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We provided healthcare for children in immigration detention. This is what we found

Introduction by Croakey: Hundreds of Australians have gathered today at Palm Sunday protest rallies in Sydney and Melbourne, urging permanent visas for many refugees.

The Refugee Action Coalition has welcomed the Federal Government’s recent announcement  to honour its promise to give permanent visas to 19,000 refugees on Temporary Protection Visas and Safe Haven Enterprise visas (SHEVs)

This means, it said in a statement, that after ten years in limbo, they will have the right to travel, family reunion and a secure future. But it warned there are thousands of other refugees with no promise of permanent visas, including:

  • 10,000 people rejected under the Coalition’s unfair fast track processing system, including many now threatened with deportation
  • 150 refugees still stranded on Nauru and in Papua New Guinea
  • 1,200 Medevac refugees and families from Nauru who are now in Australia but told they cannot stay in Australia. Many have already been here for five years or more and have partners, jobs and lives here.

The Refugee Action Coalition says Labor has also made no commitment to resettle any of the 14,000 refugees stuck in limbo in Indonesia. “It is continuing to turn back refugee boats and maintain offshore detention. We need to demand justice and permanent visas for all refugees,” it said.

See pictures and tweets from the rally at the bottom of this post.

Meanwhile the devastating and ongoing costs of detention for children have been documented in damning and painstaking research into the experiences of children who attended the Royal Children’s Hospital Immigrant Health Service in Melbourne between January 2012 and December 2021.

The research is outlined in the article below by Dr Shidan Tosif, Honorary Clinical Associate Professor at the University of Melbourne; Dr Georgia Paxton, Associate Professor of Paediatrics, Murdoch Children’s Research Institute; and Dr Hamish Graham, Associate Professor International Child Health and a paediatrician at the Murdoch Children’s Research Institute. It was originally published at The Conversation.

They write:

Our team has been seeing refugee children for more than 20 years. We have extensive experience in refugee health, forensic medicine and child development, but nothing prepared us for the complexity of looking after these children.”


Shidan Tosif, Georgia Paxton, Hamish Graham write:

Australia’s immigration policies allow for indefinite locked detention, including for children and families. Detention is mandatory for people arriving without a valid visa – all those who arrived by boat between 2009 and 2013 were held in Immigration Detention Centres in Australia, or in Australian-contracted detention in Nauru or Papua New Guinea (PNG).

Australian detention numbers peaked in mid-2013, with 2,000 children detained at this time. By mid-2014, the average duration of detention exceeded 400 days.

While the last children were released from locked detention at the end of 2018, Australian law and policy still mandate detention for children arriving without visas. While the government refers to “held” or “locked” “detention”, to be plain, these children were imprisoned for seeking asylum.

We have just published a study describing the health of asylum-seeker children who experienced detention attending our Refugee Health Clinic over the past ten years.

Our team has been seeing refugee children for more than 20 years. We have extensive experience in refugee health, forensic medicine and child development, but nothing prepared us for the complexity of looking after these children.

Trauma, mental illness, lack of protection

Our cohort of 277 patients comprised 239 children who had been detained, including 31 infants born in detention, and another 38 children born after release to families who experienced detention.

There were 79 children from families who had been detained on Nauru/PNG, 47 children had been detained offshore. Most children had spent time in at least three different Australian detention facilities.

The duration of locked detention ranged from a few months to more than five years. Children sent to Nauru/PNG were detained for longer (typically three to five years) than those held in Australia (typically around one year), and many of this group remain in community detention.

The experience of these children was traumatic. They arrived with trauma – 62% had experienced major trauma before or during their journey to Australia, 8% had experienced the death of an immediate family member. They then experienced trauma in detention. They were exposed to self-harm, suicide attempts and violence – in unrelated adults and within their own families.

One in five children were separated from a parent in detention, often for weeks or months, and young children were left alone in detention while their parents were hospitalised. More than half the cohort had parents with mental illness, this reached 86% in the Nauru/PNG cohort, and 21% of these children had parents requiring psychiatric admission.

The trauma and deprivation of immigration detention had profound impact on children’s health. Two-thirds had a mental health problem (most commonly anxiety, depression and/or post-traumatic stress disorder) and 75% presented with developmental concerns. Child protection issues were common – 19% required child protection notification and 8% were referred for sexual assault concerns in detention.

Protective systems were limited or absent. Almost half the children had interrupted education in detention. Schooling was unavailable or extremely limited for most children on Christmas Island for long periods. In Melbourne, within 20km of our hospital, school-aged children were not enrolled in school, often for months.

No health screening or follow-ups

While basic medical services were provided in detention, health screening was effectively absent – both in detention, and in the community in Victoria.

Only 1% of children had a recommended health screen before being seen in our service and only 29% of children had received routine childhood immunisation. We saw children with severe mental health, developmental and medical diagnoses that had not been recognised in detention.

In the early stages, there were some children seen once, who were transferred to another detention centre before their review appointment and never seen again. Families attended clinic with multiple guards, and were often late, completely missing their appointment time, despite the detention centre being notified well in advance.

Parents were frequently incapacitated by their own mental illness. We saw parents with severe depression, catatonic and psychotic features, and witnessed profoundly disordered attachment. Often it was difficult for them to even tell us what had happened to them and their children and what symptoms they were experiencing. In some cases, we admitted children directly to hospital, for immediate safety or medical concerns.

Documentation was unavailable, and we spent hours chasing paperwork, painstakingly piecing together health records for families, and notifying the detention health providers and the Department of Home Affairs of the issues.

Precarious migration status is traumatising too

We had not anticipated detention could, or would, last for years, or that we would still be seeing these children in 2023.

After release from detention, most children experienced improvements in family function, wellbeing and mental health. However, short-term bridging visas precluded parents working for years, and in many families, financial stress has impacted housing and food security.

The impact of detention, years of precarious migration status and trauma is ongoing, and many individuals in families in the Nauru cohort remain extremely unwell. These children have now been here nearly ten years – meaning some have entered and almost completed schooling.

The transition to permanent residency will be life-changing for the families detained in Australia, but deeply distressing for those sent offshore, who do not have access to this pathway.

What has to happen

Our research provides clinical evidence for the harm to children from Australian immigration detention, migration law, and related policies.

Governments must avoid detaining children and families – in Australia, and in other countries. It is unsafe and harms children.

We urge a compassionate approach to resolving the immigration status of these children and families, including those sent offshore to Nauru or PNG, that also recognises the impact of time.

These children have grown up in Australia, their identity is now Australian, and we should support them as children and young people in Australia.


#Justice4Refugees Palm Sunday rally

#Justice4Refugees rally in Melbourne: Photo: Jane Salmon


See Croakey’s archive of stories on asylum seeker and refugee health

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