NAURU: New MSF report shows the disastrous mental health impact of Australia’s offshore processing policy

Médecins Sans Frontières/Doctors Without Borders (MSF) is today releasing the first independent medical data demonstrating the extreme mental health suffering on Nauru, due to the Australian policy of indefinite offshore processing. MSF strongly reiterates its urgent call for the Australian government to end this policy and immediately evacuate all refugees and asylum seekers – men, women and children from Nauru to avoid further deterioration of their health.
According to the medical report Indefinite Despair, the mental health suffering on Nauru is among the most severe MSF has ever seen around the world, including in projects providing care for victims of torture.
The severity of mental illness among MSF patients was rated using the Global Assessment of Functioning (GAF) scale, which measures the extent to which a patient’s symptoms affect his/her everyday life, ranging from 1 for lowest functioning to 100 for highest functioning. Scores above 70 are considered healthy.
MSF’s patients had very low scores, in both the Nauruan and the refugee and asylum seeker patient groups.
For the Nauruan patients, the median GAF score at initial assessment was 35, reflecting the high rates of untreated psychosis among this group. For the refugees and asylum seekers it was 40. Other MSF projects that treat severe mental health conditions report medians around 60.
The mental health GAF scores of MSF’s refugee and asylum seekers significantly declined in May and June 2018, coinciding with a surge of negative responses to the US resettlement deal, and demonstrating the strong impact of policy decisions on patients’ mental health. No such decrease was observed in Nauruan patients during the same time period.
 “The medical data we release today confirms the heart-breaking reality that I witnessed on Nauru,” says Dr Christine Rufener, clinical psychologist and MSF Mental Health Activities Manager. “Every day I worried which of my patients might attempt to take their own lives, because after five years of waiting people had lost all sense of hope.”
Kazem* is Iranian refugee who has been held on Nauru for five years and three months. “I left Iran because of my religion. I converted from Islam to Christianity, and in my country, if you do this, the first thing that happens is torture and prison. At the highest level, you are facing death.”
“I have tried to be strong and healthy to support my family, to support my wife, to support myself. But right now, I’m really, really tired. My life looks like a boat with a big hole in it, and I can see my life going down and sinking into the oceans.”
”Some people from the Australian government say ‘we’re going to evacuate all the kids before Christmas’. Then another one says, ‘no, we never said that’. There is no deadline, there is nothing, no rules – they are just playing.”
Among the 208 asylum seekers and refugees MSF treated on Nauru,
124 had suicidal thoughts and 63 had attempted suicide. Twelve adults and children who MSF treated were diagnosed with resignation syndrome, existing in a semi-comatose state and unable to eat or drink.
Although three-quarters of refugee and asylum seeker patients reported experiencing traumatic events before reaching Nauru, such as conflict situations or detention, MSF’s report shows that it was the situation on Nauru that was most damaging to their mental health. A total of 65% of asylum seekers and refugee patients felt they lacked control over their lives, and these patients were significantly more likely to be suicidal or diagnosed with major psychiatric conditions. 
“While many of our patients had experienced trauma, it was the Australian policy of indefinite processing that destroyed all their hope for the future and devastated their mental health,” says Dr Rufener.
More than one-third of asylum seeker and refugee patients were separated from close family members. People who were split from their families because some members had been medically evacuated from the island – a tactic used by the Australian government to coerce medically evacuated refugees to return to Nauru - were 40% more likely to be suicidal. 
In 11 months on Nauru, MSF provided mental healthcare to 285 patients, including Nauruans, refugees and asylum seekers. A total of 1,526 consultations were provided for refugees and asylum seekers, and 591 for Nauruans.
The Nauruan Government forced MSF to leave the island in early October, when more than 200 patients were still under our care. MSF remains deeply concerned for the ongoing care of the patients we left behind, Nauruan nationals, asylum seekers and refugees. 
The mental health situation of Nauruans was also severe; almost half MSF’s Nauruan patients had psychosis, with many requiring psychiatric hospitalisation that was not available.
Strikingly, more than half of MSF’s Nauruan patients showed improvements in their mental health functioning under MSF’s care, while only 11% of asylum seeker and refugee patients improved. 
 “Our Nauruan patients’ mental health improved in a way that was not mirrored in our asylum seeker and refugee patients, despite receiving the same quality of care. This illustrates that living under a policy of indefinite processing creates a perpetual state of despair, making it impossible for asylum seekers and refugees to recover,” says Dr Stewart Condon, MSF Australia President. “The current mental health crisis on Nauru is tragically predictable. After five years of arbitrary deprivation of liberty, the situation is desperate. The Australian government must stop this brutal policy and immediately evacuate all refugees and asylum seekers from Nauru, as well as Manus island. There is no time to waste.”
MSF calls on Australia to immediately end the containment of asylum seekers and refugees offshore. MSF welcomes any resettlement options, including New Zealand’s, as long as they are fast, voluntary, respect family unity and allow for people to rebuild their lives and mental health. 
MSF began providing psychological and psychiatric healthcare on Nauru in November 2017, under a Memorandum of Understanding with the Nauruan Ministry of Health. Mental health support was available to everyone living on Nauru under a “one-door-for-all” strategy. A total of 73% of our patients were refugees or asylum seekers, while 22% were Nauruan nationals. On 5 October 2018, the Nauruan government told MSF that our services were “no longer required” and that we must cease activities within 24 hours. 
* Name has been changed to protect the patient