Detained on nauru: A cross sectional examination of the health and wellbeing of children and young people after prolonged detention

Abstract

Background: Since 1992, Australia has been unique in mandating indefinite detention of people arriving “unauthorised” by boat, contravening multiple international conventions to which Australia is signatory. Families, including children and young people (CYP), seeking asylum were held in offshore detention on Nauru from 2013 to 2019. Most were subsequently transferred to Australia for medical care. Protracted detention of 4-5 years is unprecedented globally. An association between deteriorating health and length of stay in detention has been demonstrated, however the effects of such prolonged detention are unknown. Aim: This study aims to describe the health and wellbeing of children after prolonged detention on Nauru. Methods: This is a cross sectional analysis of a national longitudinal cohort of CYP (under 19 years of age), detained on Nauru between 2013 and 2019. Treating clinicians, from participating Australian sites, documented the cohort's socio-demographic factors and health and wellbeing outcomes immediately after release from detention. An online survey, completed by the clinicians, was used to collect study data. Survey questions were codeveloped with a refugee with lived experience and Australian clinicians experienced in care for refugee CYP. Protective and risk factor data, including exposure to abuse and witnessed trauma, was collected using the Adverse Childhood Experiences (ACE) and Refugee-specific ACE instruments (R-ACE). Key outcomes were categorised into physical illness, neurodevelopmental disorders and mental health conditions. Results: A total of 222 CYP were detained on Nauru, of which 100 were seen in Australian states serviced by participating health sites. We present preliminary analysis of the first 35 study participants (35% of the total eligible cohort). The mean age was 8.9 years (3.5 months -17 years); a slight majority (19, 54%) was male and most originated from the Eastern Mediterranean Region (21, 60%), particularly Iran (10, 28%) and Iraq (6, 17%). The majority (23, 66%) were subject to more than four years of detention. High rates of physical illness (34, 97%) and mental health concerns (26, 74%) was seen. Neurodevelopmental diagnoses were suspected in six children (17%) including Global Developmental Delay (2, 5%) and language delay (2, 5%). A significant proportion had four or more ACEs (27, 77%) or R-ACEs (34, 97%). Modifiable risk factors for adverse health outcomes included parent English language difficulties (26, 74%), parent mental illness (21, 60%) and family separation (4, 11%). These rates of morbidity are similar to or higher than findings from previous studies of shorter durations of immigration detention. Conclusions: Australia's immigration policy of mandatory indefinite detention is associated with detrimental health and wellbeing outcomes for CYP. Even after this unprecedented prolonged detention (4-5 years), there is the potential to intervene through reducing modifiable risk and enhancing protective factors. This could take the form of targeted interventions including sustained mental health support for children and parents, prevention of family separation and health and wellbeing reviews by appropriately trained practitioners. Ultimately, however, these findings, along with international evidence, support the call for the abolition of immigration detention and highlights the particularly damaging effects of prolonged detention.L6351316162021-06-02 <br />