the community,” [68].
Of further concern are reports of access to toilet facilities. In some cases the toilet block can be up to 500 m away. Because of the distance and the environment, children have been known to wait until they are incontinent. Female ex-detainees have reported their unease about passing men ‘who hang around’ the toilet block and mothers will not allow their children to go to the toilet blocks alone. Visitors and ex-detainees have described the toilets in detention centres as being ‘filthy and splattered with blood’ [69]. This situation does not comply with the UN rules specifying that
“Sanitary installations should be so located and of a sufficient standard to enable every juvenile to comply with their physical needs in privacy and in a clean and decent manner,”[70].
These stories concerning sanitation have been told by a former detainee:
Water for washing and drinking was only available in the toilets, but towards the end of this former detainee’s stay, they were given small tanks nearby that stored drinking water. Water ran hot because the pipes were in the sun. People tried to run the water long enough for it to cool but got into trouble for wasting the water. After that the water was turned off during the day. Toilets are fairly clean. The people in the detention centres clean them and are paid about $15/week |
Many mothers make their own napkins for their babies from old sheets or other material.Disposable nappies are not readily available all the time. Forms must be filled and submitted at the right time to the right person and mothers have to pay for disposing of them. It was difficult to get proper clothes for the children. They had to make an order for them which took anything from 6-9 months. When the clothes finally arrived they did not fit their children. They were either too large or too small. They were for the wrong season. Mothers were therefore often very embarrassed to take their children outside of their caravans. |
Injury
Children are at risk of injury because they are inquisitive, adventurous and may not fully understand the consequences of their actions. The main types of injuries in children in Australia (that have relevance to children in detention) include falls, burns and scalds, poisoning, finger jams and cuts and bruises. The environment in a detention centre needs to have the same standards, with regard to childhood injury, that are recommended in homes. Injury rates are relative to the age of the child, that is the younger the child the higher the chance of injury. One-year-olds are particularly at risk (80% of home injuries in Australia) compared to 5- to 9-year-olds (40% of home injuries) compared to 10- to 14-year-olds (25%) [71].
The physical environment of immigration detention facilities may have a significant effect on the emotional and physical health of children. The presence of razor wire, high steel fencing, high brick walls, the lack of gardens or grassed areas, locked doors and metal detectors may have a detrimental impact on the fears and anxieties of children, who in likelihood are already traumatised. A child-friendly environment includes consideration of the needs of children of all ages, and included physical elements such as bright colours, pictures, windows, fresh air, gardens/trees, large outdoor areas for physical activity and play and quiet spaces free of loud or industrial noises, as well as safety.
Ø What is the nature of the physical environment of the detention centre?
Ø Do children have age-appropriate and culturally appropriate facilities (ie. space and toys) and opportunities for play?
Ø What is the physical environment of sleeping, dining and recreational areas?
Ø Are there areas specifically constructed for children?
Ø What safety measures are in place for children in the sleeping, dining and recreational areas?
Ø Do the Immigration Detention Centre compounds meet WHO requirements, such as providing an adequate number of showers and toilets, ensuring availability of clean drinking water, appropriate distances of toilets, laundry facilities, medical clinic, kitchen and dining room from the living quarters.
Ø Does the mother/parent have sufficient access to necessary items such as baby clothes, nappies, bottles, appropriate sleeping facilities, clean and sanitary areas for changing, bathing and feeding?
As briefly described in the introduction, the emotional health of children is of particular significance for the overall health, development and wellbeing of children. This topic will be covered in detail in the section of the submission concerned with children’s mental health. Children’s emotional health is inseparable from their overall health. Emotional development during childhood will impact upon the individual’s lifelong emotional wellbeing. Children who live in an environment that is characterised by physical, social or emotional deprivation are at risk of developing significant emotional problems that may cause problems that lead to lifelong emotional turmoil [72].
There are numerous accounts of the impact on children in detention of parental suffering. The psychological impact on children is discussed in detail in the mental health section of this submission. However it is worth noting that children can also present with physical symptoms (also known as somatic symptoms) as a result of emotional issues, including stomach ache, head ache, and in extreme cases mutism [73].
Dr Shanti Raman is the paediatric adviser for Sydney's Western Area Health Service.
She has visited Villawood detention centre unofficially. The following is an account of her observations.
In addition, Zachery Steel, a clinical psychologist who has been involved in treating a number of detainees, when talking about symptoms of developmental problems of children in detention, stated:
Section 4: Parental Health and Wellbeing and it’s Impact on Child
Parental health and wellbeing, and particularly maternal health and wellbeing, are of paramount importance for child health, development and wellbeing. Research findings repeatedly report that the health and wellbeing of parents is directly associated with the health of their children [75]. Of particular significance is the mental health of parents, and particularly the person who spends the majority of time with the child, usually the mother. This is pertinent to the children in Australian immigration detention centres as there is a great deal of evidence that the mental health of adult detainees is highly compromised.
The psychological health and wellbeing of children’s parents is one of the most significant aspects of the family that impacts upon children. Poor mental health of the parent is highly likely to effect the process of attachment as already described elsewhere in this submission. Infants may “fail to thrive” (that is, fail to meet developmental milestones and weight for height norms) as a direct result of the poor mental health of their primary care giver. It has also been documented that infants of depressed mothers have been found to exhibit higher heart rates when compared to infants of non-depressed mothers. Such higher heart rates may have long-term consequences [76].
There are numerous accounts of the impact of parental suffering on children in detention. The psychological impact on children is discussed in detail in the mental health section of this submission.
While the concept of hope has not received much attention in the academic literature, it is widely accepted that hope is an essential element for the maintenance of emotional wellbeing. It may be argued that despair is the absence of hope, and the experience of many detainees within Australia’s immigration detention centres provoke feelings of despair, leading to depression and anxiety. Many factors contribute to this dysfunction of emotional health, including the length of time individuals are required to remain in detention, the conditions of detention, previous experiences of torture and trauma, separation from family members and loved ones, and perhaps most importantly, the uncertainty that their future may hold. Release from detention facilities into the community is only a small step in the rehabilitation of peoples’ lives and those issued with Temporary Protection Visas are offered little reassurance that their future is secure. The uncertain nature of this situation will be examined in greater detail in Section 13. The impact of all these factors on the emotional wellbeing of parents will have a profound and lasting impact on the emotional health of children under their care.
Being a sole caregiver of children is a demanding task. There are many instances where there are sole caregivers and sole parents looking after children in Australian detention centres.Support networks can relieve the immense burden of being a sole caregiver of children, however reports from within the detention centres suggests that social support is unlikely to be present for many in detention. As already discussed in this submission, families are often separated while in detention. This is also likely to compound the stress experienced by parents and sole parents of children in detention.
Parental physical health is also of importance with regard to child health, development and wellbeing. Caregivers need to be in a fit state to do provide care; if they are not, the health and wellbeing of their children is likely to be affected. An example that clearly demonstrates the importance of the caregivers health is how the physical health of pregnant and breastfeeding mothers can directly effect child health and development.
The most significant standard with regard to the health and wellbeing of parents and its effects on child health, development and wellbeing is in the United Nations Conventions on the Rights of the Child.
Article 5states that:
“States Parties shall respect the responsibilities, rights and duties of parents or, where applicable, the members of the extended family or community as provided for by local custom, legal guardians or other persons legally responsible for the child, to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the present Convention.”
The physical health of mother and/or parent/carer will have a clear impact upon the health and wellbeing of the child, in addition to the parents’ physical ability to care for the child.
Ø Has the mother/parent had any health or physical problems prior to arrival in Australia?
Ø What was the nature of health checks performed for mother/parent upon arrival in Australia?
Ø Has the mother/parent had any health or physical problems since arrival in Australia?
Ø How have these issues been addressed and treated? In a culturally appropriate manner? In a language understood by mother/parent or in the presence of an appropriately trained translator?
Ø What is the nutritional status of the mother/parent?
Ø Is she or he receiving adequate sleep and opportunity for physical activity?
Ø How has the health and physical status of the mother/parent impacted on her/his ability to care for the child?
Clearly, the psychological health of the mother or parent/carer will have a significant impact upon the emotional wellbeing of the child in addition to the parents’ capacity to care for the child.
Ø Has the mother/parent suffered any emotional trauma prior to arrival in Australia?
Ø Had they received any counselling or treatment for this at the time? Are they currently?
Ø Has the mother/parent suffered any emotional or psychological problems since arrival in Australia?
Ø If so, how has this impacted upon their ability to care for the child?
Ø Are they receiving any counselling or treatment for this? Is this conducted in a culturally appropriate manner and in a language understood by mother/parent?
Ø Does the mother/parent have the opportunity to engage socially with other adults in a culturally appropriate manner?
Ø Does the child/children have the opportunity to engage in family-oriented activities?
Ø Does the physical and social environment of the detention centre allow for such activities to occur?
Ø Does the physical or emotional health of mother/parent adversely affect their ability to fulfil parental roles and responsibilities?
Ante-natal Care
Ø Did the mother have any health problems prior to pregnancy?
Ø What was the nature of the mother’s nutritional status prior to pregnancy?
Ø Did the mother/parent receive education regarding family planning and reproductive health prior to pregnancy?
Maternal Health during pregnancy:
Ø Did the mother have comprehensive health checks?
Ø What did they involve?
Ø Was she given real opportunity to express any concerns?
Ø Did the mother have any physical or health-related problems at the time of pregnancy?
Ø If so, how were these treated upon her arrival in Australia?
Ø During health checks and medical examinations, was there someone present who could speak her language?
Ø Were the doctors/nurses male or female?
Ø How did she feel during medical examinations, was she comfortable?
Ø How many visits to a doctor/obstetrician/midwife did the mother have during her pregnancy?
Ø Did she receive any education regarding reproductive health, pregnancy or childbirth upon arrival in Australia?
Ø Did the mother receive appropriate and sufficient dietary intake during her pregnancy?
Ø Did the mother receive adequate sleep during her pregnancy?
Ø If she felt anxious or depressed during pregnancy, did she receive culturally appropriate counselling in her own language?
At the time of delivery:
Ø What was the location for birth: IDC/Hospital/Clinic?
Ø Who was present at the time of delivery: doctor/obstetrician/midwife?
Ø Was the mother allowed personal support during labour: husband/partner/relative/ friend?
Ø Was there someone present who could speak the mother’s language?
Ø Were there any complications during or immediately after birth for mother or child?
Ø If so, how were these treated? Was the mother given all relevant information regarding her condition, in a language that she understood?
Ø How many days did the mother spend in hospital (providing she gave birth outside an IDC)?
Ø If she did give birth in an IDC, what were the conditions like and what services were made available to her? What the reasons for her giving birth inside the IDC?
Following birth:
Ø How many post-natal visits have mother and child had (from doctor/paediatrician/nurse)?
Ø Has a support person trusted by the mother been present?
Ø Have those visits been conducted in a language the mother understands?
Ø Have these visit been conducted in a comfortable environment?
Ø Has the mother been provided with a realistic opportunity to express any concerns?
Ø Have the mother and child had any health related problems since birth?
Ø If so, how have these been treated?
Ø Is the mother breastfeeding?
Ø Is she able to breastfeed in a private and comfortable environment?
Ø Is she having any difficulties with breastfeeding?
Ø If so, is she receiving counselling and assistance from a lactation nurse (or suitable health care professional)?
Ø Has the mother been depressed or anxious since the birth of her child?
Ø If so, has she received ongoing counselling?
Ø Are mother and child able to have sufficient sleep and rest?
Ø What is the nature of the environment that mother and child are living in?
Ø Is mother receiving adequate nutritional intake, particularly if breastfeeding?
A complete discussion about the educational needs and rights of kids in Australian immigration detention centers will be addressed in more detail elsewhere in this submission. As with emotional health, learning and education are inextricably linked to healthy child development and wellbeing. This section gives a brief outline of the importance of opportunities for learning at all stages in childhood, including formal education.
Internationally there is a substantial amount of evidence that supports that opportunities for learning and participation in formal education of a high standard during childhood leads to improved health and wellbeing in later life. Participation in learning and education opportunities results in improved self-esteem, better employment prospects, decreased delinquency, and improved health.
Developmental problems often contribute to learning difficulties even where the child has a "normal" level of intelligence. Accordingly, problems in hearing, speech, and cognitive development must be addressed if emotional and behavioural problems are to be prevented. The importance of addressing these problems is discussed in more detail in Section12 of this report that addresses the needs of children with disabilities; however, development of cognitive skills is important for all children.
Success in school is clearly associated with improved life chances; conversely, failure to complete formal secondary education results in an increased likelihood of low income, poor employment prospects, and other problems later in life [77]. The acquisition of social and other life skills through learning and education is also crucial to healthy child development.
Early childhood
It must be recognised that children begin learning in infancy and learn a great deal before they have the opportunity for formal education. A social and physical environment that is conducive to learning is therefore absolutely crucial. The environment must be stimulating and there must be the opportunity, space and equipment for culturally appropriate play. This is addressed in more detail in the section concerned with the physical environment. Learning in early childhood is known to have a significant impact on academic success once formal education is commenced.
Adolescence
This age group has particular educational needs due to the developmental changes which occur during adolescence. Health education is vital, particularly with regard to sexual health and development, specifically issues such as periods, contraception and safe sex. This information must be given in a culturally appropriate manner. Adolescents are also in need of opportunities to learn vocational skills.
Accepted standards regarding education and learning and evidence of the situation for children in Australian immigration detention centers will be given in more detail in the section of the submission that addresses this topic comprehensively. Some of the more relevant articles of the 1989 United Nations Convention on the Rights of the Child are as follows:
Article 28 states that,
“States Parties recognize the right of the child to education”
Article 29 states that,
“States Parties agree that the education of the child shall be directed to: The development of the child’s personality, talents and mental and physical abilities to their fullest potential;
The preparation of the child for responsible life in a free society, in the spirit of understanding, peace, tolerance, equality of sexes, and friendship among all peoples, ethnic, national and religious groups and persons of indigenous origin” [78].
Stories
The following information was provided by a former detainee from Woomera Immigration Reception and Processing Center and has been substantiated and added to by a Registered Nurse employed at the centre.
After a baby is delivered no special advice is given regarding breastfeeding. Accessing infant formula is difficult due to bureaucratic processes. There are no proper nutrition or health services for children under one. The lack of Maternal and Child Health services leads to a lack of support and advice regarding child nutrition such as weaning advice. There are no age appropriate weaning foods available. Most of the children hated the food that was given at the detention centre. Because of this they lived on chips and sweets which were expensive, but the parents bought them if they could afford to. Rice that was not properly cooked was often served along with boiled vegetables and meat. Nobody enjoyed it because it was prepared badly. Some of the women helped in cleaning and chopping but not cooking the meal itself. Sometimes the meat served was rotten and people fell ill and had to be admitted to hospital. They were told the meat was halal but did not feel confident that it was. Children lost a considerable amount of weight. |
It is firmly established that child health, development and wellbeing are dependent upon a healthy diet [79] [80]. For healthy development it is necessary for kids to receive adequate quantities of food with adequate amounts of nutrients for the complex process of development [81]. What is adequate depends on the specific needs of each individual child. Eating food also has important cultural and social functions which impact upon the wellbeing and development of children.
Children have been referred to in the World Declaration and Plan of Action for Nutrition, as the most vulnerable group of people in the world [82]. Child asylum seekers are an even more vulnerable sub-group as they are likely to have been deprived of nutritious food on the journey to Australia and for some time in their countries of origin[83]. This can lead to micro-nutrient deficiency, causing diseases such as scurvy which results from a deficiency in vitamin C and leads to a number of symptoms including weakness, anaemia, spongy ulcerating gums and loose teeth and hardening of the muscles of the legs.
To ensure the healthy development of children who arrive in Australia seeking asylum, and due to the increased risk of these children to nutritional deficiencies, it is necessary for their nutritional status to be assessed on arrival. This must be done using techniques that are accepted internationally as the best way to assess nutritional status (i.e. comparing children’s height for weight/age taking into account cultural and geographic differences in child development). All efforts need to be made to ensure that nutritional needs of children in detention are met. At present there is substantial evidence that they are not. It is not only necessary for children and their families in immigration detention centres to receive nutritious food, the food must be both appealing and culturally acceptable to the children and their families to ensure they are actually eating the food provided.
The health and nutrition of mothers is also very important with regard to the health of infants and children. In Australia pregnant and lactating women are a priority with regard to public health nutrition activity, as outlined in the recent publication Eat Well Australia. [84]. This document clearly outlines the evidence as to how the nutritional status of mothers affects the development of the foetus and the birth weight of infants [85]. As highlighted in this document, of specific importance is the intake of folate and iron, both prior to conception and in early pregnancy [86]. There is no evidence that these health needs are considered for pregnant and lactating women in detention.
Breastfeeding provides the infant with the nutrients required for development as well as protection against infectious diseases, and there is evidence that breastfeeding may give long-term protection against other conditions such as cancer, type 2 diabetes, coronary vascular disease and asthma [87]. Encouraging breastfeeding is a national priority due to it’s numerous demonstrated benefits [88]. It is clear that breastfeeding is neither encouraged nor supported in detention centres. The availability of advice to new mothers with regard to breastfeeding is essential to encouraging breastfeeding in detention centres. If infants are in detention, breast-feeding should be encouraged and practical as well as socio-cultural barriers to breastfeeding should be identified and all effort made to remove them.
The provision of inadequate foods to meet the needs of growing children in Australian immigration detention centers strengthens the argument that children should not be detained. If children are institutionalised they must be given choices of a variety of culturally appropriate, nutritious foods, of adequate amounts, with snacks available between meals, all of which must be appealing to the children. Advice from maternal and child health experts is also essential. It is evident that there are many examples of child nutrition standards not being met in immigration detention centres.
There are different nutritional requirements at different stages during childhood. The detail of requirements of different food groups and their components (e.g. micronutrients such as vitamins and minerals) is beyond the scope of this submission. Therefore, only the most significant points will be made here.
A wide variety of foods are required throughout the life span. A diet that contains fruits, vegetables, wholegrains, legumes, dairy foods and lean meats can fulfil these basic requirements [89].
Infants need a higher concentration of nutrients than older children and adults because they grow proportionately more than during other periods of life [90]. Breast milk generally supplies an infant with adequate amounts of nutrients, fluids and energy until six months of age. Breast milk is preferred to formula, as it contains protective and immune factors that benefit the baby. All infants require extra water when solid foods are introduced [91].
The infant should ideally be weaned from the breast at around six months of age, unless slow growth rates are causing concern. In such cases weaning should begin earlier - at around four or five months [92]. Solids introduced too early can damage a baby's kidneys and/or lead to allergies. Introducing food too late may affect growth and development, and/or influence food acceptance later on [93]. Different cultures have different practices and traditions with regard to what food is more appropriate to begin with [94]. It is important that culturally sensitive foods and preparation methods be encouraged as long as they are nutritionally adequate [95]. There are many specific processes that need to be adhered to with regard to weaning infants and advice must be available to new mothers with regard to these practices [96]. An important point is that generally cow's milk should be avoided in the first 12 months of life [97]. Foods that contain certain micronutrients (i.e. vitamin C, D and iron) are recommended during the introduction of solids to ensure their adequate intake.
A large variety of foods need to be offered to young children. Children’s food needs vary widely and children will eat more or less dependent upon their patterns of growth and activity level [98]. Ideally, young children should be accumulating stores of nutrients for the growth spurt experienced in adolescence. The intake of sugary food should be minimised to prevent tooth decay. Overeating, and eating a large amount of “junk food” can cause excessive body weight and obesity and this can be exacerbated by an inadequate level of physical activity [99].
As children enter into adolescence energy requirements are higher than at any other time of life, except during pregnancy and lactation [100]. Food therefore needs to be high in energy, while at the same time containing high nutrient levels. Calcium levels also need to be sufficient to support significant bone growth [101].
Rule 37 in theUnited Nations Rules for the Protection of Juveniles Deprived of their Libertystates that:
“Every detention facility shall ensure that every juvenile receives food that is suitably prepared and presented at normal meal times and of a quality and quantity to satisfy the standards of dietetics, hygiene and health and, as far as possible, religious and cultural requirements. Clean drinking water should be available to every juvenile at any time,”[102].
The nutritional status of children in detention has a direct and marked impact on their immediate health and wellbeing continuing physical development. Children’s nutritional status pre- and post- arrival in Australia, has an impact upon physical growth, motor skills, and ability to cope with infection, illness or injury. The emotional health of the child will also have an impact on their nutritional and dietary intake.
Ø What was the nature of the child’s nutritional status prior to arrival in Australia?
Ø Are children examined for micronutrient deficiencies on arrival?
Ø If there were any deficiencies, how were these assessed and treated, and have they had any lasting detrimental effects on the general health of the child?
Ø What has been the nature of the nutritional status of the child since arrival in Australia?
Ø Does the child have a good appetite?
Ø Does the child receive a number of well-balanced and substantial meals during the day, including nutritious snacks in between meals?
Ø Does the child have access to nutritious food outside the usual meal times?
Ø Does the child receive a diet that is both age-appropriate and culturally appropriate?
Ø Is the menu flexible enough to accommodate the different tastes and fluctuating appetites of children?
Ø Are families encouraged in the preparation of their own culturally, appropriate food?
Ø If the mother continues to breastfeed does she receive adequate nutrition, sleep and rest?
Ø If the child is not breastfed, do mother/parent receive adequate and appropriate infant formula?
Ø Are mother/parents provided with education regarding hygiene and care of the newborn, for example the sterile preparation of infant formula?
Ø Are there adequate facilities inside the IDC for the correct preparation of infant formula, and does the mother/parent have sufficient access to these facilities and to supplies of infant formula?
A refugee movement can disrupt nearly every aspect of a culture.Before and during the migration process, refugee children are forced to face multiple changed situations that threaten their familial relationships, break their connections with their community of origin, challenge the behavioural expectations of their culture and leave them uncertain about their future.
This submission will address cross-cultural issues related to health service delivery in detention centres and how these issues impact upon the health and welfare of children in particular.
The United Nations Convention on the Rights of the Child states that,
“The importance of the traditional and cultural values of each people for the protection and harmonious development of the child’ must be taken into account,” [103].
Article 30 states that,
“Every child who belongs to an ‘ethnic, religious or linguistic’ minority or indigenous group has ‘the right, in community with other members of his or her group, to enjoy his or her culture, to profess and practice his or her own religion, or use his or her own language,” [104].
The participation of children capable of forming their own views in decision-making is a central theme of the Convention on the Rights of the Child. Positive measures may be needed to ensure child asylum seekers are heard and their needs met. The UN Human Rights Committee has clarified that
“States Parties may need to undertake positive measures ‘to protect the identity of a minority and the rights of its members to enjoy and develop their culture and language and to practise their religion, in community with other members of their group”
By learning the values and traditions of their culture, children learn how to fit into their family, community and the larger society. Each society has a unique body of accumulated knowledge, which is reflected in its social and religious beliefs, and ways of interpreting and explaining the world around them.
When a society's guiding and regulating mechanisms are lost, individuals find themselves deprived of their normal social, economic and cultural environment. Moreover, children often lose their role models in a refugee situation. Under normal circumstances, parents provide the primary role model for their children, contributing significantly to the development of their identities and to their acquisition of skills and values.
Children in detention have a history of exile, exposure to war, organised violence and human rights violation. They have often experienced the same trauma as their parents prior to arrival in Australia. During incarceration in detention centres they are further exposed to the psychological distress and despair of parents who are living outside their culture, with little control over their lives and kept unaware of their legal status as refugees. Exposure to parents who are distressed and anxious, and who no longer behave according to their cultural norms, can seriously disrupt the normal emotional development of children. This disruption can also contribute to growing alienation between child and parent.
In detention centres,families live together in cramped conditions. There is little privacy and few facilities for family activities. In many cases families are housed in multiple groups separated by a curtain only. At the same time, because of isolation between families in different sections of detention centres according to the status of the processing, families do not have access to the support mechanisms that may be available within communities.
The environment in detention centres is very different from the cultural environment with which children are familiar. The family members cannot perform their routine tasks such as planning and undertaking their daily activities. They cannot even be involved in decision making about the food they will eat. Even when both refugee parents are present, parents’ potential for continuing to provide role models for their children is likely to be hampered by the loss of their normal livelihood and pattern of living and this situation is likely to have a negative impact on normal childhood development.
Pliskin describes Iranians experiencing social and cultural problems brought on by revolution, war, immigration and their impact on the health of communities [105]. Changes in family status are expressed as narahati – depression, nervousness, sadness and anger that are usually masked or expressed nonverbally through sulking or not eating. Children exposed to this sort of family behaviour commonly respond with disturbed behaviour but also by exhibiting symptoms of somatised illness. The illness can be manifest physically as well as mentally with for example, headaches, tiredness, abdominal pain and gastric disturbances. It is important that clinicians trained to understand these problems are employed. But more important is the support of the family to remain a nurturing unit. Montgomery and Foldspang are among authors who stress the prime importance of the family environment in maintaining the health of children [106].
According to the United Nations High Commissioner for Refugees (UNHCR), it is vital to consider the cultural acceptability, palatability and digestibility of the food provided, in addition to its nutritional quality. Cultural considerations must be taken into account with respect to food type, preparation and serving, particularly considering the traditional roles of family members in relation to the child’s food. It is therefore vital that children in Immigration Detention Centres are provided with food that is culturally and religiously appropriate. Further it is important that the child’s family members prepare and serve the food in accordance with the family’s cultural practices (including appropriate times of day.
Complaints about food have been echoed by all ex-detainees and ex-staff of Immigration Detention Centres we have interviewed and Mares describes the situation at Port Hedland that resulted in marked improvement of the food situation and the morale of detainees. Innovations by the catering manager allowed food to be planned and prepared by chosen representatives of the cultural groups [107].
During the period when Kosovars and East Timorese were accommodated in Safe Havens at Portsea and Puckapunyal in Victoria, residents were allowed involvement in the design and preparation of meals. At the same time the professional caterers were able to monitor food quality and procedures. This strategy resulted in markedly improved morale amongst the residents of the Safe Havens,
It has been argued that culturally appropriate food is prepared in Woomera Detention Centre, with input from detainees; but essentially the only input detainees have is work as kitchen hands.
Children’s right to a name is connected with their identity and must be respected always, including through registration and record-keeping in Australia.
Article 8 of the United Nations Convention on the Rights of the Child states that:
“States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations as recognised by law without unlawful interference.”
And that:
“Where a child is illegally deprived of some or all of the elements of his or her identity, States Parties shall provide appropriate assistance and protection, with a view to re-establishing speedily his or her identity,” [108].
A teacher at Port Hedland has told how children replied with their numbers when she asked their names.
Replacement of names with numbers contributes significantly to dehumanisation of individuals. This process will also have an impact on staff working with detainees. Many ex staff have reported the difficulties associated with maintaining their own ethical standards in an environment where the highest priority was securing the asylum seekers.
It is important that the child is able to renew religious and ritual practices, which may have been disrupted during refugee or migrant movement. These practices are important physical manifestations of the child’s culture and assist in preserving the identity and therefore the self-esteem of the child. The 1994 UNHCR Guidelines on Protection and Care of Refugee Children stress the benefit to community mental health of festivals and rites of passage:
“Religious festivals and rites of passage such as birth, transition into adulthood, marriage and death are extremely important in unifying a community and in conferring identity on its individual members. The importance of such activities to community mental health should not be underestimated. For example, the provision of extra food for communal meals, or other material assistance for funerals (burial cloths, coffins, firewood, etc.) can give vital emotional support and sustain culture through a crisis,” [109].
There are reports that some religious practitioners have visited detention centres, however, they have been mainly Christian. Although their visits have been appreciated, it may not be the most appropriate response. The population of detention centres reflects a cross section of a normal population and may include religious leaders who can be encouraged to play an appropriate role in the detention centre community. Alternatively qualified religious representatives should be allowed to pay pastoral visits to child asylum seekers in detention to ensure proper instruction in their religious beliefs.
In order to practise their religion, along with other members of their group, a child should have access to books and other items of religious observance and instruction and a diet in keeping with his or her religion. They should be allowed to attend regular religious services. Parents’ responsibilities in ensuring their children receive appropriate teaching and practice should be specifically recognised.
The continuity of experience required for normal childhood development may be further undermined for refugee children when they come into contact with different cultures. The language, religion and customs of other groups in the centres, as well as that of officials and aid workers may be quite different from those of the refugee community. In such cross-cultural situations, in particular in the context of detention, children frequently ‘lose’ their culture much more quickly than adults.
There must be mechanisms in place to prevent officials or members of other groups reacting in a negative manner to the cultural or religious beliefs and practices of detainees, particularly children.
Language is an important element of a child’s identity and any loss of the child’s first language may have long-term consequences for the child. Involvement of teachers, childcare workers and leaders from the community in the education of children will help develop literacy and maintain their mother tongue. Child asylum seekers must be able to retain and, where necessary, become literate in their mother tongue, in addition to learning the local language.
While children’s rights to use their own language may not necessarily include being taught entirely in that language, it may require that part of their education be in their first language, particularly for young children.
Health professionals working with children need to be able to communicate effectively with distressed children taking into account cultural factors to understand how children react to distressing experiences. Mobilising community women and adolescents in particular is important for support of culturally appropriate children’s programs in their own languages. The absence of these sorts of programs can contribute to the physical and mental health problems of children.
The effectiveness of interpreting services is dependent on whether the organisation has some measures in place, such as use of interpreting guidelines or a policy requiring competence in staff concerning working with interpreters.
Commonly, when interpreters from the detainee community are used, they will be men rather than women because men are more likely to speak English. This situation can impact on women’s willingness to freely discuss some health or domestic issues with health care providers. The use of family and community members as translators is not appropriate, due to privacy and quality considerations and must be discouraged.
The presence of quality assurance mechanisms and ongoing training of staff on how to work with interpreters should be part of the accreditation procedures for organisations working with asylum seekers.
Cross-cultural training for health professionals working with asylum seekers, particularly adult girls, is essential. Among the some of the groups currently in detention centres are young females from cultures where genital infibulation or circumcision is practised. This practice has been termed female genital mutilation in the western world and is the medically unnecessary modification by cutting and stitching of female genitalia. In many societies, particularly from the Horn of Africa and the Middle East, it is considered an important cultural practice. Health care professionals need to understand the important aspects of this problem, including management of complications, cultural attitudes, and sensitivities.
The procedure typically occurs at about 7 years of age, but women suffer severe medical complications throughout their adult lives. Adolescent girls who have undergone this procedure are much more at risk of urinary tract infections and other disorders than ‘normal’ adolescent girls. Young girls in any culture are often shy to consult health professionals, particularly about reproductive issues. For these young girls, consultation with a health practitioner who has not been culturally prepared can be particularly traumatic. The reaction of the health practitioner can be, often unconsciously, quite judgemental. Although interventions to prevent the continuation of this practice are important, it is not the place of the health professional to challenge patients consciously or subconsciously about the practice. A negative reaction can deter young women from seeking medical help and therefore exacerbate potentially dangerous conditions as well as causing further cultural alienation.
Afghan women have come from a culture and sociopolitical environment where they were denied access to health care if there was no female health professional available. It is important that female health professionals are available in Australian facilities because these women may be more likely to accept health care from a female professional than from a male.
The Preamble to the Convention of the Rights of the Child underlines the importance of the traditions and cultural values of each people, for the protection and harmonious development of the child. At the organisational level, the inquiry must look at the culture, leadership, work structure, contractual agreements, and policies and procedures or practices of organisation involved in the care of asylum seekers.At the individual staff level, the HREOC inquiry must look at the dynamics of personal assumptions, biases, prejudice, stereotypes, expectations and perceptions, past experiences and feelings of individual staff in the service organisation.
Cultural competence in health care is defined in this document as the ability of individuals and systems to respond respectfully and effectively to people of all cultures, in a manner that affirms the worth and preserves the dignity of individuals, families and communities. Cultural competence is a crucial skill for health-care providers, who deal daily with diverse people in life and death situations.
The culturally competent provider:
- has the knowledge to make an accurate health assessment, one which takes into consideration a patient's background and culture
- has the ability to convey that assessment to the patient, to recognize culture-based beliefs about health and to devise treatment plans which respect those beliefs
- is willing to incorporate models of health and health care delivery from a variety of cultures into the biomedical framework
To be culturally competent, a provider should acknowledge culture's profound effect on health outcomes and should be willing to learn more about this powerful interaction.
Organisational strategy within the detention centre system is paramount and service providers to be aware that the needs of children in detention centres with a ‘one fits all’ approach. The principle of diversity stipulates that having policies in place is not enough. Organisations must ensure that all of their leaders are proactively working to create and lead a respectful workplace, one free from abuse, harassment and discrimination and one that promotes cultural harmony.
Although the communities in detention centres reflect most facets of a common community - there are teachers, lawyers, health workers, etc. – detainees’ skills are rarely beneficially employed. The UN guidelines recommend that community members who know and can help their communities should be integrated into the health delivery system. Others who can contribute are child-care workers and community leaders.
Ø Do living arrangements enhance and protect cultural, social and religious values?
Ø Are cultural, religious and social preferences of refugee families respected?
Ø Are refugees able to practice their religion and do they have the facilities to do so?
Ø Are participatory strategies being implemented in the planning and implementation of services?
Ø Is the children's native language used and taught to the children?
Ø Are appropriate recreational activities promoted?
Ø Are coercive religious and cultural practices by assistance agencies monitored and countered?
Ø What are the broader diversity and cross-cultural challenges facing the organisation?
Ø What are the organisation’s initiatives and responses to these challenges?
Ø Are responses to the challenges being dealt with in a systemic fashion:
- requiring cross-cultural competence as part of their own accreditation?
- providing cross-cultural training, to all staff rather than individual staff?
Ø How do the organisation’s leaders and employees perceive diversity? As a human resource intervention? As a skill development or educational intervention? As a public relation effort? As a way to avoid discrimination, abuse and maltreatment of children in detention centres?
Section 8: Administration of Health Care Services
Recently health experts in Australia have begun to speak publicly about the impact of detention on the health of adults and children, in particular on the emotional and psychological well-being of these detainees [110]. The evidence overwhelmingly suggests that detention is indeed harming the health of many children in detention in Australia today and that the situation needs urgent reappraisal.
Australasian Corrective Services (ACS) is contracted by the Department of Immigration and Indigenous Affairs (DIMIA) to operate all six Immigration Detention Centres (IDCs) in Australia. Australasian Correctional Management (ACM) is the company that provides these operational services, including health services. ACM has been the sole operator of immigration detention services since 1998.
An incomplete version of the contract between ACM and the Federal Government for the running of IDCs is publicly available as are the Immigration Detention Standards [111]. These Standards as they pertain to children’s health care needs are brief and vague in the extreme. Under the section on infants and young babies it states that “the special needs of babies and young children are met.” More detailed guidelines and/or protocols are either non-existent or not on the public record. This raises the serious question of public accountability. Indeed medical professionals have recently called for ACM to be more transparent in its provision of health services within the IDCs. To date repeated requests to the Federal Government from the Australian Medical Association and the specialist colleges for an independent review of the centres have been rejected.
Health care within the detention centres is funded by ACM, and not by the government funded Medicare scheme. Herein arises a possible conflict of interests whereby a private company may be tempted to withhold medical services (especially for non-emergency conditions) as a means of reducing its overall operating costs.
A health care professional who visits the Maribrynong Detention Centre regularly has reported that one detainee, who requires ongoing extensive medical care after a severe injury, which occurred in detention, was told by a staff member at the facility that he was “costing the company a lot of additional money”. |
Training
The UNHCR Guidelines on the Protection and Care of refugee children is just one of many documents that stress the importance of employing health staff with adequate cross-cultural training as well as specific training for working with refugee populations. If trained staff are not available, training must be provided by the institution [112].
According to an informant, staff are not appointed to IDCs in Australia on the basis of their training or experience in working with refugee populations. It has been reported that instead nurses are recruited primarily for their suitability in a correctional environment. Another concern is the limited training available to staff on working with individuals suffering from the effects of trauma and torture. This lack of training potentially makes it more difficult for staff toidentify children who have been exposed to previous trauma, torture and sexual abuse, all more prevalent in this population.
A former staff member of the Woomera Immigration Reception and Processing Centre has reported that officers who were not medically trained were ordered to administer medication to detainees. Despite officers refusing on the grounds that they were not qualified to perform such tasks, they were told “not to worry about that, as officers always gave out medication”. |
Treatment protocols and operating procedures
It would appear that in Australian detention centres, there are no treatment guidelines or protocols to cover the responsibilities of different levels of staff – middle-level health providers are forced to rely on their own individual judgments often without appropriate expertise or experience. A doctor working at Woomera was concerned that nursing staff were forced out of their depth to supervise procedures that would normally require expert supervision [113]. A Registered Nurse who has worked at Woomera has also reported that there is very little professional supervision within the IDCs.
Staff Contracts and Codes of Conduct
While staff may be committed to their own Codes of Conduct many ex staff have reported the difficulties associated with maintaining their own ethical standards in an environment where the highest priority is securing the asylum seekers and not delivering care responsive to their broader health needs. Even more worrying is that the employment contract signed between health professionals and ACM actually prevents these health practitioners, under threat of legal action, to discuss the details of their working environment with people outside of the centres. Doctors have reported their concern that the duty of care they have to individual patients is being compromised by those agreements. It is particularly alarming when these agreements may be compromising mandatory reporting of child sexual abuse. A doctor should report suspected cases of sexual abuse but anecdotal evidence from nurses at Woomera is that they were told not to report because of their confidentiality agreements.
Medical records should facilitate better care of the patient. Medical records contain personal health information, defined as information which concerns the patient's health, medical history or past or present medical care; and which is in a forma that enables or could enable the patient to be identified’. This information includes information recorded by doctors, nurses and other health practitioners and includes information about the patient's family, education and training and so forth.
It is imperative that when a detainee is released from detention, any medical records should accompany them or be forwarded to another health practitioner in the community. On several occasions, however, it has been alleged that discharged detainees have not had written medical records to give to their doctors once in the broader community. The Australian Medical Association, for example has documented cases where this has happened with detainees suffering from diabetes, a potentially life-threatening condition if not properly managed.
DIMIA has access to and ultimate ownership of all detainee records [114]. In Victoria at least, this raises the question as to whether DIMIA and ACM are complying with the recently legislated Victorian Health Records Act 2001, which aims to facilitate freer patient access to personal health records.
The equivalent to medical records for children is the Child Health Record, which contains immunisation history, achievement of developmental milestones, growth charts and other information specific to an individual child. It is imperative that this accurate record of a child’s development is kept and given to a child’s parents on release.
Ø What are the accountability mechanisms for the delivery of health care services within Australian immigration detention facilities?
Ø What are the Performance Measures and tools for evaluation pertaining to the delivery of health care services and the activities of health care personnel?
Ø Are there any financial disincentives with regard to the treatment of complicated or costly medical treatments?
Ø Are there any health or medical records released with individuals from the detention centres into the community?
Section 9: Access and availability of health care services in detention
Information on the range of health problems facing refugees and asylum seekers in Australia is limited, due to a lack of research in this area of public health.
However, it is generally recognised that in addition to the range of health complaints suffered by the general population, refugees and asylum seekers are more likely to experience:
· psychological illness, including depression and anxiety disorders and post-traumatic stress disorder,
· unrecognised chronic disorders eg. diabetes,
· poor oral health as a consequence of poor nutrition and dental hygiene and lack of access to dental services in their countries of origin,
· infectious diseases, including tuberculosis and intestinal parasites,
· direct physical effects of torture eg. musculoskeletal disorders, deafness.
All of the above apply equally to children as they do to adults. In addition, in refugee populations, young children are more likely to suffer from delayed growth and/or development and may not be up-to-date with their scheduled immunisations because of disruption in health services or access to these services in their countries. Sexually active adolescents and young adults coming from countries where rates of hepatitis B, C and HIV are higher than Australia may be at risk of long term complications of these disease if they go undetected and untreated.
It has been reported that when they or their children are ill, detainees have to inform a guard and provide details before they can be seen by a doctor. A mother with small children may worry because small children can become very ill very rapidly, but she is also confronted with obtaining permission for a consultation through a guard. Although it is reported that guards do not routinely sit in at medical consultations, they were likely to be within earshot at nurses’ clinics.For privacy as well as cultural reasons this situation is not appropriate.
This scenario has been described by several health professionals who work or who have worked in detention centres. Many find it difficult to reconcile the system with their own professional standards. They also describe other health providers who have become ‘acculturated’ and ‘fit in with the system’.
Staff ratios
‘Personnel should be qualified and include a sufficient number of specialists such as educators,…counselors, social workers, psychiatrists and psychologists’ [115]
Dr. Sparrow, a Perth paediatrician reported in The Age in March 2002 that staffing levels at Woomera were inadequate to meet the health needs of detainees. There were 3 psychologists for 500 people and one full-time doctor. A teacher quoted in the same article stated that there were just three teachers to 1500 people when she started work at Woomera in 2001.
Access to interpreters
It is vital that the services of a trained interpreter be available if health provider and patient do not speak the same language. It is inappropriate to use family members or other detainees to interpret, especially when trying to elicit information about sexual health, sexual violation, trauma and torture. An ex-staff member at Woomera reports that the gender bias in interpreters means that there are more men than women available to interpret.This is also likely to impact on the willingness of a woman to seek treatment wither for herself or for her child.
Access to private consultation with health providers.
From consultation with an ex-staff member at Woomera, we were able to ascertain that both doctor and nurse clinics are held at regular intervals. Nurses are present on-site over a 24-hour period and have access by telephone to the doctor, and also to ambulance transport. Guards are generally in attendance during nurse clinics and when medications are given out. Nurses’ clinics are usually held while people wait in a queue, and other detainees are often within earshot. This lack of privacy seriously compromises the therapeutic relationship between patient and health provider especially when considering concepts of confidentiality and consent may have been already severely eroded in such populations.
A doctor attends at designated times, either on a referral basis, or via ambulance to the hospital in emergencies.
Detainees are discouraged from seeking health care outside of working hours, often have to wait in the hot sun and are introduced by number, rather than name.
It seems there is very little access to specialist attention within IDCs and some specialist doctors who have worked “inside” are disturbed by what they have seen.
“Every juvenile shall receive adequate medical care, both preventive and remedial, including dental, ophthalmological and mental health care, as well as pharmaceutical products and special diets as medically indicated,” [116]
Both the United Nation Guidelines on the Protection and Care of Refugee Children and the Australasian Juvenile Justice Standards specify the need for appropriate preventive, public health and curative services to be accessible within detention centres.
There is evidence to suggest that there is very little that resembles comprehensive health care within the IDCs.Staff and ex-detainees have indicated that treatment provided to detainees is often substandard. Access to a doctor is at the discretion of Registered Nurses. One ex-detainee described a number of instances where nurses would bar patients from consulting the doctor even when the patients felt the their problem may require a doctor's attention. Instead, paracetamol (a mild analgesic) is prescribed for ‘everything’. In fact nurses in the IDCs are not allowed to prescribe S4 (prescription only) medication. When doctors are not in regular attendance, it is likely that detainees may have to wait some time for anything more complex than a few ‘headache tablets’.
Even the Australian Medical Association has asserted that detainees are often deprived of basic medical care. In addition the living conditions within some IDCs may even be harmful to a child’s health.
In Woomera, it is alleged that children do not have enough room to crawl around or play inside and the climate is too extreme to spend long periods outdoors. The housing units have no running water and the toilet block can be up to 500m away. Because of this distance, children have been known to be wait until they are incontinent.
It seems that preventive medicine is not practiced to any extent.
An ex-staff member at Woomera reports “when I was at Woomera, the dentist would not treat children and perform extractions only for adults. No regular check-ups were available.” |
The Child Health Record produced by the Department of Human Services Victoria outlines certain time points in a child’s life (birth through to adolescence) where children should be reviewed by a health provider for an assessment of their health and development. Included in these health check-ups are the regular monitoring of a child’s hearing and sight. We have no information regarding the adherence of health staff inside detention to these regular check-ups at specified ages. Parents also need information about expected milestones of child development in their native language.
Australia-wide standards apply for the administration of vaccines. Within the guidelines there is a special “catch-up” provision which applies to children of refugees or immigrants when there is no documentation of previous vaccinations. Registered Vaccine Providers should administer vaccines based on current recommendations, maintain safe storage and handling of vaccines, and record all vaccine information correctly, eg. report to national database of administration and of adverse events, clinic records, and that an immunisation record be given post release.
To aid growth and development of a healthy child, food should be available at all times, especially for small or “fussy” eaters and not just at designated meal times. Detention imperatives often forbid food to be taken to dormitories. Other reports from Woomera indicate that many children do not like the food and parents are supplementing their diet with sweets and crisps.
Mothers do not get regular assistance with breastfeeding or weaning. Nor are weaning foods necessarily provided that are appropriate for the age of the child. Each week families are given 2L of cow’s milk, some of which mothers are reported to give to children less than 12 months of age. This is too young for a child’s immature digestive system to handle.
During crisis periods, detainees have been known to be confined in isolation for long periods and others report to have suffered reprisals after such crises eg. restriction on visitors or difficulties in accessing legal or medical care. During a hunger strike in Villawood in 2000 all electrical power and water supplies to the cellblock where the strikers were housed were cut off. This effected the children and other adults who were not participating in the strike. Indeed this highly militarised approach breeds fear and anxiety, especially in the children who are spending a crucial period in abnormal environments with distressed care-givers.
In addition to the psychological effects, children are more vulnerable to adverse physical outcomes during crises periods. Due to their small height children are susceptible to head and eye injuries when the water cannon is turned on. This applies especially to Woomera, which is located in the Gibber Desert. A high velocity water stream directed at the ground causes stones to become airborne which may hit children.
There are many issues of particular importance to certain developmental stages and these special considerations are highlighted in the questions below.
Infancy (0-1years)
Ø Does the child regular receive Well-Baby Checks, as indicated below?
Age | What checks are performed? |
0-2 wks | Review feeding, jaundice checks, review sleeping patterns, issues regarding safety during bathing, sleeping, general physical development |
6-8 wks | General physical development, review of feeding and sleeping patterns |
6-9 mths | General physical development, motor skills such as rolling, sitting, crawling, feeding including introduction to solids, safety issues |
18-21 mths | General physical development, motor skills such as walking, speech development, feeding and dietary intake |
3-3.5 yrs | Play, socialisation, toileting issues |
School entry | Dental health checks, diet, general physical development, immunisation certificate |
Height (or length), weight and head circumference (at earlier visits only) all measured at each visit.
Ø If so, are these health checks conducted in a comfortable child-friendly environment?
Ø Are these health checks conducted in a language clearly understood by the mother/parents? And/or in the presence of an appropriate translator?
Ø Are these health checks performed by specialist paediatric clinicians?
Ø Did the mother/parent receive and give fully informed consent regarding any diagnostic tests, procedures and treatments given to their child upon arrival in Australia? (This is relevant across all age-groups)
Preschool (1-5 years)
Ø If the child is exhibiting dysfunctional social, emotional and behavioural patterns, is there qualified counselling and therapy available for the child and/or mother/parent?
Ø If the child is displaying poor physical development, how is this assessed in the IDC and what treatment/referrals are made and to whom?
Adolescence (12-18 years)
Ø Do boys and girls receive age-appropriate and culturally appropriate advice/education/counselling/support about reproductive and sexual health issues?
Ø Is the mother/parent involved in these discussions?
Ø Is there an appropriate trained and readily available member of staff to assist with this (if required or requested by parents)?
Ø Are boys and girls able to sleep, dress and attend their hygiene needs in privacy?
Ø Do girls have ready access to feminine hygiene products as required (eg. without having to ask a guard)?
Ø Is there culturally appropriate and sensitive vigilance for girls’ problems and appropriate means to address these (eg. a girl who has been infibulated (female circumcision) might be more likely to get a urinary tract infection)? Does the medical staff react with shock/horror or are they aware how to respond?
Ø If a girl has stopped menstruating, does she have access to sensitive investigations and counseling? Also for her mother or carer? (Stress or many other things can cause menstruation to stop but the mother might think the child has been abused)
Ø Are staff sensitive enough to be approached about these sorts of issues or will the family try to hide them?
Ø Are boys given appropriate education about their sexual health and reproductive changes, in a manner that is culturally appropriate and sensitive?
Ø What mechanisms are in place to ensure prevention of physical and sexual abuse of children in detention?
Ø If there is suspicion/allegation of abuse, what mechanisms are in place to investigate and address this problem?
Dental Health:
Ø How often are dental health checks performed?
Ø Are interpreters available at the time of dental health checks to help alleviate fears and anxieties?
Ø Are parents/mother present during dental health checks of children?
Ø Are dental health checks conducted in a child-friendly environment in order to minimise fear and anxiety?
Ø What preventative measures are undertaken in Immigration Detention Centres to ensure the dental health of children?
Immunisation:
Ø Is the child receiving appropriate immunisations for his or her age according to the Standard Vaccination Schedule?
Ø If Registered Nurses are administering vaccinations are they registered as immunisation providers?
Ø Were medically skilled interpreters available on arrival to assess immunisation status, and check for previous adverse events and contraindications?
Vaccination schedules are different in each State. The schedule for Victoria is as follows (for infants born after May 2000):
Birth: Hep B
2 months: DTPa, Comvax (Hib-HepB), OPV
4 months DTPa, Comvax (Hib-HepB), OPV
6 months: DTPa, OPV
12 months: MMR, HiB-HepB
18 months: DTPa
4 yrs: DTPa, MMR, OPV
15-19 years: Tetanus, OPV
Non-immune women of childbearing age should receive MMR (measles, mumps, and rubella)
Unwell Events
The occurrence of an ‘unwell event’ may include illness or injury whilst in detention. These may vary in severity and urgency; they may be satisfactorily treated within the Immigration Detention Centre health facilities or they may require treatment at an external facility. The mechanisms for addressing unwell events in children within Immigration Detention Centres need to be examined in terms of accountability, referral systems and the maintenance of medical records.
Ø Has the child been unwell or sustained an injury while in detention?
Ø If so, where was this treated? IDC or external facility?
Ø What systems are in place for referral to outside facilities/specialists?
Ø If a child leaves to attend a specialist appointment, can a parent or carer accompany them or are there only guards to escort them?
Ø How are medications dispensed, and how appropriate is this procedure?
Ø Who is responsible for paying medical costs, DIMIA, ACM?
Ø Has chemical restraint ever been utilised with regard to children, particularly during deportation?
Ø Did the mother/parent receive and give fully informed consent regarding any diagnostic tests, procedures and treatments given to their child upon arrival in Australia?
The issue of informed consent is an important one for any minor receiving health or medical consultations and treatment, and is particularly problematic for those who are unaccompanied. In essence, informed consent entails obtaining permission from an individual to perform a test or procedure, however the notion of consent embodies a number of principles that go beyond simply obtaining permission. Consent must be obtained for all medical procedures including basic physical examinations and inquiring about an individual’s medical history. Informed consent must be sought and given in a language clearly understood by both parties, and this may involve verbal or written consent. Written consent is predominantly sought for invasive medical procedures, and, in the case of minors, requires the signature of a parent or legal guardian; it is also essential that these signatures be witnessed. The legal responsibility for giving informed consent for medical procedures and treatment resides with the child’s parent or legal guardian. As highlighted in Section 8, on-shore arrivals in Australia are given an initial health check, which includes a basic physical examination in addition to invasive procedures such as blood tests and any immediate or urgent medical treatment that may be required. Individuals must be able to give informed consent for these procedures to take place, as it is unethical and illegal to forcibly perform medical procedures on individuals, particularly on children without the informed consent of their parent or guardian. Health care professionals and medical personnel who fail to obtain informed consent are in breach of their duty of care, and a number of legal cases have proven medical negligence on these grounds.
With regard to unaccompanied or unattached minors in detention, the issue of obtaining informed consent becomes highly problematic in the absence of an immediately available guardian. This is an issue of deep concern, particularly in terms of providing adequate protection and upholding the best interests of the child.
The volatile and fractured nature of the refugee experience commonly results in the separation of family members, often for long periods of time. The anxiety and distress of such a separation is compounded by the uncertainty of the whereabouts of family members and not knowing whether they may be alive or dead. The separation of children from parents during this time of extreme upheaval has devastating implications for their personal safety, psychological health and can have serious long-term consequences for the child’s development and wellbeing. Separation for long periods may lead to the formation of other attachments for children, therefore making the process of family reunification and rehabilitation even more difficult.
A study conducted by the Department of Child Psychiatry, Turku University Hospital, Finland, examined the traumatic events and behavioural symptoms of 46 unaccompanied refugee minors, waiting for placement in an asylum reception centre in Finland. The study found that unaccompanied refugee minors were in a highly vulnerable situation. Younger refugee children were more vulnerable to emotional distress than older children, indicating that the current procedures for dealing with asylum seekers may contribute to a high level of stress and emotional symptoms in previously traumatised refugee children [117].
The importance of reuniting children with their parents or other family members can never be underestimated, particularly in terms of determining the capacity of children to rebuild their lives and achieve positive long-term outcomes. For minors issued with Temporary Protection Visas (TPV), the prospect of ever being reunited with family members is extremely poor due to restrictions placed on movement and the ability to rejoin family members. Issues affecting children with TPVs will be examined in greater detail in Section 14.
The United Nations High Commission for Refugees recommends that unaccompanied minors should never be detained and that alternative care arrangements be sought in the community with family members who have residency. If this is not possible, then appropriate arrangements need to be made to ensure minors receive adequate accommodation and supervision. While this may be found in community residential care or through fostering, it must be noted that institutional care is to be avoided and that there are significant risks associated with foster arrangements. In determining the best and most appropriate care arrangements for unaccompanied minors, authorities also need to ensure that the psychological health needs of these children are met. Ideally, family tracing and reunification programs should be a high priority in planning the response for any refugee situation.
The Department of Immigration, Multicultural and Indigenous Affairs states that,
“There are special arrangements for unaccompanied children in immigration detention. These arrangement take into account the needs of their particular age and gender and include placement, where possible within the facility with an adult or adults, able and willing to take a care and custody role in relation to the child. Social activities are available as well as provision for contact with family members overseas,” [118].
The primary guiding principles highlighted by the United Nations High Commission for Refugees in providing for unaccompanied refugee children is upholding and meeting the best interests of the child. In terms of the day-to-day provision of care and services to unaccompanied minors to ensure their health, development and wellbeing, the areas of main concern are the identification of medical or health related problems and protection.
While the same health care services may be available to all children in detention, the ability to access those services is likely to differ significantly in the case of unaccompanied or unattached children. In most cases, parents of children in detention will identify health or medical problems of their child and seek the services of health-care personnel within the detention facility. For unaccompanied children however, the responsibility for this vigilance is unclear and children may be reliant upon untrained detention centre staff to identify health or medical issues. Some older children may have the confidence to seek out medical attention independently, although this is problematic without the presence of an adult to advocate on their behalf. Unaccompanied female children are particularly vulnerable in this situation and it is often culturally inappropriate for female children and adolescents to seek medical treatment without the presence of a female adult. For these and other reasons it may be likely that many health and medical issues of unaccompanied or unattached minors remain unidentified and are not addressed, leading to poor health outcomes for this group.
The issue of protection of unaccompanied minors is a seemingly obvious one, unfortunately this is often overlooked and the special needs of this vulnerable group are frequently neglected. The risk of sexual abuse of unaccompanied or unattached children is significant and while much attention is paid to the welfare and protection of unaccompanied female minors, 95% of the unaccompanied minors in Australian detention centres are boys. This group is particularly vulnerable as the following anecdotal evidence illustrates.
A former staff member of the Woomera Immigration Reception and Processing Centre reported that when a group of unaccompanied Afghan boys, aged 12 to 14 years, arrived at the centre they were distressed, suffering from depression and terrified. They feared being raped by other adult male detainees. A welfare officer at the Centre shared their concerns and felt the boys were being targeted for sexual abuse and assault. The officer took these concerns to management staff of the centre, but management did not acknowledge the seriousness of the situation and refused to act to isolate the boys and establish mechanisms for their protection. The management staff were informed that if an incident did occur and the boys were sexually abused, that they would be held responsible. This finally prompted staff at the centre to act and the boys were isolated from the adult male detainees. |
All care and planning for unaccompanied refugee children should be in keeping with the provisions of the United Nations Convention on the Rights of the Child and other international and regional instruments. Key principles within the UN Convention on the Rights of the Child that are of particular importance in the Australian context include upholding the best interests of the child, facilitating full participation of the child and fostering family unity.
The United Nations Convention on the Rights of the Child states that,
“A child temporarily or permanently deprived of his or her family environment…shall be entitled to special protection and assistance…” (Article 20).
The Universal Declaration of Human Rights states that,
"the family is the natural and fundamental group unit of society and is entitled to protection by society and the State" (Article 15).
The Final Act of the United Nations Conference of Plenipotentiaries on the Status of Refugees and Stateless Persons (1951) recommends [119],
"Governments to take the necessary measures for the protection of the refugee's family especially with a view to:
(2) The protection of refugees who are minors, in particular unaccompanied children and girls, with special reference to guardianship and adoption," (Article iv B).
The Department of Immigration, Multicultural and Indigenous Affairs has formulated a series of Immigration Detention Standards, which indicate the expected levels of care and standard of living conditions in detention centres. Standards relating to the care of unaccompanied minors are brief and give no indication of how these standards are to be met.
“ Unaccompanied minors are detained under conditions which protect them from harmful influences and which take account of the needs of their particular age and gender,” [120].
Through Freedom of Information procedures the authors of this section of the submission have sought to obtain the Performance Measures within the DIMIA/ACM Contract Agreement by which these standards are evaluated. To date this has been unsuccessful. In the absence of such documentation it is extremely difficult to assess how ACM propose to achieve and maintain these standards and the lack of transparency regarding monitoring and evaluation is an issue of great concern.
Ø How are the health and medical needs of unaccompanied minors identified and who is responsible for this?
Ø Who is responsible for giving informed consent on behalf of unaccompanied minors in detention?
Ø How are the protection needs of unaccompanied minors met?
Ø If unaccompanied minors are placed in the care of other adult detainees, how is the appropriateness of this arrangement monitored?
Ø What mechanisms are in place to provide for the emotional and psychological care of unaccompanied minors?
Ø What arrangements are made for the care and supervision of unaccompanied minors who are released from detention?
Ø Are there family-tracing and reunification programs in place for unaccompanied minors, particularly those issued with Temporary Protection Visas?
Section 11: Trauma, Torture and Child Welfare Issues
Children currently in immigration detention centres are likely to have experienced a variety of different traumatic experiences. These experiences could include, for example, exposure to the torture and murder of family members in their country of origin, trauma associated with the refugee experience in countries on the route to Australia, growing up with parents traumatised by imprisonment or torture and exposure to violence in immigration detention centres. There are innumerable reasons why these children are likely to have experienced trauma. These are merely the some of the most obvious. The welfare of children is put at serious risk when they are exposed to traumatic experiences. The developmental processes that a child is undergoing may be seriously disrupted as a result of the experience of trauma. As the effects of trauma have the most significant impact upon the emotional health of the child, this topic will be addressed more comprehensively in the section of the submission about the emotional health of the child. The main points only will be provided here with regards to trauma, torture and child welfare issues (i.e. child maltreatment issues) because these issues are extremely important to the health and wellbeing of children in Australian immigration detention centres.
The term ‘trauma’ refers to a wound either of a physical or psychological nature. Children in detention are likely to have experienced psychological trauma, that is, the reaction a person has when exposed to an experience that is out of the individuals control and for which previous coping mechanisms are insufficient [121].It should be noted at this point that child maltreatment in all its forms, including exposure to torture., is extremely likely to result in trauma. Trauma may be the result of one specific event or the combination of many events or living conditions, such as the experience of living in a refugee camp [122]. There is a growing body of research that demonstrates an increasing number of Post Traumatic Stress Disorder (PTSD) diagnoses in child, and more specifically, adolescent refugees from around the world [123].
A comprehensive explanation of the process of trauma is beyond the scope of this section of the submission, thus a summary of the most important points only will be provided here. The process of development is disturbed when children experience traumatic events [124]. Problems that arise as a result of trauma in childhood may manifest in a variety of different ways including: learning difficulties, abnormal socialisation, altered levels of moral functioning, somatic complaints and poor physical well being [125]. Research supports the theory that loss of or separation from family members inflicts the highest degree of trauma on children [126].
Many of the children in immigration detention centres will have been effected by torture. They may have experienced it directly, witnessed the torture of family and friends or may be effected by torture as a result of the emotional problems of care givers that have been tortured. The emotional effects of exposure to torture are often severe and long lasting [127]. Identification of survivors of torture is crucial so that treatment can be provided to these individuals to promote their full recovery from the trauma they have experienced. There have been reports that personnel performing these assessments are not trained to do so.
Child maltreatment in all its forms, including torture and the exposure to war and political and ethnic violence, may result in the development of trauma responses as discussed above. Trauma responses may reasonably be considered as abnormalities of child development in that they are an indication that usual coping mechanisms have been overwhelmed [128]. Trauma responses should therefore be treated appropriately just as other special developmental needs should be attended to. Assessment of all children and their families with regards to the effect of the many traumatic experiences that they are likely to have experienced is essential if children’s needs are to be met. It is again essential that adequately trained personnel perform the initial and ongoing assessment. The way that these special developmental needs are addressed should be determined by the age and developmental capabilities of each child. The treatment of these children and their families must also be culturally appropriate.
For younger children opportunities to work through their experiences using free play is essential. The role of therapeutic play opportunities should not be underestimated in the process of recovery. For older children and adolescents the opportunity to access appropriate counseling and other therapeutic services is important as they provide a forum for the process of understanding and coming to terms with adverse life experiences and enhances opportunities to enjoy healthier psychological well-being, thereby improving quality of life overall
‘Child welfare’ is the term used to refer to issues pertaining to child maltreatment in all its forms. All children need protection from all forms of child maltreatment: physical abuse including sexual abuse, emotional abuse and neglect. Children in immigration detention centres are already vulnerable to emotional problems and therefore their protection from maltreatment is essential.
Child protection laws in Australia differ from state to state. Detention centres in each state are bound by the child protection laws of the state in which they are located. So concerned are child welfare authorities in South Australia that they are assessing the situation with regards to child welfare in Woomera.
The 1989 United Nations Convention on the Rights of the Child state that:
“States Parties undertake to ensure the child such protection and care as is necessary for his or her well-being”.(Article 3)
Article 34 states that,
“States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse”.
And,
Article 37 states that,
“States Parties shall ensure that: No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment”.
(b) No child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time.”
Article 39 states that.
“States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self-respect and dignity of the child”.
Ø How thoroughly and transparently are allegations of child sexual abuse in Australian immigration detention centres investigated?
Ø Are the results of these investigations made available to members of the public?
Ø What accountability mechanisms are in place regarding situations of child sexual or physical abuse?
Ø What mental health counseling facilities are available for children who have suffered or witnessed torture and trauma?
Ø How are issues of Mandatory Reporting of child sexual or physical abuse dealt with in Australian immigration detention facilities?
In Western countries most childhood disabilities are caused by damage to the nervous system and are called developmental disabilities. The majority are caused by factors occurring before birth (prenatal) with about 15% caused during the time around birth (perinatal) and about 10% during infancy or childhood (postnatal).
Developmental disabilities include intellectual impairment, autism spectrum disorders, cerebral palsy, visual and hearing impairments and language disorders. These disabilities can affect other aspects of the development of the child and are usually (except for mild intellectual disability) detected in the first two years of a child’s life.
Milder but lifelong intellectual disability may not be recognized until the preschool years.
Severe emotional difficulties for the infant and young child if not recognized, can also cause profound effects on a child’s development resulting in long-term developmental disabilities in the areas of learning, and language.
Early intervention programs reduce the impact of the disability on the child’s development. The key components of early intervention programs that have been found to be important are:
· early identification
· communication with parents about the child’s development
· parent support groups
· preschool services including home-based services
· development of individual programs for the child and
· family support services, including short-term care and day care.
Refugee children are at increased risk of disability, including developmental disabilities as a result of
· maternal malnutrition
· inadequate antenatal and obstetric care
· malnutrition
· vitamin deficiencies, especially vitamin A and D
· lack of immunizations, eg. polio
· burns and other accidents
· injuries related to armed conflict, torture and other severe trauma
· complications from pneumonia and gastroenteritis
· severe ear and eye infections.
· lack of infant screening for congenital defects
· reduced surveillance of development especially vision and hearing
In addition to the above, the rate of congenital malformations in Iraq has risen dramatically over the last decade.
According to our research, staff recruited to work in detention centres are not required to have cross-cultural training. Cross-cultural competency would include skills to work with disabled children from different settings.
One of the major reasons why children with disabilities are discriminated against is because of other people’s attitudes towards or about them. In detention centres there are different cultural groups with different attitudes. Staff need special skills to be able to address negative attitudes towards disability and to ensure that all children, including those with disabilities, have access to services to meet their basic needs and that they are able to exercise their rights. A social approach to disability is needed that highlights the interaction between persons with disabilities and the environment. It also needs to ensure the effective protection, development and inclusion of children with disabilities.
The International Covenant on Economic Social and Cultural Rights (1966) Article 12 recognizes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. It also states that the steps to be taken to realize this right include those necessary for the provision for the healthy development of the child [129].
The General Comment No 14 (2000) discusses this right to health in more detail referring also to this right in Article 24 of the Convention on the Rights of the Child of 1989 [130] [131]. The entitlements to health include accessibility for all without discrimination, including physical accessibility, affordability based on equity and information accessibility. Paragraph 17 emphasises the availability of medical services and medical attention to all people when needed. This includes rehabilitative health services and appropriate treatment of disabilities. Paragraph 18 refers to articles 2(2) and 3 of the Covenant, which proscribes any discrimination to access to health care on the grounds of disability. This paragraph also draws attention to the General Comment 3, which states that in times of severe resource limitations the vulnerable or marginalised members of society must be protected by the adoption of relatively low-cost targeted programs. Paragraph 26 refers specifically to the need to ensure that not only the public health sector but also those private providers of health services and facilities comply with the principle of non-discrimination in relation to persons with disability [132].
The Convention on the Rights of the Child (1989) applies to all children including those with disability. Article 6, paragraph 2 recognizes the importance of the State to ensure the development of the child. Article 23 is specifically about children with disability.
“ State Parties recognize that a mentally or physically disabled child should enjoy a full and decent life, in conditions that ensure dignity, promote self reliance and facilitate the child’s active participation in the community,” [133]
It also recognizes the right of the disabled child to special care and effective access to education, training, health care services, rehabilitation services, preparation for employment and recreation opportunities so the child achieve her fullest possible social integration and individual development [134].
In 1993 the General Assembly adopted the Standard Rules on the Equalization of Opportunities for Persons with Disabilities. Although the Rules are not compulsory they are an instrument for policy making and action and provide a basis for technical and economic cooperation among States, the United Nations and other international organizations.
In Australia there are neonatal screening programs for conditions causing disability; clinical examination by a doctor after birth and blood tests for rare metabolic disorders and hypothyroidism. There is also a comprehensive program by maternal and child health nurses to screen for congenital anomalies during infancy, and detection of hearing and visual problems, and developmental delay which may indicate a developmental disability, during the first years of life. Hearing and vision are also screened for during the early school years.
State legislation in Victoria ensures the rights of children with developmental delay to early intervention services.
The rights of the child with disability has long been recognised by law in the United States of America (PL 94-142) (1975) amended in 1997 as the Individuals with Disabilities Education Act. It is known that the education, function and development of many children with a disability can be improved through planning and timely therapy assessment and intervention.
In the United Kingdom it is recommended that refugee children be examined by a doctor with appropriate referrals if there is any suspicion of conditions that can cause disability or if there is any delay in development.
Our research from a nurse who worked at the Woomera Immigration Reception and Processing Centre stated:
· the initial medical assessment did not include an examination by a child specialist and there was no assessment of child development. · education was not compulsory, and that there was no curriculum or support material |
Our research from a former detainee at the Woomera centre revealed that:
· during her time there were two deliveries at the detention center, whereas most deliveries occur at the nearby hospital · a baby was born at the Center after a prolonged labour, and in spite of the mother asking for a doctor to check the child because of concerns about a swelling in the neck and no medical checks were done. · it took 6 months for a boy who was fainting daily to be diagnosed with heart disease that required an operation · there was no access to health care after hours or on weekends. |
Dr Shant Raman, a paediatrican who had visited Villawood unofficially, has reported that there were many young babies and toddlers who had developmental delay.
DIMIA reported that as of February 1, 2002, there were a total of 16 of 378 children at Port Hedland and Woomera who had disabilities. The disabilities included cerebral palsy, vision and hearing impairments, dwarfism, trauma, Perthes disease, cardiac, asthmatic and genetic disabilities.
Ø Are infants and children routinely screened on arrival for congenital defects, developmental delay, and hearing and visual problems, by someone with training in child health on arrival?
Ø Do young children have blood tests to screen for hypothyroidism, galactosemia and phenylketonuria?
Ø Do young children have regular developmental, including vision and hearing, screening?
Ø Are children with developmental delay referred for multi-disciplinary assessment and medical assessment?
Ø Do children with developmental delay and/or disability have access to early intervention? This includes a comprehensive understanding by the family of the nature of the disability with strategies to assist both the child and the family.
Ø What access do children with physical disability have to mobility aides?
Ø Do children have a medical examination to exclude disease and disability associated with vitamin deficiencies?
Ø Do staff in the detention centers have access to training in disability as outlined in the UNHCR publication,Action for the Rights of Children (ARC), Critical Issues, Disability, 2001?
Ø Do children with disabilities have access to education?
The release of refugee children and their families into the community following successful outcomes of their claims to asylum is clearly an extremely positive step in terms of starting the process of rehabilitation and the rebuilding of fractured lives. For large numbers of people however, this process of rehabilitation is severely hampered by a number of factors, and many suggest that rehabilitation is a goal that, for some, will never be realised. Both the lasting impacts of detention, and the constraints placed on individuals by Temporary Protection Visas have significant implications for the capacity of individuals to achieve positive life outcomes. These issues become even more salient when discussing the situation for unaccompanied minors living in the community following release from detention.
13.2 Impacts of Detention
The lasting impacts of detention on the physical and emotional health of children may not be visible at the time of release from detention, but soon become apparent as children and their families attempt to function within a new community and in a new environment. The length of time spent in detention will be a factor affecting the ability of children to cope, as will the issue of family unity. If the family unit has not been fractured during flight, then coping mechanisms of the family as a whole may be more effective than if some family members are missing. From anecdotal evidence and personal accounts there is very little to suggest that activities inside the detention centres in any way prepare individuals for release into the community. While there are a number of organisations that assist people upon release from detention many people, especially children, live each day with fear and anxiety and are concerned about the uncertainty of their future.
A family detained for a period of over 12 months and who were later released from immigration detention has reported that their young children are continuing to experience frequent nightmares, have regressed developmentally and behaviourally (e.g. bed-wetting), display frequent outbursts of anger and have experienced difficulty in settling into schooling and establishing social relationships. The trauma and upheaval associated with the refugee experience and prolonged detention upon arrival in Australia leaves many children with emotional and psychological scars, the extent of which may not be realised for some time to come.
13.3 Temporary Protection Visas
In 1999, Temporary Protection Visas (TPVs) were introduced for on-shore arrivals in Australia, these are valid for three years after which time the applicant must again apply for refugee status. The majority of immigration detainees who are successful in the claims will be issued with a TPV and released into the community subsequent to character and security checks. TPVs restrict the ability of the individual to access a range of settlement and language services that are available to those who have permanent refugee status. Perhaps the most debilitating aspect of this temporary status is the inability of people to be reunited with family members (spouse or children) and the uncertainty and insecurity about the future. TPV holders have the right to work, although because of restrictions on language and education services, many people are unable to find adequate or long-term employment.
Perhaps the most pressing issue for children released into the community on Temporary Protection Visas is the issue of family reunification. While this has obvious implications for unaccompanied minors (this issue is discussed in more detail in Section 10) this also has a significant impact on children of families where one parent has been separated from the family group. It is most often the case that the father has been separated from the family either before or during flight, or may actually still be in detention. A female-headed household in this situation experiences a range of difficulties including the inability to work because of parenting responsibilities and a lack of English language skills to issues of parental psychological health – all of which has a significant impact on the health and wellbeing of the child.
While Temporary Protection Visa holders have access to Medicare benefits (provided they have lodged an application for permanent residency) this does not necessarily mean that individuals have access to appropriate and culturally sensitive health services. In addition to this, costs of basic pharmaceuticals, diagnostic procedures such as blood tests and x-rays and fees for specialist treatment are generally well beyond the means of families who are TPV holders. There are some benefits available through Centrelink, although this barely covers the most basic needs. As highlighted in Section 8, refugees released from detention are not provided with copies of their medical records, and these records are not made available to health care and medical professionals in the community. This is of particular importance with regard to childhood immunisation, and ongoing care of children with congenital diseases, disabilities and other health or medical problems. Without appropriate medical records and documentation relating to immunisation status, many children face restricted access to schooling and community-based programs.
Ø What is the nature of preparation for refugees upon their release into the community?
Ø What documentation is sent with refugees upon their release into the community?
Ø What services, medical and otherwise are refugee families directed to following release into the community?
Ø What mechanisms are in place for the release of unaccompanied or unattached minors into the community?
Ø How are local communities and community agencies prepared with regard to the release of refugees from detention into the community?
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[1] Australian Broadcasting Corporation, 2002; Lateline: “Australian doctors have expressed concern over the health of children in detention centres”, ABC TV http://www.abc.net.au/lateline/av/2002/03/20020319ll_children.ram
[2] Ibid.
[3] Ibid.
[4] Ibid.
[5]United Nations High Commission for Refugees, 1994, Refugee Children: Guidelines on Protection and Care, United Nations High Commission for Refugees, Geneva.
[6] United Nations, 1989, United Nations Convention on the Rights of the Child, Preamble, United Nations, Geneva.
[7] Ibid.
[8] Ibid.
[9] Ibid.
[10] Ibid.
[11] Ibid.
[12] Ibid.
[13] Ibid.
[14]United Nations High Commission for Refugees, 1999, UNHCR’s Guidelines on applicable Criteria and Standards relating to the Detention of Asylum Seekers, UNHCR, Geneva.
[15]United Nations High Commission for Refugees, 1994, Refugee Children: Guidelines on Protection and Care, United Nations High Commission for Refugees, Geneva, p. 8.
[16] Shonkoff JP, Phillips A., 2000; From Neurons to Neighborhoods, The Science of Early Childhood Development, National Academy Press, Washington.
[17] Montgomery E, Foldspang A., 2001; Traumatic experience and sleep disturbance in refugee children from the Middle East. Eur J Public Health. Mar;11(1):18-22.
[18]United Nations High Commission for Refugees, 1994, Refugee Children: Guidelines on Protection and Care, United Nations High Commission for Refugees, Geneva, p. 8.
[19] Ibid.
[20] Shore R. Rethinking the Brain. New Insights into Early Development. New York: Families and Work Institute, 1997.
[21] Shonkoff JP, Phillips A., 2000; From Neurons to Neighborhoods, The Science of Early Childhood Development, National Academy Press, Washington.
[22] Ibid.
[23] Ibid.
[24] Ibid.
[25] Coleman J.S., 1988; Social capital in the creation of human capital. American Journal of Sociology;94:95-120.
[26] Parcel TL. 1993; Family social capital and children's behaviour problems. Social Psychology Quarterly; 56:120-35.
[27] NICHD - Early Child Care Research Network.; 1998; Early child care and self-control, compliance, and problem behavior at twenty-four and thirty-six months. The NICHD Early Child Care Research Network. Child Development 69:1145-70.
[28] Moore KA and Halle TG.; 2001; Preventing Problems vs. Promoting the Positive: What Do We Want for Our Children. Suggested New Indicators. Communitarian Network.
[29] Cassidy J.; 1986; The ability to negotiate the environment. Child Development;57:103-6.
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[31] Matas L, Arend RA, Sroufe LA., 1978; Continuity of adaptation in the second year: The relationship between quality of attachment and later competence. Child Development; 49:547-56.
[32] Suess G, Grossman K, Sroufe LA., 1992; Effects of infant attachment to mother and father on quality of adaption in preschool. International Journal of Behavioural Management; 15:43-65
[33] Arend R, Gove FL, Sroufe LA., 1979, Continuity of individual adaptation from infancy to kindergarten: A predictive study of ego-resiliency and curiosity in preschoolers. Child Development; 50:950-9.
[34] Parke RD. 1996; Fatherhood. Cambridge Press : Harvard,.
[35] Tsoi MM, Yu GK, Lieh-Mak F. 1986; Vietnamese refugee children in camps in Hong Kong. Social Science and Medicine; 23(11): 1147-50.
[36] Berman H., 2001; Children and war: current understandings and future directions. Public Health Nurse, Vol.18 (4). July/Aug 2001. 243-252.
[37] Moore KA and Halle TG.; 2001; Preventing Problems vs. Promoting the Positive: What Do We Want for Our Children. Suggested New Indicators. Communitarian Network.
[38] Ibid.
[39] Ibid.
[40] United Nations, 1989, United Nations Convention on the Rights of the Child, United Nations, Geneva.
[41] Ibid.
[42] Ibid.
[43] Ibid.
[44] Ibid.
[45] Shonkoff JP, Phillips A., 2000; From Neurons to Neighborhoods, The Science of Early Childhood Development, National Academy Press, Washington.
[46] OECD/WHO-ECEH, 1997; Workshop on Environmental and Environmental Health Information to support National Environmental Action Programmes (NEAP) and National Environmental Health Action Plans (NEHAPS): using data and indicators. Budapest, 22 and 23 May. International Journal of Occupational Medicine & Environmental Health 1998;11:273-8.
[47]Blair, S., Kohl, H, Paffenbarger, R. Jr., Clark, D, Cooper, K, and Gibbons, L. Physical, 1989; Fitness and All-Cause Mortality. JAMA 1989;262(17):2395-401.
[48] Ibid.
[49]Malina, R. 1996; Tracking of Physical Activity and Physical Fitness Across the Lifespan. Physical Education, Recreation and Dance;67(3):S48-S57.
[50]Sallis J, Patterson, M., Buono, M., and Nader, P., 1988; Relation of Cardiovascular Fitness and Physical Activity to Cardiovascular Disease Risk Factors in Children and Adults. American Journal of Epidemiology;127:933-41.
[51]Kemper, H., Snel, J., Verschuur, R., and Storm-van Essen, L., 1990; Tracking of Health and Risk Indicators of Cardiovascular Dieaeses From Teenage to Adult: Amsterdam Growth and Health Study. Prevetive Medicine;19:642-55.
[52]Slattery, M., 1996; How Much Physical Activity Do We Need to Maintain Health and Prevent Disease? Different Diseases_Different Mechanisms. Research quarterly for exercise and sport; 67(2):209-12.
[53]Paffenbarger, R. Jr. and Lee, I., 1996; Physical Activity and Fitness for Health and Longevity. Research quarterly for exercise and sport; 67(3):11-28.
[54]DeLany J., 1998; Role of Energy Expenditure in the Development of Pediatric Obesity. American Journal of Clinical Nutrition;68 (supplement):950S-5S.
[55]Sallis, J, Prochaska, J, and Taylor, W., 2000; A Review of Correlates of Physical Activity of Children and Adolescents. Medicine and science in sports and exercise;32(5):963-75.
[56]Slemenda, C, Miller, J, Hui, S, Reister, T, and Johnston, C., 1991; Role of Physical Activity in the Development of Skeletal Mass in Children. Journal of Bone and Mineral Reseach; 6(11):1227-33.
[57]Welton, D, Kemper, H, Post, G, Van Mechelen, W, Twisk, J, Lips, P, and Teule, G. 1994; Weight-Bearing Activity During Youth Is a More Important Factor for Peak Bone Mass Than Calcium Intake. Journal of Bone and Mineral Research;9(7):1089-95.
[58]Blair, S., Kohl, H, Paffenbarger, R. Jr., Clark, D, Cooper, K, and Gibbons, L. Physical, 1989; Fitness and All-Cause Mortality. JAMA 1989;262(17):2395-401.
[59]Baranowski, T., Bouchard, C., Bar-Or, O., Bricker, T., Heath, G., Kimm, S., Strong, W., Truman, B., and Washington, R., 1992; Assessment, Prevalence, and Cardiovascular Benefits of Physical Activity and Fitness in Youth. Medicine and science in sports and exercise; 24(6):S237-S247.
[60]Paffenbarger, R. Jr., Wing, A., and Hyde, R., 1978; Physical Activity As an Index of Heart Attack Risk in College Alumni. American Journal of Epidemiology; 108:161-75.
[61]Anderssen, N. and Wold, B., 1992, Parental and Peer Influences on Leisure-Time Physical Activity in Young Adolescents. Research quarterly for exercise and sport; 63(4):341-8.
[62]Moore, L., Lombardi, D., White, M., Campbell, J., Oliveria, S., and Ellison, C. 1991, Influence of Parents’ Physical Activity Levels on Activity Levels of Young Children. Journal of Pediatrics;118:215-9.
[63] Sallis J, Conway T, Prochaska J, McKenzie T, Marshall S, and Brown M., 2001; The Association of School Environments With Youth Physical Activity. American Journal of Public Health; 91(4):618-20.
[64] United Nations, 1990, United Nations Rules for the Protection of Juveniles Deprived of their Liberty, United Nations, Geneva.
[65] United Nations, 1989, United Nations Convention on the Rights of the Child, United Nations, Geneva.
[66] United Nations, 1990, United Nations Rules for the Protection of Juveniles Deprived of their Liberty, United Nations, Geneva.
[67] Ibid.
[68]United Nations High Commission for Refugees, 1994, Refugee Children: Guidelines on Protection and Care, United Nations High Commission for Refugees, Geneva.
[69]Mares P. 2001. Borderline. University of New South Wales Press.
[70] United Nations, 1990, United Nations Rules for the Protection of Juveniles Deprived of their Liberty, United Nations, Geneva.
[71] Australian Injury Prevention Bulletin: Injury Mortality Australia, National Injury Surveillance Unit, 1992 & 1997.
[72] Rutter M, Quinton D., 1977; Psychiatric disorder: ecological factors and concepts of causation. Ecological Factors in Human Development, pp 173-87, North-Holland Publishing Co., Amsterdam.
[73] Pliskin KL. 1992. Dysphoria and somatization in Iranian culture. West J Med 1992 Sep;157(3):295-300
[74] Australian Broadcasting Corporation, 2002; Lateline: “Australian doctors have expressed concern over the health of children in detention centres”, ABC TV http://www.abc.net.au/lateline/av/2002/03/20020319ll_children.ram
[75] Shonkoff JP, Phillips A., 2000; From Neurons to Neighborhoods, The Science of Early Childhood Development, National Academy Press, Washington.
[76]Dawson, G., Ashman, SB., Hessl, D., Spieker, S., Frey, K., Panagiotides, H., Embry. L.; 2001; Autonomic and brain electrical activity in securely and insecurely attached infants of depressed mothers. Infant behaviour and Development,
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[77] Shonkoff JP, Phillips A., 2000; From Neurons to Neighborhoods, The Science of Early Childhood Development, National Academy Press, Washington.
[78] United Nations, 1989, United Nations Convention on the Rights of the Child, United Nations, Geneva.
[79] Nutrition Australia website. 2001
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[80] Federal Interagency Forum on Child and Family Statistics, 2001; "America's Children" Key National Indicators of Wellbeing.. Washington, D.C., US Government Printing Office. Federal Interagency Forum on Child and Family Statistics.
[81] Ibid.
[82] International Conference on Nutrition, Rome, 1992,www.foa.org/waicent/foainfo/economic/esn/icn/icnconts.htm;
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[83] Ackerman L.K., 2000, Health Problems of Refugees. Journal of American Board of family Practice, 10(5) p337 cited in Burns C, Webster K, Crotty P, Balinger R, Vincenzo R, Rozman M. (2000) Easing the transition: food and nutrition issues of new arrivals. Health Promotion Journal of Australia, 10(3), p 230-231.
[84]National Public Health Partnership. Eat Well Australia. An Agenda for Action for Public Health Nutrition. 1-126. 2002. Canberra.
[85] Ibid.
[86] Ibid.
[87] Ibid.
[88] Ibid.
[89] Nutrition Australia website. 2001
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[90] Ibid.
[91] Ibid.
[92] Ibid.
[93] Ibid.
[94] Ibid.
[95] Ibid.
[96] Ibid.
[97] Ibid.
[98] Ibid.
[99] Ibid.
[100] Ibid.
[101] Ibid.
[102] United Nations, 1990, United Nations Rules for the Protection of Juveniles Deprived of their Liberty, United Nations, Geneva.
[103] United Nations, 1989, United Nations Convention on the Rights of the Child, United Nations, Geneva.
[104] Ibid.
[105] Pliskin KL. 1992. Dysphoria and somatization in Iranian culture. West J Med 1992 Sep;157(3):295-300
[106] Montgomery E, Foldspang A., 2001; Traumatic experience and sleep disturbance in refugee children from the Middle East. Eur J Public Health. Mar;11(1):18-22.
[107]Mares P. 2001. Borderline. University of New South Wales Press.
[108] United Nations, 1989, United Nations Convention on the Rights of the Child, United Nations, Geneva.
[109]United Nations High Commission for Refugees, 1994, Refugee Children: Guidelines on Protection and Care, United Nations High Commission for Refugees, Geneva.
[110] Steel Z, Silove DM., 2001; The mental health implications of detaining asylum seekers. Med J Aust. Dec 3-17; 175(11-12):596-9.
[111]Department of Immigration, Multicultural and Indigenous Affairs, 2001, Immigration Detention Standards, DIMIA websitehttp://www.immi.gov.au/illegals/det_standards3.htmAccessed 18/12/01
[112]United Nations High Commission for Refugees, 1994, Refugee Children: Guidelines on Protection and Care, United Nations High Commission for Refugees, Geneva.
[113]Mares P. 2001. Borderline. University of New South Wales Press.
[114]Department of Immigration, Multicultural and Indigenous Affairs, 2001, Immigration Detention Standards, DIMIA websitehttp://www.immi.gov.au/illegals/det_standards3.htmAccessed 18/12/01
[115] United Nations, 1990, United Nations Rules for the Protection of Juveniles Deprived of their Liberty, United Nations, Geneva.
[116] Ibid.
[117] Sourenda A., 1998; Behaviour Problems and Traumatic Events of Unaccompanied refugee Minors. Child Abuse and Neglect, 22(7):719-27
[118]Department of Immigration, Multicultural and Indigenous Affairs, 2001, Unauthorised Arrivals and Detention Information Paper, DIMIA website
http://www.immi.gov.au/illegals/det_standards3.htm
Accessed 18/12/01
[119]Refugee Council of Australia, 2001, Position on Family Unity and Family Reunification, Refugee Council of Australia.
[120]Department of Immigration, Multicultural and Indigenous Affairs, 2001, Immigration Detention Standards, DIMIA websitehttp://www.immi.gov.au/illegals/det_standards3.htmAccessed 18/12/01
[121] Herman JL, 1992; Trauma and Recovery, United States of America: Basic Books.
[122] Montgomery, E., 1998, 'Refugee Children from the Middle East'. Scandinavian Journal of Social Medicine. Supplement 54
[123] Berman H., 2001; Children and war: current understandings and future directions. Public Health Nurse, Vol.18 (4). July/Aug 2001. 243-252.
[124] Pynoos, RS, Steingerg, AM, Wraith, R., 1995; Developmental Model of Childhood Traumatic Stress. In:Cicchetti D, Cohen, DJ, eds. Developmental Psychopathology. New York: John Wiley & sons, Inc,:3-72.
[125] Ladd, G W.,1996; Children: ethnic and political violence. Cairns Child Development, 67,pp14-18
[126] Berman H., 2001; Children and war: current understandings and future directions. Public Health Nurse, Vol.18 (4). July/Aug 2001. 243-252.
[127] Montgomery, E., 1998, 'Refugee Children from the Middle East'. Scandinavian Journal of Social Medicine. Supplement 54
[128] Ibid.
[129]United Nations,1966, International Covenant on Economic, Social, and Cultural Rights. General Assembly of UN Resolution 2200 A (XX1), 16 December, Geneva.
[130] United Nations, 2000, General Comment No.14, Committee on Economic, Social and Cultural Rights of the United Nations, Geneva.
[131] United Nations, 1989, United Nations Convention on the Rights of the Child, United Nations, Geneva.
[132] United Nations, 2000, General Comment No.14, Committee on Economic, Social and Cultural Rights of the United Nations, Geneva.
[133] United Nations, 1989, United Nations Convention on the Rights of the Child, United Nations, Geneva.