Need for independent oversight of health services
The committee received evidence from a wide range of individuals and
organisations, including health professionals, human rights experts, advocates
for refugees and asylum seekers, and lawyers. All submissions and witnesses
emphasised the importance of the independent oversight of health services
provided to asylum seekers who are sent to regional processing countries.
In its submission, the Australian Human Rights Commission (AHRC) stated:
Given that Australia retains some responsibility for the
treatment of asylum seekers transferred to third countries, and given that it
is well documented that the prolonged detention of asylum seekers and refugees
in remote locations may have a detrimental impact on their physical and mental
health, the [AHRC] encourages the Australian Government to take necessary steps
to establish a mechanism to monitor the health and mental health of people transferred
to third countries for processing of their claims for protection.
Dr Gillian Singleton of The Royal Australian College of General
Practitioners argued that independent expert oversight for the provision of
health services in regional processing facilities would 'minimise the risk of
harm to clients, to staff and to the department in these challenging
An officer from the Department of Immigration and Citizenship
(Department or DIAC) told the committee that '[t]here is a range of scrutiny
bodies that will be looking at the healthcare provision to people in regional
processing centres', and referred specifically to the proposed Joint Advisory
Committees and the Immigration Health Advisory Group, which are to be
established by the government for this purpose.
Proposed Joint Advisory Committee
The Australian Government has signed Memorandums of Understanding (MOUs)
with Nauru and Papua New Guinea (PNG) relating to the transfer and assessment
of asylum seekers to those countries. Each MOU provides for a 'Joint Committee with
responsibility for the oversight of practical arrangements required to
implement this MOU including issues relating to the duration of stay of
At the public hearing, officers of the Department updated the committee
on the progress of these arrangements with Nauru and PNG:
The administrative arrangements with both Nauru and Papua New
Guinea are in the process of being finalised, but both of those documents
contemplate having a joint advisory or oversight committee to look at the
operations, the welfare of [asylum seekers], the management of the centres et cetera.
At the moment we are in the process of establishing an interim joint committee
to advise the minister. That will run for about six months and will be able to
advise the respective governments of what is happening on the ground in that
six months and also of permanent terms of reference for a permanent advisory
committee for each regional processing country.
Officers from the Department were unable to advise the committee on the
specific medical or health qualifications of the individuals appointed to the
interim Joint Advisory Committee.
Professor Louise Newman of The Royal Australian and New Zealand College of Psychiatrists
pointed out that none of the members of the interim Joint Advisory Committee
are representatives of professional health organisations, such as The Royal
Australian College of General Practitioners and The Royal Australasian
College of Physicians.
Proposed Immigration Health Advisory Group
The Immigration Health Advisory Group (IHAG) is an independent advisory
group to the Department, comprising nominated representatives of professional
IHAG will succeed the Detention Health Advisory Group (DeHAG), which was
established in 2006 to provide the Department with 'independent, expert advice
on health policy, standards for health care services, data and reporting, and
mental health training'.
At the public hearing, an officer of the Department explained to the
committee the reasons for the transition from DeHAG to IHAG:
IHAG has been established by the [Department's] secretary,
taking advantage of the lessons learned over the course of the last six years
of [DeHAG's] operation. The secretary wants that new group to take a broader,
more systemic look at health policy and service delivery across not only the
detention environment but also the whole of the immigration environment.
It is not clear what role IHAG may have in the oversight of health
services provided to asylum seekers in regional processing countries. At the
committee's supplementary estimates hearing in October 2012, the Secretary of
the Department advised that the transition from DeHAG to IHAG 'had been
envisaged before we got into regional processing'.
The Secretary noted that he did not see any reason why IHAG would not be
involved in oversight of the regional processing centres; however, that role
had not 'necessarily been included in the terms of reference at this stage'.
During the current inquiry, a departmental officer told the committee
that '[m]any drafts of the terms of reference [for IHAG] have been exchanged
with DeHAG members'.
Dr Singleton, who was a member of DeHAG, noted that 'it is not clear that
in the new IHAG terms of reference there will be any monitoring of offshore
At the public hearing, the departmental officer indicated that there is
an expectation, based on the precedent set by DeHAG visiting onshore detention
centres, that IHAG would seek to visit regional processing centres and such
requests would be facilitated by the Department.
A role for IHAG in monitoring health services provided offshore?
Although IHAG is still in the process of being established, and its
terms of reference are yet to be finalised, there was some debate during the
hearing as to whether IHAG – based on the experiences of DeHAG – could fulfil
the role of the expert Panel envisaged in the Bill. A number of witnesses, including
some former DeHAG members, commented on the differences between the role of
IHAG and the Panel as proposed by the Bill.
The Department's website notes that DeHAG was established 'in response
to the recommendations' in the 2005 report by Mr Mick Palmer AO APM on the
immigration detention of Cornelia Rau.
The Palmer Report recommended that the Minister for Immigration establish an
'Immigration Detention Health Review Commission' as an independent body under
the Commonwealth Ombudsman's legislation to 'carry out independent
external reviews of health and medical services provided to immigration
detainees and of their welfare'.
In an answer to a question on notice in the current inquiry, the Department
clarified the events surrounding the establishment of DeHAG:
The proposed Immigration Detention Health Review Commission [recommended
in the Palmer report] was not established following consultation with the
Commonwealth Ombudsman and Dr David Chaplow, Director of Mental Health in the
New Zealand Ministry of Health and consulting psychiatrist to the Palmer
Inquiry. They agreed that the Commission was not needed given the new
oversighting role of the Commonwealth Ombudsman for Immigration. In addition,
the Detention Health Advisory Group (DeHAG) was established (March 2006) to
ensure that the Department was appropriately advised on the development and
provision of health care services for people in immigration detention.
Dr Choong-Siew Yong of the Australian Medical Association (AMA) noted
that the AMA has previously proposed an expert health panel similar to that in
and sought to distinguish any such Panel from the Department's advisory health
[The] model that [the AMA] had in mind was one of an
inspectorate-type body which would be different from an advisory group within
the department which is advising on such things as operational aspects and
general issues. One of the things we are aware of is that there is currently
nobody that can independently look at the situation of immigration detainees
throughout the whole system, particularly now that there are offshore centres
outside of Australia, and report back to the parliament or to government about
the quality of the healthcare being provided, and the needs of the group. I
think that you can make a clear distinction between an internal body to the
department with health expertise—which is what they have had in the past—to
something that sits outside.
Dr Yong also referred to DeHAG as being 'reactive rather than proactive':
[O]n occasions the department and the detention provider have
come up with operational policies or plans that really would have benefited
from the input around the impact on the health of the detainees. Some of the
provisions that the detention provider had around managing behaviour were done
without reference to the health impact.
The Castan Centre for Human Rights Law noted the lack of public
information available about the work that has been carried out to date:
DeHAG seems to have published its last public report in March
2008. The 2008 report reveals that DeHAG made only two visits to detention
centres over the course of the preceding year...DeHAG contributed to a 2011
review of the Detention Health Framework, but there is otherwise little information
available publicly on DeHAG's activities over the four years since its last
Associate Professor Amanda Gordon of the Australian Psychological
Society indicated that it may be possible for IHAG to undertake the role of a
panel, provided the problems which faced DeHAG are addressed:
I believe, if the reporting mechanisms could be properly
established it could be one and the same, and then have working groups below
it...One of the issues with DeHAG...was that we did not always have access. For instance,
the only visits that were ever made to detention centres were made when they
were organised by the department. They were always prearranged, everything was
very sanitised in that there were limits to what we could see and we could not
see. I do not believe that if IHAG was a replica of that it would be an
appropriate expert advisory oversight panel...IHAG, if it became the expert
group, would have to have proper access at its own behest. It would have to
have access to records, and it would have to have proper ability to both see what
is going on, to advise the Secretary and then to be able to escalate if
necessary to the minister through parliament.
The submission by the independent group of health experts representing
key health and mental health professional organisations proposed a model where a
panel could work in tandem with IHAG:
We believe that this should include independent review and monitoring
processes of health services and the establishment of a separate, independent body
to the Departmental health advisory group (IHAG) which can provide the results
of its review and monitoring to the Secretary of the Department of Immigration
and Citizenship, the Chief Medical Officer of the Department and the IHAG on
health service provision and risk mitigation strategies.
We believe that this is the most robust structure to allow
for efficient and timely identification and resolution of issues, which may
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