Child Trauma on Nauru – The Facts

The Australian Government is holding 102 children and their families on Nauru  under it’s offshore processing policy.

Nauru became the site of regional processing centres for Australian immigration in July 2013 under Labor Rudd government. People seeking asylum arriving by sea were taken to Nauru for processing under Australia’s mandatory offshore processing and detention policy.

Women, children and families are held on Nauru and single men are held on Manus Island. The population of refugees and people seeking asylum on Nauru comprises around 1100 people who have resided in the two regional processing centres (RPC2 and RPC3) and in various ‘settlement sites’ around the island over a period of years.

Most children have been determined to be refugees along with their families through a refugee status determination process under Nauruan law.

Children live with their families inside RPC3 and in ‘settlement sites’ in demountable-style accommodation, generally in groupings. There are a few separate houses where large families reside. Those who remain inside the RPC reside in marquee style tents and sleep on camping cots, where they have been for nearly 5 years.

Each marquee style tent is divided by tarpaulins, which create rooms in which families live. There are around 8 families per tent. Tents have mould health risks and are highly unsuitable as long term accommodation in humid weather and tropical rain conditions on Nauru.

Inside the tents can reach temperatures above 50 degrees celsius, and they are located on phosphate rock with limited shade and grassed areas around the camp.

Mental Health

Children living in offshore processing are indefinitely held with their parents in circumstances and an environment that cause high levels of chronic distress and severe mental health symptoms, and do not have access to adequate medical facilities or care providers to treat them.

Entire families struggle with severe mental health challenges caused by prolonged and uncertain detainment, compounded by untreated past trauma from being displaced peoples and exposure to abuse, violence and extreme adult distress.

Some of the children have experienced sexual abuse, while most have witnessed violence and/or self-harm in the regional processing centre. Symptoms and behaviours of children include:

• suicidal ideation; suicide attempts, in some cases multiple;
• hallucinations; social withdrawal;
• repeated expressions of hopelessness;
• persistent fear, including refusal to leave the home;
• panic attacks;
• flat affect and/or inability to speak;
• appearance of cognitive / developmental impairment.

Traumatic Withdrawal Syndrome (TWS)

Children on Nauru are displaying symptoms of Traumatic Withdrawal Syndrome with mental health conditions worsening due to prolonged illness and non-treatment.

Traumatic Withdrawal Syndrome is a rare condition and a syndrome of extreme severity that can be life-threatening.

It is most commonly seen in children and young adolescents, and has the clinical features dramatic social withdrawal, with severe reduction or inability to walk, talk, eat, and drink, self-care or socialise. It is most often seen in girls aged 7–15 years, but has been documented in males and in a patient as young as 4 years and through the adult age range.

A similar syndrome has been found in overwhelmingly traumatic environments such as people seeking asylum in Sweden, referred to as Resignation Syndrome.

Generally accepted criteria for diagnosis include:

1. Partial or complete withdrawal in three or more of the following domains: eating, mobilisation, speech, attention to personal care, including self-toileting
2. Active resistance or non-response to acts of care and encouragement
3. Social withdrawal

No organic condition accounts for the severity of the degree of symptoms. No other psychiatric disorder could better account for the symptoms.

The science suggests there is a trauma related neurobiological overdrive process resulting in sympathetic and parasympathetic nervous system hyperarousal. This leads to maximal internal physiological arousal and maximal behavioural withdrawal.

This isolate/withdrawal response to trauma is well known as a component in the Flight/Fight/Freeze triad of responses to very stressful situations. In this group of people the options for Flight are unavailable and the options to Fight have been suppressed and drained from the individuals and families.

The increasing prevalence of this Freeze-Isolate-Withdrawal response is predictable in circumstances of sustained detention and trauma which include the following factors:

• Pervasive uncertainty
• Lack of freedoms – strong external controls and little internal control or choice, which create feelings of extreme helplessness
• Ongoing re-traumatising experiences
• Little or no opportunity for positive emotions

These factors affect all family members and undermine the parent’s ability to buffer and support the child to cope with traumas.

The endangered state of the patient requires hospitalisation. Parents – who also suffer trauma related mental health challenges – are currently caring for children with TWS in home environment, struggling to get food and water into their bodies in states of withdrawal.

Traumatic Withdrawal Syndrome is life threatening for children on Nauru.

Number of children experiencing symptoms

We estimate there are at least 30 children on Nauru currently experiencing symptoms of Traumatic Withdrawal Syndrome, but some staff members and clients on Nauru are reporting significantly higher numbers.

Most children on Nauru have symptoms of mental health conditions, including suicidality that are at risk of escalating and compounding into symptoms of TWS.

The ASRC’s work with children and families on Nauru

The ASRC’s Detention Rights Advocacy Program is working with the parents of a number of children on Nauru, aged between 7 and 17 years, for whom are currently experiencing severe symptoms including increasing rates of repeated suicidal behaviour.

The ASRC team are inundated with referrals for families on Nauru with children, and work with legal partners including the National Justice Project (NJP) to ensure the children receive critical medical treatment required to save their lives.

However, both ASRC and our legal partners are now overwhelmed with the sheer volume of children on Nauru who are experiencing mental health crises. Currently there are 70 people on Nauru needing urgent attention and care on our waiting list alone.

Medical facilities on Nauru

Republic of Nauru Hospital (RONH)

The Republic of Nauru Hospital is responsible for the care of children who have refugee status. This includes children with refugee status who reside in RPC3 and at settlement sites. The RONH is very aged, and despite the Government of Australia alleging that they have invested money, there are limited developments visible.

The RONH does not have the facilities to provide inpatient mental health care for children, and children who self-harm or overdose are normally admitted for a short period, monitored briefly and then discharged.

The clinical standards at the RoNH are not reviewed or subject to outside independent scrutiny.

RONH does not have the capacity to manage the complex health needs of the refugee population, including Traumatic Withdrawal Syndrome and suicidality in children.

International Health and Medical Services (IHMS)

IHMS provides primary health care to the refugee population in a newer clinic adjacent to the RONH. This clinic refers to the RONH for more complex or acute health issues.

There is an IHMS RPC1 clinic located at RPC1. In some particular circumstances it appears that the refugee population is able to access this clinic; generally in acute emergency health care situations, for example acute cases of dengue fever.

Within RPCs there are accommodation areas to provide ‘respite’ for those with the most serious mental or physical health concerns. These accommodation areas consist of demountable buildings surrounded by high barbed wire fences and locked gates – they are managed by security officers, and IHMS staff visit regularly.

These accommodation areas are used to prevent extremely suicidal adults and children from harming themselves by allowing them to be monitored and physically restrained by security officers. The areas are extremely small and there is no common space. These areas are known to be extremely traumatic for those housed there, as there are regularly people screaming, self-harming and being restrained by security.

The most acute children, particularly those making repeated suicide attempts, are generally accommodated there as a means of managing their risk. These locations, however, do not amount to inpatient care, as IHMS is not contracted nor insured to provide inpatient care for children.

Overseas Medical Referral (OMR)

Where a person is clinically deemed to require treatment that is not available in the Republic of Nauru, a referral is made to the Government of Nauru’s OMR committee to determine whether the matter warrants transfer to an overseas location for treatment. Locations for overseas treatment currently available include Port Moresby, Papua New Guinea; Taiwan and Australia.

Where the OMR committee deems the transfer necessary, approval is sought from the Australian Border Force (ABF), who make a final determination regarding if and when the transfer occurs. These decisions are regularly made in a manner that privileges political imperatives over clinical recommendations.

On the basis of the medical evidence and regular contact with the families it is the view of the ASRC that children are being unnecessarily and irrevocably harmed, and that they are cannot be kept safe or recover from their mental health issues without adequate medical treatment and a safe environment.

The environment in which they currently reside is the primary factor impacting on both the deterioration of these children’s mental health and development, as well as their parents’ capacity to care for them.

Number of children brought to Australia via interlocutory injunction and other legal interventions

Lawyers in partnership with The ASRC have been legally intervening to force the Australian government to process doctor’s Overseas Medical Requests for individual children with severe and life threatening mental health symptoms to be brought to Australia to save their lives.

So far 27 OMRs over 8 months in total have been secured for transfer and hospitalisation of critically ill children in Australia, many of whom were suffering from symptoms of Traumatic Withdrawal Syndrome.

The Department of Home Affairs consistently argues against legal intervention and blocks OMRs, insisting symptoms of Traumatic Withdrawal Syndrome do not require specialist medical treatment and care.

These children cannot recover on Nauru because the Nauru is the cause of their trauma.

All children must be evacuated to Australia for urgent medical treatment. Sign the petition and make Canberra listen. And Email your MP.

Last edited: September 2018