Offshore detention: cross-sectional analysis of the health of children and young people seeking asylum in Australia

Abstract

ObjectiveTo describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia’s immigration policy of indefinite mandatory detention on Nauru.DesignCross-sectional analysis of a cohort of CYP seeking asylum.SettingAustralian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia.ParticipantsSixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years.Main measuresHealth outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools.ResultsOver half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01); originated from the Eastern Mediterranean region (p<0.05); witnessed trauma (p<0.05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p<0.05). Neurodevelopmental concerns were seen in eight children (13%).ConclusionsThis study highlights the almost universal physical and mental health difficulties in a sample of CYP who experienced forced migration and were subjected to Australia’s offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.

Health and health care in Australian immigration detention: a comparison between onshore and offshore data

“…In a study using data collected during the 2014 Australian Human Rights Commission Inquiry into Children in Immigration Detention, Mares (2016) found extremely high rates of mental disorder in both adults and children detained on Christmas Island, offering further evidence of the profound negative consequences of prolonged immigration detention for health. A recent cross-sectional analysis of a cohort of children and young people subjected to detention on Nauru ( n = 62) have also shown that the vast majority of the cohort had physical health (89%) and mental health (79%) concerns, including self-harm or suicidal ideation/attempt (45%); as per the study’s findings, mental health concerns were also more likely in children and young people who had been held in detention for a year or longer (Amarasena et al , 2023). Gleeson (2016) has also documented cases of self-harm and suicide attempts by offshore detainees, highlighting the psychological toll of prolonged detention and the harsh living conditions in RPCs on Manus and Nauru.…”

Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study

“…Separate studies are being conducted regarding the health of asylum seeking CYP residing in Australia. 59 The extended 11 year time period allows for analysis of the trends over time. Nonetheless, this study is not longitudinal in design which limits predictive analysis.…”