Is it time for doctors to make a stand on detention?

The ‘detention industry’ – the private infrastructure that supports and implements the government’s policy of mandatory detention – is booming, and it’s time for all of us to start talking about how our actions, big and small, legitimise a system that we know causes serious harm to the health of so many. 

This is especially urgent given the chaos and harm to which asylum seekers in Australia’s care have been exposed on Manus Island this week.

The role of healthcare professionals in providing services that support the policy of mandatory detention is a central yet fraught one. Discussing its consequences involves two separate but related ethical issues, hinging on a wider understanding of moral choice.

The first concerns the ethics of providing services that support the system of mandatory detention, and its necessary mirror, the consequences of refusing to provide those services.

One might imagine that these choices were contemplated by the 15 doctors, employed by International Health and Medical Services (IHMS), who penned a letter late last year detailing serious lapses in standards of care provided to detainees on Christmas Island, eventually leaked to the Guardian

The dilemma faced by providers of essential healthcare services is difficult, and one worthy of serious contemplation.

The negative consequences of withdrawal of such services are easy to spot: would it constitute a further indignity, a further abandonment of people already at such dire risk? Would refusing to provide services result in more harm than providing them?

The last hypothetical is a vexed one, and pokes uncomfortably at non-maleficence. It is a weighing of harms in the context of an impossibility of doing none.

Do healthcare professionals, by the act of their participation in a system of inevitable damage to asylum seekers’ health and welfare, lend undue legitimacy to that system? Can the overlaying harm of legitimation be weighed against potential harms consequent upon a refusal to provide healthcare?

Now that the Independent Health Advisory Group has been disbanded over alleged “conflicts of interest,” will healthcare professionals speaking about the harms of mandatory detention be heard by government?

Professor Louise Newman, former member of the IAHG said in Australian Doctor last week, “[t]he advice now being offered to the government does not come with genuine independence … and it does not come from the areas of expertise the government needs.”

On the advisory role of Dr Paul Douglas, the Chief Medical Officer at the Department of Immigration and Border Protection, Professor Newman commented, “surely it is a conflict of interest for a doctor working in the immigration department to be giving advice on health issues when they also have professional duties to promulgate and implement government policy.”

If there were a withdrawal of healthcare labour from detention camps it would signify a refusal to participate in the harms of mandatory detention. More important than the symbolic point though is the material one: withdrawing a vital piece of mandatory detention’s infrastructure would put serious pressure on the detention network as a whole.

These issues can only be addressed from within the profession. In fairness, suggestions along these lines have been made for some time. And though a full withdrawal of services would seem from the outside unlikely, I am not privy to discussions happening right now within healthcare professions.

The second issue is however – because of its broad applicability – somewhat easier to address as an outsider: what are the ethics of making a profit off the back of mandatory detention?

IHMS, which provides all health services at Australia’s immigration (or, more accurately, internment) camps, is a for-profit entity. In the last few years it has held contracts worth close to a billion dollars with the Department of Immigration and Border Protection.

Profiteering off this system is legal but cannot withstand moral scrutiny. Such profits are derived from circumstances which involve massive, systematic human rights abuse; they have been described by various local and international bodies, such as the UNHCR and Amnesty International, as cruel, degrading, and inhumane.

There is no ethical ambiguity here: companies and individuals profiting from abusive systems are actively complicit in their harms. Such complicities are, rightly, especially acute for the healthcare professions, for obvious reasons.

One way for the professions to oppose mandatory detention would be to take a stand that for-profit healthcare professional labour should, must, be withdrawn.

However, the question of profit applies well beyond the medical profession to any other contractors involved in the system, and also to indirect value chain relationships.

For example, construction and infrastructure company Transfield Services has agreed to take on contracts for “garrison support services” and “welfare” on both Manus Island and in Nauru.

Transfield’s investors include a range of industry super funds – such as health and community services fund HESTA – implicating not only the funds but the account holders, who materially benefit from their funds’ investments, in the detention industry.

In response to pressure from union members after this link was made public, the NSW branch of the Australian Services Union announced support for a call to HESTA to divest from Transfield that has now gone to the national executive.


Transfield is also the founding sponsor of international arts festival the Sydney Biennale. That event is now facing a potential boycott by artists who do not want to benefit from the profits of human rights abuse, which is rapidly gaining traction.

By catching so many in the detention industry’s web, consecutive governments have made us all complicit in human rights abuse. Therein lies their central and insidious corruption. Near-universal complicity has – to an extent – both legitimised human rights abuse and immobilised us in responding to it. 

But the flipside of mass complicity of course, is that it also creates  opportunities for widespread, decentralised and accessible acts of non-compliance.

By applying scrutiny to profit generated through human rights abuse we can start a conversation about our many, varied complicities in it. It is only when we understand how we are all implicated that we can begin to undo the system of mandatory detention that – as medical professionals and those who have experienced it have repeatedly told us – produces and reproduces irreparable harm.

Ms O’Brien is a lawyer and researcher, and a PhD Candidate in the Faculty of Law at the University of Technology, Sydney. She researches the supply and investment chains of human rights abuse. These comments are given in her personal capacity.

[Republished from Australian Doctor21 February, 2014]

Is it time for doctors to make a stand on detention?


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