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    “Prudent That Close Scrutiny Be Avoided”: Inside The Meetings That Decide Sick Refugees’ Fates

    “Members discussed the level of compassion to be shown…” Redacted minutes from a powerful committee show how decisions are made on the fate of sick refugees and asylum-seekers detained offshore.

    A powerful task force that decides whether ill refugees and asylum-seekers detained on Nauru and Manus Island can be transferred to Australia for medical treatment discussed avoiding “close scrutiny” of a high-profile case.

    The task force also discussed whether there was “any compassion” in the policy of avoiding medical transfers to Australia and noted the case could be a “reputational risk” to the Department of Home Affairs.

    Minutes from more than a year of meetings of the department’s Transitory Persons Committee, obtained by BuzzFeed News via a Freedom of Information request, provide rare insight into the decision-making process behind medical evacuations from Nauru and Manus Island.

    The heavily redacted documents include minutes from meetings dating from May 16, 2017, to Aug. 8, 2018.

    The Australian government body considers transfer requests from Nauru and Manus Island. It is made up of senior members of the Department of Home Affairs, including the Australian Border Force, and is chaired by Elizabeth Hampton, who is the first assistant secretary of the Health Services Policy & Child Wellbeing Division.

    Between November 2017 and July 2018, when the position of chief medical officer was vacant, there was apparently no member with a medical background, although the minutes indicate medical officers were present as advisers.

    In a meeting on June 20 this year, the committee discussed a case in which a sick detainee on Nauru had refused a transfer to Taiwan.

    According to the minutes, the committee heard it was preferable to avoid “close scrutiny” of the case due to there being two weeks in which it was unclear how the case was managed.

    It was essential to make sure the time frame was correct because “if this matter goes to court the dates and actions will all be examined”, the minutes said.

    “Specifically, [REDACTED] may have presented with symptoms well before the department was first notified; once notified there appears to be a two week period where it is unclear how his case was managed; and then the tempo of subsequent actions. For these reasons it was noted that it would be prudent that close scrutiny be avoided.”

    The minutes reveal there was a significant amount of media interest in the case and noted that the committee was there to discuss “the medical issues”. Despite this, discussions took place on the reputation of the department and whether compassion should play a role in the decision.

    “The reputational risk to the department needs to be considered as well as the precedents this case will set,” the minutes read.

    “[First Assistant Secretary for Property and Major Contracts David] Nockels noted that if we do allow [REDACTED] to transfer to Australia it will null and void Taiwan and any other third country option and undermine the policy … Members discussed the level of compassion to be shown and if there is any compassion in the policy.”

    At the time the meeting took place, there was significant media attention on the case of a 63-year-old Hazara refugee dying from lung cancer who refused to be flown to Taiwan for palliative care. The refugee was transferred to Australia on June 23, according to media reports, following a large campaign backed by the Australian Medical Association.

    The documents also reveal that the company contracted by the Australian government to provide medical services on Nauru had started regularly reporting by mid-2018 that the environment of the Pacific island was a factor causing ill health among refugees and asylum-seekers.

    “IHMS [International Health and Medical Services] also noted that the ‘environment’ is a causal factor in this case, and many others in Nauru. Advice more broadly from IHMS is starting to focus on this point specifically,” the minutes read from a meeting on July 6.

    The clinical advisory team, part of the department's Health Services and Policy Division, told the committee: “In the short term this acute deterioration may settle down and [REDACTED] might be able to continue to be managed on Nauru. But in the longer term, resolution seems unlikely in the current situation.”

    At the time this discussion was taking place, the mental health of people detained on Nauru was in a sharp downturn, partly prompted by several refugees, primarily Iranians, being knocked back from the settlement deal with the United States. A well-known and respected young asylum-seeker killed himself in June. Later in July, the fifth anniversary of the policy dictating asylum-seekers who arrived by boat would never settle in Australia contributed to the anguish, advocates say.

    The notion that the environment of Nauru is in itself highly detrimental to the health of refugees and asylum-seekers has been publicly stressed by international medical charity Médecins Sans Frontières, which spent 11 months providing mental health services on the island before it was ejected by the Nauruan government in October.

    The documents broadly lend insight into how the committee implemented the policy of avoiding transfers to Australia unless the situation was life-threatening and a third country was not available.

    In a meeting on July 20, 2017, committee chair Hampton, who later acted as the chief medical officer despite not being a doctor, suggested providing treatment for “complex cases” in the Regional Processing Centre on an Australian Royal Navy ship. Chief medical officer John Brayley said this was not appropriate.

    In a meeting on Oct. 6, 2017, Hampton told the committee that they were working to “ensure the new IHMS contract does not mention ‘Australian Standard’”. BuzzFeed News understands the “Australian standard” referred to timelines under which people needed to be evacuated for treatment.

    The documents also shed light on the delicate international relations that undergird the Pacific Solution and the government’s policy of avoiding providing medical care in Australia in all but the most extreme cases. They reveal that Papua New Guinea temporarily stopped issuing visas to people Australia wished to transfer there from Nauru in order to receive medical treatment.

    In a meeting of the committee on May 5, 2017, a discussion point was the PNG Immigration & Citizenship Service Authority’s “suspension of PNG visa grants to transferees on Nauru”. The minutes note that the department's Offshore Health Operations Section, part of the Detention Services Division, had made inquiries with the department’s International Division and the policy adviser at Australia’s High Commission in PNG about the suspension. The issue appears to have been resolved by mid-August, when the committee met again.

    They also show that Australia’s memorandum of understanding with Taiwan, under which Taiwan provides healthcare to people from Nauru and Manus, was executed on Sept. 12, 2017. An FOI request for the terms of the MOU by BuzzFeed News was rejected on the basis that it was agreed to be confidential by the two states.

    The Department of Home Affairs, which handled the FOI request, was forced to recall the document it initially provided to BuzzFeed News after it inadvertently included the personal information of a man detained on Nauru. In an email to BuzzFeed News this week, the department’s FOI Section said that some personal information that was exempt from disclosure under the FOI Act was not redacted in the original version of the documents, and asked BuzzFeed News to destroy existing copies of the documents.

    “The FOI Section has reported the suspected privacy breach to the Privacy Section,” the email said.

    BuzzFeed News has contacted the Department of Home Affairs for comment.

    The FOI documents can be found here.


    In a statement, a Department of Home Affairs spokesperson said that each transfer request was considered independently by the committee on a case-by-case basis.

    "A decision is not made to refuse a transfer, but a transfer may be deferred until recommended treatment options have been explored and any barriers have been addressed," the spokesperson said. "At times it is possible to provide the required service in Nauru or PNG via visiting medical specialists."

    The spokesperson also said that on top of a person's health condition, the committee would consider the availability of appropriate treatment options, a person's consent to the release of their medical records, any barriers to them leaving the country they are in, and the provision of supporting services in the location to which they are transferring.