Women detained on Nauru who experienced complications late in pregnancy waited for days for proper medical care while lawyers fronted court in desperate bids to get them to Australia, according to an expert obstetrician.
Caroline de Costa, a professor with 45 years of experience in obstetrics and gynaecology, said she had been involved in many cases where expert care in Australia was required and delays had been "detrimental" to women's health.
She made the remarks in a submission supporting the medevac law, which gives doctors greater control over medical transfers from offshore detention to Australia.
The Australian government is currently trying to repeal the law, and a parliamentary inquiry is considering the issue.
Since 2013, de Costa has given advice and written reports for women on Nauru, many of which were tendered as evidence in court to secure their transfer to Australia for treatment.
Some of these reports were for women who had undergone female genital mutilation.
"Complicated pregnancy and even pregnancy itself is not well cared for on Nauru," de Costa told BuzzFeed News. "The facilities for birthing are not what they should be."
De Costa noted that complications can occur quickly and unexpectedly, and said the previous system — which sometimes involved court action by refugee lawyers — was beset with delays that endangered women.
"Pregnancy and birth are only normal until they become abnormal, and if that happens on a place like Nauru it is very difficult to transfer a woman, it is not safe and it can be very time-consuming."
She gave one example of a woman with several complications late in her pregnancy.
The Australian government initially said the woman could be adequately cared for on Nauru, according to de Costa. It was difficult to get information on the woman's health.
The woman's husband ended up accompanying her to a consultation and making a secret recording.
"I got the recording of that consultation and it was horrifying," she said. "The doctor had no idea what he was doing."
Eventually, de Costa said, the Australian government agreed to her transfer – but the Nauruan government objected. It was ten days before the woman would end up in Australia.
"Women who have conditions that absolutely needed to be cared for in Australia all went through similar processes," she said.
All of the women de Costa wrote reports for ended up in Australia, but the process took too long, she said.
"It simply took a long time to get the information, to communicate with the woman, and then to argue with the authorities in order to then be able to court and say, 'they're holding this up'," she said.
Writing the reports was demanding. "It takes a while, because [medical contractor International Health and Medical Services] can send you pages and pages of records, which really say nothing except the woman was seen by a nurse on a day and was given two Panadol. You've got to sort through this kind of stuff in order to get to the actual facts of the case. Often the diagnosis is written not using the kind of medical language that we would use in Australia.
"It was not always appropriate and sometimes it was incomprehensible."
Under medevac, home affairs minister Peter Dutton has 72 hours to approve a transfer once two doctors have recommended it. He can refuse on security or medical grounds, and an independent panel of medical experts can review medical refusals.
Sometimes the women on Nauru would be transferred to Port Moresby in Papua New Guinea for treatment that was "inadequate", de Costa said.
"I have very considerable experience of PNG medicine, I've worked there for some years, and I was aware that these women were getting inadequate care."
Doctors' groups including the Australian Medical Association, the Royal Australian College of General Practitioners, the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Psychiatrists have also made submissions supporting medevac.
The home affairs department argues that the law is encouraging self-harm and that the pre-existing system of transfers was adequate.