After almost a year of providing psychological and psychiatric services to refugees in Nauru, Médecins Sans Frontières has been forced to leave the island this month by Nauru’s government.
In November 2017, Médecins Sans Frontières (MSF), also known as Doctors Without Borders, started providing critically-needed mental health care to refugees – many of whom have attempted suicide – and the local Nauruan people. This was in keeping with 'one door for all' policy, which is evident in the memorandum of understanding between the Nauruan government and MSF:
“Beneficiaries of the project: People suffering from various mental health issues, from moderate to severe, members of the various communities living in the Republic of Nauru, including Nauruan residents, expatriates, asylum seekers and refugees with no discrimination.”
These services were put on hold on 5 October 2018 when the government of Nauru informed MSF that their services were “no longer required” and requested that MSF end activities within 24 hours.
“It is absolutely disgraceful to say that MSF’s mental health care is no longer required; the mental health situation of the refugees indefinitely held on Nauru is devastating”, said Dr Beth O’Connor, MSF psychiatrist. “Over the past 11 months on Nauru, I have seen an alarming number of suicide attempts and incidents of self-harm among the refugee and asylum-seeker men, women and children we treat.”
As corroborated by MSF medical analysis, refugee patients exist in a vicious cycle of deep despair with many having lost the will to live. Among them, at least 78 patients seen by MSF had suicidal ideations and/or engaged in self-harm or suicidal acts. Children as young as nine have told MSF staff that they would rather die than live in a state of hopelessness on Nauru. Among the most severely ill patients are those separated from their immediate family as a result of Australia’s immigration policy.
“We were particularly shocked by the many children suffering from traumatic withdrawal syndrome, where their status deteriorated to the extent they were unable to eat, drink, or even walk to the toilet”, Dr O’Connor said.
“Our patients often describe their situation as far worse than prison, because in prison you know when you can get out,” continues Dr O’Connor. “Whilst in my professional opinion there is no therapeutic solution for these patients as long as they are trapped on the island, I fear the withdrawal of MSF’s psychiatric and psychological health care from Nauru will claim lives.”
Although many of the refugees on Nauru have experienced trauma in their countries of origin or during their refugee journey, according to MSF, it is the Australian government’s policy of indefinite offshore detention that has destroyed their resilience and shattered all hope that they will one day lead safe, meaningful lives. During MSF’s time on Nauru, more than 70 people received negative responses from the US resettlement program, prompting an increase in mental health issues.
At a press conference on Thursday 11 October, MSF Australia’s director, Paul McPhun told reporters that their visas were cancelled on the way out “to make it clear there was no intention of inviting us back”. During the conference, it was also revealed that they were asked to leave because the government concurrently provided the same services – a claim the MSF staff have denied.
According to Dr Christine Rufener, "The Nauru hospital has no psychologists or therapist on staff. There is one mental health nurse who supports Nauruan patients only and who will continue to do her best. The hospital employs one full-time psychiatrist and that person does not even speak English. She has no translator to communicate with patients."
Médecins Sans Frontières is asking people to show their support by signing and sharing their petition.
MSF calls for the immediate evacuation of all asylum seekers and refugees from Nauru, Médecins Sans Frontières Australia, 11 October 2018.
Refugees' lives in danger with MSF forced to end mental healthcare activities, Médecins Sans Frontières International, 11 October 2018.
Médecins Sans Frontières calls for immediate evacuation of all refugees on Nauru, Helen Davidson, The Guardian, 11 October 2018.
MSF says Peter Dutton wrong to claim it wasn't contracted to treat Nauru refugees, Helen Davidson and Gareth Hutchens, The Guardian, 10 October 2018.
Images via Médecins Sans Frontières. Edits by Kendall Benton-Collins.