The evidence is clear: the medevac law saves lives. But even this isn’t enough to alleviate refugee suffering



Protesters holding a vigil last year for deceased asylum seeker Hamid Khazaei, who died in a Brisbane hospital due to an infection at the Manus Island detention centre in 2014.
Darren England/AAP

Sara Dehm, University of Technology Sydney

Tasmanian Senator Jacqui Lambie has some sobering reading to do over the coming weeks: an 88-page Senate report into the government-sponsored bill to repeal the medevac law that allow refugees and asylum seekers in Papua New Guinea and Nauru to seek medical care in Australia. The publication of the report last Friday paves the way for a Senate vote on the bill in mid-November.

As predicted, the Senate committee that issued the report split along party lines, with the Coalition majority calling for the medevac provisions to be repealed and the ALP, Greens and Centre Alliance senators releasing dissenting reports.




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What is less predictable is how the report will influence Lambie’s deciding vote. She has indicated she will approach the bill as a conscience vote, saying

Tasmanians don’t want deals done over humanity.

An overwhelming health crisis in offshore detention

The medevac law allows a person to be transferred to Australia for medical treatment or assessment if two Australian-registered doctors recommend such care is necessary and unavailable in PNG or Nauru. There are limited exceptions for the minister of home affairs to reject a transfer on security and character grounds.

Since the law came into effect in March, over 130 people have been transferred for care.

The Coalition government maintains the pre-medevac medical transfer policy for refugees was adequate. This allowed transfers only in life-threatening cases in which the required specialist medical care could not be provided on PNG, Nauru or a third country like Taiwan.

However, evidence given to the Senate committee showed a drastic drop in medical transfers to Australia from 2015 to mid-2018, despite clear medical need.

Statistics given to the committee by the National Justice Project, a not-for-profit legal service that acts on behalf of refugees, documented how some patients had to wait more than four years for medical transfers to Australia.

Tony Bartone, the Australian Medical Association president, described the government’s pre-Medevac process as “torturous” and involving “long periods of delay,” without any appropriate oversight.

Court injunctions and prospective litigation from mid-2018 onwards did compel the government to bring around 350 people to Australia for urgent medical treatment or as an accompanying family member. But such court interventions can be costly, slow and resource-intensive for those in need of immediate medical attention.




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And that need is still extremely high for those refugees remaining in offshore detention. An independent health assessment in June found a staggering 97% of those in detention and processing facilities have been diagnosed with physical health conditions. A further 91% were experiencing mental health problems, including severe depression and PTSD.

All but two of the 95 public submissions received by the committee were strongly in favour of retaining the medevac law.

Tellingly, those two submissions were from the Department of Home Affairs and the International Health and Medical Service, a government-contracted health provider on Nauru.

Overlooked refugee suffering in Australia

What is missing from the Senate report is any mention of the intolerable situation that refugees and asylum seekers face even after they have been transferred to Australia.

Although people can access critical medical treatment here, most remain in community detention, facing economic insecurity and legal uncertainty about their future. Research shows such legal limbo can lead to feelings of despair and dehumanisation.

The day before the report’s release, 32-year-old Afghan doctor Sayed Mirwais Rohani died in Brisbane, the victim of an apparent suicide. Rohani had come to Australia for medical treatment two years ago, after spending four years in immigration detention on Manus Island.

After his death, his former roommate posted on Facebook:

We shared same pain for long time, long enough to destroy someone’s life.

Rohani’s death was at least the 13th among refugees held in offshore detention on Manus or Nauru.

‘Trying to kill themselves because they’ve lost hope’

No doubt the government will use the Senate report to convince Lambie to support its bill when the vote happens next month.

So far, Lambie has remained relatively reticent, even if she did rebuff Dutton’s claim that the “vast majority of veterans” want her to vote to repeal medevac.




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Instead, Lambie indicated she would look to “national security” considerations in weighing up the report’s findings, including the dissenting reports. She has in the past called for children not to be in immigration detention and voted against the Coalition government’s bill to introduce temporary refugee visas in 2014.

Even if the medevac provisions stay in place, the status quo of Australia’s offshore detention regime remains unsustainable and inhumane.

As former MP Kerryn Phelps, a key architect of the medevac law during her brief time in parliament, stated in her evidence to the Senate committee, refugees and asylum seekers are

not trying to make a point; they’re trying to kill themselves because they’ve lost hope.The Conversation

Sara Dehm, Lecturer, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Peter Dutton is whipping up fear on the medevac law, but it defies logic and compassion



The medevac law was passed to streamline the process for emergency medical evacuation of refugees from Manus Island and Nauru. Thirty-one people have been transferred since its passage.
Refugee Action Coalition

Alex Reilly, University of Adelaide

With all the hyperbole about the medevac law, it is easy to lose sight of its purpose.

Refugees have been transferred off Nauru and Manus Island for emergency medical treatment since offshore detention restarted on these islands in 2013. The Department of Home Affairs reported to Senate estimates that 898 refugees and asylum seekers had been sent to Australia for medical treatment prior to the passage of the medevac law earlier this year. Of those, 282 were returned to Manus and Nauru after receiving treatment, and the rest remained in Australia in detention.

These transfers occurred in response to pleas from doctors and health professionals on an ad hoc basis. And it was up to the Home Affairs Department and Minister Peter Dutton whether to comply with such a request. Medical emergencies could include life-threatening brain or heart conditions, complex abortions, or emergency psychiatric care for children at risk for suicide – all of which are beyond the capacity of the health systems on Nauru and Manus to treat.

Although some refugees were granted emergency medical evacuation, many others were not. In response, legal cases were brought against the government for breaching its responsibility to care for the refugees.




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This required the federal court to convene at short notice to hear cases. It also required the expenditure of huge amounts of taxpayer money to call expert medical witnesses and file thousands of pages of supporting documentation.

Because of the delays in treatment, these legal battles were enormously risky for those in need of medical care.

Through these early cases, the court established that it was a breach of the government’s duty not to provide refugees with emergency medical treatment. And yet, the Home Affairs Department continued to fight applications for transfers for emergency medical treatment, only to be overturned by the courts, time and time again.

How the process works under the medevac law

The medevac law was passed due to concerns the department was rejecting transfer applications for political rather than medical reasons. The point was to provide an expedient, objective process to determine whether transfers were required.

And despite the Coalition government’s opposition to the bill, the process for determining which refugees are moved off Nauru and Manus for treatment remains highly deferential to the minister and Department of Home Affairs.




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There are two stages to this process.

First, two doctors must assess the person and make a recommendation for transfer. The federal court recently ruled it was possible to make this medical assessment based on documentation alone, as opposed to an in-person or teleconference assessment. This was a necessary adjustment to the law, given that the Nauru government has banned teleconferences for residents.

The minister is required to approve or refuse the recommendation for transfer within 72 hours. There are three grounds for refusal:

  1. the person is deemed a security risk
  2. the person has a “substantial criminal record” (which equates to having been convicted of an offence with a sentence of imprisonment for 12 months or more)
  3. the minister does not accept the transfer is necessary on medical grounds.

If the minister rejects the transfer on medical grounds, the second stage of the process kicks in, with an independent health advice panel (IHAP) assessing the doctors’ recommendation. It is important to note that this panel is comprised of government medical officers and other health professionals appointed by the minister.

To date, there have been 31 medical transfers under the law. In addition, nine recommendations were refused by the government. The panel of health experts upheld seven of the minister’s refusals, and overturned two.

Dutton’s claims don’t stand up under scrutiny

Dutton has made a number of claims about the impact of the medevac law that he argues justify its repeal. All defy reason and logic.

First, the minister has claimed “activist doctors” were using the law to bring people to Australia when they do not require emergency medical care.

This is frankly highly offensive to the medical profession in Australia, and contradicts the clear intention of the law to take politics out of transfer decisions. Even if doctors making the initial recommendation are too left-leaning for Dutton, the expert panel is stacked with medical practitioners of his choosing.




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Second, the minister has argued that the capacity to be transferred to Australia for emergency medical treatment will lead to a resumption of the people-smuggling trade.

This is patently absurd. It is true that people smugglers can make up all sorts of stories about Australia relaxing its policies and it being easier to get to Australia. But the facts are crystal clear: the Coalition government maintains a policy of boat turn-backs and indefinite offshore detention for anyone thinking of making the journey.

Medical transfers to Australia are for a temporary period. Once people have been treated, they are returned to detention on Nauru or Manus. It is true that many asylum seekers have remained in Australia for extended periods for ongoing treatment, but these refugees remain within the immigration detention system. They are escorted to medical appointments and remain under guard while receiving treatment. They are given no hope of putting down roots in Australia.

The deterrent to people smugglers remains overwhelming. And, unsurprisingly, we have not seen a restarting of boat arrivals following the passage of the medevac law. Dutton’s own department has signalled this is unlikely in a briefing:

[Potential illegal immigrants] will probably remain sceptical of smuggler marketing and await proof that such a pathway is viable, or that an actual change of policy has occurred, before committing to ventures.

The only possible messaging that people smugglers might use to persuade people to get on a boat is the Coalition government’s own dire warnings of reopening the floodgates and political stunts like the brief resurrection of the Christmas Island detention centre at the staggering cost to taxpayers of over A$180 million.

Dutton’s third claim is that some refugees are refusing resettlement offers in the US because of the medevac law.

Again, it defies logic for refugees to refuse the US option – it is the only hope of resettlement currently on offer. One wonders whether the minister is using this claim as a cover for the fact that transfers to the US have come to a grinding halt under President Donald Trump.

The medevac law and human compassion

For over six years, successive Australian governments have maintained an unwavering narrow focus on stopping refugee boats with no concern for the victims of this policy – the innocent people on Manus and Nauru.

These people are under Australia’s care. It is Australia that pays the governments of Nauru and PNG to house offshore detention centres to create the disincentive for others to travel by boat to Australia. It is Australia that pays the security companies to keep them detained. And so it is Australia that is responsible for the dramatic decline in their mental and physical health.

It is the narrowest of concessions to offer emergency medical treatment in Australia to people we have so mistreated.The Conversation

Alex Reilly, Director of the Public Law and Policy Research Unit, Adelaide Law School, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Lambie’s vote key if government wants to have medevac repealed


Michelle Grattan, University of Canberra

The government almost certainly would have to obtain the support of Tasmanian crossbench senator Jacqui Lambie to amend or repeal the medevac legislation.

Home Affairs minister Peter Dutton on Sunday claimed Labor was reconsidering its position on the legislation, but that was quickly dismissed by his opposite number Kristina Keneally.

The Coalition would need four of the six non-Green crossbench Senate votes, assuming the ALP and Greens opposed.

The government could rely on One Nation, which will have two senators, and Cory Bernardi from the Australian Conservatives.

But that would leave it one vote short. Stirling Griff, one of the two Centre Alliance senators, said Centre Alliance was “100% opposed” to repeal or amendment of the legislation. That position was “non-negotiable”, Griff said.

This would put Lambie, who is returning to the Senate after having to quit in the citizenship crisis, as the swing vote. Her spokeswoman said she was not giving answers on anything yet.




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The government said in the election campaign that it would repeal the legislation.

It claimed when the medevac bill was passed – against Coalition opposition during the period of minority government – that it would lead to a flood of transfers from Manus and Nauru, including of people accused of serious crimes. It reopened Christmas Island and said any transferees under the medevac legislation would be sent there.

Dutton said on Sunday just over 30 people had come under the new law, none of whom had been sent to Christmas Island. Asked on the ABC whether they included any criminals or people charged with offences Dutton said he didn’t know. When pressed he said, “we don’t bring anyone to our country where we can’t mitigate the risk”.

Dutton continued to insist the government could be compelled under the legislation to transfer criminals, although the medevac legislation gives the minister power to veto people on security grounds.

The minister claimed Labor was reconsidering its position “and that they would be open to suggestions about how that bill could be repealed or at the very least wound back”.

But Keneally said he had misrepresented Labor’s position; she stressed it supported the legislation.

It was “up to the government to explain if changes are necessary. I have no information that would suggest changes are necessary,” she said.

“If the government believes that the medevac legislation is no longer necessary to ensure that sick people can get the health care they need then the government needs to explain why to the parliament.

“And if the government wants to improve the medevac legislation to ensure that people can more readily get the health care that they need then the government needs to explain that to the parliament.

“The government has said nothing about either of those two aspects of the legislation”.




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Dutton said there were now just over 800 people remaining across Nauru and Manus.

He did not think the United States would take the maximum 1,250 people under the deal between Malcolm Turnbull and Barack Obama.

So far 531 had gone to the US and there were about 295 in the pipeline who had approvals but hadn’t gone yet. More than 300 had been rejected by the US.

He hoped all offered a place would take it up. About 95 had either withdrawn from consideration or rejected an offer. “If we can get those 95 across the line, we get closer to zero”.

In a controversial decision, Australia accepted under the US deal two Rwandan men accused of involvement in the murder of tourists on a gorilla-watching expedition in Uganda in 1999. The government says the men have been found by Australian security agencies not to pose a threat.

Pressed on whether these two were the only ones coming here to fulfil Australia’s side of the deal, Dutton said: “We don’t have plans to bring any others from America at this stage.”

Dutton, while saying it was a matter for the department, also indicated the security company Paladin was likely to have its contract for services on Manus rolled over, despite an ongoing investigation by the Australian National Audit Office into the Home Affairs department’s management of the procurement process for the earlier A$423 million contracts.

Keneally said the A$423 million contract had been “given out by the government in a closed process – a closed rushed process […] to an organisation that was registered in a beach shack on Kangaroo Island, that had one member barred from entering PNG, had another accused of fraud”.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.